School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006-2020 in Catalonia.

BACKGROUND: The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME's recommendations in the meals provided by school cafeterias in Catalonia during the period 2006-2020. METHODS: Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System's "Consensus document on nutrition in schools" and the Public Health Agency of Catalonia's current guide "Healthy eating at school". Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category. RESULTS: Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p = < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216). CONCLUSIONS: The positive evolution in compliance with PReME's recommendations provides evidence of the programme's effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Promoting physical activity through primary health care: the case of Catalonia.

BACKGROUND: In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors). METHODS: The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance). RESULTS: PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a "healthy route" (Reach). The proportion of patients with at least one cardiovascular risk factor who were "sufficiently active" increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance). CONCLUSIONS: In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.

Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care.

BACKGROUND: The DE-PLAN-CAT project (Diabetes in Europe-Prevention using lifestyle, physical activity and nutritional intervention-Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention-Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible. METHODS: A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45-75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation. RESULTS: The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively). CONCLUSIONS: A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.

[Trends in the nutritional status of the Spanish population: results from the Catalan nutrition monitoring system (1992-2003)]. / Tendencias del estado nutricional de la población española: resultados del sistema de monitorización nutricional de Cataluña (1992-2003).

BACKGROUND: The purpose of this study was to evaluate the changes in the nutricional habits and nutricional status of the Catalan population over 10 years interval of the two Catalan Nutricional Surveys conducted in 1992-93 and 2002-03. METHODS: 2641 individuals in 1992-93 and 2060 individuals in 2002-03 aged 10 to 75 years participated in the surveys. Two 24 hour recall, a food frequency questionnaire, and a general questionnaire with information on physical activity, knowledge and opinions on nutrition and supplements use were administered. Weight (Kg), height (cm) and waist circumference (WC) (cm) were measured. A subsample of the population underwent a biochemical evaluation. Total cholesterol, HDL cholesterol, LDL cholesterol, tryglicerides and beta-carotene, alpha-tocopherol and retinol were measured. RESULTS: A decrease in the consumption of fruit, vegetables, potatoes, meat and fish and an increase in the consumption of dairy products and fast food (in young individuals) were reported. An increase in the mean value of Body Mass Index (BMI) was observed among males, and an increase in WC mean value was observed in males and females. BMI value decreased in females (except among the younger ones). The prevalence of obesity increased among males (from 9.9% to 16.6%), but not in females. Both total cholesterol and HDL cholesterol decreased. A decrease was observed in the percentage of population with sedentary habits during leisure time. CONCLUSIONS: There is a need for an effective nutrition policy promoting healthy nutrition in accordance with the ongoing dietary guidelines.

[Cost-utility analysis of insulin pumps compared to multiple daily doses of insulin in patients with type 1 diabetes mellitus in Spain]. / Análisis coste-utilidad de las bombas de insulina frente a múltiples dosis diarias en pacientes con diabetes mellitus tipo 1 en españa.

BACKGROUND: The use of continuous subcutaneous insulin infusion (CSII) for treating Type I diabetes mellitus (DM1) has been related to better metabolic control compared it to daily multiple insulin injections (DMI) and thus to a lowering of the related costs. However, this therapy is now being used to a lesser extent due, at least partially, to the higher initial cost of purchase. This study is aimed at estimating the clinical and economic consequences of using CSII as compared to DMI by means of a cost-utility analysis. METHODS: A mathematical simulation model was adapted using nationwide clinical and economic data to simulate the long-term clinical and economic consequences for a DM1 patient. The time horizon was the patient's lifetime, including only direct healthcare costs and updating both costs and benefits at an annual 3% rate. RESULTS: In the basecase, the patients treated using CSII gained 0.890 years (p < 0.05) and 0.852 QALYs (p < 0.05). CSII treatment gives rise to an incremental average cost of 25,523 Euro (p < 0.05) per patient treated, which gave us an incremental cost- utility ratio of 29,947 Euro-QALY [CI 95% (29,519; 30,375)]. CONCLUSIONS: The improvement in the glucose control among those patients treated using CSII was related to an overall lower cost in the handling of DM1 patients, which was found to have a favourable cost-utility ratio in comparison to conventional MDI treatment.

