A Validation Study on the Frequency and Natural History of Miscarriages Using the Spanish Primary Care Database BIFAP.

(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan-Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68-11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8-12). The IR according to age was: 2.71 (CI 95% 2.59-2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55-9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08-3.62)), use of antihypertensives (1.49 (1.21-1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07-1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.

An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies.

PURPOSE: There has been a notable progress on the development of methods for identification of pregnancies using primary care databases. We aimed to evaluate the prescription of medications during pregnancy applying a novel algorithm. METHODS: We identified pregnancies in women aged 15 to 49 years registered in the Database for Pharmacoepidemiological Research in Primary Care (BIFAP) between 2002 and 2015. The algorithm applied sequential cycles that searched in hierarchical order for indicators of conception, delivery or pregnancy loss, and other codes suggestive of pregnancy. Length of pregnancy was assessed by searching for last menstrual period (LMP) date, gestational age, and outcomes of pregnancy. Prescription of specific drugs during the pre-pregnancy period and first trimester and time trends during pregnancy were evaluated. RESULTS: We identified a total of 155 419 pregnancies during the study period (77.5% completed pregnancies, 21.5% pregnancies losses, 0.8% ectopic pregnancies, and 0.2% stillbirths). Excluding vitamins and supplements, 43.8% of women received at least one prescription during the pre-pregnancy period and 68.4% during the first trimester. During the first trimester, the most commonly drugs prescribed were analgesics (16.3%) followed by antibiotics (11.8%). From 2002/2003 to 2014/2015, there was an increase of prescriptions for thyroid hormones (1.0% vs 4.7%), H2 blockers (1.0% vs 2.2%), and PPIs (1.4% vs 2.2%). While antidepressants (2.0% vs 1.5%) and benzodiazepines (3.1% vs 2.4%) decreased in the last period. CONCLUSION: Having in mind the challenges of identifying pregnancies in health care databases, this study demonstrates the usefulness of BIFAP database for studies on drug utilization during pregnancy.

Sports facilities, socio-economic context and overweight among the childhood population in two southern European cities: a cross sectional study.

BACKGROUND: To evaluate relationship between socio-economic environment and overweight in Madrid and Barcelona, adjusting for possible confounding factors. METHODS: We obtained three indicators which reflected socio-economic context, namely, unemployment rate, percentage of population with tertiary education, and percentage with a second home. The design is a cross sectional study. The association with overweight was estimated using odds ratios by multilevel logistic regression. The statistical analysis, data synthesis, or model creation was performed from the 2017. In all, 707 children from 21 districts of Madrid and 474 children from 10 districts of Barcelona were analysed. RESULTS: In Madrid, standardised ORs for personal and family characteristics were 1.17, 1.53 and 1.57 by reference to unemployment rate and percentages of population with a university education and second home. After adjustment, only the OR obtained with unemployment rate decreased, specifically by 58%. In Barcelona, the following ORs were obtained: 1.80 with unemployment rate; 1.80 with population having a university education; and 1.86 with population having a second home. After being standardised, these ORs decreased by 14% in the case of unemployment rate, 10% in the case of population with a university education, and 9% in the case of population with a second home. CONCLUSIONS: Overweight displayed a risk gradient in Madrid and Barcelona alike. This risk of overweight is not accounted for by physical inactivity and could, in part, be due to the availability of sports facilities.

Cardiovascular Disease, Digestive Diseases, Traffic Accidents, and Suicides: Leading Causes of Death Responsible for Excess Mortality in Farmers in Spain.

OBJECTIVE: The aim of this study was to compare mortality from the leading causes of death in farmers and in all other workers. METHODS: Mortality by cause of death was calculated from a longitudinal study in which 9.5 million men were followed up for 10 years. We estimated the contribution of the causes of death to the difference in all-cause mortality. RESULTS: Most of the excess in all-cause mortality in farmers was due to cardiovascular diseases, digestive diseases, and external causes, which contributed 22.3%, 17.2%, and 53.3% to the difference in all-cause mortality, respectively. Traffic accidents and suicide were the main contributors to the excess mortality from external causes. CONCLUSION: Farmers are a vulnerable group in terms of health, thus there is a need to identify the factors that influence excess mortality from cardiovascular diseases, digestive diseases, traffic accidents, and suicide.

