Trends in hospitalisation for urinary tract infection in adults aged 18-65 by sex in Spain: 2000 to 2015.

OBJECTIVE: To analyse trends in urinary tract infection (UTIs) hospitalisation among patients adults 18-65 aged in Spain from 2000-2015. METHODS: Retrospective observational study using the Spanish Hospitalisation Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). Variables: Type of UTIs (pyelonephritis, prostatitis, cystitis and non-specific-UTIs), sex, age (in 5 categories: 18-49 and 50-64 years in men, and 18-44, 45-55 and 56-64 years in women), comorbidity, length of stay, costs and mortality associated with admission. The incidence of hospitalisation was studied according to sex, age group and type of UTIs per 100,000. Trends were identified using Joinpoint regression. RESULTS: From 2000-2015, we found 259,804 hospitalisations for UTIs (51.6% pyelonephritis, 7.5% prostatitis, 0.6% cystitis and 40.3% non-specific UTIs). Pyelonephritis predominated in women and non-specific UTIs in men. The hospital stay and the average cost (2,160 EUR (IQR 1,7872,540 were greater in men. Overall mortality (0.4%) was greater in non-specific UTIs. More women were admitted (rates of 79.4 to 81.7) than in men (30.2 to 41). The greatest increase was found in men aged 50-64 years (from 59.3 to 87). In the Joinpoint analysis, the incidence of pyelonephritis increased in women [AAPC 2.5(CI 95% 1.6;3.4)], and non-specific UTIs decreased [AAPC -2.2(CI 95% -3.3;-1.2)]. Pyelonephritis decreased in men [AAPC -0.5 (CI 95% -1.5;0.5)] and non-specific UTIs increased [AAPC 2.3 (CI 95% 1.9;2.6)] and prostatitis increased [AAPC 2.6 (CI 95% 1.4;3.7)]. CONCLUSIONS: The urinary infection-related hospitalisation rate in adults in Spain increased during the period 2000-2015. Pyelonephritis predominated in women and non-specific UTIs in men. The highest hospitalisation rates occurred in the women but the greatest increase was found in men aged 65-74. The lenght of stay and cost were higher in men.

Light cigarette smoking and all-cause mortality in Spain. A national population-based cohort study.

PURPOSE: Regular light cigarette consumption (light smoking) is increasing in many countries; however, few studies have assessed its impact on mortality. The main aim of this study is to estimate the association between the number of cigarettes consumed and all-cause mortality in Spain while focusing on light smoking. METHODS: Longitudinal study based on data from 42,902 individuals aged ≥15 years included in the 2011-2012 (Spanish) National Health Survey or the 2014 European Health Survey for Spain. Data were linked with the mortality registry up to December 2020. Multivariate Cox regression models were used to estimate hazard ratios (HR) adjusted for sociodemographic variables, lifestyle factors, and health status indicators. RESULTS: Compared to never smokers, the mortality HR for nondaily smokers was 1.30 (95% CI: 0.81-2.09), increasing to 2.23 (95% CI: 1.25-3.96) among those smoking 1-2 cigarettes/d, and to 1.54 (95%CI: 1.14-2.07) for consumers of 3-5 cigarettes/day. When individuals who reported trying to quit during the previous year were excluded, resulting HRs were 1.31 (95% CI: 0.81-2.10), 1.48 (95% CI: 0.69-3.19) and 1.64 (95% CI: 1.16-2.34), respectively. CONCLUSIONS: Compared to never smokers, consumers of small quantities of tobacco, that is, light smoking, had an increased mortality risk. In view of these results, we suggest the need for awareness-raising campaigns regarding how smoking even a small number of cigarettes a day causes serious harm to one´s health.

Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status.

OBJECTIVE: Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES). DESIGN: Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models. SETTING: City of Madrid. 2016 and 2019 to cover a representative sample. PARTICIPANTS: Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151). RESULTS: Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas. CONCLUSIONS: Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.

[Adherence to mediterranean diet and its associated factors in adolescents from Madrid.] / Adherencia a la dieta mediterránea y su asociación con factores sociodemográficos y antropométricos en adolescentes de Madrid.

