[Uncontrolled type 2 diabetes in primary care health center: Modifiable factors and target population]. / Mal control de la diabetes tipo 2 en un centro de salud de atención primaria: factores modificables y población diana.

AIMS: To detect modifiable factors and target populations associated with uncontrolled type 2 diabetes in primary care. DESIGN: Retrospective cross-sectional descriptive study. LOCATION: Health center of Barranco Grande, Tenerife. PARTICIPANTS: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. MAIN MEASUREMENTS: In addition to the control of DM2, sociodemographic, clinical data, lifestyle and follow-up of preventive and therapeutic measures were obtained. After bivariate analysis, a multilevel multivariate model was adjusted by taking the quota of patients assisted by each physician as a second-level mixed-effect variable and the rest as first-level variables. RESULTS: 587 patients were recruited (46.5% female), treated with 1.9-1.1 antidiabetic drugs, with 4.1% therapeutic non-compliance, and suffering 13.8% therapeutic inertia. 23.7% showed poor DM2 control, being significantly worse (p<0.05) in male sex, age <65 years, evolution DM2 -5 years, work-active, upper-middle studies, inadequate diet, metabolic syndrome, ratio TG/HDL-3, complications of DM2, Charlson index<5, nursing visits <3/year, without ECG in the last year, and more drugs prescribed for DM2. The doctor-nurse quota was associated with poor control with an intraclass coefficient of 0.01. CONCLUSIONS: Men under 65 years of age with DM2 evolution longer than 5 years are a target population to intensify interventions. Therapeutic non-compliance, inadequate diet, lack of adherence protocols and ratio TG/HDL>3 are the main modifiable factors on which to intervene. The association of the doctor-nurse quota with the control of DM2 is weak, probably due to adequate follow-up of preventive programs.

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences.

BACKGROUND: To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015. METHODS: Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stay and mortality risks were analyzed using regression models adjusted for sex, age and smoking. RESULTS: The major amputations incidence rate per 100,000 person-years was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR2015 = 2.0 [CI95% = 1.5, 2.6]) and in Madrid (IR2015 = 0.1 [CI95% = 0.1, 0.2]). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death [1.7 (CI95% = 1.4; 2.1), p < 0.001] and La Rioja the lowest risk (0.5 [CI95% = 0.2; 0.9]; p = 0.026). The longest hospital stay was registered in the Canary Islands [(CI95% = 11.4;13.3], p < 0.001)], and the shortest in the Valencian Community [(CI95% = - 7.3; - 5.8), p < 0.001)]. CONCLUSION: MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]. / Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias.

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

Genomic Analyses of Human European Diversity at the Southwestern Edge: Isolation, African Influence and Disease Associations in the Canary Islands.

Despite the genetic resemblance of Canary Islanders to other southern European populations, their geographical isolation and the historical admixture of aborigines (from North Africa) with sub-Saharan Africans and Europeans have shaped a distinctive genetic makeup that likely affects disease susceptibility and health disparities. Based on single nucleotide polymorphism array data and whole genome sequencing (30×), we inferred that the last African admixture took place ∼14 generations ago and estimated that up to 34% of the Canary Islander genome is of recent African descent. The length of regions in homozygosis and the ancestry-related mosaic organization of the Canary Islander genome support the view that isolation has been strongest on the two smallest islands. Furthermore, several genomic regions showed significant and large deviations in African or European ancestry and were significantly enriched in genes involved in prevalent diseases in this community, such as diabetes, asthma, and allergy. The most prominent of these regions were located near LCT and the HLA, two well-known targets of selection, at which 40‒50% of the Canarian genome is of recent African descent according to our estimates. Putative selective signals were also identified in these regions near the SLC6A11-SLC6A1, KCNMB2, and PCDH20-PCDH9 genes. Taken together, our findings provide solid evidence of a significant recent African admixture, population isolation, and adaptation in this part of Europe, with the favoring of African alleles in some chromosome regions. These findings may have medical implications for populations of recent African ancestry.

Austerity Policies and Mortality in Spain After the Financial Crisis of 2008.

OBJECTIVES: To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS: We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS: During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS: The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.

[ETAP: A smoking scale for Primary Health Care]. / ETAP: una escala de tabaquismo para la atención primaria de salud.

OBJECTIVE: To obtain a scale of tobacco exposure to address smoking cessation. DESIGN: Follow-up of a cohort. Scale validation. SETTING: Primary Care Research Unit. Tenerife. PARTICIPANTS: A total of 6729 participants from the "CDC de Canarias" cohort. METHODS: A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI). RESULTS: The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors. CONCLUSION: The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking.

