Factores asociados al sobrepeso, la obesidad general y la obesidad abdominal en la población adulta de la Comunidad de Madrid, Spain. Estudio PREDIMERC / Factors associated with overweight, general obesity and abdominal obesity in the Madrid Community's adult population. Study PREDIMERC

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Unperceived intimate partner violence and women's health

Objective: Women who experience intimate partner violence (IPV) often do not perceive themselves as abused. This study sought to estimate the health effects of unperceived IPV (uIPV), taking violence-free women as the reference, and to compare the effects of uIPV with those of perceived IPV (pIPV). Method: We performed a cross-sectional population study through telephone interviews of 2835 women aged 18 to 70 years living in the region of Madrid and having an ongoing intimate partner relationship or contact with a former partner in the preceding year. Based on 26 questions from the Conflict Tactics Scale-1 and the Enquête Nacional sur les Violences envers les Femmes en France and the question "Do you feel abused by your partner?" a variable was constructed in three categories, namely, the absence of IPV, uIPV and pIPV. Using logistic regression, we analyzed the association between health problems, medication use, health-service utilization and IPV (perceived and unperceived) vis-à-vis the absence of IPV. Results: There were 247 cases of uIPV and 96 of pIPV (prevalences of 8.8% and 3.4%, respectively). The multivariate analysis showed that a substantial number of the outcomes explored were associated with uIPV, pIPV, or both. The highest odds ratios (ORs) were obtained for depression (Patient Health Questionnaire-9 > 10) (uIPV: OR 3.4, 95% CI 2.4-3.8; and pIPV: 4.1, 95%CI 2.5-6.8). In most problems, the ORs did not significantly differ between the two types of IPV. Conclusions: uIPV is 2.6 times more frequent than pIPV and is associated with at least as many health problems as pIPV (AU)

Objetivo: Las mujeres que sufren violencia de pareja (VPM) a menudo no se perciben a sí mismas como maltratadas. Se pretende estimar los efectos en salud de la violencia no percibida (VPMnp), tomando a las mujeres libres de violencia como referencia, y comparar con los efectos de la violencia percibida (VPMp). Método: Estudio transversal poblacional mediante encuesta telefónica a 2835 mujeres de 18 a 70 años de edad residentes en la Comunidad de Madrid, con relación de pareja o contacto con la ex pareja en el último año. Basándonos en 26 preguntas de la Conflict Tactic Scale-1 y de la Enquête Nacional sur les Violences envers les Femmes en France, y en la pregunta "¿se siente usted maltratada?", se construyó una variable en tres categorías: ausencia de VPM, VPMnp y VPMp. Se estudió la asociación de problemas de salud, consumo de medicamentos y frecuentación de servicios con la VPM (bien percibida o no) respecto a la ausencia de VPM, mediante regresión logística. Resultados: Se encontraron 247 casos de VPMnp y 96 de VPMp (prevalencia del 8,8% y el 3,4%, respectivamente). En el análisis multivariado, un gran número de problemas resultaron asociados con la VPMnp, con la VPMp o con ambas. Las odds ratio (OR) más altas se obtuvieron para la depresión (PHQ9 ≥ 10) (VPMnp: OR 3,4, intervalo de confianza del 95% [IC95%] 2,4-3,8; VPMp: OR 4,1, IC95% 2,5-6,8). En la mayoría de los problemas, las OR no mostraron diferencias significativas entre los dos tipos de VPM. Conclusiones: La VPMnp es 2,6 veces más frecuente que la VPMp y se asocia al menos a tantos problemas de salud como la VPMp (AU)

Unperceived intimate partner violence and women's health.

