Impact of mHealth application on adherence to cardiac rehabilitation guidelines after a coronary event: Randomised controlled clinical trial protocol.

Background: Coronary disease is the main cause of death around the world. mHealth technology is considered attractive and promising to promote behavioural changes aimed at healthy lifestyle habits among coronary patients. The purpose of this study is to evaluate the efficacy of an mHealth intervention regarding improved results in secondary prevention in patients after an acute myocardial infarction (AMI) or angina in terms of lifestyle, clinical variables and therapeutic compliance. Methods: Randomised clinical trial with 300 patients who underwent a percutaneous coronary intervention (PCI) with stent implant. They will be assigned to either the mHealth group, subject to a self-monitored educational intervention involving an internet application installed on their mobile phone or tablet, or to a control group receiving standard healthcare (150 patients in each arm). The primary outcome variables will be adherence to the Mediterranean diet, physical activity, smoking, therapeutic compliance, knowledge acquired, user-friendliness and satisfaction with the application. Measurements of blood pressure, heart rate, body weight, waist circumference (WC) and the 6-min walk test will be taken. Furthermore, the blood lipid profile, glucose and HbA1c will be evaluated. Clinical interview will be conducted, and validated questionnaires completed. The primary quantitative results will be compared using an analysis of covariance adjusted for age and sex. A multivariate analysis will be performed to examine the association of the intervention with lifestyle habits, the control of cardiovascular risk factors (CDRFs) and the results after the hospital discharge (major adverse events, treatment compliance and lifestyle). Conclusions: The study will provide evidence about the effectiveness of an mHealth intervention at improving the lifestyle of the participants and could be offered to patients with coronary disease to complement existing services. Trial registration: NCT05247606. [https://ClinicalTrials.gov]. 21/02/2022.

Assessment of an intervention for preventing pediatric overweight and obesity through the World Café technique: A qualitative study.

PURPOSE: To evaluate the self-reported perspectives of participants involved in the Previene Cádiz intervention for preventing pediatric overweight and obesity. DESIGN AND METHODS: This qualitative study collected information through the World Café technique. A purposive sample of 40 participants was used, of which 14 were schoolchildren, 12 were teachers, and 14 were parent volunteers. The data were segmented, and concepts were created and grouped into dimensions and categories. RESULTS: The participants confirmed they had learned new information and behaviors about healthy habits. Parental awareness was considered a crucial and necessary element in changing family habits; therefore, increasing the motivation of family members was deemed a critical task in public health interventions conducted in school settings. DISCUSSION: Despite the suitability of qualitative methodology to evaluate the perceptions of the main players in an educational intervention, scientific literature is scarce. Obtaining information from the educational community about an intervention is not always easy, so the perspectives of teachers, students, and families about the Previene Cádiz intervention through the World Café approach is considered a relevant contribution. CONCLUSIONS: The participants considered the intervention positive in terms of learning and fostering increased knowledge, awareness, and healthy behaviors. PRACTICE IMPLICATIONS: Future interventions should encourage the active participation of all social groups involved, integrating dynamic and collaborative training activities that are acceptable to all participants.

Design of a Nutritional Survey to Detect High Dietary Salt Intakes and Its Usefulness in Primary Care Compared to 24-Hour Urine Sodium Determination.

Many population studies report salt intakes that exceed the WHO recommendation (2 g/day of Na+ or 5 g/day of salt). We do not have tools for detecting high salt intakes that are easy to apply in primary health care (PHC). We propose the development of a survey to screen for high salt intake in PHC patients. A cross-sectional study of 176 patients determines the responsible foods, and a study of 61 patients studies the optimal cut-off point and discriminant ability (ROC curve). We assessed the salt intake using a food frequency questionnaire and a 24 h dietary recall and used a factor analysis to identify the foods with the highest contribution to be included in a high intake screening questionnaire. We used 24 h urinary sodium as a gold standard. We identified 38 foods and 14 factors representing a high intake, explaining a significant proportion of the total variance (50.3%). Significant correlations (r > 0.4) were obtained between nutritional survey scores and urinary sodium excretion, allowing us to detect patients who exceed salt intake recommendations. For sodium excretion ≥ 2.4 g/day, the survey has a sensitivity of 91.4%, a specificity of 96.2% and an area under the curve of 0.94. For a prevalence of high consumption of 57.4%, the positive predictive value (PPV) was 96.9% and the negative predictive value (NPV) was 89.2%. We developed a screening survey for subjects with a high probability of high salt intake in primary health care, which could contribute to the reduction in diseases associated with this consumption.