OBJECTIVE: Unhealthy diet is the main contributor to childhood obesity. The aim of this study was to assess adherence to the mediterranean diet in a sample of adolescents and analyse adherence-related factors. METHODS: Cross-sectional descriptive study (June-October 2020), in a non-probabilistic sample of 473 patients with Substance Use Disorder, from the 8 Addiction Care Centers (CAD) of the Madrid City Council. Their demographic, habits and health characteristics, IgM and IgG for SARS-CoV-2, previous PCR, presence of symptoms, contact with COVID-19 cases were described, and multivariate analysis was performed using binary logistic regression. RESULTS: A total of 64.3% of participants displayed a medium level and 21.3% a high level of adherence to the mediterranean diet. High adherence was less frequent among teenage girls (17% [PR=0.63; p=0.02]), those whose mothers had not gone beyond primary school (16.3% [PR=0.58; p=0.07]), those who slept less than 8.5 h/day (16.8% [PR=0.54; p<0.01]), and those who used a mobile telephone for more than 2.6 hours per day (12.2% [PR=0.56; p=0.02]). CONCLUSIONS: Adherence to the mediterranean diet is less than optimum in four out of five adolescents, and is lower in teenage girls whose mothers had not gone beyond primary school or who devote more time to mobile telephones and less time to sleeping. Our results highlight the importance of paying attention to sleeping habits and reducing the use of screens when seeking to improve mediterranean diet adherence among adolescents.

OBJETIVO: La dieta poco saludable es el principal factor que contribuye a la obesidad infantil. El objetivo de este estudio fue evaluar la adherencia a la dieta mediterránea en una muestra de adolescentes y analizar los factores asociados a la misma. METODOS: Se realizó una encuesta transversal a 573 adolescentes de entre 11 y 14 años en Madrid en 2018. Se recogieron variables mediante un cuestionario. La adherencia a la dieta mediterránea se midió con el índice KIDMED. Las características asociadas a una alta adherencia se analizaron mediante razones de prevalencia (RP) obtenidas con regresión de Poisson de varianza robusta. RESULTADOS: El 64,3% de los participantes presentaron un nivel de adherencia medio a la dieta mediterránea. La alta adherencia fue menos frecuente en adolescentes mujeres (17% [RP=0,63; p=0,02]), cuyas madres no habían superado los estudios primarios (16,3% [RP=0,58; p=0,07]), que dormían menos de 8,5 horas al día (16,8% [RP=0,54; p<0,01]) o que usaban el móvil más de 2,6 horas al día (12,2% [RP=0,56; p=0,02]). CONCLUSIONES: La adherencia a la dieta mediterránea es inferior a la óptima en cuatro de cada cinco adolescentes, y resulta menor en adolescentes mujeres, cuyas madres no superaron los estudios primarios o que dedicaban más tiempo al móvil y menos a dormir. Nuestros resultados apuntan a la importancia de atender a los hábitos de sueño y a reducir el uso de pantallas para mejorar la adherencia a la dieta mediterránea en adolescentes.

Public Support for the Imposition of a Tax on Sugar-Sweetened Beverages and the Determinants of Such Support in Spain.

(1) Background: Taxes on sugar-sweetened beverages are an effective public health intervention, but can be difficult to implement in the absence of public support. This is the first study to analyze the Spanish population's support for a tax on sugar-sweetened beverages. (2) Methods: We conducted a cross-sectional study of a representative sample of the Spanish adult population (n = 1002), using a computer-aided telephone interview with a questionnaire on nutritional policies. The support for the tax was calculated by the percentage of those who agreed plus those who strongly agreed with the measure. The sociodemographic determinants of support for the tax were analyzed using chi-squared test (χ2) and Poisson multiple regression models with robust variance. (3) Results: Of the participants, 66.9% supported a tax on sugar-sweetened beverages. Support for the tax was 9.2% higher (70% vs. 64.1%) when responders were first asked about support for tax relief and subsidies for healthy foods (p = 0.049). Support for the tax was 16% and 35% lower among persons reporting center and right-wing political sympathies (p < 0.01), and 16% lower among regular consumers of sugar-sweetened beverages (p = 0.01). (4) Conclusions: A clear majority of the Spanish population is in favor of imposing a tax on sugar-sweetened beverages. Awareness-raising campaigns and a policy of combining the measure with subsidies or tax cuts on healthy foods could increase the level of support among those currently against the intervention.

Effect of excise tax on sugar-sweetened beverages in Catalonia, Spain, three and a half years after its introduction.