OBJECTIVE: Women who experience intimate partner violence (IPV) often do not perceive themselves as abused. This study sought to estimate the health effects of unperceived IPV (uIPV), taking violence-free women as the reference, and to compare the effects of uIPV with those of perceived IPV (pIPV). METHOD: We performed a cross-sectional population study through telephone interviews of 2835 women aged 18 to 70 years living in the region of Madrid and having an ongoing intimate partner relationship or contact with a former partner in the preceding year. Based on 26 questions from the Conflict Tactics Scale-1 and the Enquête Nacional sur les Violences envers les Femmes en France and the question "Do you feel abused by your partner?" a variable was constructed in three categories, namely, the absence of IPV, uIPV and pIPV. Using logistic regression, we analyzed the association between health problems, medication use, health-service utilization and IPV (perceived and unperceived) vis-à-vis the absence of IPV. RESULTS: There were 247 cases of uIPV and 96 of pIPV (prevalences of 8.8% and 3.4%, respectively). The multivariate analysis showed that a substantial number of the outcomes explored were associated with uIPV, pIPV, or both. The highest odds ratios (ORs) were obtained for depression (Patient Health Questionnaire-9≥10) (uIPV: OR 3.4, 95% CI 2.4-3.8; and pIPV: 4.1, 95%CI 2.5-6.8). In most problems, the ORs did not significantly differ between the two types of IPV. CONCLUSIONS: uIPV is 2.6 times more frequent than pIPV and is associated with at least as many health problems as pIPV.

Factores de riesgo cardiovascular en España en la primera década del siglo xxi: análisis agrupado con datos individuales de 11 estudios de base poblacional, estudio DARIOS / Cardiovascular risk factors in Spain in the first decade of the 21st century, a pooled analysis with individual data from 11 population-based studies: the DARIOS study

Introducción y objetivos. Analizar la prevalencia de factores de riesgo cardiovascular en personas de 35-74 años en 10 comunidades autónomas españolas y determinar el grado de variabilidad geográfica en la distribución de los factores de riesgo cardiovascular. Métodos. Análisis agrupado con datos individuales de 11 estudios desarrollados en la primera década del siglo xxi con un promedio de tasa de participación del 73%. Se midió el perfil lipídico (con validación cruzada de laboratorios), glucemia, presión arterial, perímetro de la cintura, peso y talla y se administraron cuestionarios estandarizados. Se estimó la prevalencia estandarizada a la población europea de tabaquismo, diabetes, hipertensión arterial, dislipemia y obesidad. Además, se estimó el coeficiente de variación entre estudios componentes en la prevalencia de cada factor de riesgo. Resultados. Se incluyó a 28.887 participantes. Los factores de riesgo cardiovascular más prevalentes fueron: hipertensión arterial (el 47% en varones y el 39% en mujeres), dislipemia con colesterol total >= 250 mg/dl (el 43 y el 40%), obesidad (el 29% en ambos sexos), tabaquismo (el 33 y el 21%) y diabetes mellitus (el 16 y el 11%). El colesterol total >= 190 y >= 250 mg/dl presentó el coeficiente de variación mínimo y máximo, respectivamente (el 7-24% en varones y el 7-26% en mujeres). La concordancia media en las determinaciones lipídicas entre laboratorios fue excelente. Conclusiones. La prevalencia de hipertensión arterial, dislipemia, obesidad, tabaquismo y diabetes mellitus, es elevada, con variabilidad relativamente baja en la población de 35 a 74 años entre comunidades autónomas. Canarias, Extremadura y Andalucía presentan mayor número de factores de riesgo cardiovascular significativamente más prevalentes que el promedio de los 11 estudios componentes (AU)

Introduction and objectives. To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spain's autonomous communities and determine the geographic variation of cardiovascular risk factors distribution. Methods. Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory cross-validation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor. Results. In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol >=250mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol >=190 and >=250mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent. Conclusions. Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies (AU)

[Cardiovascular risk factors in Spain in the first decade of the 21st Century, a pooled analysis with individual data from 11 population-based studies: the DARIOS study]. / Factores de riesgo cardiovascular en España en la primera década del siglo xxi: análisis agrupado con datos individuales de 11 estudios de base poblacional, estudio DARIOS.

INTRODUCTION AND OBJECTIVES: To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spain's autonomous communities and determine the geographic variation of cardiovascular risk factors distribution. METHODS: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory cross-validation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor. RESULTS: In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol ≥ 250 mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol ≥ 190 and ≥ 250 mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent. CONCLUSIONS: Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies.

Intimate partner violence: last year prevalence and association with socio-economic factors among women in Madrid, Spain.

