Prácticas alimentarias del alumnado de secundaria durante la jornada escolar en Andalucía asociadas a la oferta del entorno / Dietary habits of secondary school students in Andalusia during school time in relation to food stores in the environment

Fundamento: El análisis del contexto ambiental es imprescindible para estudiar las prácticas alimentarias en adolescentes. Se describen las prácticas alimentarias durante la jornada escolar del alumnado usuario de los comercios de alimentos circundantes a los centros de educación secundaria en Andalucía y las características de los mismos. Métodos: Estudio descriptivo transversal, sobre una muestra de 8068 estudiantes y 95 centros de secundaria. Muestreo aleatorio polietápico por conglomerado: estratificado por provincia y tamaño de hábitat y sistemático por aulas. El tipo de establecimiento, oferta alimentaria, distancia y visualización desde el centro y demanda del alumnado se realizó mediante observación directa y entrevistas, y las características socio-demográficas y las prácticas alimentarias a través de cuestionario. Resultados: Los centros tienen establecimientos cercanos con oferta alimentaria dirigida al alumnado (72,63%). Predominan bares y cafeterías (55), tiendas de comestibles (54) y quioscos de chucherías (23). La oferta de chucherías, bollería y bocadillos se constata en todos los establecimientos. El 25,73% del alumnado compra su merienda escolar en estos comercios, encontrando relaciones significativas en el consumo de golosinas y paquetes de fritos envasados frente al alumnado que no sale del instituto durante la hora del recreo. Conclusiones: El número y las características de la oferta de los establecimientos circundantes a los centros educativos obligan a profundizar en la influencia sobre las prácticas alimentarias del alumnado para establecer medidas de salud pública que controlen la oferta insalubre detectada (AU)

Background: The analysis of the environmental context is indispensable to study the eating habits in adolescents. Feeding practices during the school day the students user surrounding grocery stores of secondary schools in Andalusia and their characteristics are described. Methods: Descriptive cross-sectional study of 8068 students and 95 secondary schools. Multistage cluster sampling: Stratified random sampling by province and population size and systematic for classrooms. The analysis of the type of store, food supply, distance and visualization from the school and students´ demands was conducted by direct observation and interviews. The socio-demographic characteristics and feeding practices were got through questionnaire. Results: The schools are surrounded by shops in which the food supply is aimed at students (72, 63 %). Pubs and cafeterias (55), grocery stores and tuck shops predominate. The presence of sweets, processed baked goods and sandwiches is confirmed in all the stores. 25.73% of students buy their school meals in these shops. There are statistically significant relationships between the consumption of sweets and fried packaged packages and to go out the high school during the playground. Conclusions: The number and characteristics of the stores surrounding the schools require studying its influence over students eating habits in order to establish public health measures to control the detected unhealthy supply (AU)

Proyecto ANDALIES: consumo, oferta y promoción de la alimentación saludable en los centros de educación secundaria de Andalucía / ANDALIES project: consumption, offer and promotion of healthy eating habits within secondary schools in Andalusia

Introducción: El contexto escolar destaca como uno de los factores influyentes en las prácticas alimentarias de los-las adolescentes. Las prácticas de consumo alimentario durante la jornada escolar, la oferta de las cafeterías y las actividades de promoción propuestas desde los centros son objetos de atención creciente para la salud comunitaria. Objetivos: Describir las prácticas alimentarias del alumnado durante la jornada escolar; conocer la oferta de las cafeterías escolares y establecimientos periféricos; y valorar si los centros de secundaria son entornos favorecedores de una alimentación saludable. Diseño y muestra: Estudio descriptivo transversal durante los cursos 2010-2012. Unidades de muestreo: centros de secundaria públicos (95) y alumnado (8.068). Muestreo polietápico por conglomerados: selección aleatoria y estratificada por provincia y tamaño de hábitat. Elección del alumnado: muestreo sistemático de aulas. Resultados: El 77,5% del alumnado desayuna en casa: lácteo con cereal (40,9%) o ingesta líquida (29,2%); el 70,3% come algo en el centro y eligen el bocadillo de embutidos mayoritariamente. La fruta, anecdótica (2,5%) y, el zumo comercial, my frecuente (63,3%). El 75% consume chucherías siendo significativamente superior en centros con cafeterías. Las cafeterías ofertan multitud de productos desaconsejados: refrescos (97,3%), embutidos (91,8%), golosinas y fritos envasados (89%). Ausencia de control de la oferta en los centros (68,42%); solo el 28,4% de directivos conocen la ley que la regula. El 72,5% de los centros realiza promoción de la alimentación con rasgos de efemérides. El 71,5% de los centros tienen en sus alrededores comercios que abastecen al alumnado. Discusión: Encontramos una baja protección de la salud alimentaria del alumnado debido a: déficits alimentarios del alumnado; baja calidad de la oferta en cafeterías escolares y locales externos e inexistencia de actividades de promoción en los centros educativos. Por ello, la administración educativa, sanitaria y local andaluza debe asumir la responsabilidad compartida en esta materia (AU)

