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Biomedical subjects

P Guallar-Castillón

Publications and source records attributed to P Guallar-Castillón.

At least 19 recordsLinked to original sources
PubMed2005

Changes in body weight and health-related quality-of-life in the older adult population.

BACKGROUND: No other study has ascertained the short-term impact of weight change on health-related quality-of-life (HRQL) on a national sample of older adults. OBJECTIVE: To examine the relationship between change in body weight and HRQL among the older adult population. METHODS: We carried out a prospective study from 2001 to 2003 of a cohort of 2364 persons, representative of the noninstitutionalized Spanish population aged 60 y and over. Weight changes during the period 2001-2003 were self-reported, and HRQL in 2003 was measured with the SF-36 questionnaire. Analyses adjusted for the principal confounders. RESULTS: Among nonobese women (body mass index (BMI) 18.5-29.9 kg/m(2)), and compared to those who underwent no important weight change, weight loss was associated with a clinically significant worsening in the role-physical, vitality, and social functioning SF-36 scales. Among obese women (BMI> or =30 kg/m(2)), weight gain led to a reduction in HRQL for four of the eight SF-36 scales, while weight loss was associated with worse scores in role-emotional and mental health scales. Results were usually similar for men, though of lower magnitude. In both sexes, weight change was associated with a reduction of over 5 points on several physical and mental scales of the SF-36, which indicates a clinically relevant worsening in HRQL. CONCLUSION: Weight change is associated with worse HRQL among the older adults, principally women. From the stance of HRQL, it is desirable to prevent weight gain, especially among the obese, and weight loss, especially among the nonobese.

Aged↗
PubMed2003

A simple estimate of mortality attributable to excess weight in the European Union.

OBJECTIVE: To estimate the current burden of mortality attributable to excess weight in the European Union (EU). METHODS: Prevalence of overweight (body mass index, BMI 25-29.9 kg/m(2)) and obesity (BMI >or=30 kg/m(2)) were based on self-reported data from a survey with samples representative of the 15 EU Member States in 1997. Primary source of relative risk (RR) of death by BMI was the first American Cancer Prevention Study (CPS I). Additional calculations were performed to account for effect of smoking (using CPS I data for non- or never-smokers), for pre-existing illness (using the second CPS, CPS II, data for healthy never-smokers) and using RRs derived from European rather than US data (using data from a meta-analysis of prospective studies). Mortality attributable to excess weight was calculated by combining the prevalences of overweight and obesity, the RRs, and the number of deaths in the EU countries. RESULTS: Annual deaths attributable to overweight and obesity totalled approximately 279 000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304 000 deaths were attributable to excess weight. In analyses using RRs which controlled for both smoking and history of disease, the number of deaths attributable to excess weight was estimated at about 337 000 based on European data and at about 401 000 based on US data. In the EU, therefore, a minimum of 279 000 deaths were attributable to excess weight (7.7% of all deaths, varying from 5.8% for France through 8.7% for the UK). More attributable deaths occurred among the obese (175 000) than among the overweight (104 000). Around 70% were cardiovascular disease deaths (195 000) and 20% cancer deaths (53 000). CONCLUSION: Mortality attributable to excess weight is a major public health problem in the EU. At least one in 13 annual deaths in the EU are likely to be related to excess weight.

Adult↗
PubMed2003

One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial.

AIMS: To assess the effectiveness of a smoking cessation intervention at the workplace. The intervention was adapted to smokers' tobacco dependence, and included minimal structured counselling at the first visit (5-8 minutes), nicotine patches for three months, and three sessions of counselling for reinforcement of abstinence (2-3 minutes) over a three month period. METHODS: Open randomised trial with two groups: the intervention group, and the control group which was subjected to standard clinical practice, consisting of short (30 seconds to one minute) sporadic sessions of unstructured medical antismoking advice. The trial was carried out among 217 smokers of both sexes, aged 20-63 years, motivated to quit smoking and without contraindications for nicotine patches, who were employees at a public transport company and at two worksites of an electric company. The main outcome measure was self reported tobacco abstinence confirmed by carbon monoxide in expired air </=10 ppm. Analysis was performed according to intention-to-treat. RESULTS: The rate of continuous abstinence at 12 months was 20.2% for the intervention versus 8.7% for the control group (OR: 2.58; 95% CI: 1.13 to 5.90; p = 0.025). In subgroup analyses, effectiveness of the intervention did not vary substantially with age, tobacco dependence, number of cigarettes smoked per day, number of years of tobacco consumption, degree of desire to quit smoking, time spent with smokers, subjective health, and presence of tobacco related symptoms. Weight gain at 12 months was similar for both groups (1.69 kg in the intervention v 2.01 kg in the control group; p = 0.21). CONCLUSIONS: A simple and easily generalisable intervention at the workplace is effective to achieve long term smoking cessation. In a setting similar to ours, nine subjects would have to be treated for three months for one to achieve continuous abstinence for 12 months.