Cross-mapping medical records to NANDA-I to identify nursing diagnoses in a vulnerable population.

PURPOSE: To assess the association between vulnerable populations and nursing care needs, using NANDA-I diagnostics, in the population of the Canary Islands, Spain. METHODS: Nursing social epidemiology study. Cross Mapping of Medical Records to NANDA-I to Identify Nursing Diagnoses in a Population usinga medical, epidemiological follow-up study of a cohort of 7,190 people. The level of vulnerability of the participants was assigned, among those who were also assigned nursing diagnoses, using the "ICE index" to calculate the expected associations. FINDINGS: The most prevalent nursing diagnosis in our sample was Sedentary lifestyle (60.5%), followed by Ineffective health self-management (33.8%) and Risk-prone health behaviour (28.7%). Significant differences were found by sex, age group and social class, with the nursing diagnoses included in the study being more prevalent among the most socio-economically disadvantaged social class. CONCLUSIONS: The cross-mapping method is useful to generate diagnostic information in terms of care needs, using the NANDA-I classification. The expected associations between high social vulnerability and care needs have been verified in a comprehensive and representative sample of the Canarian population (Spain). IMPLICATIONS FOR NURSING PRACTICE: From an epidemiological perspective, identifying nursing diagnoses at the population level allows us to find the most prevalent needs in the different community groups and to focus appropriate nursing interventions for their implementation and impact assessment.

OBJETIVO: Evaluar la asociación entre las poblaciones vulnerables y las necesidades de cuidados de enfermería, utilizando la clasificación diagnóstica NANDA-I, en la población de las Islas Canarias, España. MÉTODOS: Estudio de epidemiología social enfermera. Mapeo cruzado de registros médicos con la clasificación NANDA-I para identificar los diagnósticos de enfermería en una población mediante un estudio de seguimiento médico y epidemiológico de una cohorte de 7.190 personas. Se asignó el nivel de vulnerabilidad de los participantes, entre los que también se asignaron diagnósticos de enfermería, utilizando el "índice REI" para calcular las asociaciones esperadas. RESULTADOS: El diagnóstico de enfermería más prevalente en nuestra muestra fue Estilo de vida sedentario (60,5%), seguido de Autogestión ineficaz de la salud (33,8%) y Tendencia a adoptar conductas de riesgo para la salud (28,7%). Se encontraron diferencias significativas por sexo, grupo de edad y clase social, siendo los diagnósticos de enfermería incluidos en el estudio más prevalentes entre la clase social más desfavorecida socioeconómicamente. CONCLUSIONES: El método de mapeo cruzado es útil para generar información diagnóstica en términos de necesidades de cuidados, utilizando la clasificación NANDA-I. Se han verificado las asociaciones esperadas entre alta vulnerabilidad social y necesidades de cuidados en una muestra amplia y representativa de la población canaria (España). IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: Desde una perspectiva epidemiológica, la identificación de los diagnósticos de enfermería a nivel poblacional permite encontrar las necesidades más prevalentes en los diferentes grupos de la comunidad y focalizar las intervenciones enfermeras adecuadas para su implementación y evaluación de impacto.

Irisin, in women and men: blood pressure, heart rate, obesity and insulin resistance.

Background: Irisin is a myokine that increases with leisure time physical activity (LTPA) and for which a cardiovascular protective role has been postulated. Our aim was to assess this role in the general population. Methods: A cross-sectional analysis was performed in a large randomly selected population sample (n=2298 women and 1529 men). Apart from age and sex, we record anthropometrics (blood pressure, heart rate, obesity), lifestyle (LTPA, smoking, alcohol), and biochemical measurements (irisin, lipid profile, insulin resistance). Correlations and regression multivariate models were used to analyze the association of irisin levels with the studied factors. Results: The variables more strongly and directly associated with irisin, adjusting the studied factors separately in women and men, were HOMA-2 (p=0.043 and p=0.001, respectively) and LTPA (p<0.001 and p=0.001, respectively). Also heart rate inversely (p=0.005 and p=0.002, respectively) and DBP directly (p<0.005 and p=0.045, respectively) were associated to irisin in both sexes. The waist/height ratio (p<0.001) was inversely associated to irisin only in women, and the alcohol drinking was directly associated (p=0.029) only in men. Conclusion: We provide new findings for irisin, such as its association with DBP and with heart rate; furthermore, in women irisin is associated to abdominal obesity, and in men is associated to the alcohol intake. We also corroborate the association of irisin with LTPA and insulin resistance. The associations detected point towards a protective role of irisin in the maintenance of cardiometabolic health.