BACKGROUND: Intimate partner violence (IPV) is a public health problem with significant consequences on women's health. This study estimates the prevalence of intimate partner violence by type among Madrid's female population and assesses the association with socio-economic variables. METHODS: We conducted a cross-sectional study in 2004, 2136 women aged 18-70 years, living in the Madrid region with a partner or who had been in contact with an ex-partner in the previous year, were interviewed by telephone. The questionnaire used to measure past-year intimate partner violence, consisted of a Spanish translation of the psychological and sexual violence module of the French National Survey on Violence against Women, and the physical violence module of the Conflict Tactics Scale-1. To assess the association with socio-economic factors, logistic regression models were fitted. RESULTS: About 10.1% [confidence interval (CI) 8.9-11.5] of the women had suffered some type of IPV in the previous year. 8.6% (CI 7.4-9.8) experienced psychological violence, 2.4% (CI 1.8-3.1) physical violence and 1.1% (CI 0.68-1.6) sexual violence; the prevalence of psychological-only violence (non-physical/non-sexual) was 6.9% (CI 5.8-8.0). Factors associated with psychological-only violence were divorced or separated status and Group III (clerical workers; supervisors of manual workers) or V (unskilled manual workers) occupation. Unemployment and divorced or separated status were associated with physical violence. CONCLUSIONS: Spanish women in our study, experienced past year partner violence at a similar level as in other industrialized countries. Unemployment and low occupational status are associated with physical and psychological-only violence, respectively.

Leisure-time physical activity in a southern European mediterranean country: adherence to recommendations and determining factors.

INTRODUCTION AND OBJECTIVES: To determine whether adults in Madrid, Spain adhere to leisure-time physical activity (LTPA) recommendations and to identify factors associated with adherence. METHODS: A telephone survey of 12,037 individuals, representative of the Madrid population aged 18-64 years, was conducted. The LTPA level was quantified in metabolic equivalent (MET) hours per week from answers to a questionnaire on the frequency and duration of LTPA. This level was compared with the recommendation to engage in at least moderate activity >or=150 min/week or vigorous activity >or=60 min/week. Factors associated with adherence to the recommendation were identified using logistic regression analysis. RESULTS: The mean LTPA level was 17.3 MET-hours/ week (95% confidence interval [CI], 16.9-17.7 MET-hours/week) and 28.8% (95% CI, 28%-29.7%) adhered to the recommendation. The recommended level was achieved more frequently in men than women (odds ratio [OR]=2.41; 95% CI, 2.20-2.64). In comparison with younger individuals, adherence decreased gradually with age until 60-64 years, when the OR was 0.20 (95% CI, 0.15-0.25). Compared with less well-educated individuals, the university-educated were more likely to meet the recommendation (OR=2.28; 95% CI, 1.82-2.87). Obese individuals achieved it less frequently (OR=0.49; 95% CI, 0.40-0.61) than normal-weight individuals. Those whose job involved low-intensity physical activity achieved it more frequently than those with sedentary occupations (OR=1.21; 95% CI, 1.10-1.34). CONCLUSIONS: The majority of adults in Madrid did not achieve the recommended LTPA level. Adherence was lower in women, older individuals, the less well-educated and the obese, while it was greater in those with a job involving low-intensity physical activity.

Actividad física de tiempo libre en un país mediterráneo del sur de Europa: adherencia a las recomendaciones y factores asociados / Leisure-time physical activity in a southern european mediterranean country: adherence to recommendations and determining factors

Introducción y objetivos. Examinar en adultos de la Comunidad de Madrid la adecuación de la actividad física en tiempo libre (AFTL) a las recomendaciones e identificar factores asociados. Métodos. Encuesta telefónica a 12.037 personas, representativa de la población de 18-64 años de Madrid. La AFTL se calculó en MET-h/semana mediante un cuestionario de frecuencia y duración de AFTL. Se comparó con la recomendación de realizar actividad al menos moderada ≥ 150 min/semana, o vigorosa ≥ 60 min/semana. Los factores asociados al cumplimiento se identificaron mediante regresión logística. Resultados. La media de AFTL fue 17,3 (intervalo de confianza [IC] del 95%, 16,9-17,7) MET-h/semana y un 28,8% (IC del 95%, 28%-29,7%) alcanzó la recomendación. La AFTL recomendada fue más frecuente en varones que en mujeres (odds ratio [OR] = 2,41; IC del 95%, 2,20-2,64). Comparando con los más jóvenes, la adherencia disminuyó gradualmente con la edad hasta los 60-64 años, donde la OR fue 0,20 (IC del 95%, 0,15-0,25). Respecto a los sujetos sin estudios, los universitarios siguieron más frecuentemente la recomendación (OR = 2,28; IC del 95%, 1,82-2,87). Las personas obesas tuvieron menos probabilidad que los normopesos de realizar la AFTL recomendada (OR = 0,49; IC del 95%, 0,40-0,61). Las personas con actividad laboral de baja intensidad se adhirieron a la recomendación con más frecuencia que las de ocupación sedentaria (OR = 1,21; IC del 95%, 1,10-1,34). Conclusiones. La mayoría de los adultos de Madrid no siguió la recomendación de AFTL. La adherencia fue menor en mujeres, al aumentar la edad, con menor nivel de estudios y en obesos, mientras que fue mayor en personas con ocupaciones que requieren baja intensidad física (AU)