Consejo y prevención a pacientes mayores en hospitales y residencias geriátricas en España / Counseling and preventive action in elderly population in hospitals and residences in Spain

OBJETIVOS: Conocer el perfil sociosanitario de los pacientes mayores atendidos en consultas; conocer las acciones preventivas que se llevan a cabo, de forma rutinaria, en hospitales, residencias geriátricas y otros centros asistenciales en España. DISEÑO: Estudio descriptivo transversal, basado en un cuestionario a médicos que atienden a población mayor de 65 años en España (2013). Emplazamiento: Centros de diferentes comunidades autónomas en España. PARTICIPANTES: Un total de 420 médicos de hospitales, residencias y otros centros. Se obtuvieron datos de 840 consultas a pacientes geriátricos. MEDICIONES PRINCIPALES: Variables principales de RESULTADOS: dependencia, comorbilidad, motivo de consulta, actuación en consulta y recomendación de estilos de vida saludable. Factor asociado, tipo de institución en la que se atendió al paciente. Análisis de prevalencias y diferencias con Chi-cuadrado. RESULTADOS: El 66,7% presentaban dependencia, siendo mayor entre las mujeres: 68,9% vs 62,4% (p = 0,055). El 88,6% de mujeres atendidas con 85 o más años presentaban comorbilidad, mientras que en hombres de ese mismo grupo de edad eran un 79,8%. Solo un 6,6% de pacientes con comorbilidad recibieron recomendaciones saludables durante la consulta. El 79,6% de pacientes atendidos en hospitales recibieron recomendaciones de estilo de vida saludable, mientras que en las residencias geriátricas las recibieron el 59,62% de los pacientes (p < 0,001). CONCLUSIONES: Se detecta una escasa acción preventiva y de promoción de la salud hacia las personas mayores, con diferencias entre hospitales y residencias geriátricas. Parece necesario incentivar la actitud promotora de salud y las intervenciones preventivas en la práctica clínica gerontológica

OBJECTIVE: To establish the profile of elderly patients, and to assess current preventive actions in hospitals, geriatric residences, and different health-care centres in Spain. DESIGN: Cross-sectional descriptive study, based on a questionnaire to be answered by doctors who treat the elderly population in Spain (2013). SETTING: Health-care centres from different regions of Spain. PARTICIPANTS: A total of 420 practitioners from hospitals, residences and other community centres, with data from 840 geriatric clinics. MAIN MEASUREMENTS: Main outcome variables are: dependence, reason for assistance, comorbidity, professional consultation, and life style recommendations. Association factor, type of institution where patients have been attended. Analysis of prevalence and association using Chi-squared test. Outcomes: Two-thirds (66.7%) of the study population were shown to be dependent, with a higher percentage among women than men: 68.9% vs.62.4% (P = .055). It was also found that among the population aged 85 or more, 88.6% of the women and 85.2% of the men suffered comorbidity. In spite of these results, only 6.6% of the patients suffering comorbidity received additional advice concerning healthy-lifestyle. A large majority (79.6%) of the patients treated in hospitals received advice concerning healthy lifestyle, while 59.62% of those treated in nursing homes received it (P < .001). CONCLUSIONS: It was observed that there is a lack of preventive action related to health promotion among the elderly, with differences between hospitals and geriatric residences. This suggests that it is time to put forward new specialised programs addressed to health professionals, in order to reinforce health promotion attitudes and preventive interventions in gerontology clinical practice

[Counseling and preventive action in elderly population in hospitals and residences in Spain]. / Consejo y prevención a pacientes mayores en hospitales y residencias geriátricas en España.

