Beyond single behaviour theory: Adding cross-behaviour cognitions to the health action process approach.

OBJECTIVES: Commonly, health behaviour theories have been applied to single behaviours, giving insights into specific behaviours but providing little knowledge on how individuals pursue an overall healthy lifestyle. In the context of diet and physical activity, we investigated the extent to which cross-behaviour cognitions, namely transfer cognitions and compensatory health beliefs, contribute to single behaviour theory. DESIGN: A total of 767 participants from two European regions (i.e., Germany n = 351, southern Europe n = 416) completed online questionnaires on physical activity and healthy dietary behaviour, behaviour-specific cognitions (i.e., self-efficacy, outcome expectancies, risk perception, intention, action planning, action control), as well as cross-behaviour cognitions, namely transfer cognitions and compensatory health beliefs. METHODS: Nested path models were specified to investigate the importance of cross-behaviour cognitions over and above behaviour-specific predictors of physical activity and healthy nutrition. RESULTS: Across both health behaviours, transfer cognitions were positively associated with intention and self-regulatory strategies. Compensatory health beliefs were negatively associated with intention. Action planning and action control mediated the effect of intentions on behaviour. CONCLUSIONS: Cross-behaviour cognitions contribute to single behaviour theory and may explain how individuals regulate more than one health behaviour. Statement of contribution What is already known on this subject? Cross-behaviour cognitions are related to a healthy lifestyle. Compensatory health beliefs hinder the adoption of a healthy lifestyle. Transfer cognitions encourage the engagement in a healthy lifestyle. What does this study add? Transfer cognitions were positively associated with intentions, action planning, and action control over and above behaviour-specific cognitions. Compensatory health beliefs were related to intentions only. Both facilitating and debilitating cross-behaviour cognitions need to be studied within a unified multiple behaviour research framework.

Educación para la salud para el autocontrol en pacientes con anticoagulantes orales / Healthcare education for self-monitoring in patients on oral anticoagulant drugs

Actualmente 800.000 personas en España están siendo tratadas con anticoagulantes orales debido a su patología, cifra que sigue creciendo debido al aumento de la esperanza de vida de la población. La importancia del control y prevención de complicaciones de estos fármacos viene ligada al seguimiento y educación de los pacientes, aspecto imprescindible para evitar problemas a largo plazo. La educación para la salud, especialmente en el medio de la Atención Primaria, es fundamental para que los pacientes con trata-miento anticoagulante oral puedan realizar el autocontrol desde sus domicilios. De esta manera se pretende mejorar su calidad y estilo de vida, consiguiendo una mayor seguridad e independencia. En este artículo se presenta el diseño de un programa de educación para la salud (PES) sobre el automanejo del tratamiento con anticoagulantes orales en el domicilio, que se desarrolla en tres fases: captación, programación de actividades, y evaluación y seguimiento

Currently, 800,000 people in Spain are being treated with oral anticoagulants for their conditions, and this figure keeps increasing due to the increase in life expectancy of the population. The importance of control and prevention of complications with these drugs is associated with patient follow-up and education, an essential aspect for preventing long-term problems. Healthcare Education, particularly in the Primary Care setting, is essential for patients on oral anticoagulant treatment, so that they can conduct self-monitoring at home. This is intended to improve their quality of life and lifestyle, achieving higher confidence and independence. We present in this article the design of a Healthcare Education Program (HEP) on self-management for oral anticoagulant treatment at home, which is developed in three stages: recruitment, scheduling of activities, evaluation and follow-up

El trabajo Infantil guatemalteco en los cafetales del Soconusco: Insumo que genera riqueza económica, pero nula valoración social / Guatemalan Child Workers in the Soconusco Coffee Farms: Income generating economic wealth but not social value

