Impact of mediterranean diet promotion on environmental sustainability: a longitudinal analysis.

OBJECTIVE: This article aims to estimate the differences in environmental impact (greenhouse gas [GHG] emissions, land use, energy used, acidification and potential eutrophication) after one year of promoting a Mediterranean diet (MD). METHODS: Baseline and 1-year follow-up data from 5800 participants in the PREDIMED-Plus study were used. Each participant's food intake was estimated using validated semi-quantitative food frequency questionnaires, and the adherence to MD using the Dietary Score. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The association between MD adherence and its environmental impact was calculated using adjusted multivariate linear regression models. RESULTS: After one year of intervention, the kcal/day consumed was significantly reduced (-125,1 kcal/day), adherence to a MD pattern was improved (+0,9) and the environmental impact due to the diet was significantly reduced (GHG: -361 g/CO2-eq; Acidification:-11,5 g SO2-eq; Eutrophication:-4,7 g PO4-eq; Energy use:-842,7 kJ; and Land use:-2,2 m2). Higher adherence to MD (high vs. low) was significantly associated with lower environmental impact both at baseline and one year follow-up. Meat products had the greatest environmental impact in all the factors analysed, both at baseline and at one-year follow-up, in spite of the reduction observed in their consumption. CONCLUSIONS: A program promoting a MD, after one year of intervention, significantly reduced the environmental impact in all the factors analysed. Meat products had the greatest environmental impact in all the dimensions analysed.

Health-related quality of life in individuals with metabolic syndrome: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected.

Anticoagulant treatment of medical patients with complex clinical conditions. / Tratamiento anticoagulante en pacientes médicos con situaciones clínicas complejas.

There is scarce available information on the treatment or prophylaxis with anticoagulant drugs of outpatients with medical diseases and complex clinical conditions. There are no clinical practice guidelines and/or specific recommendations for this patient subgroup, which are frequently treated by internists. Complex clinical conditions are those in which, due to comorbidity, age, vital prognosis or multiple treatment with drugs, a clinical situation arises of disease-disease, disease-drug or drug-drug interactions that is not included within the scenarios that commonly generate the scientific evidence. The objective of this narrative review is collecting and adapting of the clinical guidelines recommendations and systematic reviews to complex clinical conditions, in which the direct application of recommendations based on studies that do not include patients with this complexity and comorbidity could be problematic.

Delphi-RAND consensus of the Spanish Society of Internal Medicine on the controversies in anticoagulant therapy and prophylaxis in medical diseases. INTROMBIN Project (Uncertainty in thromboprophylaxis in internal medicine). / Consenso Delphi-RAND de la Sociedad Española de Medicina Interna sobre controversias en terapia y profilaxis anticoagulante en enfermedades médicas. Proyecto INTROMBIN (INcertidumbre en TROMBoprofilaxis en Medicina INterna).

The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice.

Dietary total antioxidant capacity and mortality in the PREDIMED study.

PURPOSE: The aim of the present study was to assess the association between the dietary total antioxidant capacity, the dietary intake of different antioxidants and mortality in a Mediterranean population at high cardiovascular disease risk. METHODS: A total of 7,447 subjects from the PREDIMED study (multicenter, parallel group, randomized controlled clinical trial), were analyzed treating data as an observational cohort. Different antioxidant vitamin intake and total dietary antioxidant capacity were calculated from a validated 137-item food frequency questionnaire at baseline and updated yearly. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were fitted to assess the relationship between dietary total antioxidant capacity and mortality. Dietary total antioxidant capacity was estimated using ferric-reducing antioxidant power assays. RESULTS: A total of 319 deaths were recorded after a median follow-up of 4.3 years. Subjects belonging to the upper quintile of antioxidant capacity were younger, ex-smokers, with high educational level, and more active and had higher alcohol intake. Multivariable-adjusted models revealed no statistically significant difference between total dietary antioxidant capacity and mortality (Q5 vs. Q1 ref HR 0.85; 95% CI 0.60-1.20) neither for the intake of all the vitamins studied. CONCLUSIONS: No statistically significant association was found between antioxidant capacity and total mortality in elderly subjects at high cardiovascular risk.