OBJECTIVE: To establish the profile of elderly patients, and to assess current preventive actions in hospitals, geriatric residences, and different health-care centres in Spain. DESIGN: Cross-sectional descriptive study, based on a questionnaire to be answered by doctors who treat the elderly population in Spain (2013). SETTING: Health-care centres from different regions of Spain. PARTICIPANTS: A total of 420 practitioners from hospitals, residences and other community centres, with data from 840 geriatric clinics. MAIN MEASUREMENTS: Main outcome variables are: dependence, reason for assistance, comorbidity, professional consultation, and life style recommendations. Association factor, type of institution where patients have been attended. Analysis of prevalence and association using Chi-squared test. OUTCOMES: Two-thirds (66.7%) of the study population were shown to be dependent, with a higher percentage among women than men: 68.9% vs. 62.4% (P=.055). It was also found that among the population aged 85 or more, 88.6% of the women and 85.2% of the men suffered comorbidity. In spite of these results, only 6.6% of the patients suffering comorbidity received additional advice concerning healthy-lifestyle. A large majority (79.6%) of the patients treated in hospitals received advice concerning healthy lifestyle, while 59.62% of those treated in nursing homes received it (P<.001). CONCLUSIONS: It was observed that there is a lack of preventive action related to health promotion among the elderly, with differences between hospitals and geriatric residences. This suggests that it is time to put forward new specialised programs addressed to health professionals, in order to reinforce health promotion attitudes and preventive interventions in gerontology clinical practice.

Socio-economic environment, area facilities and obesity and physical inactivity among children.

BACKGROUND: To evaluate whether the relationship between socio-economic environment and obesity and physical inactivity in children can be explained by household socio-economic position and area facilities. METHODS: Two indicators of the socio-economic context of neighbourhood of residence based on wealth and deprivation were estimated in a sample of 727 children and adolescents residents in Madrid (Spain). Multilevel logit models were used to calculate the relationship between each indicator and obesity and physical inactivity. RESULTS: After adjusting for household socio-economic position, obesity prevalence was 3.79 times higher among subjects living in deprived areas than among those living in non-deprived areas (CI: 1.95-7.34), and 2.38 higher among subjects living in less wealthy areas than in those living in wealthier areas (CI: 0.85-6.65). Adjustment for the availability of retail shops in subjects' neighbourhood of residence failed to change the magnitude of the association. Neither neighbourhood socio-economic context nor availability of sports facilities was related to physical inactivity. CONCLUSION: In the city of Madrid, socio-economic context of neighbourhood of residence shows an inverse relationship with obesity but not with physical inactivity among children. The relationship observed with obesity is not explained by the availability of area facilities.

Low mortality in the poorest areas of Spain: adults residing in provinces with lower per capita income have the lowest mortality.

The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain's 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95% CI 0.95-0.93) in men and 0.91 (0.87-0.96) in women, among the adult population; and 1.02 (0.97-1.08) in men and 1.08 (1.02-1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.

Desigualdades en inactividad física según el nivel de estudios en España, en 1987 y 2007 / Inequalities in physical inactivity according educational level in Spain, 1987 and 2007

OBJETIVO: Comparar la magnitud de las desigualdades en la frecuencia de inactividad física en España en 1987 y 2007. DISEÑO: Estudio descriptivo, diseño transversal, nivel nacional. Participantes: Datos de la Encuesta Nacional de Salud de 1987 y 2007, población adulta de 25 a 64 años. Tamaño muestral 30.000 sujetos (1987) y 29.478 (2006/7). Mediciones principales: Variable principal de resultados, inactividad física en tiempo libre. Factor de exposición, nivel educativo. Análisis de prevalencias y asociación a través de odds ratio (OR). Ajuste por variables socioeconómicas: edad en decenios, estado civil, situación laboral, clase social del cabeza de familia e ingresos del hogar. RESULTADOS: Descenso de la prevalencia de inactividad física en tiempo libre en 2007 respecto a 1987, tanto en mujeres como hombres. Mayores descensos observados entre los sujetos con estudios universitarios. La magnitud de las desigualdades en salud ha aumentado con el tiempo. Así ocurrió por ejemplo con el grupo de varones de 45 a 64 años, con OR de 2,43 (1,91-3,09) en 1987, a OR de 2,77 (2,17-3,54) en 2007, ajustadas por todas las variables socioeconómicas), en el caso de sujetos con peor nivel de estudios. CONCLUSIONES: a prevalencia de inactividad física descendió entre 1987 y 2007, y los mayores descensos fueron en sujetos con estudios universitarios. La brecha de las diferencias en prevalencias y OR de inactividad física en tiempo libre, ha aumentado con el tiempo. Parece necesario contribuir, desde estrategias de Educación para la Salud y promoción de la equidad, a la reducción de las desigualdades en conductas de riesgo