Correlaciones entre la ingesta de sal en la dieta y la eliminación de sodio en la orina de 24 h en una muestra de población urbana de Cáceres / Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres

Objetivo: La ingesta excesiva de sal se asocia a mayores cifras de tensión arterial y prevalencia de enfermedades cardiovasculares. La OMS recomienda consumir menos de 5 g/día de sal (equivalente a 2 g de Na+/día). Identificar alimentos y comportamientos con mayor contribución al exceso de aporte facilitaría el consejo dietético preventivo. Diseño: Estudio observacional. Sitio: Centro de Salud Urbano en Cáceres. Medidas principales: Estimamos el consumo de sal mediante dos cuestionarios de frecuencia de consumo de alimentos (CFA), uno genérico y otro con alimentos con elevado contenido en Na+, y encuesta recordatoria de 24 h. Empleamos el programa Evalfinut para la valoración nutricional de la dieta. Analizamos correlaciones entre ingesta estimada de sal y eliminación de sodio en orina de 24 h (gold standard). Resultados: El 92% de la muestra presenta consumos superiores a las recomendaciones con ingestas equivalentes a 9,5 g/día de sal (3,7 g/día de Na+). Cuando la ingesta de sodio se determina por el cociente Na+/K+, el 79,54% tiene ingestas elevadas. La eliminación de sodio sigue una tendencia ligeramente creciente con el IMC. La percepción de consumo de sal es baja, el 56,3% lo considera «adecuado»; el 32,4% añade sal a los alimentos una vez servidos. Los CFA infraestiman la ingesta de Na+ y encuestas dirigidas aportan valores más elevados. La correlación entre CFA y eliminación urinaria de Na+ es débil. Conclusión: Debemos reducir la ingesta de sal aumentando la percepción del consumo, mejorando el conocimiento sobre el contenido de sal en alimentos e identificando a pacientes diana del consejo sanitario.(AU)

Objective: Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. Design: Observational study. Site: Urban Health Center in Cáceres. Main measurements: We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). Results: 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it “adequate”. 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. Conclusion: We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.(AU)

[Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres]. / Correlaciones entre la ingesta de sal en la dieta y la eliminación de sodio en la orina de 24 h en una muestra de población urbana de Cáceres.

OBJECTIVE: Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. DESIGN: Observational study. SITE: Urban Health Center in Cáceres. MAIN MEASUREMENTS: We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). RESULTS: 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it "adequate". 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. CONCLUSION: We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.

[Social media and cyberbullying in eating disorders]. / Redes sociales y ciberacoso en los trastornos de la conducta alimentaria.

Introduction: Eating disorders (ED) are a multifactorial pathology. In their origin multiple variables are involved to which nowadays a possible enhancing factor is added: the diffusion and promotion of the culture of thinness and the apology of ED through the social media (SM) used by the youngest people. Through the feedback tools of the social networks (likes, comments, visits, retweets, etc.) and the elements of comparison between equals of the most visual SMs, many users come to develop risk behaviours that in turn give feedback to others. In addition, a sense of belonging to a group or tribe is created through communities whose members feel supported and where very restrictive diets are shared in an affective way, as well as ways of hiding these and other behaviours from those who do not belong to the group; both elements make it difficult for professionals and the family to intervene. Due to the extensive use of SMs, the rapid dissemination of all that is published, and the limited control over shared content, it is virtually impossible to control those sites that advocate and promote behaviours that contribute to the development or maintenance of ED. Cyberbullying or intimidation through digital technologies often uses body image criticisms that damage the self-esteem of the most vulnerable. This cyberbullying is a factor increasingly present in young people who have suffered an ED. The key to prevention is considered to be media literacy in the use of SM, as well as parental supervision of the youngest. People at risk or who have already been diagnosed with ED find in these networks the social support they seek but are biased towards risk behaviours, when it is possible for health professionals to use them to the benefit of promoting healthy habits and for recovery from these disorders.