Does the Mediterranean diet counteract the adverse effects of abdominal adiposity?

BACKGROUND AND AIM: We tested the hypothesis that an intervention with a Mediterranean diet (MeDiet) could mitigate the well-known harmful effects of abdominal obesity on cardiovascular health. METHODS AND RESULTS: We assessed the relationship between baseline waist-to-height ratio (WHtR) and major cardiovascular events during a median follow-up of 4.8 years in the Prevention with Mediterranean Diet (PREDIMED) randomized primary prevention trial, which tested a MeDiet against a control diet (advice on a low-fat diet). We also examined whether the MeDiet intervention was able to counteract the detrimental cardiovascular effects of an increased WHtR. The trial included 7447 participants (55-80 years old, 57% women) at high cardiovascular risk but free of cardiovascular disease (CVD) at enrollment. An increased risk of CVD events (myocardial infarction, stroke, or cardiovascular death) was apparent for the highest versus the lowest quartile of WHtR (multivariable-adjusted hazard ratio: 1.98) (95% confidence interval: 1.10-3.57; linear trend: p = 0.019) only in the control-diet group, but not in the two groups allocated to intervention with MeDiet (p for interaction = 0.034). This apparent interaction suggesting that the intervention counterbalanced the detrimental cardiovascular effects of adiposity was also significant for body mass index (BMI) (p = 0.01) and waist circumference (p = 0.043). CONCLUSIONS: The MeDiet may counteract the harmful effects of increased adiposity on the risk of CVD.

Dietary inflammatory index and anthropometric measures of obesity in a population sample at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) trial.

The dietary inflammatory index (DII) is a new tool to assess the inflammatory potential of the diet. In the present study, we aimed to determine the association between the DII and BMI, waist circumference and waist:height ratio (WHtR). We conducted a cross-sectional study of 7236 participants recruited into the PREvención con DIeta MEDiterránea trial. Information from a validated 137-item FFQ was used to calculate energy, food and nutrient intakes. A fourteen-item dietary screener was used to assess adherence to the Mediterranean diet (MeDiet). Sex-specific multivariable linear regression models were fitted to estimate differences (and 95 % CI) in BMI, waist circumference and WHtR across the quintiles of the DII. All nutrient intakes, healthy foods and adherence to the MeDiet were higher in the quintile with the lowest DII score (more anti-inflammatory values) except for intakes of animal protein, saturated fat and monounsaturated fat. Although an inverse association between the DII and total energy was apparent, the DII was associated with higher average BMI, waist circumference and WHtR after adjusting for known risk factors. The adjusted difference in the WHtR for women and men between the highest and lowest quintiles of the DII was 1·60 % (95 % CI 0·87, 2·33) and 1·04 % (95 % CI 0·35, 1·74), respectively. Pro-inflammatory scores remained associated with obesity after controlling for the effect that adherence to a MeDiet had on inflammation. In conclusion, the present study shows a direct association between the DII and indices of obesity, and supports the hypothesis that diet may have a role in the development of obesity through inflammatory modulation mechanisms.

Multivariate explanatory model for sporadic carcinoma of the colon in Dukes' stages I and IIa.