El Soconusco, Chiapas, desde hace más de un siglo, se ha convertidoen una región receptora de familias jornaleras, procedentes de los departamentos fronterizos de Guatemala. Los migrantes llegan en busca de empleo temporal a las fincas cafetaleras. En este artículo se pretende mostrar el trabajo que realizan los niños, niñas y adolescentes, las condiciones en las que lo hacen, la invisibilidad de su aporte y las consecuencias para su salud y educación. La investigación fue realizada en trece fincas cafetaleras de la región Suconusco, Chiapas, donde se aplicó un cuestionario a 453 jornaleros y jornaleras de quienes se obtuvo la información cuantitativa y catorce entrevistas a profundidad con las que se elaboraron los testimonios cualitativos. A través del análisis de los datos se puede observar la participación infantil y adolescente como migrantes y trabajadores o trabajadoras, tanto en el corte de café, como en las labores culturales de este producto y en las domésticas y de cuidado, así como la invisibilización de su aporte, ya que solo son reconocidos como “ayuda”; su papel es de acompañantes, sin derechos laborales y sociales, pero con efectos negativos para la salud y el acceso a la educación.

The Mediterranean diet in Spain: adherence trends during the past two decades using the Mediterranean Adequacy Index.

OBJECTIVE: The purpose of the present study was to analyse the evolution of the Spanish population's global and regional adherence to the Mediterranean diet (MD) since 1987. DESIGN: A cross-sectional study was conducted analysing food consumption from the Spanish Household Consumption Surveys administered by the Spanish Ministry of Agriculture, Fisheries and Food. SETTING: The Mediterranean Adequacy Index (MAI) was applied to measure the adherence to the MD. The significance of the MAI trend was evaluated using a regression model. SUBJECTS: The sample comprises a household consumption data set, which consisted of 2500 households in 1987 and increased to 6200 in 2005. RESULTS: There was a significant decrease in the MAI (P=0.001) during the past two decades in Spanish households. From 1987 to 1997, MD adherence significantly decreased, but since 1998 it appears to have stabilised. In recent years, the daily household availability of several of the food components of the MD has increased. The MAI was observed to be significantly higher during the entire period in some Mediterranean regions, such as Andalusia, and significantly lower in more inland regions, such as Castile-Leon. CONCLUSIONS: During the past two decades, Spain has experienced a significant downward trend in adherence to the predominant dietary pattern, likely as a result of numerous socio-economic changes. However, a stabilisation and a recent slight recovery have been observed during the past decade.

Physiological and public health basis for assessing micronutrient requirements in children and adolescents. The EURRECA network.

This paper provides an overview of the current knowledge relating to the nutritional requirements and corresponding recommended nutrient intake values of children and adolescents for micronutrients and specificities related to these requirements in the course of childhood and adolescence in Europe. Aspects that can influence micronutrient requirements, such as physiological requirements and bioavailability of the nutrients in the organism, are discussed. The methodology used to obtain the data and also the main knowledge gaps regarding these concepts are emphasized. Methodological critical points in achieving the data and physiological aspects of children and adolescents are important in order to standardize the reference values for micronutrients among Europe for these stages of life.

Physical activity in children and youth in Spain: future actions for obesity prevention.

The aim of the study presented here was to determine the relationship between age and certain socioeconomic factors and the effect that physical activity may have on the prevalence of overweight and obesity among Spanish children and adolescents. The sample derived from the enKid study, a cross-sectional study of a representative sample of the Spanish population aged 2-24 years. Body mass index was calculated from measured weight and height. A physical activity questionnaire was administered. Age, socioeconomic level of the families, the mother's level of education, and the geographical area of residence were related to the prevalence of overweight and obesity among Spanish males.

Situación de la obesidad en España y estrategias de intervención / No disponible

La obesidad se ha configurado como un importante problemade salud pública en la mayor parte de los paísesdesarrollados y también en las economías en transición.La magnitud alcanzada en las últimas décadas y su rápidaevolución, sobre todo entre la población más joven handado la voz de alarma.Entre la población infantil y juvenil afecta en mayor medidaa los varones en edad prepuberal y la prevalencia en estegrupo de población se ha duplicado en los últimos 15 años.En la población adulta, la obesidad es más frecuente enlas mujeres, especialmente a partir de los 40 años y enmayor medida en los colectivos de entorno socioeconómicoy cultural desfavorecido.Su asociación con un aumento en la aparición de enfermedadescardiovasculares, diabetes tipo 2, patología delsistema musculoesquelético e incluso con algunos tipos decáncer, entre otras enfermedades, hace que la obesidadconlleve un deterioro en la calidad de vida e incluso en laesperanza de vida, además de importantes costes económicosy sociales añadidos.Importantes cambios sociales y económicos en las últimasdécadas han inducido transformaciones en los hábitosalimentarios y de actividad física. Como consecuenciael perfil medio de la dieta, con un elevado contenido enelementos refinados, se caracteriza por una elevada densidadenergética y una densidad nutricional inadecuada. Almismo tiempo, se ha impuesto de manera predominanteun estilo de vida sedentario en todos los grupos de edad,tanto en el desempeño de las ocupaciones diarias comoen el tiempo de ocio, con desplazamientos mecanizados,ocio sedentario y escasa dedicación a la práctica deejercicio físico.La Organización Mundial de la Salud y otros organismoshan llamado la atención sobre la necesidad urgente de lapuesta en marcha de planes de acción efectivos...(AU)

