Factors associated with adherence to the Mediterranean diet in the adult population.

Our aim was to analyze the variables associated with adherence to the Mediterranean diet in the adult population. We conducted a cross-sectional study in an established cohort of 1,553 healthy study participants (mean age=55 ± 14 years; 60.3% women). Mediterranean diet adherence was evaluated based on a 14-item questionnaire and the Mediterranean diet adherence screener, which defines adequate adherence as a score of ≥ 9. Physical activity was evaluated using the 7-day physical activity record. Sociodemographic, biological, and anthropometric variables were also evaluated. The differences between Mediterranean diet compliers and noncompliers are defined by the consumption of fruit, red meats, carbonated beverages, wine, fish/shellfish, legumes, pasta, and rice (P<0.01). Adherence was lower among individuals younger than 49 years of age. In the first age tertile, adherence was greater in women and in nonobese individuals, and the triglyceride levels were lower among compliers. In the second age tertile, the compliers exercised more and had a lower body fat percentage. In the third age tertile, the compliers also possessed less body fat. The logistic regression analysis revealed the following factors associated with improved Mediterranean diet adherence: more physical exercise (odds ratio=1.588), older age (odds ratio=2.162), and moderate alcohol consumption (odds ratio=1.342). The factors associated with improved Mediterranean diet adherence included female sex, age older than 62 years, moderate alcohol consumption, and more than 17 metabolic equivalents (METs)/h/wk of physical exercise. Poorer adherence was associated with males and obesity.

Blood pressure circadian pattern and physical exercise assessment by accelerometer and 7-day physical activity recall scale.

BACKGROUND: The relationship between regular physical activity, measured objectively and by self-report, and the circadian pattern of 24-hour ambulatory arterial blood pressure (BP) has not been clarified. METHODS: We performed a cross-sectional study in a cohort of healthy patients. We included 1,345 patients from the EVIDENT study (mean age 55 ± 14 years; 59.3% women). Physical activity was assessed using the 7-day physical activity recall (PAR) questionnaire (metabolic equivalents (MET)/hour/week) and the Actigraph GT3X accelerometer (counts/minute) for 7 days; ambulatory arterial BP was measured with a radial tonometer (B-pro device). RESULTS: The dipper-pattern patients showed a higher level of activity than nondipper patients, as assessed by accelerometer and 7-day PAR. Physical activity measures correlated positively with the percent drop in systolic BP (SBP; ρ = 0.19 to 0.11; P < 0.01) and negatively with the systolic and diastolic sleep to wake ratios (ρ = -0.10 to -0.18; P < 0.01) and heart rate (ρ = -0.13; P < 0.01). In logistic regression, considering the circadian pattern (1, dipper; 0, nondipper) as the dependent variable, the odds ratio of the third tertile of counts/minute was 1.79 (95% confidence interval [CI], 1.35-2.38; P < 0.01) and of MET/hour/week was 1.33 (95% CI, 1.01-1.75; P = 0.04) after adjustment for confounding variables. CONCLUSIONS: Physical activity, as evaluated by both the accelerometer and the 7-day PAR, was associated with a more marked nocturnal BP dip and, accordingly, a lower SBP and diastolic BP sleep to wake ratio. CLINICAL TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01083082.

Association of television viewing time with central hemodynamic parameters and the radial augmentation index in adults.

BACKGROUND: We conducted a study to explore the relationship between television viewing time and central hemodynamic parameters and the radial augmentation index (AIx) in adults. METHODS: Random sampling was used to select 732 individuals who attended primary-care centers as subjects for the study. The self-reported time that these individuals spent in viewing television was elicited with a questionnaire and included the number of hours that they spent watching television while sitting or lying down. The subjects' physical activity was estimated through accelerometers attached to their waists. Central hemodynamic parameters and the peripheral augmentation index adjusted for a heart rate of 75 bpm (PAIx75) were measured with pulse-wave application software (A-Pulse CASP). RESULTS: The subjects' systolic blood pressure (SBP) (central and peripheral), pulse pressure, and radial AIx showed significant differences between tertiles of television viewing time, with the lowest values in the first tertile (P < 0.01). After adjustment for age and sex, a multiple linear regression analysis showed an association of television viewing time with office SBP. Although the association of television viewing time with central SBP followed the same trend as for office BP, it did not reach statistical significance. After adjustment for age, sex, waist-to-height ratio, physical activity reflected by accelerometer data (counts/min), high-density lipoprotein cholesterol, smoking, antihypertensive and antidiabetic medication, and the use of lipid-lowering drugs, an increase in PAIx75 of 0.22 was estimated for each hour of increase in television viewing time (P < 0.01). CONCLUSIONS: Television viewing time was directly correlated with PAIx75 in an adult population. This correlation was maintained even after adjustment for physical activity, age, sex, and other cardiovascular risk factors.