OBJECTIVE: We obtained before an explanatory model with six dependant variables: age of the patient, total cholesterol (TC), HDL cholesterol (HDL-C), VLDL cholesterol (VLDL-C), alkaline phosphatase (AP) and the CA 19.9 tumour marker. Our objective in this study was to validate the model by means of the acquisition of new records for an additional analysis. DESIGN: Non-paired case control study. SETTING: Urban and rural hospitals and primary health facilities in Western Andalusia and Extremadura (Spain). PATIENTS: At both the primary care facilities and hospital level, controls were gathered in a prospective manner (n= 275). Cases were prospective and retrospective manner collected on (n=126). MAIN OUTCOME MEASURES: Descriptive statistics, logistic regression and bootstrap analysis. RESULTS: The AGE (odds ratio 1.02; 95% CI 1.003-1.037) (p= 0.01), the TC (odds ratio 0.986; 95% C.I. 0.980-0.992) (p< 0.001) and the CA 19.9 (odds ratio 1.023; 95% C.I. 1.012- 1.034) (p<0.001) were the variables that showed significant values at logistic regression analysis and bootstrap. Berkson's bias was statistically assessed. CONCLUSIONS: The model, validated by means of logistic regression and bootstrap analysis, contains the variables AGE, TC, and CA 19.9 (three of the original six) and has a level 4 over 5 according to the criteria of Justice et al. (multiple independent validations) [Ann. Intern. Med.1999; 130: 515].

[Efficacy of educational sessions to modify the prescription of new drugs]. / Eficacia de las sesiones educativas para modificar la prescripción de fármacos nuevos.

OBJECTIVE: To evaluate the efficacy of an educational intervention to minimise the prescription of those new medicines whose therapeutic effects are of little benefit. DESIGN: Controlled and randomised experimental study. SETTING: 27 health centres in the province of Sevilla, Spain. PARTICIPANTS: 376 general practitioners. The 264 who worked in the same posts were randomised for the 6 pre-intervention months. 10 of them did not complete the post-intervention period. INTERVENTIONS: Four 45-minute training sessions in a 2-month period, given by health team doctors, with a critical reading of the studies available on recently marketed drugs, plus personal feed-back on prescription and bulletins on therapeutic novelties. The control group received only the feed-back and bulletins. MAIN MEASUREMENTS: Prescription of new medication of little benefit, measured as the number of packages out of the total. Second, the amount of coxib and eprosartan measured as defined daily doses. RESULTS: In the 6 months after the educational sessions, the doctors in the intervention group prescribed proportionately fewer therapeutic novelties of little benefit than those allocated to the control group (1.34% vs 1.62%; P<.001). The coxib and eprosartan prescribed showed only a non-significant trend towards less prescription by the intervention group. CONCLUSIONS: The group educational sessions, run by doctors trained in aspects of evidence-based medicine and prepared jointly with the pharmacy unit, reduced discreetly the prescription of new medicines that were not very innovative.

[Dietary habits of the population of an urban health district]. / Hábitos dietéticos en la población de una zona básica de salud urbana.

OBJECTIVE: To find the eating habits of the adult population of an urban health district. DESIGN: Descriptive cross-sectional study. SETTING: Primary care. Urban health centre. PARTICIPANTS: 260 people (124 men and 136 women) over 20 (mean age of 43.6 +/- 17.1; 42.0 +/- 16.4 for men and 45.1 +/- 17.7 for women), selected at random from among those living in the health district. MAIN MEASUREMENTS: Through a semi-quantitative questionnaire on frequencies of food consumption, filled out in all cases by a single observer, the food habits of the participants and the nature of their diet during the previous week were determined. Intake of calories and biomolecules were calculated as a function of the kind of foods. RESULTS: Mean daily calory intake was 2612 +/- 836 kcal, 22.5% more than the theoretical requirements of this population. Mean daily protein ingested was 96.4 +/- 28 grams, fats 130.2 +/- 42.7 grams, and carbohydrates 277.1 +/- 123.3. 21.5 +/- 5.5% of the total calory intake were monounsaturated fatty acids; 7.7 +/- 4.3% were polyunsaturated; and 13 +/- 2.9% were saturated. Cholesterol consumption was 475 +/- 213.8 mg/day, and roughage consumed was 18.6 +/- 8.0 grams. CONCLUSIONS: The adult population of our health district consumed the typical, not very healthy Western-style diet: over-rich in calories, rich in saturated fats and cholesterol, and poor in roughage. Nevertheless, the diet conserved the high intake of monounsaturated and polyunsaturated fatty acids which is characteristic of traditional Mediterranean food.