Introduction and objectives. To determine whether adults in Madrid, Spain adhere to leisure-time physical activity (LTPA) recommendations and to identify factors associated with adherence. Methods. A telephone survey of 12,037 individuals, representative of the Madrid population aged 18-64 years, was conducted. The LTPA level was quantified in metabolic equivalent (MET) hours per week from answers to a questionnaire on the frequency and duration of LTPA. This level was compared with the recommendation to engage in at least moderate activity ≥150 min/week or vigorous activity ≥60 min/week. Factors associated with adherence to the recommendation were identified using logistic regression analysis. Results. The mean LTPA level was 17.3 MET-hours/ week (95% confidence interval [CI], 16.9-17.7 MET-hours/week) and 28.8% (95% CI, 28%-29.7%) adhered to the recommendation. The recommended level was achieved more frequently in men than women (odds ratio [OR]=2.41; 95% CI, 2.20-2.64). In comparison with younger individuals, adherence decreased gradually with age until 60-64 years, when the OR was 0.20 (95% CI, 0.15-0.25). Compared with less well-educated individuals, the university-educated were more likely to meet the recommendation (OR=2.28; 95% CI, 1.82-2.87). Obese individuals achieved it less frequently (OR=0.49; 95% CI, 0.40-0.61) than normal-weight individuals. Those whose job involved low-intensity physical activity achieved it more frequently than those with sedentary occupations (OR=1.21; 95% CI, 1.10-1.34). Conclusions. The majority of adults in Madrid did not achieve the recommended LTPA level. Adherence was lower in women, older individuals, the less well-educated and the obese, while it was greater in those with a job involving low-intensity physical activity (AU)

A sampling design for a Sentinel General Practitioner Network

Objective: To construct a design for probabilistic sampling of reporting physicians in sentinel networks. Methods: We performed a multi-stage sample selection study. Data on primary care physicians and their patients were obtained from the Madrid Health Institute for 2005. The geographical unit of reference was the basic health area. A factorial analysis was performed on the basis of demographic, socio-cultural and socio-occupational variables. A cluster analysis was conducted to group the 247 basic health areas into homogeneous strata, which were then tested using a discriminant analysis. The general practitioners and pediatricians needed in each stratum were selected by simple random sampling. The representativeness of the population monitored by the selected physicians was studied with respect to the population of Madrid. Results: Factorial analysis yielded five factors. Using these, 14 strata were obtained, which were shown to be homogeneous and mutually different by discriminant analysis. The minimum population that needed to be monitored consisted of 146,946 adults and 24,518 children, proportionally distributed among the respective strata. Eighty-eight general practitioners and 32 pediatricians were selected, who respectively covered populations of 154,610 and 31,336 persons representative of the general population. Conclusions: Obtaining samples through suitable designs improves the accuracy of the information gathered by health sentinel networks in epidemiologic surveillance. Ensuring the representativeness of the study population vis-à-vis the general population is essential; cluster analysis and simple random sampling are methods that meet this need. Selecting physicians by means of probabilistic methods enables the accuracy of estimates to be ascertained (AU)