Introduction: The school context stands out as one of the factors influencing the food practices of adolescents. Food consumption during the school day, the cafeterias´ supply and the promotional activities proposed by the centers are objects of increasing attention to community health services. Objectives: To describe students´ eating habits during the school day; to analyze the food on offer by the cafeterias and surrounding establishments; and to assess whether secondary schools are suitable environments for the promotion of healthy eating habits. Design and sample: Cross-sectional study during 2010- 2012 courses. Sampling units: public secondary schools (95) and students (8.068). Multistage cluster sampling: random and stratified selection by province and habitat size. Selection of students: systematic sampling of classrooms. Results: 77.5% of students have breakfast at home: cereals and a dairy product (40.9%) or a liquid (29.2%); 70.3% eat something at school and most of them choose a cold meat sandwich. Fruit consumption is infrequent (2.5%) while packed juices are very common (63.3%). 75% eat sweets, the figure increasing significantly in schools with cafeterias. Cafeterias offer a large number of non-recommended products: soft drinks (97,3%), cold meats (91,8%), sweets and chips (89%). Lack of control of the products on offer is common (68.42%); only 28.4% of the managers know the law. 72.5% of the centers undertake isolated activities for the promotion of healthy eating habits. 71.5% of the centers are surrounded by shops that supply the students. Discussion: Low protection of students´ food health is evident, resulting from: students´ nutritional deficits, the low quality of the food offered by the cafeterias and the lack of activities to encourage healthy habits. For which reason, educational, health and local administrations must accept shared responsibility on this subject (AU)

[ANDALIES project: consumption, offer and promotion of healthy eating habits within secondary schools in Andalusia]. / Proyecto ANDALIES: consumo, oferta y promoción de la alimentación saludable en los centros de educación secundaria de Andalucía.

INTRODUCTION: The school context stands out as one of the factors influencing the food practices of adolescents. Food consumption during the school day, the cafeterias' supply and the promotional activities proposed by the centers are objects of increasing attention to community health services. OBJECTIVES: To describe students' eating habits during the school day; to analyze the food on offer by the cafeterias and surrounding establishments; and to assess whether secondary schools are suitable environments for the promotion of healthy eating habits. DESIGN AND SAMPLE: Cross-sectional study during 2010-2012 courses. Sampling units: public secondary schools (95) and students (8.068). Multistage cluster sampling: random and stratified selection by province and habitat size. Selection of students: systematic sampling of classrooms. RESULTS: 77.5% of students have breakfast at home: cereals and a dairy product (40.9%) or a liquid (29.2%); 70.3% eat something at school and most of them choose a cold meat sandwich. Fruit consumption is infrequent (2.5%) while packed juices are very common (63.3%). 75% eat sweets, the figure increasing significantly in schools with cafeterias. Cafeterias offer a large number of non-recommended products: soft drinks (97,3%), cold meats (91,8%), sweets and chips (89%). Lack of control of the products on offer is common (68.42%); only 28.4% of the managers know the law. 72.5% of the centers undertake isolated activities for the promotion of healthy eating habits. 71.5% of the centers are surrounded by shops that supply the students. DISCUSSION: Low protection of students' food health is evident, resulting from: students' nutritional deficits, the low quality of the food offered by the cafeterias and the lack of activities to encourage healthy habits. For which reason, educational, health and local administrations must accept shared responsibility on this subject.