Introducción: Los trastornos de la conducta alimentaria (TCA) son una patología multifactorial. En su inicio están implicadas múltiples variables a las que se les suma hoy en día un posible potenciador: la difusión y promoción de la cultura de la delgadez y la apología de los TCA a través de las redes sociales (RR. SS.) usadas por los más jóvenes. A través de las herramientas de feedback de las redes (likes, comments, visitas, retweets, etc.) y los elementos de comparación entre iguales de las RR. SS. más visuales, muchos usuarios llegan a desarrollar conductas de riesgo que a su vez retroalimentan a otros. Por otra parte, se crea la sensación de pertenencia a un grupo o tribu a través de comunidades cuyos miembros se sienten apoyados y donde se comparten de forma afectiva dietas muy restrictivas, así como formas de ocultarlas y otras conductas a quienes no pertenecen al grupo; ambos elementos dificultan la intervención por parte de los profesionales y la familia. Debido al uso extensivo de las RR. SS., a la rápida difusión de todo aquello que se publica y al escaso control que hay sobre el contenido que se comparte, resulta prácticamente imposible controlar los sitios donde se hace apología y se promueven las conductas que contribuyen al desarrollo o mantenimiento de los TCA. El ciberacoso o intimidación por medio de tecnologías digitales utiliza con frecuencia críticas sobre la imagen corporal que dañan la autoestima de los más vulnerables, y es un factor cada vez más presente en los jóvenes que han padecido un TCA. Se considera que la clave de la prevención reside en la alfabetización mediática del uso de las RR. SS., así como la supervisión parental de los más jóvenes. Las personas en riesgo o ya diagnosticadas de TCA encuentran en estas redes el apoyo social que buscan, pero sesgado hacia las conductas de riesgo, cuando sería posible explotarlas en beneficio de la promoción de hábitos saludables y para la recuperación de estos trastornos.

[Advertising and the media in eating disorders]. / Publicidad y medios de comunicación en los trastornos de la conducta alimentaria.

Introduction: The media, by means of advertising, convey an ideal of unreal beauty associated with positive traits such as popularity, esteem, acceptance, intelligence, etc. This can be one of the factors that compromise emotional and physical health, being responsible for creating unrealistic expectations and body dissatisfaction, and exerting a very important influence on the triggering or maintenance of bad eating habits that can lead to eating disorders. The youngest population has a low capacity to anticipate the harmful effects of certain messages with commercial interests, and this requires implementing preventive programs based on media education, accompanied by modeling in the family nucleus to promote a healthy lifestyle.

Introducción: Los medios de comunicación, a través de la publicidad, transmiten un ideal de belleza no real asociado con rasgos positivos como popularidad, aprecio, aceptación, inteligencia, etc. Esto puede constituir uno de los factores que comprometen la salud emocional y física, siendo responsables de crear expectativas poco realistas e insatisfacción corporal y ejerciendo una influencia muy destacada en el desencadenamiento o mantenimiento de los malos hábitos alimentarios que pueden abocar en trastornos de la conducta alimentaria. La población más joven tiene una baja capacidad para prever los efectos nocivos de ciertos mensajes con intereses comerciales, por lo que se requiere la puesta en marcha de programas preventivos basados en la educación mediática, acompañada de un modelado del núcleo familiar en el que se promueva un estilo de vida saludable.

[Characterization, epidemiology and trends of eating disorders]. / Caracterización, epidemiología y tendencias de los trastornos de la conducta alimentaria.

Introduction: Background: eating disorders are a group of conditions in which negative beliefs about food, body shape, and body weight together with behaviors such as restricted food intake, binge eating, excessive exercise, self-induced vomiting, and use of laxatives. They can become serious, affect quality of life, and lead to multiple physical and even psychiatric complications with a fatal outcome. The purpose of this chapter is to describe the characteristics, epidemiology, and trends of eating disorders with updated information based on the most recent publications. Methods: we conducted a systematic literature search in Medline, EMBASE, Cochrane, and Web of Science. The search terms were "anorexia nervosa", "bulimia nervosa", "binge eating disorders" and "epidemiology" both in titles and in abstracts. Results and conclusions: EDs generally occur in adolescents and young adults. The best characterized TCAs are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (TA). Prevalence studies indicate wide differences by age group and sex, much higher in young women (NA, 0.1-2 %; BN, 0.37-2.98 %; BED, 0.62-4.45 %). The prevalence of EDs is 2.2 % (0.2-13.1 %) in Europe, 3.5 % (0.6-7.8 %) in Asia, and 4.6 % (2.0-13.5 %) in America. Comorbidity is high with psychiatric problems such as depression, anxiety, attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and personality disorders.