Adherence to the Mediterranean diet and waist-to-hip ratio in middle-aged postmenopausal women are the main factors associated with semantic verbal fluency 12 years later.

Few studies have analized the effect of vascular risk factors and lifestyle habits affecting the middle age of postmenopausal women on later cognitive performance in old age. We have carried out an observational study to identify those factors and whether they differ from those acting in men. Postmenopausal women and males, both aged 40-60 years old at recruitment, from a community dwelling cohort were included. Data for this study were collected from the first visit at recruitment (2001 to 2005). Participants were interviewed with a questionnaire on their health-related antecedents and underwent a physical exam. The cohort was contacted again for a new presential visit between 2014 and 2015. A semantic verbal fluency test was included in this new visit protocol as a brief measure of cognition. Besides educational attainment, Mediterranean diet adherence 20th percentile (OR = 1.93; 95%CI = 1.07-3.47) and waist to hip ratio 80th percentile (OR = 1.81; 95%CI = 1.10-2,98) were the main factors associated to low semantic fluency performance in postmenopausal women, while declared diabetes mellitus (OR = 2.24; 95%CI = 1.16-4,33), HOMA 2 insulin resistance index (OR = 1.77; 95%CI =1.04-3,02), light physical activity in leisure time (OR = 0.41; 95%CI = 0.19-0,93) and recommended moderate to vigorous physical activity (OR = 2.09; 95%CI = 1.23-3.56) did in men. Factors in middle age that explain semantic verbal fluency in old age are different between postmenopausal women and men. Menopause related fat redistribution may be a precondition for other vascular risk factors. The effect of Mediterranean diet on cognition deserves new specific studies centered on postmenopausal women as group.

Digging into the admixture strata of current-day Canary Islanders based on mitogenomes.

The conquest of the Canary Islands by Europeans began at the beginning of the 15th century and culminated in 1496 with the surrender of the aborigines. The collapse of the aboriginal population during the conquest and the arrival of settlers caused a drastic change in the demographic composition of the archipelago. To shed light on this historical process, we analyzed 896 mitogenomes of current inhabitants from the seven main islands. Our findings confirm the continuity of aboriginal maternal contributions and the persistence of their genetic footprints in the current population, even at higher levels (>60% on average) than previously evidenced. Moreover, the age estimates for most autochthonous founder lineages support a first aboriginal arrival to the islands at the beginning of the first millennium. We also revealed for the first time that the main recognizable genetic influences from Europe are from Portuguese and Galicians.

Incidence and mortality of cerebrovascular disease in Spain: 1,600,000 hospital admissions between 2001 and 2015.

BACKGROUND: To analyze the incidence and mortality of cerebrovascular diseases (CeVD) in Spain from 2001 to 2015. METHODS: Retrospective study of hospital incidence, hospital case fatality and population mortality, with records from the Spanish Government Statistics. Days of hospital stay and risk of death (RD) during admission were estimated adjusting for age, sex, first stroke (FS), atrial fibrillation (AF), diabetes, hypertension, and smoking. RESULTS: There were 1,662,487 stroke cases older than 15 years of age admitted to hospital (1,096,748 FS), with a national incidence = 291/105 in this period (Murcia maximum (367/105), Canary Islands minimum (238/105)). Population mortality (-50%) decreased while case fatality remained stable (-3%), despite the increase in the age of patients (+2.29 years) and the incidence (+25%). Canary Islands had the youngest patients (-3.5 years for men and -6 years for women) and the longest hospital stay (+5.1 days). Andalusia (odds ratio (OR) = 1.21 (1.19; 1.22)) and the Canaries (OR = 1.18 (1.15; 1.21)) had the highest RD. The factors associated to the highest increases in RD were FS (OR = 1.34 (95% confidence interval (CI) = 1.33-1.35)) and AF (OR = 1.30 (95% CI = 1.29-1.31)). CONCLUSION: Population mortality due to CeVD was reduced by half in Spain between 2001 and 2015, but hospital incidence increased. Andalusia and the Canary Islands had the highest RD in the country. These islands presented the lowest incidence, but their patients were younger, and their hospital stay longer. FS and AF were the factors associated with a higher RD.