Introducción. El contexto escolar destaca como uno de los factores influyentes en las prácticas alimentarias de los-las adolescentes. Las prácticas de consumo alimentario durante la jornada escolar, la oferta de las cafeterías y las actividades de promoción propuestas desde los centros son objetos de atención creciente para la salud comunitaria. Objetivos. Describir las prácticas alimentarias del alumnado durante la jornada escolar; conocer la oferta de las cafeterías escolares y establecimientos periféricos; y valorar si los centros de secundaria son entornos favorecedores de una alimentación saludable. Diseño y muestra. Estudio descriptivo transversal durante los cursos 2010-2012. Unidades de muestreo: centros de secundaria públicos (95) y alumnado (8.068). Muestreo polietápico por conglomerados: selección aleatoria y estratificada por provincia y tamaño de hábitat. Elección del alumnado: muestreo sistemático de aulas. Resultados. El 77,5% del alumnado desayuna en casa: lácteo con cereal (40,9%) o ingesta líquida (29,2%); el 70,3% come algo en el centro y eligen el bocadillo de embutidos mayoritariamente. La fruta, anecdótica (2,5%) y, el zumo comercial, my frecuente (63,3%). El 75% consume chucherías siendo significativamente superior en centros con cafeterías. Las cafeterías ofertan multitud de productos desaconsejados: refrescos (97,3%), embutidos (91,8%), golosinas y fritos envasados (89%). Ausencia de control de la oferta en los centros (68,42%); solo el 28,4% de directivos conocen la ley que la regula. El 72,5% de los centros realiza promoción de la alimentación con rasgos de efemérides. El 71,5% de los centros tienen en sus alrededores comercios que abastecen al alumnado. Discusión. Encontramos una baja protección de la salud alimentaria del alumnado debido a: déficits alimentarios del alumnado; baja calidad de la oferta en cafeterías escolares y locales externos e inexistencia de actividades de promoción en los centros educativos. Por ello, la administración educativa, sanitaria y local andaluza debe asumir la responsabilidad compartida en esta materia.

Educational inequalities and cardiovascular risk factors. A cross-sectional population-based study in southern Spain.

OBJECTIVES: To determine the prevalence and distribution of modifiable cardiovascular risk factors focused on educational level differences, in an adult population in Southern Spain. DESIGN AND SAMPLE: Cross-sectional population-based study. Random sample from the adult population assigned to a Primary Health Care Centre in Málaga (Southern Spain), which attends 38,625 inhabitants. MEASURES: Level of education, physical activity, blood pressure, waist perimeter, body mass index, lipid profile, fasting plasma glucose, among others, were assessed. RESULTS: Final sample included 2,270 subjects with a mean age of 43.65 (SD: 16.65), 49.74% male and 50.26% female. 57.6% had none or only primary studies. Overweight was present in 55.8%, smokers were 27.6% and sedentary people 51.9%. Once adjusted by sex and age, all modifiable factors were lower in people with higher education. The highest risks were sedentarism (OR 1.95; 95% CI: 1.16-3.29) and hypertension (OR: 2.07 95% CI: 1.49-2.80) for those with lower education. CONCLUSIONS: There is a clear inverse gradient of cardiovascular risk factors and educational level in the study population. Public health and community nurses should develop strong interventions for this challenge and extend their influence to public policies focused on educational inequalities and health.

[Research lines proposed by Andalusian Association of Community Nursing]. / Líneas de investigación propuestas por la Asociación de Enfermería Comunitaria de Andalucía.

OBJECTIVE: To define and prioritise the future research lines of the Andalusian Association of Community Nursing (ASANEC). METHOD: Application of the Delphi technique within the members of the Working Group of the Research area of ASANEC, consisting of Community nurses from clinical and educational settings, as regards research in seven Andalusian provinces. Three rounds of participation were performed, with the last one being prioritised using a Linear Scale. Averages and standard deviations have been calculated. RESULTS: The total number of participants on this technique was 13 professionals (54.16%). The main research lines finally agreed and prioritised, were the following, in decreasing order: «care management¼, «quality of life¼, «lifestyles and health education in children and adolescent population¼, «design and validation of nursing assessment tools¼, «patient safety¼, «accessibility to healthcare services and development of self-care capacity¼. CONCLUSIONS: Research on the new model of care management introduced into Andalusian primary care was given priority, although there are more emerging research lines related to Health Promotion and Prevention of Health problems in the general population, children, young people and vulnerable populations. These results have been the deciding factors in the choice of the current research lines developed by the ASANEC Research Group.