OBJECTIVE: To compare the magnitude of inequalities in the frequency of physical inactivity in Spain in 1987 and 2007, and assess whether the magnitude of inequality varies depending on the wealth of the area of residence. DESIGN: Descriptive cross-sectional study, national scope. Participants: Data from the National Health Survey, 1987 and 2007, adult population between 25-64 years: 30,000 individuals (1987) and 29,478 (2006/7). Main measurements: Main outcomes variable, leisure-time physical inactivity; exposure factor, educational level. An analysis was made of the prevalence and association using odds ratio (OR). Adjustment for socioeconomic variables: age, marital status, employment status, social class of head of household, and household income. RESULTS: Physical inactivity prevalence decreased in the two decades. There were more than three times more inactive males among those with primary education or less, compared to those with university studies. The magnitude of inequalities has increased in time: in a 45-64 years old man with primary school education: OR 2.43 (1.91-3.09) in 1987, to OR 2.77 (2.17-3.54) in 2007, adjusted for all socioeconomic variables. CONCLUSIONS: The prevalence of physical inactivity decreased between 1987 and 2007, and the largest decreases were in individuals with university studies. The gap in the differences in prevalence and OR of leisure-time physical inactivity has increased over time. It's necessary to contribute, with health education strategies and equity promotion are needed to help reduce the inequalities in risk behaviors

Risk behaviors and sports facilities do not explain socioeconomic differences in childhood obesity: a cross-sectional study.

BACKGROUND: To assess whether the relationship between neighborhood socioeconomic context of residence and childhood obesity is explained by family socioeconomic position, risk behaviors and availability of sports facilities. METHODS: Based on the income and educational level of residents in the neighborhoods of the city of Madrid, two indicators of socioeconomic context were calculated using the information about income and education and grouped into quartiles. In a sample of 727 children aged 6-15 years, the relationship of these indicators with overweight and obesity was studied using multilevel logit models. RESULTS: With respect to children and adolescents living in neighborhoods having higher per capita incomes or higher population percentages with university education those living in neighborhoods having lower per capita incomes or lower population percentages with university education had age- and sex-adjusted odds ratios (ORs) of overweight that were 1.84 (95% CI, 1.03-3.29) and 1.68 (0.95-2.94) times higher, respectively. After adjustment for family socioeconomic position, unhealthy diet and physical inactivity, these ORs fell to 1.80 (0.99-3.29) and 1.56 (0.87-2.79), respectively. In the case of obesity, the age- and sex-adjusted ORs in these quartiles of both indicators of socioeconomic context were 3.35 (1.06-10.60) and 3.29 (1.03-10.52), respectively, rising to 3.77 (1.12-12.70) and 3.42 (1.00-11.68) after adjustment for the remaining variables. The highest OR was observed in the third quartile, except in the case of the relationship between per capita income and obesity. No relationship between the number of sport facilities per 1,000 population and physical inactivity was observed. CONCLUSION: The socioeconomic context is associated with obesity but not with overweight children in Madrid. The relationship is not explained by family socioeconomic position, risk behaviors and availability of sports facilities.

Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España / Socioeconomic pattern in unhealthy diet in children and adolescents in Spain