BACKGROUND: The World Health Organisation urges countries to levy specific excise taxes on SSBs. Currently, more than 50 countries have introduced some type of tax on SSBs. In March 2017, the Autonomous Region of Catalonia approved the introduction of a tiered excise tax on SSBs for public health reasons. To evaluate the effect of the Catalonian excise tax on the price and purchase of sugar-sweetened beverages (SSBs) and their possible substitutes, i.e., non-sugar-sweetened beverages (NSSBs) and bottled water, three and half years after its introduction, and 1 year after the outbreak of the COVID-19 pandemic. METHODS: We analysed purchase data on soft drinks, fruit drinks and water, sourced from the Ministry of Agriculture food-consumption panel, in a random sample of 12,500 households across Spain. We applied the synthetic control method to infer the causal impact of the intervention, based on a Bayesian structural time-series model which predicts the counterfactual response that would have occurred in Catalonia, had no intervention taken place. RESULTS: As compared to the predicted (counterfactual) response, per capita purchases of SSBs fell by 0.17 l three and a half years after implementing the SSB tax in Catalonia, a 16.7% decline (95% CI: - 23.18, - 8.74). The mean SSB price rose by 0.11 €/L, an 11% increase (95% CI: 9.0, 14.1). Although there were no changes in mean NSSB prices, NSSB consumption rose by 0.19 l per capita, a 21.7% increase (95% CI: 18.25, 25.54). There were no variations in the price or consumption of bottled water. The effects were progressively greater over time, with SSB purchases decreasing by 10.4% at 1 year, 12.3% at 2 years, 15.3% at 3 years, and 16.7% at three and a half years of the tax's introduction. CONCLUSIONS: The Catalonian SSB excise tax had a sustained and progressive impact over time, with a fall in consumption of as much as 16.7% three and half years after its introduction. The observed NSSB substitution effect should be borne in mind when considering the application of this type of tax to the rest of Spain.

Effect of health-promoting messages in television food commercials on adolescents' attitudes and consumption: A randomized intervention study.

INTRODUCTION: The HAVISA plan is a Spanish government's policy for the promotion of healthy lifestyles via health messages in television food advertisements. This study evaluated the positive or negative impact (health halo effect) of health messages on food choices and predisposition towards healthy habits of Spanish adolescents. METHODS: Randomized controlled study in 11-14 years old adolescents. The intervention group watched television advertisements for unhealthy foods with HAVISA health messages, while the control group watched the same advertisements without them. A self-administered questionnaire measured participants' attitudes towards the products advertised, to diet and physical activity, and recognition of messages. Afterwards they chose between fruit and unhealthy snacks. The differences between the two groups were then compared. RESULTS: A total of 27.2% of the control group versus 29.6% of the intervention group chose fruit (p = 0.54). Both groups displayed high desire for (7.24 vs. 7.40, p = 0.29) and intention to consume (6.67 vs. 6.73, p = 0.63) the unhealthy products advertised. There were no differences in perceived healthiness of these foods (4.11 vs. 4.19, p = 0.74), or perceived importance of a healthy diet (3.17 vs. 3.12, p = 0.55) or physical activity (4.53 vs. 4.51, p = 0.73). Desire for vegetables (2.49 vs. 2.66, p = 0.08) and fruit (3.15 vs. 3.30, p = 0.09) were higher in the intervention group, but the differences were not significant. Only 47.6% of participants noticed the presence of health messages; of these, 31% correctly recalled their content. CONCLUSION: HAVISA health messages changed neither the attitudes nor immediate eating behaviors of adolescents. There was no immediate healthy-lifestyle promoter or adverse health halo effect, probably due to the messages' low prominence. Further research should evaluate the long-term effect of repeated exposure to health messages.

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED).

The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool's ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.

Impact of an excise tax on the consumption of sugar-sweetened beverages in young people living in poorer neighbourhoods of Catalonia, Spain: a difference in differences study.

BACKGROUND: Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain). METHODS: Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax's introduction (May 2017) and again at 1 year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance weighted using propensity scores. RESULTS: While the prevalence of regular consumers of taxed beverages fell by 39% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects. CONCLUSIONS: The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.

[Food policies to prevent obesity and the main non-transmissible diseases in Spain: where there's a will there's a way]. / Políticas alimentarias para prevenir la obesidad y las principales enfermedades no transmisibles en España: querer es poder.

INTRODUCTION: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments. THE POWER (PODER IN SPANISH) OF FOOD POLICIES: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugar-sweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulación): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance. A FINAL THOUGHT: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy foods.

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries.

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.