Hábitos dietéticos en la población de una zona básica de salud urbana / Dietary habits of the population of an urban health district

Objetivo. Conocer los hábitos alimentarios de la población adulta de una zona básica de salud urbana. Diseño. Estudio descriptivo transversal. Emplazamiento. Atención primaria. Centro de salud urbano. Participantes. Un total de 260 individuos (124 varones y 136 mujeres) mayores de 20 años (edad media de 43,6 ñ 17,1 años: 42,0 ñ 16,4 en varones y 45,1 ñ 17,7 en mujeres), seleccionados aleatoriamente entre las viviendas de la zona básica. Mediciones principales. Mediante un cuestionario semicuantitativo de frecuencias de consumo de alimentos, cumplimentado en todos los casos por un único observador, se determinaron los hábitos alimentarios de los participantes, así como el tipo de dieta realizada en la última semana. Se calculó la ingesta calórica y de principios inmediatos en función del tipo de alimentos. Resultados. La ingesta calórica media diaria fue de 2.612 ñ 836 kcal, un 22,5 por ciento más de los requerimientos teóricos calculados para esta población. La media diaria de proteínas ingeridas fue de 96,4 ñ 28 g; de grasas, 130,2 ñ 42,7 g y de hidratos de carbono, 277,1 ñ 123,3 g. Los ácidos grasos monoinsaturados representaron el 21,5 ñ 5,5 por ciento del total de la ingesta calórica; los poliinsaturados, el 7,7 ñ 4,3 por ciento, y los saturados, el 13 ñ 2,9 por ciento. El consumo de colesterol fue de 475 ñ 213,8 mg/día y el de fibra, 18,6 ñ 8,0 g. Conclusiones. La dieta consumida por la población adulta de nuestra zona básica tiene el típico y poco saludable estilo occidental: es hipercalórica, rica en grasas saturadas y colesterol y pobre en fibra; sin embargo, conserva la elevada ingesta de ácidos grasos monoinsaturados y poliinsaturados característica de la alimentación mediterránea tradicional (AU)

[An alternative method for the diagnosis of an anterosuperior hemiblock]. / Método alternativo para el diagnóstico de hemibloqueo superoanterior.

OBJECTIVE: To develop and validate a rapid method for diagnosing superior anterior hemiblock, comparing it with the system seen as standard. DESIGN: Comparison study of two diagnostic tests. SETTING: Urban health centre. PARTICIPANTS: Adult population with prior diagnosis of superior anterior hemiblock included in a computer file of clinical records. MEASUREMENTS AND RESULTS: The presence or otherwise of superior anterior hemiblock was found by applying the standard criteria for electrocardiograms contained in the clinical records of the participating patients. The proposed test was then applied by finding the precise cardiac axis and the confirmation or rejection of the diagnosis of superior anterior hemiblock. Out of the 121 histories analysed, 40 had superior anterior hemiblock according to the standard criteria, and 81 did not. The system proposed detected 38 of the 40 hemiblock cases, 95% sensitivity, and rejected as normal 76 of the 81 electrocardiograms without superior anterior hemiblock according to the standard pattern, specificity of 93.8%. CONCLUSIONS: Superior anterior hemiblock can be diagnosed by an alternative method which was quicker than the standard pattern, so markedly simplifying the analysis of this feature of the electrocardiogram.