Objetivo: Elaborar un diseño de muestreo probabilístico de los médicos notificadores en redes centinelas sanitarias. Métodos: Estudio de muestreo multietápico. La información sobre los médicos de Atención Primaria y la población atendida procede del Instituto Madrileño de Salud para 2005. La unidad geográfica de referencia fue la Zona Básica de Salud. Partiendo de variables demográficas, socioculturales y sociolaborales, se realizó un análisis factorial. Se hizo un análisis de clusters para agrupar las 247 Zonas Básicas de Salud en estratos homogéneos. Como comprobación se realizó un análisis discriminante. Se seleccionaron los médicos necesarios en cada estrato mediante muestreo aleatorio simple. Se estudió la representatividad de la población vigilada con respecto a la población de Madrid. Resultados: Se extrajeron 5 factores mediante análisis factorial. Se obtuvieron 14 estratos, que el análisis discriminante demostró homogéneos y distintos entre sí. Se determinó que era necesario vigilar una población mínima de 146.946 adultos y 24.518 niños, distribuidos proporcionalmente en cada estrato. Se seleccionaron 88 médicos de familia y 32 pediatras, que cubrían unas poblaciones de 154.610 y 31.336 personas, representativas de la población general. Conclusiones: La obtención de muestras con un adecuado diseño asegura la validez de la información generada por redes centinelas sanitarias en la vigilancia epidemiológica. Debe buscarse la representatividad de la población estudiada con respecto a la población general. El análisis de clusters y el muestreo aleatorio simple son métodos que responden a esta necesidad. La selección de médicos mediante métodos probabilísticos permite conocer la precisión de las estimaciones (AU)

A sampling design for a sentinel general practitioner network.

OBJECTIVE: To construct a design for probabilistic sampling of reporting physicians in sentinel networks. METHODS: We performed a multi-stage sample selection study. Data on primary care physicians and their patients were obtained from the Madrid Health Institute for 2005. The geographical unit of reference was the basic health area. A factorial analysis was performed on the basis of demographic, socio-cultural and socio-occupational variables. A cluster analysis was conducted to group the 247 basic health areas into homogeneous strata, which were then tested using a discriminant analysis. The general practitioners and pediatricians needed in each stratum were selected by simple random sampling. The representativeness of the population monitored by the selected physicians was studied with respect to the population of Madrid. RESULTS: Factorial analysis yielded five factors. Using these, 14 strata were obtained, which were shown to be homogeneous and mutually different by discriminant analysis. The minimum population that needed to be monitored consisted of 146,946 adults and 24,518 children, proportionally distributed among the respective strata. Eighty-eight general practitioners and 32 pediatricians were selected, who respectively covered populations of 154,610 and 31,336 persons representative of the general population. CONCLUSIONS: Obtaining samples through suitable designs improves the accuracy of the information gathered by health sentinel networks in epidemiologic surveillance. Ensuring the representativeness of the study population vis-à-vis the general population is essential; cluster analysis and simple random sampling are methods that meet this need. Selecting physicians by means of probabilistic methods enables the accuracy of estimates to be ascertained.

Impact of the "Tobacco control law" on exposure to environmental tobacco smoke in Spain.

BACKGROUND: The initial evaluations of the introduction of legislation that regulates smoking in enclosed public places in European countries, describe an important effect in the control of exposure to environmental tobacco smoke. However, the evidence is still limited. The objective of this study is to estimate the short-term effects of the comprehensive "Tobacco control law" introduced in Spain on January 2006, which includes a total ban of smoking in workplaces and a partial limitation of smoking in bars and restaurants. METHODS: Cross-sectional, population-based study. The self-reported exposure to environmental tobacco smoke at home, at work, in bars and restaurants of the population aged 18 to 64 years in the Madrid Region during a period prior to the law (October and November 2005; n = 1750) was compared to that of the period immediately after the law came into force (January-July 2006; n = 1252). Adjusted odds ratios (OR) were calculated using logistic regression models. RESULTS: Passive exposure to tobacco smoke at home has hardly changed. However, at indoor workplaces there has been a considerable reduction: after the law came into force the OR for daily exposure > 0-3 hours versus non-exposure was 0.11 (95% CI: 0.07 to 0.17) and for more than 3 hours, 0.12 (95% CI: 0.09 to 0.18). For fairly high exposure in bars and restaurants versus non-exposure, the OR in the former was 0.30 (95% CI: 0.20 to 0.44) and in the latter was 0.24 (95% CI: 0.18 to 0.32); for very high exposure versus non-exposure they were 0.16 (95% CI: 0.10 to 0.24) and 0.11 (95% CI: 0.07 to 0.19), respectively. These results were similar for the smoking and non-smoking populations. CONCLUSION: A considerable reduction in exposure to environmental tobacco smoke in the workplace and, to a lesser extent, in bars and restaurants, is related to the implementation of the "Tobacco control law". Although only initial figures, these results already demonstrate the effectiveness of strategies that establish control measures to guarantee smoke-free places.

