Association of physical activity with body mass index, waist circumference and incidence of obesity in older adults.

Background: There is limited, and inconsistent, data on the prospective association between physical activity and surrogate markers of adiposity in older adults. We aim to determine the prospective association of leisure time physical activity (LTPA) with body mass index (BMI), waist circumference (WC) and the incidence of obesity. Methods: This prospective analysis included 7144 individuals with a mean age of 67 ± 6.2 years, from the PREvención con DIeta MEDiterránea (PREDIMED) study. BMI and WC were measured and LTPA was recorded using the Minnesota Leisure Time Physical Activity Questionnaire. Exposure and outcome variables were calculated as cumulative average of repeated measurements. Results: Total LTPA was inversely associated (P < 0.001) with BMI and WC. The difference in BMI and WC between extreme quintiles of LTPA (Q1-Q5) was 2.1 kg/m2 (95% confidence interval (CI) 1.68; 2.49, P < 0.001) and 4.8 cm (CI 2.28; 7.25, P < 0.001), respectively. Low-intensity LTPA was inversely associated with BMI but not with WC, while moderate/vigorous LTPA showed an inverse relationship with BMI and WC. The hazard of general and abdominal obesity incidence decreased across quintiles of total and moderate/vigorous LTPA (P < 0.001 for both), whereas low-intensity LTPA was inversely associated with the incidence of general obesity (P < 0.001). Conclusion: LTPA was inversely associated with BMI, WC and incidence of general and abdominal obesity. The finding that low-intensity LTPA was inversely related to BMI and the incidence of obesity is of particular importance because this level of physical activity could be a feasible option for many older adults.

[Epistemology as health research propedeutics]. / La epistemología como propedéutica de la investigación sanitaria.

The present article advocates the need for epistemological training prior to the study of biostatistics and epidemiology. Taking Plato as the starting point, we reached this conclusion after analysis of the paradigm problems affecting biostatistics and the connotations of causality and research time in major epidemiological designs. External validity is intimately linked to the philosophical problem of induction. Evidence-based health could be renamed as "neopositive health" and could possibly have a French origin.

La epistemología como propedéutica de la investigación sanitaria / Epistemology as health research propedeutics

En este trabajo se defiende la necesidad de un conocimiento epistemológico previo al estudio de laestadística y de la epidemiología. Tras un comienzo platónico, llegamos a esta conclusión después delanálisis de los problemas de paradigma que sufre la bioestadística y de las connotaciones de causalidady de tempo investigacional que tienen los principales dise˜nos epidemiológicos. La validez externa estáíntimamente unida al problema filosófico de la inducción. La «salud basada en la evidencia» podría serrebautizada como «salud neopositiva» y realmente tendría un origen francés (AU)

The present article advocates the need for epistemological training prior to the study of biostatisticsand epidemiology. Taking Plato as the starting point, we reached this conclusion after analysis of theparadigm problems affecting biostatistics and the connotations of causality and research time in majorepidemiological designs. External validity is intimately linked to the philosophical problem of induction.Evidence-based health could be renamed as “neopositive health” and could possibly have a French origin (AU)

Multivariate explanatory model for sporadic carcinoma of the colon in Dukes' stages I and IIa.

OBJECTIVE: We obtained before an explanatory model with six dependant variables: age of the patient, total cholesterol (TC), HDL cholesterol (HDL-C), VLDL cholesterol (VLDL-C), alkaline phosphatase (AP) and the CA 19.9 tumour marker. Our objective in this study was to validate the model by means of the acquisition of new records for an additional analysis. DESIGN: Non-paired case control study. SETTING: Urban and rural hospitals and primary health facilities in Western Andalusia and Extremadura (Spain). PATIENTS: At both the primary care facilities and hospital level, controls were gathered in a prospective manner (n= 275). Cases were prospective and retrospective manner collected on (n=126). MAIN OUTCOME MEASURES: Descriptive statistics, logistic regression and bootstrap analysis. RESULTS: The AGE (odds ratio 1.02; 95% CI 1.003-1.037) (p= 0.01), the TC (odds ratio 0.986; 95% C.I. 0.980-0.992) (p< 0.001) and the CA 19.9 (odds ratio 1.023; 95% C.I. 1.012- 1.034) (p<0.001) were the variables that showed significant values at logistic regression analysis and bootstrap. Berkson's bias was statistically assessed. CONCLUSIONS: The model, validated by means of logistic regression and bootstrap analysis, contains the variables AGE, TC, and CA 19.9 (three of the original six) and has a level 4 over 5 according to the criteria of Justice et al. (multiple independent validations) [Ann. Intern. Med.1999; 130: 515].

[1991-2004 follow-up of a Spanish general population cohort. Mortality and raising risk factors in the DRECE III Study (Diet and Risk of Cardiovascular Diseases in Spain)]. / Seguimiento de 1991 a 2004 de la mortalidad y los factores de riesgo emergentes en una cohorte de población general española. Estudio Drece III (Dieta y Riesgo de Enfermedades Cardiovasculares en España).

