Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020).

Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.

Effectiveness of a Smartphone App (e-12HR) in Improving Adherence to the Mediterranean Diet in Spanish University Students by Age, Gender, Field of Study, and Body Mass Index: A Randomized Controlled Trial.

There is an urgent need to implement intervention programs to promote adherence to the Mediterranean diet (AMD) in university students to prevent non-communicable diseases. A powerful tool for this is smartphone apps. Furthermore, it is necessary to determine the subgroups that are most likely to benefit from these technologies. The objective is to evaluate the effectiveness of an app (e-12HR) at improving AMD in a sample of Spanish university students and different strata. The study method was a controlled and randomized clinical trial over a four-week follow-up period and involving 385 participants (76.9% women). The participants were in two parallel groups: the control group (CG) and the intervention group (IG), with only the IG receiving feedback to improve their AMD. There were significant statistical improvements (with higher values in the IG) at week four, after no significant statistical differences at baseline (Week One): in the whole sample: +25.7% AMD index and +74.5% percentage with moderate/high AMD index. In the subgroups, seven of eight subgroups, ranging in AMD index from +17.8% (≥20 years) to +33.0% (<20 years); and for males, in weeks two (+27.9%) and three (+23.9%), but not at week four. In conclusion, e-12HR could improve AMD among university students (in the total sample and all subgroups, except ≥25 kg/m2).

Evaluation of an Application for Mobile Telephones (e-12HR) to Increase Adherence to the Mediterranean Diet in University Students: A Controlled, Randomized and Multicentric Study.

Mediterranean diet (MD) is potentially one of the best diets regarding health benefits and sustainability. However, it is faced with serious difficulties staying alive, even in traditionally Mediterranean regions. The objective was to evaluate the effectiveness of an application (e-12HR) to improve adherence to the MD (AMD) in university students. This study was a controlled, randomized, and multicentric clinical trial with two parallel groups (control group (CG) and intervention group (IG)), a 28-day follow-up period, and 286 participants (74.1% women). There were two versions of e-12HR: 'feedback' e-12HR (IG) and 'non-feedback' e-12HR (CG). Only the 'feedback' e-12HR had two specific automatic functions: 1. Evaluation of the user's AMD; 2. Identification of the food groups for which the user has not fulfilled the MD recommendations. Both versions of the application allowed the collection of data on dietary intake in order to calculate the AMD. When comparing CG and IG at 14-, 21-, and 28-days follow-up (no significant statistical differences at baseline), there were significant statistical improvements in favor of IG in AMD index (0.71, 1.56, and 1.43 points, respectively), and in the percentage of participants with medium/high AMD index (14.4%, 20.6%, and 23.7%, respectively). In conclusion, e-12HR could improve AMD among university students.

Weekend-Weekday Differences in Adherence to the Mediterranean Diet among Spanish University Students.

Daily routines may influence eating patterns; however, differences in intake on weekdays and at weekends have rarely been explored. Furthermore, these differences have not been analyzed among university students (a particularly interesting group among the younger generations). The aim of the study was to evaluate weekend−weekday variation in the Mediterranean diet among Spanish university students, while investigating the potential influence of age, gender, studies, body mass index, smoking status and physical activity status. A repeated-measurement 28-day cross-sectional observational study with self-reported dietary intake collected using the e12HR app was conducted. There were 361 participants: average age 20.6 years; 72.9% women; 58.2% students of Pharmacy; average BMI 21.9 kg/m2; 91.4% nonsmokers; 77.6% performed ≥150 min/week of physical activity. Outcome measurements were adherence to the Mediterranean diet (AMD) index and percentage of participants meeting recommendations for each food group on weekdays and at weekends. In all subgroups, Spanish university students' global diet was associated with low AMD, with poorer diet quality (>12% reductions in mean scores of AMD index and >26% reductions in adequate adherence scores (≥9)) at weekends. In conclusion, weekend health behaviors of Spanish university students displayed less favorable eating behavior, making the weekend an important target for public health interventions aiming to improve dietary intake.

First evaluation steps of a new method for dietary intake estimation regarding a list of key food groups in adults and in different sociodemographic and health-related behaviour strata.