Clustering of behavioural risk factors and compliance with clinical preventive recommendations in Spain.

OBJECTIVE: To examine the relationship between the clustering of behavioural risk factors and compliance with clinical preventive practices. METHOD: Cross-sectional study using a telephone interview of a sample of 16043 persons, representative of the population aged 18-64 years in the Madrid Region (Spain). The criteria for providing clinical preventive services were based on recommendations issued by the Spanish Society for Family and Community Medicine. Analyses were performed using logistic regression with adjustment for age, education, social class and year of interview. RESULTS: A positive dose-response association was observed between the number of behavioural risk factors (tobacco smoking, hazardous alcohol drinking, leisure-time sedentariness and unbalanced diet) and non-compliance of recommendations for blood-pressure and cholesterol testing, and for cytology and mammography screening (P < 0.001). Compared to subjects with no behavioural risk factors, those with all four risk factors showed a higher frequency of non-compliance of blood pressure assessment: OR = 2.5 (95% CI: 1.6, 3.8) in men and 2.7 (1.5, 4.8) in women, and cholesterolaemia testing: OR = 2.6 (1.8, 3.9) in men and 2.7 (1.5, 5.1) in women. Furthermore, among women, the presence of these four risk factors was also associated with a higher frequency of non-performance of cytology: OR = 6.4 (2.8, 14.8) and mammography screening: OR = 10.2 (2.1, 49.8). However, as it is a cross-sectional study, we do not know the direction of this relationship, therefore, any causal inference should be made with caution. CONCLUSIONS: Clustering of behavioural risk factors is associated with greater non-compliance with recommendations for both blood pressure and cholesterolaemia testing, and for cytology and mammography screening.

Clustering of behavior-related risk factors and its association with subjective health.

OBJECTIVES: To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health. METHODS: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 18-64 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor). RESULTS: Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women). CONCLUSIONS: Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.

Agregación de factores de riesgo ligados al comportamiento y su relación con la salud subjetivaAgregación de factores de riesgo ligados al comportamiento y su relación con la salud subjetiva / Clustering of behavioural risk factors and their association with subjective health

Objetivos: Describir la agregación de factores de riesgo relacionados con el comportamiento en la población adulta de la Comunidad de Madrid y evaluar la asociación del grado de agregación de dichos factores con la salud subjetiva sub-óptima. Métodos: Los datos proceden del Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles (SIVFRENT). Las relaciones entre el consumo de tabaco, el consumo de alcohol de riesgo, el sedentarismo en tiempo libre y la dieta desequilibrada fueron estudiadas en 16.043 personas de 18 a 64 años, y se compararon las proporciones observadas respecto a las esperadas. Mediante un análisis de regresión logística se estimó la asociación entre la agregación de factores de riesgo y la salud percibida subóptima (regular, mala y muy mala). Resultados: Cerca del 20% de los sujetos presentan 3 o 4 factores de riesgo simultáneamente. La mayoría de combinaciones de 3 factores de riesgo son superiores a las esperadas, destacando la agregación de los 4 factores con un cociente observado/esperado de 2,15 (IC del 95%, 1,93-2,38) en varones y de 2,96 (IC del 95%, 2,46-3,46) en mujeres. En ambos sexos, el factor individual que más se asocia al resto de factores de riesgo es el tabaco. La agregación de factores de riesgo es más frecuente en varones, en edades jóvenes y en el nivel educativo bajo. En comparación con los que carecen de los 4 factores de riesgo, los que presentan simultáneamente 3 o 4 de ellos tienen con mayor frecuencia una salud percibida subóptima (OR = 2,49; IC del 95%, 1,59-3,90 en varones y OR = 1,96; IC del 95%, 1,29-2,97 en mujeres). Conclusiones: Los factores de riesgo ligados al comportamiento se agregan, y esta acumulación es superior en varones, en personas jóvenes y con bajo nivel de estudios. Un mayor grado de agregación se asocia a mayor frecuencia de salud percibida subóptima