Prevalencia de sobrepeso y obesidad en población adulta de un área de Salud Urbana / Prevalence of overweight and obesity in adults in an urban health area

Objetivo. Estimar la prevalencia de sobrepeso y obesidad en adultos de un área de salud urbana e identificar a grupos de alto riesgo cardiovascular (diabéticos e hipertensos) que puedan beneficiarse de una intervención enfermera sobre modificación de estilos de vida para reducir el peso. Método. Estudio transversal analítico realizado con una muestra aleatoria de 2.270 individuos obtenida a partir de la población adulta (18–80 años) perteneciente a un centro de salud. A todos los participantes se les realizó una historia clínica (incluyendo datos sociodemográficos), una exploración física y determinaciones analíticas. Resultados. El índice de masa corporal (IMC) medio se encontraba en el rango del sobrepeso (26,9±5,1kg/m2) y fue superior en varones. El 38% de la muestra tenía sobrepeso y el 22% obesidad. No se encontraron diferencias entre sexos en la prevalencia de obesidad, aunque las mujeres presentaron una mayor prevalencia de obesidad grados ii y iii. El sobrepeso fue más frecuente en los varones. La prevalencia de sobrepeso y obesidad aumenta con la edad. El 7% de la muestra (156 personas) presentaron diabetes, el 31% (707) tenían hipertensión arterial y en el 5% (111 personas) coincidían ambas patologías. El IMC fue significativamente mayor (p<0,001) en los pacientes con diabetes e hipertensión (31,4±5,3), hipertensión (29,7±5,2) y diabetes (28,5±4,6) que en aquellos que no tenían estas patologías (25,4±4,3). Conclusiones. En nuestra población existe una alta prevalencia de sobrepeso y obesidad siendo más elevada en pacientes con diabetes e hipertensión (AU)

Objective. To estimate prevalence of overweight and obesity in adults and to identify those individuals at high cardiovascular risk (subjects with type 2 diabetes or hypertension) in whom a nurse intervention might be beneficial in terms of life-style changes and reduction in body weight. Method. A cross-sectional study on 2270 adults (18–80 years-old) from an urban Primary Health Care Centre. Medical history, social and demographic data, physical examination and blood tests were collected. Results. The mean body mass index was 26.9±5.1kg/m2 and was found to be higher in men. Thirty-eight percent of subjects were overweight and 22% were obese. Although the prevalence of obesity was identical in both sexes, women had higher prevalences of type ii and iii obesity than men, but overweight was more frequent in men. Among those older than fifty years-old, 84% were overweight or obese. One-hundred and fifty-six (7%) subjects had type 2 diabetes and 707 (31%) had hypertension, and 111 (5%) subjects with both diabetes and hypertension. BMI was higher (P<0.001) in patients who suffered from, hypertension (29.7±5.2), diabetes (28.5±4.6), and diabetes and hypertension (31.4±5.3), than in those who did not suffer from these diseases (25.4±4.3). Conclusions. Obesity and overweight is highly prevalent in the population studied and is higher in patients with diabetes and hypertension (AU)

[Prevalence of overweight and obesity in adults in an urban health area]. / Prevalencia de sobrepeso y obesidad en población adulta de un área de Salud Urbana.

OBJECTIVE: To estimate prevalence of overweight and obesity in adults and to identify those individuals at high cardiovascular risk (subjects with type 2 diabetes or hypertension) in whom a nurse intervention might be beneficial in terms of life-style changes and reduction in body weight. METHOD: A cross-sectional study on 2270 adults (18-80 years-old) from an urban Primary Health Care Centre. Medical history, social and demographic data, physical examination and blood tests were collected. RESULTS: The mean body mass index was 26.9±5.1kg/m(2) and was found to be higher in men. Thirty-eight percent of subjects were overweight and 22% were obese. Although the prevalence of obesity was identical in both sexes, women had higher prevalences of type ii and iii obesity than men, but overweight was more frequent in men. Among those older than fifty years-old, 84% were overweight or obese. One-hundred and fifty-six (7%) subjects had type 2 diabetes and 707 (31%) had hypertension, and 111 (5%) subjects with both diabetes and hypertension. BMI was higher (P<0.001) in patients who suffered from, hypertension (29.7±5.2), diabetes (28.5±4.6), and diabetes and hypertension (31.4±5.3), than in those who did not suffer from these diseases (25.4±4.3). CONCLUSIONS: Obesity and overweight is highly prevalent in the population studied and is higher in patients with diabetes and hypertension.