Introducción: Introducción: los trastornos de la conducta alimentaria (TCA) son un grupo de afecciones en las cuales las creencias negativas sobre la comida, la forma del cuerpo y el peso corporal se acompañan de conductas que incluyen restricción de la ingesta, atracones, realización excesiva de ejercicio, provocación del vómito y uso de laxantes. Pueden llegar a ser graves, repercutir sobre la calidad de vida y conducir a múltiples complicaciones físicas y psiquiátricas, incluso con desenlace fatal. El propósito de este artículo es describir las características, la epidemiología y las tendencias de los TCA con información actualizada a partir de las publicaciones más recientes. Métodos: se ha realizado una búsqueda sistemática de la literatura en Medline, EMBASE, Cochrane y Web of Science. Los términos de búsqueda fueron "anorexia nervosa", "bulimia nervosa", "binge eating disorders" and "epidemiology" en título y resumen. Resultados y conclusiones: los TCA se presentan generalmente en adolescentes y adultos jóvenes. Los mejor caracterizados son la anorexia nerviosa (AN), la bulimia nerviosa (BN) y el trastorno por atracón (TA). Los estudios de prevalencia indican amplias diferencias en función del grupo de edad y el sexo, muy superior en las mujeres jóvenes (AN: 0,1-2 %; BN: 0,37-2,98 %; TA: 0,62-4,45 %). La prevalencia de los TCA es del 2,2 % (0,2-13,1 %) en Europa, del 3,5 % (0,6-7,8 %) en Asia y del 4,6 % (2,0-13,5 %) en América. La comorbilidad es elevada con problemas psiquiátricos como la depresión, la ansiedad, el déficit de atención e hiperactividad, el trastorno obsesivo-compulsivo y los trastornos de personalidad.

Design and Validation of a Scale of Knowledge of Cardiovascular Risk Factors and Lifestyle after Coronary Event.

BACKGROUND: It is important for health professionals to have tools available to assess patients' knowledge of lifestyle and cardiovascular risk factors after they have suffered a coronary event and determine whether educational interventions are effective. This study aims to design and validate a scale to evaluate this knowledge. METHODS: Four-phase instrument design: (A) Conceptual review. (B) Review by experts. (C) Pilot test-retest. (D) Psychometric validation of the final version of the questionnaire with 24 items. A panel of experts performed the content validity. The reliability of the scale was measured using Cronbach's alpha score and criterion validity was evaluated by comparing the total scores for knowledge obtained by the participants among the three education level groups. The construct and dimensional structure validity were assessed using exploratory factor analysis. RESULTS: A total of 143 people participated, 30 in the pilot study and 113 (68% male, 60.2 ± 9 years) in the psychometric validation of version 3 of the scale. A Cronbach's alpha score of 0.887 was reached for this version. The factor analysis showed that the items were distributed into five factors that explained 57% of the variance. Significant differences were observed in the level of knowledge among the patients of the three levels of education (low, moderate and high) (99.20 ± 11.93, 105.92 ± 7.85, 109.78 ± 8.76 points, p = 0.003), as there was a negative correlation between age and knowledge level (r = -0.213, p = 0.024). CONCLUSIONS: The scale presents psychometric properties that are evidence of its reliability and validity. The relationship demonstrated between the level of knowledge and age, sex and level of education shows the importance of emphasizing educational interventions for elderly people and those with a lower level of education.

Independent and Combined Association of Lifestyle Behaviours and Physical Fitness with Body Weight Status in Schoolchildren.

(1) Background: Lifestyle behaviours and physical fitness play a critical role in the development of childhood obesity. It has been demonstrated in this study that self-reported physical fitness is representative of a healthy lifestyle and thus is associated with a lower incidence of overweight/obesity. The objective of this study was to analyse the independent and combined association of lifestyles (physical activity, screen time, diet and hours of sleep) and self-reported physical fitness with body weight in schoolchildren. (2) Methods: This study performed a descriptive and cross-sectional analysis. The study sample consisted of 864 schoolchildren between 8−9 years old from 26 schools of the province of Cádiz. To measure lifestyles and self-reported physical fitness, questionnaires were administered to both schoolchildren and families. To obtain the body weight status, the children were measured by body mass index (BMI). To verify the influence of lifestyles and self-reported physical fitness on the body weight status of schoolchildren, a combined score of lifestyles and self-reported physical fitness was calculated. (3) Results: Schoolchildren who followed healthier lifestyles and presented good physical fitness had a better body weight status (p < 0.001). Schoolchildren who had less healthful lifestyles and bad physical fitness had a 10.34 times higher risk of being overweight or obese (p = 0.004). (4) Conclusions: It has been shown that there is an independent and combined association between lifestyles and physical fitness on the body weight of the schoolchildren. We have suggested strategies to get children to adopt healthy lifestyles and good physical fitness to maintain a healthy body weight and prevent obesity.