Obesity is considered a major public health problem inmost developed countries and economies in transition.The magnitud reached in recent decades and increasingtrends, especially among children and adolescents raisedattention.In school aged population the prevalence rates are higheramong boys in prepubertal age; in Spain prevalence rates inthis population group doubled in the past 15 years. In adults,prevalence in higher among women, particularly older than40 years, and among those in lower socioeconomic andeducational environments.Obesity is associated to increased rates of cardiovascularediseases, type 2 diabetes, squeletal diseases and evencertain types of cancer, among other conditions, thusleading to impaired quality of life and even decreased lifeexpectancy, apart from ikmportant social and economicaladded costs.Rapid social and economical changes in recent decadeshave induced changes in food habits and physical activity.As a consequence the average dietary pattern, rich in refiendproducts, is characterized by high enery density whileinadequate nutrient density. In parallel, sedentarism is theprevailing lifestyle in all age groups, both in occupationalactivities as well as in leasure time, mechanized transportation,sedentary leasure time activities and limited physicalexercise and sport practice.The World Health Organization and other international bodieshave called for attention to this fact and the urgent needfor action by developing and implementing multisectoraland multistrategy effective action plans. In 2004 the WorldHealth Assembly approved the Global Strategy on Diet andPhysical Activity; WHO encourages member states to implementnational action plans. The Spanish Ministry of Healththrough the Spanish Agency of Food Safety and Nutrition(AESAN) lunched the NAOS Strategy on this basis, with aspecific program for schools, the PERSEO program(AU)

Effectiveness of the Mediterranean diet in the elderly.

The Mediterranean diet is known to be one of the healthiest dietary patterns in the world due to its relation with a low morbidity and mortality for some chronic diseases. The purpose of this study was to review literature regarding the relationship between Mediterranean diet and healthy aging. A MEDLINE search was conducted looking for literature regarding the relationship between Mediterranean diet and cardiovascular disease (or risk factors for cardiovascular disease), cancer, mental health and longevity and quality of life in the elderly population (65 years or older). A selection of 36 articles met the criteria of selection. Twenty of the studies were about Mediterranean diets and cardiovascular disease, 2 about Mediterranean diets and cancer, 3 about Mediterranean diets and mental health and 11 about longevity (overall survival) or mental health. The results showed that Mediterranean diets had benefits on risks factors for cardiovascular disease such as lipoprotein levels, endothelium vasodilatation, insulin resistance, the prevalence of the metabolic syndrome, antioxidant capacity, the incidence of acute myocardial infarction, and cardiovascular mortality. Some positive associations with quality of life and inverse associations with the risk of certain cancers and with overall mortality were also reported.

The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review.

The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components. Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations. A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

Scientific evidence of interventions using the Mediterranean diet: a systematic review.