Objectives: To describe the clustering of behavioural risk factors in the adult population of the Autonomous Community of Madrid (Spain), and to evaluate the association between the level of aggregation of such factors and suboptimal subjective health. Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles - SIVFRENT). We studied the relationships between tobacco use, high-risk alcohol consumption, leisure-time inactivity and unbalanced diet in 16,043 people aged 18-64, comparing observed against expected proportions. Logistic regression was used to estimate the association between aggregation of risk factors and suboptimal health (fair, poor and very poor health). Results: Almost 20% of subjects had 3 or 4 risk factors. Most combinations of three risk factors exceeded expectations and, in particular, 4-factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI], 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, smoking was the individual factor most frequently associated with the remaining risk factors. Aggregation of risk factors was more frequent among men, in younger age groups and among subjects with low educational level. Compared to people with none of the 4 risk factors, those with 3 or four reported suboptimal subjective health more frequently (OR = 2.49; 95% CI, 1.59-3.90 for men and OR = 1.96; 95% CI, 1.29-2.97 for women). Conclusions: Behavioural risk factors tend to aggregate, and this clustering is higher among men, in younger age groups and among subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal self-rated health

[Risk factors surveillance for non-communicable disease through telephone survey. Results in the Autonomous Community of Madrid from 1995-2003]. / Vigilancia de los factores de riesgo de las enfermedades no transmisibles mediante encuesta telefónica: resultados de la Comunidad de Madrid en el período 1995-2003.

OBJECTIVE: To illustrate -for the first time with Spanish data- the usefulness of telephone-interview-based surveillance of non-communicable diseases risk factors for the purpose of drawing up public health policies. METHODS: We analysed information from the Non-Communicable Disease Risk Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles- SIVFRENT) for the period 1995-2003. This system is based on monthly telephone interviews covering a representative population sample, aged 18-64 years. 18,049 interviews were conducted for the whole period. Indicators of overweight and obesity, sedentary lifestyle, diet, tobacco and alcohol consumption, preventive practices, accidents and injuries, and road safety were calculated. The time trend was estimated using average annual prevalence ratios, obtained from generalised linear models with binomial family and logarithmic link. RESULTS: Among men, the changes of greatest magnitude corresponded to an increase in overweight and obesity, which registered a relative annual rise of 3.7%, and a decrease in dieting (-3%), high alcohol consumption (-6.1%) and non-use of safety belts (-4%). Among women, there was a marked increase in overweight and obesity (3.3%), cessation of smoking (3.1%) and recourse to mammograms (6.4%), and a decrease in dieting (-4.1%) and non-use of safety belts (-4.5%). CONCLUSIONS: Although important progress was observed in a number of indicators, such as tobacco and alcohol consumption, road safety and the undertaking of preventive practices, the situation worsened in others, i.e., fundamentally the increase in overweight and obesity.

Vigilancia de los factores de riesgo de las enfermedades no transmisibles mediante encuesta telefónica: resultados de la Comunidad de Madrid en el período 1995-2003 / Risk factors surveillance for non-communicable disease through telephone survey. Results in the Autonomous Community of Madrid from 1995-2003

Objetivo: Ilustrar por primera vez con datos españoles la utilidad de la vigilancia por encuesta telefónica de los factores de riesgo de enfermedades no transmisibles para orientar las políticas de salud pública. Métodos: Se analiza la información del Sistema de Vigilancia de Factores de Riesgo asociados con Enfermedades No Transmisibles (SIVFRENT) entre 1995 y 2003, basada en encuestas telefónicas mensuales y dirigida a la población de 18-64 años de la Comunidad de Madrid. Se realizaron 18.049 entrevistas durante todo el período. Se calculan los indicadores de sobrepeso y obesidad, sedentarismo, dieta, consumo de tabaco y alcohol, prácticas preventivas, accidentabilidad y seguridad vial. La tendencia se estima a través del promedio anual de las razones de prevalencia obtenidas mediante modelos lineales generalizados con vínculo logarítmico y familia binomial. Resultados: Los mayores cambios en los varones corresponden al incremento del sobrepeso y la obesidad, con un aumento relativo del 3,7% anual, y al descenso de la realización de dietas (­3%), del consumo elevado de alcohol (­6,1%) y de la no utilización del cinturón de seguridad (­4%). En las mujeres se incrementan el sobrepeso y la obesidad (3,3%), el abandono del consumo de tabaco (3,1%) y la realización de mamografías (6,4%), y disminuye la realización de dietas (­4,1%) y la no utilización del cinturón de seguridad (­4,5%).Conclusiones: Se observan importantes progresos en numerosos indicadores, como el consumo de tabaco y alcohol, la seguridad vial y la realización de prácticas preventivas, mientras que en otros la situación empeora, fundamentalmente el incremento del sobrepeso y la obesidad