Caracterización, epidemiología y tendencias de los trastornos de la conducta alimentaria / Characterization, epidemiology and trends of eating disorders

Introducción: los trastornos de la conducta alimentaria (TCA) son un grupo de afecciones en las cuales las creencias negativas sobre la comida, la forma del cuerpo y el peso corporal se acompañan de conductas que incluyen restricción de la ingesta, atracones, realización excesiva de ejercicio, provocación del vómito y uso de laxantes. Pueden llegar a ser graves, repercutir sobre la calidad de vida y conducir a múltiples complicaciones físicas y psiquiátricas, incluso con desenlace fatal. El propósito de este artículo es describir las características, la epidemiología y las tendencias de los TCA con información actualizada a partir de las publicaciones más recientes. Métodos: se ha realizado una búsqueda sistemática de la literatura en Medline, EMBASE, Cochrane y Web of Science. Los términos de búsqueda fueron “anorexia nervosa”, “bulimia nervosa”, “binge eating disorders” and “epidemiology” en título y resumen. Resultados y conclusiones: los TCA se presentan generalmente en adolescentes y adultos jóvenes. Los mejor caracterizados son la anorexia nerviosa (AN), la bulimia nerviosa (BN) y el trastorno por atracón (TA). Los estudios de prevalencia indican amplias diferencias en función del grupo de edad y el sexo, muy superior en las mujeres jóvenes (AN: 0,1-2 %; BN: 0,37-2,98 %; TA: 0,62-4,45 %). La prevalencia de los TCA es del 2,2 % (0,2-13,1 %) en Europa, del 3,5 % (0,6-7,8 %) en Asia y del 4,6 % (2,0-13,5 %) en América. La comorbilidad es elevada con problemas psiquiátricos como la depresión, la ansiedad, el déficit de atención e hiperactividad, el trastorno obsesivo-compulsivo y los trastornos de personalidad (AU)

Background: eating disorders are a group of conditions in which negative beliefs about food, body shape, and body weight together with behaviors such as restricted food intake, binge eating, excessive exercise, self-induced vomiting, and use of laxatives. They can become serious, affect quality of life, and lead to multiple physical and even psychiatric complications with a fatal outcome. The purpose of this chapter is to describe the characteristics, epidemiology, and trends of eating disorders with updated information based on the most recent publications. Methods: we conducted a systematic literature search in Medline, EMBASE, Cochrane, and Web of Science. The search terms were “anorexia nervosa”, “bulimia nervosa”, “binge eating disorders” and “epidemiology” both in titles and in abstracts. Results and conclusions: EDs generally occur in adolescents and young adults. The best characterized TCAs are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (TA). Prevalence studies indicate wide differences by age group and sex, much higher in young women (NA, 0.1-2 %; BN, 0.37-2.98 %; BED, 0.62-4.45 %). The prevalence of EDs is 2.2 % (0.2-13.1 %) in Europe, 3.5 % (0.6-7.8 %) in Asia, and 4.6 % (2.0-13.5 %) in America. Comorbidity is high with psychiatric problems such as depression, anxiety, attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and personality disorders (AU)

Publicidad y medios de comunicación en los trastornos de la conducta alimentaria / Advertising and the media in eating disorders

Los medios de comunicación, a través de la publicidad, transmiten un ideal de belleza no real asociado con rasgos positivos como popularidad, aprecio, aceptación, inteligencia, etc. Esto puede constituir uno de los factores que comprometen la salud emocional y física, siendo responsables de crear expectativas poco realistas e insatisfacción corporal y ejerciendo una influencia muy destacada en el desencadenamiento o mantenimiento de los malos hábitos alimentarios que pueden abocar en trastornos de la conducta alimentaria. La población más joven tiene una baja capacidad para prever los efectos nocivos de ciertos mensajes con intereses comerciales, por lo que se requiere la puesta en marcha de programas preventivos basados en la educación mediática, acompañada de un modelado del núcleo familiar en el que se promueva un estilo de vida saludable (AU)

The media, by means of advertising, convey an ideal of unreal beauty associated with positive traits such as popularity, esteem, acceptance, intelligence, etc. This can be one of the factors that compromise emotional and physical health, being responsible for creating unrealistic expectations and body dissatisfaction, and exerting a very important influence on the triggering or maintenance of bad eating habits that can lead to eating disorders. The youngest population has a low capacity to anticipate the harmful effects of certain messages with commercial interests, and this requires implementing preventive programs based on media education, accompanied by modeling in the family nucleus to promote a healthy lifestyle (AU)

Redes sociales y ciberacoso en los trastornos de la conducta alimentaria / Social media and cyberbullying in eating disorders