OBJETIVO: Investigar la posible asociación de patrones alimentarios relacionados con la obesidad y la posición socioeconómica en la población infantil y adolescente española. DISEÑO: Estudio descriptivo transversal. Participantes: Los datos proceden de la Encuesta Nacional de Salud de 2007, realizada a una muestra representativa española de 0 a 15 años. En este estudio se han analizado 6.143 sujetos de 5 a 15 años. Mediciones principales: Se ha estimado la prevalencia de omisión de desayuno, la prevalencia de bajo consumo de fruta y verdura y la prevalencia de alto consumo de comida rápida, snacks y bebidas azucaradas. Los indicadores de posición socioeconómica han sido el nivel de estudios y la clase social de la persona que aportaba más ingresos económicos al hogar. En cada consumo de alimentos se han estimado las diferencias socioeconómicas mediante la razón de prevalencia, tomando como referencia la categoría socioeconómica más alta. RESULTADOS: Tanto en la infancia como en la adolescencia la magnitud de la razón de prevalencia muestra un gradiente socioeconómico inverso en todos los consumos de alimentos investigados: la menor y la mayor razón de prevalencia se observa en los sujetos de familias de posición socioeconómica más alta y más baja, respectivamente. CONCLUSIÓN: En la población infantil y adolescente española la alimentación no saludable relacionada con la obesidad muestra un patrón socioeconómico claro

OBJECTIVE: To investigate the possible association of dietary patterns associated with obesity and socioeconomic status in Spanish children and adolescents. DESIGN: Cross-sectional study. Participants: Data were drawn from the 2007 National Health Survey, conducted on a representative sample of Spanish 0-15 years. In this study we have analyzed 6143 subjects from 5 to15 years. Main measurements: It has been estimated prevalence of breakfast skipping, the prevalence of low consumption of fruit and vegetable and the prevalence of high fast food, snacks and sugary drinks consumption. Socioeconomic status indicators were educational level and social class of primary household earner. In each type of food consumption socioeconomic differences were estimated by prevalence ratio using the higher socioeconomic status as reference category. RESULTS: Both in childhood and adolescence, the magnitude of the prevalence ratio shows an inverse socioeconomic gradient in all foods consumption investigated: the lowest and highest prevalence ratios have been observed in subjects from families of higher socioeconomic status and lower, respectively. CONCLUSION: Unhealthy food related with obesity show a clear socioeconomic pattern in Spanish children and adolescents

[Inequalities in physical inactivity according educational level in Spain, 1987 and 2007]. / Desigualdades en inactividad física según el nivel de estudios en España, en 1987 y 2007.

OBJECTIVE: To compare the magnitude of inequalities in the frequency of physical inactivity in Spain in 1987 and 2007, and assess whether the magnitude of inequality varies depending on the wealth of the area of residence. DESIGN: Descriptive cross-sectional study, national scope. PARTICIPANTS: Data from the National Health Survey, 1987 and 2007, adult population between 25-64 years: 30,000 individuals (1987) and 29,478 (2006/7). MAIN MEASUREMENTS: Main outcomes variable, leisure-time physical inactivity; exposure factor, educational level. An analysis was made of the prevalence and association using odds ratio (OR). Adjustment for socioeconomic variables: age, marital status, employment status, social class of head of household, and household income. RESULTS: Physical inactivity prevalence decreased in the two decades. There were more than three times more inactive males among those with primary education or less, compared to those with university studies. The magnitude of inequalities has increased in time: in a 45-64 years old man with primary school education: OR 2.43 (1.91-3.09) in 1987, to OR 2.77 (2.17-3.54) in 2007, adjusted for all socioeconomic variables. CONCLUSIONS: The prevalence of physical inactivity decreased between 1987 and 2007, and the largest decreases were in individuals with university studies. The gap in the differences in prevalence and OR of leisure-time physical inactivity has increased over time. It's necessary to contribute, with health education strategies and equity promotion are needed to help reduce the inequalities in risk behaviors.

[Socioeconomic pattern in unhealthy diet in children and adolescents in Spain]. / Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España.

OBJECTIVE: To investigate the possible association of dietary patterns associated with obesity and socioeconomic status in Spanish children and adolescents. DESIGN: Cross-sectional study. PARTICIPANTS: Data were drawn from the 2007 National Health Survey, conducted on a representative sample of Spanish 0-15 years. In this study we have analyzed 6143 subjects from 5 to 15 years. MAIN MEASUREMENTS: It has been estimated prevalence of breakfast skipping, the prevalence of low consumption of fruit and vegetable and the prevalence of high fast food, snacks and sugary drinks consumption. Socioeconomic status indicators were educational level and social class of primary household earner. In each type of food consumption socioeconomic differences were estimated by prevalence ratio using the higher socioeconomic status as reference category. RESULTS: Both in childhood and adolescence, the magnitude of the prevalence ratio shows an inverse socioeconomic gradient in all foods consumption investigated: the lowest and highest prevalence ratios have been observed in subjects from families of higher socioeconomic status and lower, respectively. CONCLUSION: Unhealthy food related with obesity show a clear socioeconomic pattern in Spanish children and adolescents.