Enfermedad arterial periférica oculta en población diabética seguida en atención primaria / Occult peripheral arterial disease in patients with type 2 diabetes in primary care

Introducción El objetivo del estudio fue estimar la prevalencia de enfermedad arterial periférica (EAP) no diagnosticada, mediante el índice tobillo-brazo (ITB), en pacientes diabéticos tipo 2 de una zona urbana seguidos en Atención Primaria (AP) y los factores asociados a la misma. Métodos Estudio descriptivo transversal (de prevalencia). Muestreo aleatorio sistemático de pacientes diabéticos tipo 2, entre 50–80 años, seguidos en AP. Nuestra variable dependiente fue la presencia de EAP diagnosticada mediante un ITB<0,9. Variables independientes: demográficas, clínicas y de laboratorio. Para determinar las variables asociadas a un ITB patológico se utilizó la regresión logística binaria por pasos hacia adelante. Resultados Muestra de 456 pacientes, de los que 243 (53%) eran hombres, con una edad media de 61±6 años. Presentaron ITB<0,9: 126 pacientes (27,6%), ITB entre 0,9 y 1,3: 310 pacientes (68%) y un ITB>1,3: 20 pacientes (4,4%). Mediante análisis multivariante las variables relacionadas con un ITB<0,9 fueron el ser o haber sido fumador, los años de evolución de la diabetes, el número de plaquetas y la hipertrigliceridemia, mientras que con un ITB>1,3 fueron el perímetro de cintura y las complicaciones microvasculares. Conclusiones La prevalencia de enfermedad arterial periférica es elevada en diabéticos tipo 2, consistente con lo publicado. Esta alta prevalencia de ITB alterado refuerza la recomendación de realizar el índice tobillo-brazo a todos los diabéticos tipo 2 mayores de 50 años valorados y seguidos en AP (AU)

Introduction The aim of our study was to estimate the prevalence and associated factors of occult peripheral arterial disease (PAD) assessed by the ankle-brachial index (ABI) in subjects with type 2 diabetes mellitus followed up in a single urban Primary Care Center. Methods This is a cross-sectional study involving subjects who were sampled randomly from patients with type 2 diabetes and aged 50 to 80 years-old. The dependent variable was the presence of PAD, assessed by an ABI below 0.9. Demographic, clinical and laboratory parameters were also recorded. A forward, stepwise, logistic binary regression was built in order to examine variables associated with abnormal ABI.ResultsFour-hundred and fifty-six patients were included; they were 61±6 years-old, of which 243 (53%) were men. An ABI<0.9 was found in 126 patients (27.6%), 310 (68%) patients had an ABI 0.9–1.3 and only 20 patients (4.4%) had and ABI higher than 1.3. Using multivariate analyses, past or present smoking, duration of diabetes, platelet count and hypertriglyceridemia, were independently associated to PAD; on the contrary, only waist cincumference and the presence of microvascular disease were associated to an ABI higher than 1.3.Conclusion The prevalence of PAD was high and consistent with the literature, thus reinforcing the measurement of ABI for all patients with type 2 diabetes followed up in primary care. Smoking, duration of diabetes, platelet count and hypertriglyceridemia were independently associated to a low ABI (AU)

[Polyurethane foam dressing. Assessment of its therapeutic effects in the treatment of moderate- to highly-exudative chronic ulcers]. / Apósito de espuma de poliuretano. Evaluación de su comportamiento terapéutico en el tratamiento de úlceras crónicas de moderada a altamente exudativas.