BACKGROUND: The DRECE III study is based on the follow up of a cohort representative of the Spanish general population. The mortality, its main causes and relevant risk factors have been analyzed. METHODS: The DRECE cohort is composed of 4783 subjects followed since 1991 to 2004 (70930 person-years). In 1991 a general medical exam including blood analysis and nutritional questionnaire was undertaken. Currently the age spam is from 18 to 73 years. Vital status and mortality causes were provided by the National Institute of Statistics. RESULTS: In this period, 125 deaths were registered: 53 persons (42.4%) due to cancer; 31 persons (24.8%) due to circulatory causes, of which 24 were due to cardiovascular origin. The remaining 41 (32.8%) deaths were included under the ICD 10 "Other chapters". For the all causes mortality the independent associated variables were: creatinina 1.5 mgr/dl, HR 3.78 (95% CI: 1.52-9.40); diabetes, HR 2.80 (95% CI: 1.74-4.46); male sex, HR 2.39 (I95% CI: 1.61-3.55); age, HR 1.08 (I95% CI: 1.07-1.10); and gammaglutamil transpeptidasa, HR 1.001 (I95% CI: 1.000-1.003). In the case of cancer mortality the risk factors founded were: age, HR 1.12 (I95% CI: 1.09-1.16); and tobacco, HR 1.33 (I95% CI: 1.14-1.54). For cardiovascular mortality were creatinina 1.5 mg/dl, HR 19.40 (I95% CI: 5.45-69.12); diabetes, HR 9.82 (I95% CI: 4.19-23.04); and age, HR 1.10 (I95% CI: 1.05-1.15). CONCLUSIONS: We obtain a mortality pattern where cancer is the most frequent cause. Classic risk factors appear associated to main death causes. Diabetes mellitus has an outstanding role as risk factor associated to early mortality. No specific diet data was associated neither to all causes mortality, nor to cardiovascular or cancer.

Seguimiento de 1991 a 2004 de la mortalidad y los factores de riesgo emergentes en una cohorte de población general española. Estudio DRECE III (dieta y riesgo de enfermedades cardiovasculares en España) / 1991-2004 follow up of an spanish general population cohort. Mortality and raising risk factors in the DRECE III study. (Diet and risk of cardiovascular diseases in Spain)

Fundamento: El estudio DRECE III se basa en el seguimiento de una cohorte de población general representativa de la sociedad española. El objetivo de este trabajo es analizar, tras 13 años de seguimiento, la mortalidad general, la distribución de la mortalidad por causas y los principales factores de riesgo asociados. Métodos: La cohorte DRECE se compone de 4.783 sujetos seguidos desde 1991 hasta 2004, el rango de edad al final se extiende desde los 18 a 73 años. Las personas participantes fueron seleccionadas mediante muestreo estratificado polietápico. Las causas de mortalidad han sido proporcionados por el Instituto nacional de Estadística. Las tasas se calcularon mediante regresión de Poisson y la identificación de factores de riesgo mediante la regresión de riesgos proporcionales de Cox. Resultados: En el periodo 1991-2004 fallecieron 125 sujetos, lo que se corresponde con una tasa de mortalidad total de 1.76 por 1000 habitantes. La distribución por causa de muerte fue: 53 personas por cáncer (42,4%) y 31 por causas circulatorias (24,8%) (24 por causa cardiovascular). Las 41 defunciones restantes (32,8%) se englobaron dentro de la categoría CIE 10 de "Otras". Para la mortalidad total las variables independientes asociadas fueron: creatinina1,5 mgr/dl, hazard ratio (HR) 3.78(IC 95%: 1,52-9,40); diabetes, HR 2,80; sexo masculino, HR 2,39 (I C95%: 1,61-3,55) ; edad, HR 1,08 (IC95%: 1,07-1,10); gammaglutamil transpeptidasa, HR 1,001 (IC95%: 1,000-1,003). Factores de riesgo asociados a cáncer fueron: edad, HR 1,12 (IC95%: 1,09-1,16); y tabaco, HR 1,33 (IC 95%: 1,14-1,54). Para la mortalidad cardiovascular fueron: creatinina 1.5 mg/dl, HR 19,40 (IC 95%: 5,45-69,12); diabetes, HR 9,82 (IC 95%: 4,19-23,04); y edad, HR 1,10 (IC 95%: 1,05-1,15). Conclusión: Se obtuvo un patrón de mortalidad en el que predomina el cáncer como causa más frecuente. Aparecen factores de riesgo clásicos asociados a las principales causas. La diabetes emerge como un factor muy llamativo asociado a mortalidad precoz. La dieta no se asoció a la mortalidad total (AU)