[Factors Associated with Overweight and Obesity in Schoolchildren from 8 to 9 Years Old. Barcelona, Spain]. / Factores asociados al sobrepeso y la obesidad en escolares de 8 a 9 años de Barcelona.

OBJECTIVE: Childhood overweight and obesity have increased progressively in the last decades, especially in countries of Southern Europe. The aim of this study was to identify the prevalence of overweight, obesity and its determinants in schoolchildren between 8-9 years old from Barcelona. METHODS: Cross-sectional study of a representative sample of 3,262 schoolchildren in 2011. Body Mass Index (BMI) was calculated following the criteria established by the World Health Organization (z-scores). Variables on eating behaviour, physical activity and use of new technologies were studied through 2 questionnaires. Logistic regression models were adjusted, obtaining adjusted odds ratio and their confidence intervals (95%). RESULTS: The prevalence of overweight was 24.0% and 12.7% for obesity. Obesity was significantly higher in boys than in girls (14.8% vs 10.8%.). No statistically significant differences were observed in the compliance of recommendations of physical activity practice and use of new technologies according to BMI. Factors associated with obesity in boys were to attend a school located in a neighbourhood of disadvantaged socio-economic status [ORa=1.88 (1.35-2.63)], to belong to an immigrant family [ORa=1.57 (1.12-2.20)], to do not eat at school [ORa=1.76 (1.20-2.59)] and to have some meal alone [ORa=1.95 (1.27-3.00)]. In girls associated factors were to belong to a single-parent family [ORa=1.58 (1.06-2.34)] and to an immigrant family [ORa=1.53 (1.07-2.18)]. CONCLUSIONS: The prevalence of childhood obesity in Barcelona is high. It is more common in boys, being the social determinants most relevant associated factors.

Factores asociados al sobrepeso y la obesidad en escolares de 8 a 9 años de Barcelona / Factors associated with overweight and obesity in schoolchildren from to years old. Barcelona, Spain

Fundamentos: El sobrepeso y la obesidad infantil han aumentado progresivamente en las últimas décadas, especialmente en países del sur de Europa. El objetivo del estudio fue identificar la prevalencia de sobrepeso, obesidad y sus determinantes en escolares de 8-9 años de Barcelona. Métodos: Estudio transversal descriptivo de una muestra representativa de 3.262 escolares en 2011. Se calculó el Índice de Masa Corporal (IMC) siguiendo los criterios establecidos por la Organización Mundial de la Salud (z-scores). Se estudiaron variables sobre conducta alimentaria, actividad física y uso de nuevas tecnologías mediante 2 cuestionarios. Se ajustaron modelos de regresión logística, obteniendo odds ratio ajustadas e intervalos de confianza (95%). Resultados: La prevalencia de sobrepeso fue del 24,0% y de obesidad del 12,7%. La obesidad fue significativamente mayor en niños que en niñas (14,8% vs. 10,8%). No se observaron diferencias estadísticamente significativas según IMC en el cumplimiento de las recomendaciones de práctica de actividad física ni uso de nuevas tecnologías. Los factores asociados a la obesidad en niños fueron asistir a escuela situada en barrios de nivel socioeconómico desfavorable [ORa=1,88 (1,35-2,63)], pertenecer a familia inmigrante [ORa=1,57 (1,12- 2,20)], no comer en el colegio [ORa=1,76 (1,20-2,59)] y hacer alguna comida solo [ORa=1,95 (1,27-3,00)]. En niñas fueron pertenecer a familia monoparental [ORa=1,58 (1,06-2,34)] y familia inmigrante [ORa=1,53 (1,07-2,18)]. Conclusiones: La prevalencia de obesidad infantil en Barcelona es alta. Es más frecuente en niños, siendo los determinantes sociales los factores asociados de mayor relevancia (AU)

