Arsenic exposure and respiratory outcomes during childhood in the INMA study.

Ingested inorganic arsenic (iAs) is a human carcinogen that is also linked to other adverse health effects, such as respiratory outcomes. Yet, among populations consuming low-arsenic drinking water, the impact of iAs exposure on childhood respiratory health is still uncertain. For a Spanish child study cohort (INfancia y Medio Ambiente-INMA), low-arsenic drinking water is usually available and ingestion of iAs from food is considered the major source of exposure. Here, we explored the association between iAs exposure and children's respiratory outcomes assessed at 4 and 7 years of age (n = 400). The summation of 4-year-old children's urinary iAs, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) was used as a biomarker of iAs exposure (∑As) (median of 4.92 µg/L). Children's occurrence of asthma, eczema, sneeze, wheeze, and medication for asthma and wheeze at each assessment time point (i.e., 4- and 7-year) was assessed with maternal interviewer-led questionnaires. Crude and adjusted Poisson regression models using Generalized Estimating Equation (GEE) were performed to account for the association between natural logarithm transformed (ln) urinary ∑As in µg/L at 4 years and repeated assessments of respiratory symptoms at 4 and 7 years of age. The covariates included in the models were child sex, maternal smoking status, maternal level of education, sub-cohort, and children's consumption of vegetables, fruits, and fish/seafood. The GEE-splines function using Poisson regression showed an increased trend of the overall expected counts of respiratory symptoms with high urinary ∑As. The adjusted expected counts (95% confidence intervals) at ln-transformed urinary ∑As 1.57 (average concentration) and 4.00 (99th percentile concentration) were 0.63 (0.36, 1.10) and 1.33 (0.61, 2.89), respectively. These exploratory findings suggest that even relatively low-iAs exposure levels, relevant to the Spanish and other populations, may relate to an increased number of respiratory symptoms during childhood.

Association between the Prime Diet Quality Score and depressive symptoms in a Mediterranean population with metabolic syndrome. Cross-sectional and 2-year follow-up assessment from PREDIMED-PLUS study.

The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (Pfor trend = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (ß (95 %) CI = -0·67 z-score (-1·17, -0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time.

[Perception of primary health care medical staff of their functions, and training and knowledge in occupational health]. / Percepción del personal médico de atención primaria de salud acerca de sus funciones, formación y conocimientos en materia de salud laboral.

OBJECTIVES: To evaluate the perception of primary health care medical staff (PHCMS) have on their functions in occupational risk prevention (ORP), as well as their knowledge and skills on the subject of occupational health (OH). DESIGN: Descriptive cross-sectional study. SETTING: Health Department 20 of Alicante province, Spain. PARTICIPANTS: All PHCMS (N=104), with a participation of 80% (N=83). PRIMARY MEASUREMENTS: The participants self-completed a questionnaire specifically developed for the study. Sixteen questions were established and covered functions in ORP and skills for developing them, as well as the amount and usefulness of training received on the subject of OH. RESULTS: The PHCMS did not perceive that they had functions as regards ORP (median [Me], 2; interquartile range [IR], 1-3). To a greater extent they considered themselves capable of identifying whether an illness seen in their clinic was of work origin or not (Me, 3; IR, 3-4). Training in OH as a medical student and in their medical internship (MIR) was identified as of minor importance (55.4% and 60%, respectively, of those surveyed scored a value of 1 in the questionnaire). The PHCMS obviously considered that better training in OH would help them in their daily professional activity. High scores were obtained for this (response options greater than or equal to 4) in more than 70% of the interviewees. CONCLUSIONS: Training in OH must be encouraged so that PHCMS are seen to be health personnel with functions in ORP and are able to acquire the necessary knowledge and skills in OH for their routine medical practice.

Percepción del personal médico de atención primaria de salud acerca de sus funciones, formación y conocimientos en materia de salud laboral / Perception of primary health care medical staff of their functions, and training and knowledge in occupational health

Objetivos. Evaluar la percepción que el profesional médico de atención primaria de salud (PMAPS) tiene sobre sus funciones en prevención de riesgos laborales (PRL), así como sus conocimientos y habilidades en materia de salud laboral (SL). Diseño. Estudio descriptivo, transversal. Emplazamiento. Departamento de Salud 20 de la provincia de Alicante. Participantes. Todos los PMAPS (n = 104), con una participación del 80% (n = 83). Mediciones principales. Los participantes autocumplimentaron un cuestionario específicamente desarrollado para el estudio. Se establecieron 16 cuestiones que abarcaban funciones en PRL y capacitación para desarrollarlas, así como cantidad y utilidad de formación recibidas en materia de SL. Resultados. El PMAPS no percibe que tenga funciones en materia de PRL (mediana [Me], 2; rango intercuartílico [RI], 1-3). En mayor medida se consideró capacitado para identificar el origen laboral o no de una enfermedad atendida en su consulta (Me, 3; RI, 3-4). La formación en SL durante la licenciatura de medicina junto con la vía MIR se han identificado como las de menor cuantía (el 55,4 y el 60% de los entrevistados puntuaron en el valor 1 del cuestionario). EL PMAPS claramente ha considerado que una mayor formación en SL le ayudaría en su actividad diaria profesional; se obtuvieron puntuaciones de tipo alto (opciones de respuesta mayores o iguales a 4) en más del 70% de los entrevistados. Conclusiones. Es necesario que se fomente la formación en SL para que el PMAPS se sienta parte integrante del personal sanitario con funciones en PRL y pueda adquirir los conocimientos y habilidades necesarios en materia de SL para su práctica médica habitual

Objectives. To evaluate the perception of primary health care medical staff (PHCMS) have on their functions in occupational risk prevention (ORP), as well as their knowledge and skills on the subject of occupational health (OH). Design. Descriptive cross-sectional study. Setting. Health Department 20 of Alicante province, Spain. Participants. All PHCMS (N=104), with a participation of 80% (N=83). Primary Measurements. The participants self-completed a questionnaire specifically developed for the study. Sixteen questions were established and covered functions in ORP and skills for developing them, as well as the amount and usefulness of training received on the subject of OH. Results. The PHCMS did not perceive that they had functions as regards ORP (median [Me], 2; interquartile range [IR], 1-3). To a greater extent they considered themselves capable of identifying whether an illness seen in their clinic was of work origin or not (Me, 3; IR, 3-4). Training in OH as a medical student and in their medical internship (MIR) was identified as of minor importance (55.4% and 60%, respectively, of those surveyed scored a value of 1 in the questionnaire). The PHCMS obviously considered that better training in OH would help them in their daily professional activity. High scores were obtained for this (response options greater than or equal to 4) in more than 70% of the interviewees. Conclusions. Training in OH must be encouraged so that PHCMS are seen to be health personnel with functions in ORP and are able to acquire the necessary knowledge and skills in OH for their routine medical practice