Background: The DRECE III study is based on the follow up of a cohort representative of the Spanish general population. The mortality, its main causes and relevant risk factors have been analyzed. Methods: The DRECE cohort is composed of 4783 subjects followed since 1991 to 2004 (70930 person-years). In 1991 a general medical exam including blood analysis and nutritional questionnaire was undertaken. Currently the age spam is from 18 to 73 years. Vital status and mortality causes were provided by the National Institute of Statistics. Results: In this period, 125 deaths were registered: 53 persons (42.4%) due to cancer; 31 persons (24.8%) due to circulatory causes, of which 24 were due to cardiovascular origin. The remaining 41 (32.8%) deaths were included under the ICD 10 "Other chapters". For the all causes mortality the independent associated variables were: creatinina 1.5 mgr/dl, HR 3.78 (95% CI: 1.52-9.40); diabetes, HR 2.80 (95% CI: 1.74-4.46); male sex, HR 2.39 (I95% CI: 1.61-3.55); age, HR 1.08 (I95% CI: 1.07-1.10); and gammaglutamil transpeptidasa, HR 1.001 (I95% CI: 1.000-1.003). In the case of cancer mortality the risk factors founded were: age, HR 1.12 (I95% CI: 1.09-1.16); and tobacco, HR 1.33 (I95% CI: 1.14-1.54). For cardiovascular mortality were creatinina 1.5 mg/dl, HR 19.40 (I95% CI: 5.45-69.12); diabetes, HR 9.82 (I95% CI: 4.19-23.04); and age, HR 1.10 (I95% CI: 1.05-1.15). Conclusions: We obtain a mortality pattern where cancer is the most frequent cause. Classic risk factors appear associated to main death causes. Diabetes mellitus has an outstanding role as risk factor associated to early mortality. No specific diet data was associated neither to all causes mortality, nor to cardiovascular or cancer (AU)

[Ambulatory blood pressure monitoring to study white coat syndrome in patients with hypertension seen in primary care]. / Estudio mediante monitorización ambulatoria de la presión arterial del efecto de bata blanca en hipertensos tratados y controlados en atención primaria.

INTRODUCTION AND OBJECTIVES: The white coat phenomenon is said to occur when the difference between systolic/diastolic blood pressure measured during visits to the doctor's office and in ambulatory recordings is greater than 20/10. These absolute differences, known as the white coat effect, may lead to normotensive patients being classified as having white coat hypertension (WCH). We used ambulatory blood pressure monitoring (ABPM) to monitor the prevalence and response (white coat effect, white coat hypertension or white coat phenomenon) in patients during pharmacological treatment for grade 1 or 2 hypertension, and 4 weeks after treatment was suspended under medical supervision. PATIENTS AND METHOD: Ambulatory blood pressure monitoring was used in 70 patients with hypertension that was well controlled with treatment. Blood pressure was recorded during treatment (phase 1) and 4 weeks after treatment was stopped (phase 2). RESULTS: 18 (26%) of the 70 patients did not participate in phase 2 because when medication was withdrawn, their blood pressure values became unacceptable and it was necessary to restart treatment. The white coat effect was significantly stronger in phase 1, and the prevalence of white coat phenomenon and white coat hypertension did not differ significantly between phases. At the end of phase 2 the prevalence of white coat hypertension was 33%. CONCLUSIONS: Withdrawal of antihypertensive medication in patients with well controlled grade 1 or grade 2 hypertension did not significantly modify the prevalence of white coat phenomenon or white coat hypertension. The white coat effect was greater while patients were on pharmacological treatment. One third of our patients were considered to have been mistakenly diagnosed as having hypertension.

[Influence on white coat effect and heart rate of antihypertensive agents used at a urban health center]. / Influencia sobre el efecto de bata blanca y la frecuencia cardiaca de los fármacos antihipertensivos usados en un centro de salud urbano.

BACKGROUND: We name white coat effect (WCE) to the difference between the systolic arterial pressure (SAP)/diastolic AP (DAP) of consulting room and the ambulatory obtained one with ambulatory blood pressure monitoring (ABPM). In our work we analyzed by means of ABPM, the influence of the antihypertensive medicaments on the WCE and the cardiac frequency of use of the antihypertensive ones. DESIGN: Almost experimental study (with a period before and a period later) and descriptive. SETTING: Primary care. Urban health centre. PARTICIPANTS AND MAIN MEASUREMENTS: Studies of ABPM were realized to 70 hypertense essential patients with good control of the arterial pressure after pharmacological treatment before suspending the antihypertensive medication (phase 1) and to the 4 weeks of leaving the treatment (phase 2). RESULT: Or all 70 hypertense patients. 18 (26%) did not manage to carry out the second ABPM (unbalanced during the wash) that forced to re-introduce the antihypertensive medicaments. The WCE systolic and diastolic is significantly more raised in patient males in treatment with diuretics with regard to which they use other pharmacological groups. The CF is significantly more raised in patient women who do not take blockaders thread (they use another group) with regard to they take it. In the blockaders alpha the CF is significantly more raised in the women who use it with regard to that they use antihypertensive other one. Of all 52 patients who were realized double ABPM, WCE was significantly top in phase 1 that in 2. CONCLUSION: In hypertense controlled patients, the diuretics (in males) are the pharmacological group that of more significant way influences on WCE, them raising with regard to the patients who take antihypertensive other one, being in influence the opposite on CF. The women with blockaders thread present values of CF significantly lower than those who use another antihypertensive medication; happening the inverse thing the blockaders alpha. In our consulting room exists a inadequate use of the antihypertensive ones. The WCE is significantly mayor when is submitted to pharmacological treatment.