OBJECTIVE: A new method known as 'current-day dietary recall' (current-day recall) is based on an application for mobile phones called 'electronic 12 h dietary recall' (e-12HR). This new method was designed to rank participants into categories of habitual intake regarding a series of key food groups. The present study compared current-day recall against a previously validated short paper FFQ. DESIGN: Participants recorded the consumption of selected food groups using e-12HR during twenty-eight consecutive days and then filled out a short paper FFQ at the end of the study period. To evaluate the association and agreement between both methods, Spearman's correlation coefficients (SCC), cross-classification analysis and weighted kappa statistics (κ w) were used. SETTING: Andalusia, Spain, Southern Europe. SUBJECTS: University students and employees over the age of 18 years. RESULTS: One hundred and eighty-seven participants completed the study (64·2 % female, 35·8 % male). For all particpants, for all food group intakes, the mean SCC was 0·70 (SCC≥0·62 were observed for all strata); the mean percentage of participants cross-classified into categories of 'exact agreement+adjacent' was 90·1 % (percentages≥87·8 % were observed for all strata); and the mean κ w was 0·55 (κ w≥0·53 in ten of the twelve strata). CONCLUSIONS: For the whole sample and for all strata thereof, the current-day recall has good agreement with the previously validated short paper FFQ for assessing food group intakes, rendering it a useful method for ranking individuals.

Is there any alternative to traditional food frequency questionnaire for evaluating habitual dietary intake? / ¿Hay alguna alternativa al tradicional cuestionario de frecuencia de consumo de alimentos para la evaluación de la ingesta alimentaria habitual?

Introduction: Dietary assessment methods are an important instrument for nutrition research. Food frequency questionnaires (FFQs) have been the most frequently used dietary assessment tool in epidemiological and intervention studies. There is a great necessity for new methods of determination of habitual dietary intake that overcome the limitations of these traditional methods. Objectives: The objectives of the present study were to develop a new method, based on an application for mobile phones called e-EPIDEMIOLOGY, designed to record individual consumption data about a short series of foods/drinks, and to compare data collected using this tool with those obtained from a previously validated short paper FFQ. Methods: University students over 18 years recorded the consumption of certain foods/drinks using e-EPIDEMIOLOGY during 28 consecutive days and then filled out a short paper FFQ at the end of the study period. To evaluate the agreement between both methods, Spearman’s correlation coefficient, cross-classification analysis and a weighted kappa statistic were used. Results: One hundred and nineteen participants completed the study (71.4% female and 28.6% male). The mean Spearman’s correlation coefficients for food/drink group intake between the two methods was 0.73. The mean percentage of participants cross-classified into categories of «exact agreement + adjacent» was 91.6%. The average weighted kappa statistic was 0.60. Conclusions: The results indicate that e-EPIDEMIOLOGY has good agreement with the previously validated FFQ short paper. However, it was noted that further testing of e-EPIDEMIOLOGY is required to establish its wider utility (AU)

Introducción: los métodos de evaluación de la dieta son importantes instrumentos para la investigación nutricional. Los cuestionarios de frecuencia de consumo de alimentos (CFCA) han sido los métodos utilizados con mayor frecuencia en los estudios epidemiológicos y de intervención. Hay una gran necesidad de nuevas herramientas que superen las limitaciones de estos métodos tradicionales. Objetivos: los objetivos del presente estudio fueron desarrollar un nuevo método, basado en una aplicación para teléfonos móviles llamada e-EPIDEMIOLOGY, diseñada para registrar los datos de consumo individual de una serie corta de alimentos/bebidas, y comparar estos datos con los obtenidos a partir de un CFCA corto (en papel) validado previamente. Métodos: estudiantes universitarios mayores de 18 años registraron el consumo de ciertos alimentos/bebidas usando e-EPIDEMIOLOGY durante 28 días consecutivos y cumplimentaron un CFCA corto (en papel) al final del periodo de estudio. Para evaluar el acuerdo entre ambos métodos se utilizaron el coeficiente de correlación de Spearman, el análisis de clasificación cruzada y el kappa ponderado. Resultados: un total de 119 participantes completaron el estudio (71,4% mujeres y 28,6% hombres). El coeficiente de correlación de Spearman medio entre ambos métodos fue 0,73. La media del porcentaje de clasificación cruzada en la categoría de «acuerdo exacto + adyacente» fue 91,6%. La media del kappa ponderado fue 0,60. Conclusiones: los resultados indican que e-EPIDEMIOLOGY tiene buena concordancia con el CFCA corto (en papel) previamente validado. Sin embargo, son necesarias más pruebas con e-EPIDEMIOLOGY para establecer su utilidad de forma más amplia (AU)