The Mediterranean Diet has been associated with greater longevity and quality of life in epidemiological studies, the majority being observational. The application of evidence-based medicine to the area of public health nutrition involves the necessity of developing clinical trials and systematic reviews to develop sound recommendations. The purpose of this study was to analyze and review the experimental studies on Mediterranean diet and disease prevention. A systematic review was made and a total of 43 articles corresponding to 35 different experimental studies were selected. Results were analyzed for the effects of the Mediterranean diet on lipoproteins, endothelial resistance, diabetes and antioxidative capacity, cardiovascular diseases, arthritis, cancer, body composition, and psychological function. The Mediterranean diet showed favorable effects on lipoprotein levels, endothelium vasodilatation, insulin resistance, metabolic syndrome, antioxidant capacity, myocardial and cardiovascular mortality, and cancer incidence in obese patients and in those with previous myocardial infarction. Results disclose the mechanisms of the Mediterranean diet in disease prevention, particularly in cardiovascular disease secondary prevention, but also emphasize the need to undertake experimental research and systematic reviews in the areas of primary prevention of cardiovascular disease, hypertension, diabetes, obesity, infectious diseases, age-related cognitive impairment, and cancer, among others. Interventions should use food scores or patterns to ascertain adherence to the Mediterranean diet. Further experimental research is needed to corroborate the benefits of the Mediterranean diet and the underlying mechanisms, and in this sense the methodology of the ongoing PREDIMED study is explained.

[Distribution of the serum concentration of beta-carotene, retinol and alpha-tocopherol in a representative sample of the adult population of Catalonia (Spain)]. / Distribución de la concentración sérica de beta-caroteno, retinol y alpha-tocoferol en una muestra representativa de la población adulta de Cataluña.

BACKGROUND: Some vitamins (beta-carotene, retinol and alpha-tocopherol) have been used in the prevention of neurovegetative diseases, immunodeficiencies and cancer because of the possible relation with the etiology and physiopathology of these disorders. Nevertheless, the serum values of such micronutrients in the population have not been described. The purpose of this study was to determine the serum concentrations of beta-carotene, retinol and alpha-tocopherol in the Catalan population and to examine the prevalence of deficits. METHOD: We studied 343 individuals from a representative sample of individuals aged 18 to 75 years who had participated in the Nutritional Status of the Catalan Population (Spain) 1992-1993 study. Serum concentrations of beta-carotene, retinol and alpha-tocopherol were analysed. RESULTS: The serum concentration of beta-carotene was 0.39 and 0.49 micromol/l in men and women, respectively, and the prevalence of deficits was 62% in men and 54% in women. The serum concentration of retinol was lower in women (1.68 mol/l) than in men (1.98 mol/l) but no deficit was detected for this vitamin. 12% of women aged 18 to 34 years showed a marginal deficit of alpha-tocopherol. CONCLUSION: Our study reveals good nutritional status of retinol and alpha-tocopherol in the sample studied. However, a high prevalence of suboptimal concentrations of beta-carotene was detected, which should be corrected increasing the intake of fruits and vegetables.

Distribución de la concentración sérica de -caroteno, retinol y -tocoferol en una muestra representativa de la población adulta de cataluña / Distribution of the serum concentration of -carotene, retinol and -tocopherol in a representative sample of the adult population of Catalonia (Spain)

FUNDAMENTO: Ciertas vitaminas ( -caroteno, retinol, -tocoferol) se han utilizado en la prevención de enfermedades neurovegetativas, inmunodeficiencias y cánceres por su posible relación con su etiopatogenia. Sin embargo, no se han descrito los valores séricos de dichos micronutrientes en la población. El objetivo de este estudio es describir la concentración sérica de caroteno, retinol, y -tocoferol en la población catalana y determinar la prevalencia de déficit nutricional de estos micronutrientes. MÉTODO: Se obtuvo una submuestra de la muestra representativa de 18-75 años de edad que participó en el Estudio del Estado Nutricional de la Población Catalana (1992-1993). Se determinó la concentración sérica de -caroteno, retinol y -tocoferol. RESULTADOS: La concentración sérica de -caroteno fue de 0,39 y 0,49 µmol/l en varones y mujeres, respectivamente, y la prevalencia de déficit fue del 62 por ciento en los varones y del 54 por ciento en las mujeres. La concentración sérica de retinol fue superior en varones (1,98 µmol/l) que en mujeres (1,68 µmol/l) y no se detectó déficit para esta vitamina. En las mujeres de 18 a 34 años de edad, un 12 por ciento presenta un déficit marginal de -tocoferol. CONCLUSIONES: Se observa un buen estado nutricional de retinol y -tocoferol en la población estudiada. Sin embargo, destaca la elevada prevalencia de valores subóptimos de -caroteno en la población, los cuales deberían corregirse aumentando el consumo de frutas y verduras (AU)