Developing CIRdb as a catalog of natural genetic variation in the Canary Islanders.

The current inhabitants of the Canary Islands have a unique genetic makeup in the European diversity landscape due to the existence of African footprints from recent admixture events, especially of North African components (> 20%). The underrepresentation of non-Europeans in genetic studies and the sizable North African ancestry, which is nearly absent from all existing catalogs of worldwide genetic diversity, justify the need to develop CIRdb, a population-specific reference catalog of natural genetic variation in the Canary Islanders. Based on array genotyping of the selected unrelated donors and comparisons against available datasets from European, sub-Saharan, and North African populations, we illustrate the intermediate genetic differentiation of Canary Islanders between Europeans and North Africans and the existence of within-population differences that are likely driven by genetic isolation. Here we describe the overall design and the methods that are being implemented to further develop CIRdb. This resource will help to strengthen the implementation of Precision Medicine in this population by contributing to increase the diversity in genetic studies. Among others, this will translate into improved ability to fine map disease genes and simplify the identification of causal variants and estimate the prevalence of unattended Mendelian diseases.

[Cardiovascular risk: initial estimation in the study cohort "CDC of the Canary Islands in Venezuela"]. / Riesgo cardiovascular: valoración inicial de la cohorte "CDC de Canarias en Venezuela".

In Venezuela as in the Canary Islands (Spain), cardiovascular disease is a major cause of morbidity and mortality. The purpose of this research is to estimate the cardiovascular risk in the Canary Islands migrants living in Venezuela and participating in the study cohort "CDC of the Canary Islands in Venezuela". 452 individuals, aged 18 to 93 years (54.9% women), were enrolled between June 2008 and August 2009. A data survey was performed and their weight, height, abdomen and hip circumferences, and blood pressure were measured. After a 12-hour fasting period, a blood sample was obtained for glucose and lipid profile determinations. 40.5% of the subjects were over 65 years of age and 8% corresponded to the younger group (18-30 years). In men, the average age was 57.69 +/- 18.17 years and the body mass index 29.39 +/- 5.71 kg/m2, whereas women were 56.50 +/- 16.91 years and 28.20 +/- 5.57 kg/m2, respectively. The prevalence of metabolic syndrome was 49.1%, overweight and obesity together 75,2%, abdominal obesity 85.4%, diabetes 17.4%, impaired fasting glucose (IFG) 12.2%, elevated blood pressure 52.9%, low HDL-cholesterol 53,8% and elevated serum triglycerides 31%. Among subjects without diabetes or IFG, a third showed a high triglycerides/HDL-cholesterol ratio, indicating insulin resistance. We conclude that the Canarian-Venezuelan community suffers high prevalence of cardiovascular risk factors (obesity, abdominal obesity, dyslipidemia, diabetes). In relation to the current population of the Canary Islands, they show a lower frequency of IFG and a higher frequency of low HDL-cholesterol. In comparison to the Venezuelan population (Zulia), they showed to have lower prevalence of IFG, low HDL cholesterol and elevated triglycerides.

Association between glycemic index, glycemic load, and fructose with insulin resistance: the CDC of the Canary Islands study.

BACKGROUND: The involvement of carbohydrates in triggering insulin resistance (IR) remains a source of controversy. AIM OF THE STUDY: To study the relation between glycemic index (GI), glycemic load (GL), and fructose with insulin resistance in a predominantly rural population in the Canary Islands. METHODS: Cross-sectional study carried out in 668 nondiabetic people aged 18-75. IR was estimated with serum glucose and C-peptide (HOMA2-IR). Nutrient intakes were obtained from a validated food frequency questionnaire. ANOVA was used to analyze nutrient distribution across quartiles of HOMA2-IR. Four multivariate nutrient density models (dependent variable: log-transformed HOMA2-IR) which differed only in the kinds of carbohydrates included were tested (Model 1: carbohydrates; Model 2: GI and then GL; Model 3: free fructose, other simple sugars and starch; Model 4: total fructose, remaining sugars and starch). RESULTS: There was no association between GI and IR. There was a direct association between GL (P < 0.001), fructose (free [P = 0.001], total [P = 0.013]), energy intake (P < 0.001), fruit fiber (<0.001), and glucose (P = 0.003) with IR. There was an inverse association between cereal (P = 0.008) and vegetable fiber (P < 0.001) and IR. Multivariate models corroborated the association of carbohydrates, GL, fructose, vegetable fiber, and energy intake with IR. The association between GL and IR disappeared when Model 2 was adjusted by total fructose intake. CONCLUSIONS: There was a direct association between fructose intake and IR. There was no relationship between GI and IR. Although a direct association of GL with IR was detected, it was attributable to the consumption of fructose.