Background: Childhood overweight and obesity have increased progressively in the last decades, especially in countries of Southern Europe. The aim of this study was to identify the prevalence of overweight, obesity and its determinants in schoolchildren between 8-9 years old from Barcelona. Methods: Cross-sectional study of a representative sample of 3,262 schoolchildren in 2011. Body Mass Index (BMI) was calculated following the criteria established by the World Health Organization (z-scores). Variables on eating behaviour, physical activity and use of new technologies were studied through 2 questionnaires. Logistic regression models were adjusted, obtaining adjusted odds ratio and their confidence intervals (95%). Results: The prevalence of overweight was 24.0% and 12.7% for obesity. Obesity was significantly higher in boys than in girls (14.8% vs 10.8%.). No statistically significant differences were observed in the compliance of recommendations of physical activity practice and use of new technologies according to BMI. Factors associated with obesity in boys were to attend a school located in a neighbourhood of disadvantaged socio-economic status [ORa=1.88 (1.35- 2.63)], to belong to an immigrant family [ORa=1.57 (1.12-2.20)], to do not eat at school [ORa=1.76 (1.20-2.59)] and to have some meal alone [ORa=1.95 (1.27-3.00)]. In girls associated factors were to belong to a single-parent family [ORa=1.58 (1.06-2.34)] and to an immigrant family [ORa=1.53 (1.07-2.18)]. Conclusions: The prevalence of childhood obesity in Barcelona is high. It is more common in boys, being the social determinants most relevant associated factors (AU)

Tendencias del estado nutricional de la población española: resultados del sistema de monitorización nutricional de Cataluña (1992-2003) / Trends in the nutritional status of the Spanish population: results from the Catalan nutrition monitoring system (1992-2003)

Fundamento: El objetivo de este estudio es analizar los cambios producidosen los hábitos alimentarios y el estado nutricional de la población catalana,a lo largo de 10 años a partir de la información procedente de las dosEncuestas Nutricionales de Cataluña desarrolladas en 1992-93 y 2002-03.Método: 2641 indivíduos en 1992-93 y 2060 en 2002-03 de 10 a 75 añosque participaron en las encuestas. Se utilizaron dos recordatorios de 24 horas,un cuestionario de frecuencia de consumo y un cuestionario general sobreactividad física, conocimientos y actitudes sobre alimentación y uso de suplementosalimentarios. Se midió el peso (kg), la talla (cm) y el perímetro de lacintura (PC) (cm). Se realizó un análisis bioquímico en una submuestra de lapoblación. Se evaluaron colesterol total, colesterol HDL, colesterol LDL, triglicéridosy ß-caroteno, a-tocoferol y retinol.Resultados: Se observa un descenso en la ingesta de fruta, verdura y patata,carne y pescado, y un aumento en el consumo de derivados lácteos y comidarápida (especialmente entre los jóvenes). Se produce un ascenso en el valormedio de índice de masa corporal (IMC) en hombres y de PC en hombres y mujeres.El valor de IMC desciende entre las mujeres (excepto entre las más jóvenes).La prevalencia de obesidad aumenta en hombres (de 9,9% a 16,6%), pero no enmujeres. Desciende la colesterolemia media, a expensas del valor de HDL colesterol.Disminuye el porcentaje de población sedentaria en el tiempo libre.Conclusiones: Es necesaria una política de nutrición que sea efectiva enla promoción de una alimentación acorde con las recomendaciones nutricionalesy la dieta mediterránea(AU)