Objective: To illustrate -for the first time with Spanish data- the usefulness of telephone-interview-based surveillance of non-communicable diseases risk factors for the purpose of drawing up public health policies. Methods: We analysed information from the Non-Communicable Disease Risk Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles- SIVFRENT) for the period 1995-2003. This system is based on monthly telephone interviews covering a representative population sample, aged 18-64 years. 18,049 interviews were conducted for the whole period. Indicators of overweight and obesity, sedentary lifestyle, diet, tobacco and alcohol consumption, preventive practices, accidents and injuries, and road safety were calculated. The time trend was estimated using average annual prevalence ratios, obtained from generalised linear models with binomial family and logarithmic link. Results: Among men, the changes of greatest magnitude corresponded to an increase in overweight and obesity, which registered a relative annual rise of 3.7%, and a decrease in dieting (­3%), high alcohol consumption (­6.1%) and non-use of safety belts (­4%). Among women, there was a marked increase in overweight and obesity (3.3%), cessation of smoking (3.1%) and recourse to mammograms (6.4%), and a decrease in dieting (­4.1%) and non-use of safety belts (­4.5%). Conclusions: Although important progress was observed in a number of indicators, such as tobacco and alcohol consumption, road safety and the undertaking of preventive practices, the situation worsened in others, i.e., fundamentally the increase in overweight and obesity

[Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices]. / Comparación entre encuestas telefónicas y encuestas "cara a cara" domiciliarias en la estimación de hábitos de salud y prácticas preventivas.

OBJECTIVE: This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices. MATERIAL AND METHOD: The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared. RESULTS: The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview. CONCLUSIONS: The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de saludy prácticas preventivas / Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices

Objetivo: En este estudio se examina la influencia del método de encuesta, telefónica y «cara a cara» domiciliaria, sobre la estimación de los factores de riesgo para la salud asociados al comportamiento y la realización de prácticas preventivas. Material y método: El mismo cuestionario fue administrado en 2 muestras independientes de población de 18-64 años residente en el municipio de Madrid. Una muestra (n = 1.391) realizó la entrevista telefónica y la otra (n = 739), la entrevista «cara a cara» domiciliaria. Se compararon los resultados de las 2 muestras para 28 variables relacionadas con la antropometría, la actividad física, el consumo de alimentos, el consumo de tabaco y alcohol, las prácticas preventivas y la accidentabilidad. Resultados: La muestra telefónica obtuvo una mayor tasa de no contactos (31,8 frente a 22,2%) pero un mayor grado de cooperación que la muestra con entrevista «cara a cara»(83 frente a 74%). En total, 19 de las 28 variables mostraron una variación relativa entre ambas encuestas < 10%, en 8 variables las diferencias se encontraban entre el 10 y el 20%,y 1 superó el 20%. Sólo en 4 variables (sedentarismo en el tiempo libre, consumo de verdura, abandono del consumo de tabaco y medición del colesterol) las diferencias fueron estadísticamente significativas, con una variación relativa del 6,1%(p < 0,01), 10% (p < 0,001), 36,7% (p < 0,01) y 8,6% (p <0,01), respectivamente. El coste global de la entrevista telefónica ha sido la mitad de la domiciliaria «cara a cara». Conclusiones: Los resultados de las encuestas telefónica y «cara a cara» domiciliaria fueron muy similares. El menor coste de la encuesta telefónica la convierte en una buena alternativa para la investigación de salud pública que requiera la recogida de datos por entrevista (AU)

Objective: This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices. Material and method: The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared. Results: The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs.74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p <0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01),respectively. The total cost of the telephone interview was half that of the face-to-face household interview. Conclusions: The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required (AU)