[The waist to height ratio as an index of cardiovascular risk and diabetes]. / El cociente perímetro abdominal/estatura como índice antropométrico de riesgo cardiovascular y de diabetes.

BACKGROUND AND OBJECTIVES: To identify the anthropometric index that best detects cardiovascular risk (CVR) and type 2 diabetes (DM2) in the adult Spanish population and to determine its cut-off point. SUBJECTS AND METHODS: Cross-sectional study in the general population (n=6279). Sensitivity and specificity were estimated for the anthropometric indexes: abdominal waist, body mass index, waist to hip ratio and waist to height ratio (WtHR). The areas of these indexes under ROC curve (AUC) were obtained for the following CVR factors: high coronary risk computed with Framingham model, Hypertension, Hyperlipemia, DM2, Metabolic Syndrome (MS) and Impaired Fasting Glucose (IFG). The odds ratio, with 95% confidence interval (CI(95%)), was calculated. RESULTS: WtHR was the index showing the highest AUC for DM2 and the remaining CVR factors, varying between 0.65 (CI(95%)=0.63-0.68) for IFG in men and 0.87 (CI(95%)=0.86-0.89) for MS in women. RA/E reached the maximum sensitivity (0.91) and specificity (0.70) in SM and its optimal cut-off point was 0.55, which displayed the highest risks amongst indexes, varying from 2.30 (1.96-2.70) in IFG to 16'20 (13.68-19.20) in MS. CONCLUSIONS: RA/E is the index presenting the best ability to detect DM2 and CVR in this population, and it shows the stronger association with them. Its cut-off point, 0.55, confirms the convenience of keeping the abdominal waist to less than half the height.

[Framingham function estimates the risk of cardio vascular mortality more effectively than SCORE function in the population of the Canary Islands (Spain)]. / En la población Canaria, la función de Framingham estima mejor el riesgo de mortalidad cardiovascular que la función SCORE.

INTRODUCTION: To compare the performance of the Framingham and SCORE functions to estimate fatal cardiovascular events. In addition, we explored the ability of both functions to detect the risk contributed by factors not included in their equations: sedentariness, obesity, abdominal circumference, abdomen/height razón, abdomen/pelvis ratio, and excessive alcohol consumption. METHODS: We performed a cross-sectional study of 5,289 individuals aged 30 to 69 years old, recruited by random sampling of the general population of the Canary Islands. We calibrated the Framingham and SCORE functions and estimated their concordance. The cardiovascular mortality rate for the population in this age range was compared with the risk predicted by the two functions. RESULTS: Among males, the mortality rate per 100,000 inhabitants was 67.4, while the Framingham, SCORE-low and SCORE-high estimations were 80, 140, and 270, respectively. Among females, the mortality rate was 19.3 while the estimations were 30, 50, and 70, respectively. Both functions detected the increased risk contributed by the factors studied, except for sedentariness among females with SCORE, and excessive alcohol consumption with both functions. Among males, taking cut points of > or = 12%, > or = 15%, and > or = 20% for Framingham, the concordance with SCORE-low yielded Kappa values of 0.6, 0.7, and 0.5, respectively. CONCLUSIONS: The Framingham function yielded the best estimate of cardiovascular mortality rates. Only Framingham detected the cardiovascular risk contributed by sedentariness in both genders. We recommend the use of the calibrated Framingham function for this population.

[Validation of the ICE model to assess social class in the adult population]. / Validación del modelo REI para medir la clase social en población adulta.

BACKGROUND: Social class has commonly been defined by the type of employment and it is assessed as a categorical variable. However, this approach has a number of drawbacks. The objective of this article is to develop and validate a readily standardizable quantitative indicator of social class and to show its ability to measure the impact of social class as a health determinant. METHODS: In 6729 individuals we measured income, crowding index, education, occupation and employment status. Two models were adjusted to study the neighborhood, dietary pattern and health problems. RESULTS: The model that included only income, crowding index and education (ICE) yielded an indicator that correlated with age (r = -0.28; p < 0.001) and consumption of potatoes (r = -0.17; p < 0.001) and salads (r = 0.10; p < 0.001). This indicator estimated that poor social classes were at significant risk for unemployment (OR = 5,), blue collar jobs (OR = 40,9), residing in poor neighborhoods (OR = 30.2), low salad consumption (OR = 2.2) and high consumption of potatoes (OR = 4.5). They also had, especially in women, a higher risk of sedentarism (OR = 1.8), obesity (OR = 4.4), metabolic syndrome (OR = 3.4) and diabetes mellitus (OR = 2.0). CONCLUSIONS: The ICE index was valid, not based on occupation or employment status, readily standardizable, and suitable for measuring social class and its impact of on health.