Background: The purpose of this study was to evaluate the changes inthe nutricional habits and nutricional status of the Catalan population over 10years interval of the two Catalan Nutricional Surveys conducted in 1992-93and 2002-03.Methodo: 2641 individuals in 1992-93 and 2060 individuals in 2002-03aged 10 to 75 years participated in the surveys. Two 24 hour recall, a foodfrequency questionnaire, and a general questionnaire with information onphysical activity, knowledge and opinions on nutrition and supplements usewere administered. Weight (Kg), height (cm) and waist circumference (WC)(cm) were measured. A subsample of the population underwent a biochemicalevaluation. Total cholesterol, HDL cholesterol, LDL cholesterol, trygliceridesand ß-carotene, a-tocopherol and retinol were measured.Results: A decrease in the consumption of fruit, vegetables, potatoes,meat and fish and an increase in the consumption of dairy products and fastfood (in young individuals) were reported. An increase in the mean value ofBody Mass Index (BMI) was observed among males, and an increase in WCmean value was observed in males and females. BMI value decreased infemales (except among the younger ones). The prevalence of obesity increasedamong males (from 9.9% to 16.6%), but not in females. Both total cholesteroland HDL cholesterol decreased. A decrease was observed in the percentage ofpopulation with sedentary habits during leisure time.Conclusions: There is a need for an effective nutrition policy promotinghealthy nutrition in accordance with the ongoing dietary guidelines(AU)

Análisis coste-utilidad de las bombas de insulina frente a múltiples dosis diarias en pacientes con diabetes mellitus tipo 1 en España / Cost-utility analysis of insulin pumps compared to multiple daily doses of insulin in patients with type 1 diabetes mellitus in Spain

Fundamento: El uso de bombas de infusión continua de insulina(BICI) para la diabetes mellitus tipo 1 (DM1) se ha relacionadocon un mejor control metabólico al compararlo con las múltiplesdosis de insulina (MDI). Este mejor control puede traducirse en unadisminución de las complicaciones asociadas a la DM1 y por lo tantouna reducción de los costes asociados. Sin embargo el uso de estaterapia ha quedado mermado, al menos en parte, debido a su mayorcoste inicial de adquisición. El objetivo del presente estudio fue estimarlas consecuencias clínicas y económicas del uso de BICI frentea MDI a través de un análisis de coste-utilidad.Métodos: Se adaptó un modelo matemático de simulación queemplea datos clínicos y económicos de ámbito nacional, para simularlas consecuencias clínicas y económicas a largo plazo de unpaciente con DM1. El horizonte temporal fue el de toda la vida delpaciente, incluyendo sólo costes directos sanitarios, y actualizandotanto costes como beneficios a una tasa del 3% anual.Resultados: En el caso base los pacientes tratados con BICIexperimentaron una ganancia de vida de 0,890 años (p<0,05) y 0,852AVACs (p<0,05). El tratamiento con BICI produce un coste medioincremental de 25.523 ? (p<0,05) por paciente tratado, lo que noscondujo a un ratio coste- utilidad incremental de 29.947 ?/AVAC [IC95% (29.519, 30.375)].Conclusiones: La mejora en el control glucémico en pacientescon BICI se asoció a una reducción del coste global del manejo depacientes con DM1, y resultó tener una relación coste-utilidad favorableal compararla con el tratamiento convencional MDI(AU)

Background: The use of continuous subcutaneous insulin infusion(CSII) for treating Type I diabetes mellitus (DM1) has beenrelated to better metabolic control compared it to daily multipleinsulin injections (DMI) and thus to a lowering of the related costs.However, this therapy is now being used to a lesser extent due, atleast partially, to the higher initial cost of purchase. This study isaimed at estimating the clinical and economic consequences ofusing CSII as compared to DMI by means of a cost-utility analysis.Methods: A mathematical simulation model was adapted usingnationwide clinical and economic data to simulate the long-term clinicaland economic consequences for a DM1 patient. The time horizonwas the patient's lifetime, including only direct healthcare costsand updating both costs and benefits at an annual 3% rate.Results: In the basecase, the patients treated using CSII gained0.890 years (p<0.05) and 0.852 QALYs (p<0.05). CSII treatmentgives rise to an incremental average cost of 25,523 ? (p<0.05) perpatient treated, which gave us an incremental cost- utility ratio of29,947 ?/QALY [CI 95% (29,519; 30,375)].Conclusions: The improvement in the glucose control amongthose patients treated using CSII was related to an overall lower costin the handling of DM1 patients, which was found to have a favourablecost-utility ratio in comparison to conventional MDI treatment(AU)