Método alternativo para el diagnóstico de hemibloqueo superoanterior / Alternative method for diagnosing superior anterior hemiblock

Objetivo. Desarrollar y validar un método rápido de diagnóstico de hemibloqueo superoanterior, comparándolo con el sistema considerado como estándar. Diseño. Estudio de comparación de 2 pruebas diagnósticas. Emplazamiento. Centro de salud urbano. Participantes. Población adulta con diagnóstico previo de hemibloqueo superoanterior incluida en un archivo informatizado de historias clínicas. Mediciones. Se constató la existencia o no de hemibloqueo superoanterior aplicando los criterios estándar en electrocardiogramas contenidos en las historias clínicas de los pacientes participantes; a continuación se aplicó el test propuesto hallando el eje cardíaco exacto y la confirmación o rechazo del diagnóstico de hemibloqueo superoanterior. Resultados. De las 121 historias analizadas, 40 tenían hemibloqueo superoanterior según los criterios estándar y 81 no lo presentaban. El sistema propuesto detectó 38 de los 40 hemibloqueos, lo que supone una sensibilidad del 95 por ciento, y rechazó como normales 76 de los 81 electrocardiogramas sin hemibloqueo superoanterior según el patrón estándar, lo que representa una especificidad del 93,8 por ciento. Conclusiones. El diagnóstico de hemibloqueo superoanterior puede hacerse por un método alternativo que resulta más rápido que el patrón estándar, simplificando de manera notable el análisis de este aspecto del electrocardiograma (AU)

[An evaluation of the Spacelabs 90207 model of the ambulatory arterial pressure monitoring system]. / Validación del sistema de monitorización ambulatoria de presión arterial modelo SpaceLabs 90207.

BACKGROUND: The aim of the present study was to validate the SpaceLabs 90207 apparatus used in non-invasive outpatient monitoring of blood pressure. METHODS: The measurements of blood pressure (BP) and cardiac frequency (CF) obtained with the SpaceLabs monitor were compared with those obtained with a mercury sphygmomanometer used as the reference method in 86 patients with a wide range of ages and BP. The differences between both methods of measurement were quantified by a previously protocolized grade system from the British Hypertension Society (BHS). RESULTS: The mean of the differences between both systems of reading was 1.59 +/- 5.9 mmHg for systolic BP (SBP) 1.05 +/- 4.4 mmHg for diastolic BP (DBP) and -0.64 +/- 2.55 beats per minute for the CF. The accumulated percentage of differences of BP less than or equal to 5, 10 and 15 mmHg was of 74, 89 and 96%, respectively corresponding to grade B according to the validation protocol of the BHS. Grade B was obtained in all the interval differences of BP except within the range of DBP greater than or equal to 100 mmHg which showed grade A. Grades A or B were obtained in all the age groups except for grade C in the SBP of subjects over the age of 65. CONCLUSIONS: The SpaceLabs 90207 monitor satisfies the criteria of internationally accepted validation criteria, therefore, its use can be recommended for the outpatient blood pressure measurement.

[Mycoplasma pneumoniae pneumonia: serologic study of a family outbreak in primary care]. / Neumonía por Mycoplasma pneumoniae: estudio serológico de un brote familiar en atención primaria.

OBJECTIVE: To describe the clinical-radiological, epidemiological, therapeutic and evolutive characteristics of an outbreak of atypical Pneumonia in a family, which was serologically diagnosed by means of the technique of complement fixation of Pneumonia caused by Mycoplasma. DESIGN: A descriptive study. SETTING: An urban Health Centre. PATIENTS AND OTHER PARTICIPANTS: A family of 7 members, consisting of father, mother and five children. MEASUREMENTS AND MAIN RESULTS: Three presented Pneumonia caused by Mycoplasma pneumoniae, with the other family members remaining asymptomatic and serologically negative. The three cases evolved until cure. Treatment was with Macrolides in two of the cases and Penicillin in the other. Clinical-radiological dissociation existed in two of the patients. 33% had a secondary attack. CONCLUSION: The accessibility of Primary Care to microserological methods, together with the greater ease with which this level of Care can reach the family environment, allows for more precise knowledge of infectious epidemic outbreaks which occur in the community.