Domain and intensity of physical activity are associated with metabolic syndrome: A population-based study.

INTRODUCTION: Little is known on how the domain and intensity of physical activity (PA) associates with metabolic syndrome (MetS). The aim of this study was to examine associations between PA domains (leisure-time, domestic, active transport, total walking and total PA), PA intensities (light, moderate and vigorous) and PA levels with MetS in the general adult population. METHODS: Cross-sectional study. Anthropometry, blood biochemistry, 79-item PA-questionnaire, lifestyle and medical history were evaluated in a representative sample of Canary Island adults (n = 6,729). MetS was diagnosed using the harmonized IDF-NHLBI-AHA criteria. T-test and multivariable logistic regression was used to analyse associations between PA domains and intensities with MetS vs. no MetS, controlling for socio-demographic, lifestyle, family antecedents and body mass index (BMI). RESULTS: For each MET-h/day spent in moderate-vigorous PA intensities, as well as in recreational domain, active transport, total walking and total PA, the odds of MetS decreased between 3-10%. Energy expenditure exclusively in light and domestic PAs was not associated with MetS, however it was important to achieve a total PA level of 3 MET-h/day, which reduced the odds of MetS by 23%. This reduction was blunted in those with more than 2 h/d of TV watching time. A PA level of 3 MET-h/d also nullified the risk of MetS in those with low PA and high TV consumption. CONCLUSIONS: Some types of leisure time PAs may contribute more than others to reducing MetS. Light and domestic PA play a complementary role in enhancing energy expenditure in the general population. TV watching time above 2 h/d counteracted the MetS risk reduction associated with PA level, but PA level also reduced the risk of METs presented by those with a low level of PA and an excess TV watching time. Physical activity explains a greater amount of the variance of MetS than any other factors of lifestyle, education, sex and family history, and substantially mitigates the strong association of age and BMI with MetS.

Hospital Mortality in 415 798 AMI Patients: 4 Years Earlier in the Canary Islands Than in the Rest of Spain.

INTRODUCTION AND OBJECTIVES: The Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes. METHODS: Cross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set. RESULTS: A total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. CONCLUSIONS: Mortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.

[Presentation of the "CDC de Canarias" cohort: objectives, design and preliminary results]. / Presentación de la cohorte "CDC de Canarias": objetivos, diseño y resultados preliminares.

BACKGROUND: The Canary Islands rank first in Spain with respect to the ischaemic heart disease and diabetes mortality rates. The Islands female population leads the country in deaths from breast cancer. The "CDC de Canarias" is a general population cohort study in order to analyse the prevalence and incidence of these diseases and the exposure to their risk factors (RF) in the adult population of the archipelago. METHODS: Prospective study with a random sampling of the general population, in which 6,729 individuals participated between 2000 and 2005 (aged 18-75). Anthropometric measurements were taken, and blood was drawn for the storage of serum and genetic samples. The following information was gathered through a questionnaire: eating habits, physical activity, personal and family medical history, exposure to occupational or environmental risk factors, smoking, etc. RESULTS: The prevalence of obesity is close to 30%, without differences between sexes, however, more male subjects were overweight than women (45 vs. 33%; p <0.001) and also presented a greater prevalence of diabetes (12 vs. 10%; p =0.005), high blood pressure (43 vs. 33%; p <0.001), excessive intake of alcohol (13 vs. 2%; p <0.001) and lack of sun protection (46 vs. 18%; p <0.001). Exposure to low levels of HDL cholesterol is more frequent in women (37 vs. 30%; p <0.001) as is also the case with a sedentary life style (71 vs. 55%; p <0.001). The exposure to the risk factors studied, including poverty, is greater in advanced age groups, except for smoking (26%) which is greater in the younger subjects. The estimate of relative risks of exposure to cardiovascular and cancer risk factors is higher in low-income social classes. CONCLUSIONS: The current adult population of the Canaries presents a high prevalence of exposure to risk factors for cardiovascular disease, diabetes and cancer, among which overweight, obesity and lack of exercise stand out particularly.