Los trastornos de la conducta alimentaria (TCA) son una patología multifactorial. En su inicio están implicadas múltiples variables a las que se les suma hoy en día un posible potenciador: la difusión y promoción de la cultura de la delgadez y la apología de los TCA a través de las redes sociales (RR. SS.) usadas por los más jóvenes. A través de las herramientas de feedback de las redes (likes, comments, visitas, retweets, etc.) y los elementos de comparación entre iguales de las RR. SS. más visuales, muchos usuarios llegan a desarrollar conductas de riesgo que a su vez retroalimentan a otros. Por otra parte, se crea la sensación de pertenencia a un grupo o tribu a través de comunidades cuyos miembros se sienten apoyados y donde se comparten de forma afectiva dietas muy restrictivas, así como formas de ocultarlas y otras conductas a quienes no pertenecen al grupo; ambos elementos dificultan la intervención por parte de los profesionales y la familia. Debido al uso extensivo de las RR. SS., a la rápida difusión de todo aquello que se publica y al escaso control que hay sobre el contenido que se comparte, resulta prácticamente imposible controlar los sitios donde se hace apología y se promueven las conductas que contribuyen al desarrollo o mantenimiento de los TCA. El ciberacoso o intimidación por medio de tecnologías digitales utiliza con frecuencia críticas sobre la imagen corporal que dañan la autoestima de los más vulnerables, y es un factor cada vez más presente en los jóvenes que han padecido un TCA. Se considera que la clave de la prevención reside en la alfabetización mediática del uso de las RR. SS., así como la supervisión parental de los más jóvenes. Las personas en riesgo o ya diagnosticadas de TCA encuentran en estas redes el apoyo social que buscan, pero sesgado hacia las conductas de riesgo, cuando sería posible explotarlas en beneficio de la promoción de hábitos saludables y para la recuperación de estos trastornos (AU)

Eating disorders (ED) are a multifactorial pathology. In their origin multiple variables are involved to which nowadays a possible enhancing factor is added: the diffusion and promotion of the culture of thinness and the apology of ED through the social media (SM) used by the youngest people. Through the feedback tools of the social networks (likes, comments, visits, retweets, etc.) and the elements of comparison between equals of the most visual SMs, many users come to develop risk behaviours that in turn give feedback to others. In addition, a sense of belonging to a group or tribe is created through communities whose members feel supported and where very restrictive diets are shared in an affective way, as well as ways of hiding these and other behaviours from those who do not belong to the group; both elements make it difficult for professionals and the family to intervene. Due to the extensive use of SMs, the rapid dissemination of all that is published, and the limited control over shared content, it is virtually impossible to control those sites that advocate and promote behaviours that contribute to the development or maintenance of ED. Cyberbullying or intimidation through digital technologies often uses body image criticisms that damage the self-esteem of the most vulnerable. This cyberbullying is a factor increasingly present in young people who have suffered an ED. The key to prevention is considered to be media literacy in the use of SM, as well as parental supervision of the youngest. People at risk or who have already been diagnosed with ED find in these networks the social support they seek but are biased towards risk behaviours, when it is possible for health professionals to use them to the benefit of promoting healthy habits and for recovery from these disorders (AU)

Nutritional Status of Non-Institutionalized Adults Aged over 65. Study of Weight and Health in Older Adults (PYSMA).

BACKGROUND: A significant increase in the prevalence of malnourishment, obesity, and sarcopenic obesity has been observed in developed countries over the last few decades. In Spain, this especially happens in populations over 65 who are not institutionalized. Differences in lifestyle, medication, and economic capacity partially explain this increase. OBJECTIVE: To study the nutritional status of a population of 65 year-olds and subjects who are not institutionalized, in the Cádiz region (Spain). METHODS: Observational, transversal study carried out on 2621 subjects who are 65 years old and over, with a direct weight and height measurement, in 150 pharmacy offices from 44 locations. A mobile application was designed for homogeneous data collection in all the pharmacy offices. The data required from all subjects was gender, age, postal code, social security contribution regime, if the patient lives alone, type of food consumed as the main meals, level of physical activity, polypharmacy, weight, and height. RESULTS: The prevalence of overweight and obesity amounts to 82.2% of the population (43.2% overweight and 39% obese). We found an inverse relationship between the prevalence of overweight and obesity with carrying out physical activity and having full dinners. CONCLUSION: We identify the need to reinforce the messages to the elderly aimed at maintaining adequate physical activity and assessing the quality and quantity of dinners, as well as reducing, as much as possible, the treatments that may lead to weight gain.