Incidence of colorectal cancer and influence of dietary habits in fifteen European countries from 1971 to 2002

Objective This study aimed to analyze the incidence of colorectal cancer in 15 European countries in recent decades and the relationship between the incidence found and changes in dietary habits .Methods Pearson's or Spearman's correlation coefficients were calculated by comparing incidence rates obtained from the International Agency for Research on Cancer for 1971-2002 with data on per capita consumption obtained from the Food and Agriculture Organization of the United Nations using 10-year delay intervals. Results Incidence rates increased in all countries except France in men and except Austria, Denmark, England and France in women. Of the dietary variables considered, there were marked increasing trends (linear regression coefficient, R ≥0.5) in red meat consumption in Germany (R = 0.9), Austria (R = 0.7), Finland (R = 0.8), Italy (R = 0.9), Poland (R = 0.5), Spain (R = 2.1), Sweden (R = 0.6), and the Netherlands (R = 0.7).Conclusions Changes in dietary habits may be consistent with the observed trends in the incidence of colorectal cancer in the distinct European countries (AU)

Introducción Este estudio analiza la incidencia de cáncer colorrectal en 15 países europeos en las últimas décadas y su relación con cambios en los hábitos alimenticios. Métodos Coeficientes de correlación de Pearson/Spearman calculados comparando las tasas de incidencia obtenidas de International Agency for Research on Cancer durante 1971-2002 con los consumos per cápita obtenidos de Food and Agriculture Organization con intervalos de retardo de 10 años. Resultados Las tasas de incidencia aumentan en todos los países, excepto en Francia, en los hombres, y en Austria, Dinamarca, Inglaterra y Francia en las mujeres. De las variables de la dieta estudiadas, hay marcadas tendencias crecientes (coeficiente de regresión lineal, R ≥0,5) para carne roja en Alemania (R = 0,9), Austria (R = 0,7), España (R = 2,1), Finlandia (R = 0,8), Italia (R = 0,9), Países Bajos (R = 0,7), Polonia (R = 0,5) y Suecia (R = 0,6).Conclusiones Los cambios en los hábitos dietéticos pueden ser concordantes con las tendencias de la incidencia de cáncer colorrectal observadas en diferentes países (AU)

Incidence of colorectal cancer and influence of dietary habits in fifteen European countries from 1971 to 2002.

OBJECTIVE: This study aimed to analyze the incidence of colorectal cancer in 15 European countries in recent decades and the relationship between the incidence found and changes in dietary habits. METHODS: Pearson's or Spearman's correlation coefficients were calculated by comparing incidence rates obtained from the International Agency for Research on Cancer for 1971-2002 with data on per capita consumption obtained from the Food and Agriculture Organization of the United Nations using 10-year delay intervals. RESULTS: Incidence rates increased in all countries except France in men and except Austria, Denmark, England and France in women. Of the dietary variables considered, there were marked increasing trends (linear regression coefficient, R ≥0.5) in red meat consumption in Germany (R = 0.9), Austria (R = 0.7), Finland (R = 0.8), Italy (R = 0.9), Poland (R = 0.5), Spain (R = 2.1), Sweden (R = 0.6), and the Netherlands (R = 0.7). CONCLUSIONS: Changes in dietary habits may be consistent with the observed trends in the incidence of colorectal cancer in the distinct European countries.

Effects of changes in dietary habits on colorectal cancer incidence in twenty countries from four continents during the period 1971-2002.