Tasa de derivación y factores asociados a la calidad de la hoja de derivación en Atención Primaria / Influence of the primary care physician in the quantity and quality of referrals to Specialist Services

Objetivo. 1) Analizar la relación entre la cantidad y calidad de las hojas de interconsulta (IC) y los factores relacionados con el médico de familia (MF). 2) Conocer su distribución por especialidades.Diseño. Estudio descriptivo, transversal.Emplazamiento. Centro de salud urbano de la ciudad de Cuenca.Sujetos. Analizamos un total de 1.214 derivaciones realizadas a través del programa informático de explotación de datos (TURRIANO) por 7 MF, durante el último trimestre del año 2005.Mediciones principales. Se han analizado retrospectivamente las hojas de IC. Recogimos variables asociadas al MF y asociadas a la propia IC (especialidad a la que va dirigida, fecha y calidad). Se establecieron 3 categorías para valorar la calidad de las IC: “mala” (cumplía al menos uno de los criterios “ausencia de motivo de consulta y/o anamnesis de la enfermedad actual” y “ausencia de exploración física y/o exploraciones complementarias”), “aceptable” (presencia simultánea de los dos criterios anteriores) y “buena” (cumplía criterios de “aceptable” más la presencia de al menos uno de los siguientes: antecedentes familiares, antecedentes personales, tratamiento habitual, diagnóstico de sospecha).Resultados. La calidad de las derivaciones fue defi ciente en un 68,2%, aceptable en un 11,4%, y buena en un20,3%. Los servicios a los que más se derivó fueron Traumatología 14,7%, Oftalmología 11,8%, Ginecología11% y Dermatología 10,1%.La proporción de derivaciones buena/aceptable en las especialidades más demandadas fue: Dermatología66,7%, Traumatología 29,1%, Otorrinolaringología 23,3%, Ginecología 19,5% y Oftalmología 16,8%. En cuantoa la calidad aceptable/buena de la interconsulta, la variable formación MIR presentó una diferencia estadísticamente significativa (p = 0,03). El 28,6% tenía formación MIR, el 57,1% eran tutores y el 57,1% hombres.Conclusiones. El número de IC realizadas por un equipo de Atención Primaria (EAP) a Atención Especializada(AE) es una referencia de su correcto funcionamiento y de su capacidad de resolución. Encontramos una granvariabilidad en el número de las IC entre los distintos médicos, que no parece justifi carse por el número detarjetas y el volumen de trabajo. Disponer de formación especializada y tutorizar residentes parece relacionarsecon mayor capacidad de cumplimentación y calidad de las interconsultas

Objective. To analyze the relationship between the quantity and quality of referrals and factors related to the family physician (FP). To determine their distribution by specialities.Design. Descriptive, cross study.Setting. Primary care centre in Cuenca city.Subjects. We analyzed a total of 1,214 referrals, using the software package (TURRIANO), made by 7 familyphysicians during the last quarter of 2005.Main measurements. Referral forms were analysed retrospectively. We compiled variables associated with the family physician (fi gure 1) and with the referral itself (speciality to which it is addressed, date and quality).Three categories were established to assess the quality of referrals. Poor quality referrals met at least one ofthe 2 following criteria “lack of consultation reason (MC) and/or current history of the disease (AD)” and “lack of physical (PE) and/or complementary tests (CT)”. In acceptable referrals, the two previous criteria were present simultaneously. Finally, a referral was evaluated as good if it fulfi lled all the criteria for being acceptable plus thepresence of at least one of the following: Family history, personal history, routine treatment, diagnosis.Results. We analyzed 1,214 referrals. The quality of the referrals was poor in 68.2%, acceptable in 11.4% andgood in 20.3%. The services that most referrals were made to were Traumatology 14.7%, Ophthalmology 11.8%,Gyneacology 11%, and Dermatology 10.1%. The proportion of good/acceptable referrals in the most popularspecialities were: Dermatology 66.7%, Traumatology 29.1%, Otolaryngology 23.3%, Gyneacology 19.5% andOphthalmology 16, 8%.With regard to the acceptable /good quality of the referral only the variable training (MIR) presented a statisticallysignifi cant difference (p = 0, 03). Of the doctors considered, 28. 6% had MIR training, 57.1% were tutors and 57.1% were male.Conclusions. The number of referrals made by a Primary Health Care team (PC) to Specialist care (SC) is relatedto correct performance of this team and their ability to solve problems in their daily work.In our study there was a great variability in the number of referrals made by different doctors, which does notappear to be justifi ed by the number of cards and workload. Having specialist training and tutoring residents appears to be associated with a greater capacity and quality completion of referrals