Lifestyle and Treatment Adherence Intervention after a Coronary Event Based on an Interactive Web Application (EVITE): Randomized Controlled Clinical Trial Protocol.

Coronary heart disease is one of the main causes of morbimortality around the world. Patients that survive a coronary event suffer a high risk of readmission, relapse and mortality, attributed to the sub-optimal control of cardiovascular risk factors (CVRF), which highlights the need to improve secondary prevention strategies aimed at improving their lifestyle and adherence to treatment. Through a randomized controlled clinical trial, this study aims to evaluate the effect of an intervention involving an online health application supported by a mobile telephone or tablet (mHealth) on lifestyle (diet, physical activity, and tobacco consumption) and treatment adherence among people with coronary heart disease after percutaneous coronary intervention. The sample will comprise 240 subjects (120 in each arm: intervention and usual care). They are assessed immediately and nine months after their hospital discharge about sociodemographic, clinical, CVRF, lifestyle, and treatment adherence characteristics. The educative intervention, involving a follow-up and self-monitoring, will be performed using an online mHealth tool consisting of an application for mobile phones and tablets. The quantitative primary outcomes from the two groups will be compared using an analysis of covariance (ANCOVA) adjusted for age and gender. A multivariate analysis will be performed to examine the association of the intervention with lifestyle habits, the control of CVRFs, and outcomes after discharge in terms of the use of health services, emergency visits, cardiovascular events and readmissions.

A Multimodal Intervention for Prevention of Overweight and Obesity in Schoolchildren. A Protocol Study "PREVIENE-CÁDIZ".

This paper describes the protocol for a study designed to address the high prevalence (40%) of childhood overweight and obesity in the province of Cádiz, Spain, as a reflection of what is happening worldwide. It is widely known that children who suffer from childhood obesity have a higher risk of developing chronic diseases in adulthood. This causes a decrease in the quality of life and an increase in health spending. In this context, it is necessary to intervene promoting healthy lifestyle habits from an early stage. The objective of this project will be to evaluate the effectiveness of a multimodal intervention (individual, school and family) called "PREVIENE-CÁDIZ" [CADIZ-PREVENT]. The intervention will be focused mainly on diet, physical activity, sedentary lifestyle and sleep, to prevent overweight and obesity in schoolchildren from 8 to 9 years old in the province of Cádiz. It will consist of a 10-session education program carried out in the classroom by the teachers. In addition, children will be assigned two workbooks, one to work on in class and the other at home with parents. A workshop aimed at parents will be included to help teach them how to obtain healthier lifestyle habits. The proposed study will involve a quasi-experimental design with a control group.

Patterns of Change in Dietary Habits and Physical Activity during Lockdown in Spain Due to the COVID-19 Pandemic.

BACKGROUND: Lockdown due to COVID-19 influenced food habits and lifestyles with potential negative health impact. This study aims to identify patterns of change in eating habits and physical activity during COVID-19 lockdown in Spain and to identify associations with sociodemographic factors and usual habits. METHODS: This cross-sectional study included 1155 adults recruited online to answer a 10-section questionnaire. The protocol assessed usual diet by means of a semi-quantitative food frequency questionnaire, usual physical activity (PA) and supplement use, dietary changes, sedentary time, PA, exposure to sunlight, sleep quality, and smoking during confinement. Patterns of dietary change were identified by factor analysis. Factor scores were included in cluster analysis together with change in PA. RESULTS: Six patterns of dietary change were identified that together with PA changes during lockdown defined three clusters of lifestyle change: a cluster less active, a more active cluster, and a third cluster as active as usual. People who were usually less active were more likely to be classified in the cluster that increased physical activity in confinement. Scores of the Healthy Mediterranean-Style dietary pattern were higher in this group. Conclusions: Different patterns of change in lifestyles in confinement suggest the need to tailor support and advice to different population groups.

Association of Adherence to Specific Mediterranean Diet Components and Cardiorespiratory Fitness in Young Adults.