INTRODUCTION: the incidence of colorectal cancer is one of the highest on a global level. Many epidemiological studies have identified risk and protective factors, many of which have a behavioral component and, therefore, are potentially avoidable or subject to modification. This study investigated the incidence rates of colorectal cancer by gender in twenty different countries, taking into account the dietary habits of the habitants of each country. MATERIAL AND METHODS: adjusted incidence rates, according to gender, were obtained for each country from the International Agency for Research on Cancer during the period 1971-2002.Annual per capita consumption data of the different dietary variables were obtained for the period 1961-2007 from the Food and Agriculture Organization of the United Nations. Pearson's correlation coefficients were calculated comparing incidence rates according to gender with different dietary variable using ten-year delay intervals. RESULTS: there is an important variation in trends of colorectal cancer incidence worldwide which were found to be related with the dietary habits of each country. DISCUSSION: based on the trends observed, each country was classified into one of four different situations based on the range of values of their incidence rates and linear trends observed. Due to the potential of primary prevention programs for colorectal cancer and to the delay between changes in the exposure to risk and protective factors and the effects on the incidence of this tumor, the application of legislative and educational measures promoting a healthy diet has become an urgent issue to stop the increasing tendency of colorectal cancer reported worldwide.

Efectos de cambios en los patrones dietéticos sobre la incidencia de cáncer colorrectal en veinte países de cuatro continentes durante 1971-2002 / Effects of changes in dietary habits on colorectal cancer incidence in twenty countries from four continents during the period 1971-2002

Introducción: el cáncer colorrectal es uno de los tumores de mayor incidencia a nivel mundial. Numerosos estudios epidemiológicos han identificado diversos factores de riesgo y protección, muchos de ellos asociados al comportamiento y que, por tanto, son potencialmente evitables o modificables. Este estudio analiza la incidencia de cáncer colorrectal, según género, en veinte países diferentes, teniendo en cuenta los hábitos dietéticos de la población en cada país. Material y métodos: las tasas ajustadas de incidencia, según género, se obtuvieron para cada país de Internacional Agency for Research on Cancer en el periodo 1971-2002. Los datos de consumo anual per cápita de las diferentes variables dietéticas se obtuvieron para el periodo 1961-2007 de Food and Agriculture Organization of United Nations. Los coeficientes de correlación de Pearson se calcularon comparando las tasas de incidencia, según género, con las diferentes variables dietéticas con un retardo de diez años. Resultados: hay importantes variaciones en las tendencias de incidencia de cáncer colorrectal en todo el mundo que pueden estar relacionadas con los hábitos dietéticos de cada país. Discusión: cada uno de los países analizados queda encuadrado en una de cuarto situaciones distintas considerando el rango de valores que toman sus tasas de incidencia y las tendencias lineales de estas en el periodo de estudio. Partiendo del enorme potencial de prevención primaria de este tumor y del desfase temporal para que los cambios en la exposición a los factores de riesgo y protección modifiquen la incidencia del tumor, se deben aplicar, de forma urgente, medidas legislativas y educativas que promuevan dietas saludables que contribuyan a detener la tendencia creciente de la incidencia del cáncer colorrectal a nivel mundial(AU)

Introduction: the incidence of colorectal cancer is one of the highest on a global level. Many epidemiological studies have identified risk and protective factors, many of which have a behavioral component and, therefore, are potentially avoidable or subject to modification. This study investigated the incidence rates of colorectal cancer by gender in twenty different countries, taking into account the dietary habits of the habitants of each country. Material and methods: adjusted incidence rates, according to gender, were obtained for each country from the International Agency for Research on Cancer during the period 1971-2002. Annual per capita consumption data of the different dietary variables were obtained for the period 1961-2007 from the Food and Agriculture Organization of the United Nations. Pearson’s correlation coefficients were calculated comparing incidence rates accord ing to gender with different dietary variable using ten-year delay intervals. Results: there is an important variation in trends of colorectal cancer incidence worldwide which were found to be related with the dietary habits of each country. Discussion: based on the trends observed, each country was classified into one of four different situations based on the range of values of their incidence rates and linear trends observed. Due to the potential of primary prevention programs for colorectal cancer and to the delay between changes in the exposure to risk and protective factors and the effects on the incidence of this tumor, the application of legislative and educational measures promoting a healthy diet has become an urgent issue to stop the increasing tendency of colorectal cancer reported worldwide(AU)