The authors evaluate the behavior of Skinfoam Polyurethane Foam Dressings in the treatment of bed sores and vascular ulcers having a moderate to high exudation level by means of a multi-centric, prospective, open, observational study of a series of clinical cases. The length of this study was up to 20 dressing changes or until the patient was cured. During the first visit with patients, the personnel recorded patient data including an evaluation of the characteristics of patient's lesion; during visits to change dressings, the medical personnel recorded the evolution of the lesion and dressing changes; during the final visit, the medical personnel evaluated the final characteristics of the lesion as well as a global evaluation of the behavior of the dressing. This study included 185 patients who had an average age of 75.5. At the end of this study, 44.32% of these patients did not have any signs of an ulcer while among the other patients, the medical team noted an important decrease in the size of their lesions, with a considerable increase of tissue epithelization. The perilesional skin showed improvement in all aspects and erythema and eczema diminished in a statistically significant manner. The presence of exudation was null when the final dressing change occurred. Patients manifested a lack of pain before the end of this study 85.15% of the professionals indicated a global satisfaction level of good, very good or excellent while 100% of the patients stated they would use this dressing again. The authors conclude that the dressing under study is effective in the treatment of bed sores and high exudation vascular ulcers; even in cases involving compressive therapy, this dressing could be the one chosen for application.

Apósito de espuma de poliuretano. Evaluación de su comportamiento terapéutico en el tratamiento de úlceras crónicas de moderada a altamente exudativas / Polyurethane Foam Dressing Evaluation of this dressing’s therapeutic behavior in the treatment of chronic ulcers having a moderate to high exudation level

Se valora el comportamiento de los apósitos de espuma de poliuretano Skinfoam®, en el tratamiento de úlceras por presión y úlceras vasculares de moderada a altamente exudativas, mediante un estudio observacional de series de casos clínicos, multicéntrico, prospectivo y abierto. La duración del estudio fue de hasta 20 cambios de apósito o hasta la curación. En la visita inicial se anotaron los datos del paciente, incluyendo una valoración de las características de la lesión; en las visitas de cambio de apósito se registró la evolución de la lesión y de los cambios de apósito, y en la visita final se evaluaron las características finales de la lesión así como la valoración global del comportamiento del apósito. Se incluyeron 185 pacientes con una edad media de 75,5 años. Al final del estudio un 44,32% de los mismos no presentaba ninguna úlcera mientras que en los restantes constatamos una disminución importante del tamaño de la lesión, aumentando considerablemente el tejido de epitelización. La piel perilesional mejora en todos los aspectos y disminuye de forma estadísticamente significativa el eritema y el eczema. La fuga de exudado llegó a ser nula en el último cambio de apósito. Los pacientes manifiestan ausencia de dolor antes de finalizar el estudio. El grado de satisfacción global indicó bueno, muy bueno o excelente por el 95,15% de los profesionales y el 100% de los pacientes volvería a utilizarlo. Se concluye que el apósito en estudio Skinfoam® es efectivo en el tratamiento de las úlceras por presión y úlceras vasculares altamente exudativas, incluso en terapia compresiva, pudiendo ser el de elección(AU)

The authors evaluate the behavior of Skinfoam® Polyurethane Foam Dre-ssings in the treatment of bed sores and vascular ulcers having a moderate to high exudation level by means of a multi-centric, prospective, open, observational study of a series of clinical cases. The length of this study was up to 20 dressing changes or until the patient was cured. During the first visit with patients, the personnel recorded patient data including an evaluation of the characteristics of patient’s lesion; during visits to change dressings, the medical personnel recorded the evolution of the lesion and dressing changes; during the final visit, the medical personnel evaluated the final characteristics of the lesion as well as a global evaluation of the behavior of the dressing. This study included 185 patients who had an average age of 75.5. At the end of this study, 44.32% of these patients did not have any signs of an ulcer while among the other patients, the medical team noted an important decrease in the size of their lesions, with a considerable increase of tissue epithelization. The perilesional skin showed improvement in all aspects and erythema and eczema diminished in a statistically significant manner. The presence of exudation was null when the final dressing change occurred. Patients manifested a lack of pain before the end of this study. 85.15% of the professionals indicated a global satisfaction level of good, very good or excellent while 100% of the patients stated they would use his dressing again. The authors conclude that the dressing under study is effective in the treatment of bed sores and high exudation vascular ulcers; even in cases involving compressive therapy, this dressing could be the one chosen for application(AU)