Decreasing income inequality and emergence of the association between income and premature mortality: Spain, 1970-2010.

This study evaluates the relationship between income and mortality in Spain over a long period of declining in income inequality. The ratio between income in the richest and poorest provinces was 2.74 in 1970 and 2.10 in 2010. Pearson correlation coefficients for the association between provincial income and the measures of mortality were estimated, as well as absolute and relative differences between the mortality rates of the poorest and richest provinces. The correlation coefficient between income and infant mortality decreased from -0.59 in 1970 to -0.17 in 2010, and lost significance from 1995 onwards. The coefficient for premature all-cause mortality increased from -0.04 in 1970 to -0.40 in 2010, and acquired significance beginning in 2005. The coefficient also increased in mortality from cardiovascular, respiratory and digestive diseases. No association was found between provincial income and cancer mortality or mortality from injuries. The findings on premature mortality do not support the theory that decreasing income inequality will lead to reduced inequalities in mortality.

Area-based socioeconomic environment, obesity risk behaviours, area facilities and childhood overweight and obesity: socioeconomic environment and childhood overweight.

OBJECTIVE: The objective of this study is to evaluate whether the relation between area-based socioeconomic environment and childhood obesity can be explained by household socioeconomic position, obesity-related risk behaviours and area facilities. METHODS: Two indicators of socioeconomic environment based on wealth and deprivation were estimated in a sample of 4529 Spanish children and adolescents in 2006. Multilevel logit models were used to calculate the relation between each indicator and obesity. RESULTS: After adjusting for socioeconomic position and risk behaviours, no relation was observed between wealth and overweight; however, obesity prevalence was 1.45 times higher in subjects living in areas with lower wealth than in those living in areas with higher wealth. After adjusting for these variables, the prevalence of overweight and obesity in subjects living in deprived areas was, respectively, 1.26 and 1.63 higher than in those living in non-deprived areas. There was a graded association between number of sports facilities and prevalence of physical inactivity, but no relation was found between the price of fruits and vegetables and frequency of consumption. CONCLUSION: The relation of socioeconomic environment with childhood obesity could not be explained by household socioeconomic position or obesity-related risk behaviours. Availability of sport facilities may mediate this relation.

Competencias y contenidos comunes de salud pública en los programas universitarios de grado / Common competencies and contents in public health in graduate programs

Objetivo Identificar competencias y contenidos básicos de salud pública en los programas de grado de enfermería, farmacia, magisterio, medicina, nutrición humana y dietética, óptica y optometría, relaciones laborales y recursos humanos, y trabajo social, y realizar propuestas de mejora. Métodos Organización del taller Contenidos de salud pública en los programas de grado en la XXI Escuela de Salud Pública de Menorca. Formación de ocho grupos coordinados por 37 profesores de universidades españolas seleccionados a través de informantes clave y bola de nieve. Se utilizaron dos estudios sobre competencias profesionales en salud pública, y los programas de los participantes, para analizar las competencias profesionales de salud pública, los contenidos y las recomendaciones para mejorar los programas de salud pública. Cada grupo trabajó sobre un grado y se compartieron los resultados. Resultados Se identificaron competencias profesionales para las tres funciones esenciales de salud pública en todas las titulaciones excepto en magisterio, óptica y optometría, y trabajo social. En enfermería, magisterio, nutrición humana y dietética, y trabajo social, se rescribieron competencias para destacar el papel de cada profesional en las funciones de salud pública. Los grupos coincidieron en los temas de introducción (conceptos fundamentales y determinantes de la salud) y en las estrategias de intervención. Conclusión Se identifican competencias y contenidos comunes en los grados. La actualización de contenidos de salud pública contribuiría a definir y visibilizar el perfil salubrista de los distintos profesionales(AU)