OBJECTIVE: Cardiorespiratory fitness (CRF) and a healthy diet may be part of an overall healthy lifestyle. The association between cardiorespiratory fitness and adherence to an overall Mediterranean Diet (MedD) pattern and specific MedD foods has been assessed. DESIGN: Subjects completed a lifestyle survey and dietary pattern, using the validated MedD Adherence 14-item questionnaire and two self-reported 24-h dietary recalls. Participants' height, body weight, waist circumference (WC), and CRF (maximum oxygen uptake, VO2max, ml/kg/min) were measured. SETTING: University of Cádiz, Spain. SUBJECTS: A sample of young adults (n = 275, 22.2 ± 6.3 years). RESULTS: Mean VO2max was 43.9 mL/kg/min (SD 8.5 mL/kg/min). Most participants had healthy CRF (75.9%). The average MedD score was 6.2 points (SD 1.8 points). Participants who consumed more servings of nuts had higher VO2max. Those who showed low CRF performed less physical activity (PA) and had a higher body mass index (BMI) and WC compared with those classified as having healthy CRF. Nut consumption was positively associated with VO2max (ß = 0.320; 95% CI 2.4, 10.7; p < 0.002), adjusting for sex, age, smoking PA, BMI, WC, and energy intake, showing the subjects who consumed more nuts were fitter than young adults who consumed less. CONCLUSIONS: CRF is positively associated with nut consumption but not with the overall MedD pattern and all other MedD foods in the young adults. The subjects who consumed more servings of nuts were fitter than young adults who consumed less. Moreover, fitter subjects performed more PA and had a lower BMI and WC than those who had lower fitness levels.

Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal / Validity and limitations of methods to measure the intake and elimination of salt

La hipertensión arterial (HTA) es el principal factor de riesgo cardiovascular modificable. La HTA se puede relacionar con el consumo elevado de sal. Para medir la ingesta no todas las encuestas de alimentación son comparables y válidas. El procedimiento de referencia para valorar la ingesta de sal consiste en medir la excreción urinaria de sodio en orina recolectada durante 24 h, aunque se han propuesto métodos alternativos, como las recolecciones de muestras de orina puntuales y cronometradas. En esta revisión analizamos qué instrumentos permiten valorar la ingesta de sal y cuáles de ellos han aportado una mayor validez y fiabilidad a través de los estudios de concordancia con la eliminación de sodio en orina. Las encuestas actuales de consumo de alimentos son inadecuados debido a su amplia variabilidad y relativamente baja correlación con la eliminación de sodio en orina de 24 h. Su principal limitación es la necesidad de validación en diferentes grupos poblacionales. En Atención Primaria se debería valorar la ingesta de sal mediante la utilización de cuestionarios de frecuencia de consumo que recojan alimentos con elevado contenido en sal, el consumo de platos preelaborados y preguntas que cuantifiquen la adición de sal en la preparación de alimentos o en la mesa. Para la validación de estos cuestionarios debe emplearse como gold standard la eliminación de sodio en orina de 24 h ajustada según el aclaramiento de creatinina

High blood pressure (HBP) is the main modifiable cardiovascular risk factor. HBP can be related to high salt intake. To measure intake, not all feeding surveys are comparable and valid. The reference procedure for assessing salt intake consists of measuring the urinary excretion of sodium in urine collected during 24 hours, although alternative methods have been proposed, such as the collection of punctual and timed urine samples. In this review, we analyze which instruments allow the assessment of salt intake and which of them have provided greater validity and reliability through studies of concordance with the elimination of sodium in urine. Current food consumption surveys are inadequate because of their wide variability and relatively low correlation with the elimination of sodium in 24-hour urine. Its main limitation is the need for validation in different population groups. In primary care, salt intake should be assessed by using frequency-of-consumption questionnaires that collect foods with a high salt content, the consumption of preprepared dishes and questions that quantify the addition of salt in the preparation of food or at the table. For the validation of these questionnaires, the standard gold elimination of 24-hour urine sodium adjusted according to creatinine clearance should be used

[Validity and limitations of methods to measure the intake and elimination of salt]. / Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal.

High blood pressure (HBP) is the main modifiable cardiovascular risk factor. HBP can be related to high salt intake. To measure intake, not all feeding surveys are comparable and valid. The reference procedure for assessing salt intake consists of measuring the urinary excretion of sodium in urine collected during 24hours, although alternative methods have been proposed, such as the collection of punctual and timed urine samples. In this review, we analyze which instruments allow the assessment of salt intake and which of them have provided greater validity and reliability through studies of concordance with the elimination of sodium in urine. Current food consumption surveys are inadequate because of their wide variability and relatively low correlation with the elimination of sodium in 24-hour urine. Its main limitation is the need for validation in different population groups. In primary care, salt intake should be assessed by using frequency-of-consumption questionnaires that collect foods with a high salt content, the consumption of preprepared dishes and questions that quantify the addition of salt in the preparation of food or at the table. For the validation of these questionnaires, the standard gold elimination of 24-hour urine sodium adjusted according to creatinine clearance should be used.