Objective To identify fundamental public health competencies and contents in nursing, pharmacy, teaching, medicine, human nutrition and dietetics, optics and optometry, labor relations and human resources, and social work in graduate programs and to formulate proposals for their improvement. Methods The workshop on Public health contents in graduate programs in the XXI Menorca Public Health School was organized as follows: eight groups were set up, coordinated by 37 Spanish university teachers participating in the workshop and selected through key informants and snowball techniques. Two studies on public health professional competencies and the participants’ own graduate programs were used to discuss public health professional competencies and contents and establish recommendations to improve public health programs. Each group worked on a particular degree course and the results were shared in plenary. Results Professional competencies for the three essential public health functions were indentified in all the degrees, except teaching, optics and optometry, and social work. Some of the competencies included in degrees in nursing, teaching, human nutrition and dietetics, and social work were rewritten to highlight the role of each type of professional in public health functions. The groups agreed on the introductory topics (basic concepts and health determinants) and intervention strategies. Conclusion Common competencies and contents were identified in graduate programs. Updating public health contents in graduate programs would help to define and promote the profile of public health professionals (AU)

[Common competencies and contents in public health in graduate programs]. / Competencias y contenidos comunes de salud pública en los programas universitarios de grado.

OBJECTIVE: To identify fundamental public health competencies and contents in nursing, pharmacy, teaching, medicine, human nutrition and dietetics, optics and optometry, labor relations and human resources, and social work in graduate programs and to formulate proposals for their improvement. METHODS: The workshop on Public health contents in graduate programs in the XXI Menorca Public Health School was organized as follows: eight groups were set up, coordinated by 37 Spanish university teachers participating in the workshop and selected through key informants and snowball techniques. Two studies on public health professional competencies and the participants' own graduate programs were used to discuss public health professional competencies and contents and establish recommendations to improve public health programs. Each group worked on a particular degree course and the results were shared in plenary. RESULTS: Professional competencies for the three essential public health functions were indentified in all the degrees, except teaching, optics and optometry, and social work. Some of the competencies included in degrees in nursing, teaching, human nutrition and dietetics, and social work were rewritten to highlight the role of each type of professional in public health functions. The groups agreed on the introductory topics (basic concepts and health determinants) and intervention strategies. CONCLUSION: Common competencies and contents were identified in graduate programs. Updating public health contents in graduate programs would help to define and promote the profile of public health professionals.

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century.

BACKGROUND: A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. METHODS: The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. RESULTS: The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. CONCLUSIONS: The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.

Heterogeneity in the association between socioeconomic position in early life and adult self-rated health in two birth cohorts of Spanish adults.

BACKGROUND: The purpose of this work was to evaluate the association between socioeconomic circumstances in early life and poor self-rated health in adulthood, and to determine whether this association varies depending on birth cohort. METHODS: Using data from the 2005 Living Conditions Survey carried out in a Spanish population sample, separate analyses were made for persons born between 1941 and 1959 who lived their childhood and adolescence in a period marked by absence of economic growth in Spain, and those born between 1960 and 1980. The authors estimated of the relation of financial difficulties in adolescence, occupation of father, education of father and education of mother with poor self-reported health, adjusted for the measures of socioeconomic position in adulthood. Also evaluated was the possibility of interaction between early and adult socioeconomic position and the cumulative effect of low socioeconomic position across the life course. RESULTS: In the two cohorts, the presence of financial difficulties in adolescence showed an association with an increased risk of poor self-rated health; in contrast, the relation of occupation and education of parents with poor self-rated health varied depending on the birth cohort and gender of the study subjects. The effect of family financial situation was shown to accumulate over the life course, whereas the effect of socioeconomic position across the life course was heterogeneous when occupation and education of parents were used. CONCLUSION: The importance of financial difficulties in the household has probably not varied over time; in contrast, the heterogeneity of the findings regarding occupation and education of parents suggests that the importance of these indicators and, consequently, their aetiological pathways may differ depending on the gender and birth cohort of the study subjects.