Adolescent↗
PubMed2002

Self-perception of being overweight in Spanish adults.

OBJECTIVE: To describe the frequency, distribution and trend in misperceived overweight and obesity. DESIGN: Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population. SETTING: Spanish adult population aged 20 y and over. SUBJECTS AND INTERVENTIONS: A total of 11 496 men and women aged 20 y and over with a body mass index (BMI) >or=25 kg/m(2). MAIN OUTCOME MEASURES: Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height. RESULTS: Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64 y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25-26.9 kg/m(2) in 1995/1997 did not perceive themselves to be overweight. CONCLUSIONS: Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

Adult↗
PubMed2002

The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women.

OBJECTIVE: To examine the relationship of overweight and obesity with subjective health and use of health-care services among women in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a 13 244-woman sample representative of the non-institutionalised Spanish population aged 16 y and over. Information was collected through home-based interviews. Multiple logistic regression models were used to calculate odds ratios for suboptimal health (fair, poor or very poor) and utilisation of health-care services by women with normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)) and obesity (BMI>or=30 kg/m(2)). Analyses were adjusted for age, education level, occupation, civil status, social support, tobacco use, alcohol consumption, physical activity at work and during leisure time, job status and town of residence. RESULTS: Frequency of suboptimal health was higher in women with overweight (OR 1.7; 95% CI 1.5-1.9) and obesity (OR 2.1; 95% CI 1.8-2.5) than in those with normal weight. Overweight and obese women visited the physician, used hospital emergency services and took medication with greater frequency than did women of normal weight. There was a positive dose-response relationship (P<0.05) of BMI>or=18.5 kg/m(2) with suboptimal health and utilisation of health-care services. These associations were not wholly explained by BMI-related risk factors and chronic diseases, since their statistical significance remained unchanged and their magnitude was only slightly reduced after adjustment for those factors. The association of overweight and obesity with the use of health-care services did not vary with age, educational level or presence of chronic disease. CONCLUSION: Overweight and obese women have worse subjective health and make greater use of health-care services. This finding is an additional argument for implementing weight-control programmes in Spain.

Adolescent↗
PubMed2002

Systolic vs diastolic blood pressure: community burden and impact on blood pressure staging.

Systolic blood pressure (SBP) is a more frequent cardiovascular risk factor than diastolic blood pressure (DBP), and has a greater impact on blood pressure staging, though this can vary with age, sex and country. Therefore this paper compares SBP and DBP in terms of community burden and impact on blood pressure staging, among Spain's middle-aged population. Data were drawn from a cross-sectional study on a representative sample of the Spanish population aged 35-64 years. Blood pressure was determined under standardised conditions, and was classified as per WHO-ISH and JNC-VI criteria. Prevalence of SBP > or =140 mm Hg was 34.1%, and that of DBP > or =90 mm Hg, 30.9%. A total of 12% of subjects had isolated systolic hypertension (ISH) and 8.7% had isolated diastolic hypertension (IDH). Of treated hypertensives, 31% had their SBP controlled and 34% their DBP controlled. Of subjects not undergoing antihypertensive drug therapy, 60.8% had congruent SBP and DBP levels, 22.5% were up-staged on the basis of their SBP, and 16.7% were up-staged on the basis of their DBP. SBP alone thus correctly classified JNC-VI staging in 83.3% of subjects vs 77.5% for DBP alone. It was solely among the population >50 years of age, in both sexes, that systolic proved more frequent than diastolic hypertension, ISH greater than IDH prevalence, SBP worse than DBP control, and the percentage of SBP higher than that of DBP up-staged subjects. SBP constitutes a greater community burden than does DBP, and has a greater impact on blood pressure staging in Spain's middle-aged population. However, the differential impact of SBP and DBP upon blood pressure burden and staging is favourable to SBP only among subjects >50 years old. These findings are in accordance with recent guidelines on hypertension management.

Adult↗
PubMed2001

[Smoking and subjective health in Spain].

BACKGROUND: To examine the relationship between smoking and subjective health in Spain. MATERIAL AND METHOD: Datacome from the 1993 National Health Survey. Analyses were performed with logistic regression, adjusting for the main confounding factors. RESULTS: Among those less than 25 years, there is a dose-response relationship (p = 0.0001)between cigarette consumption and suboptimal health (fair, pooror very poor health). CONCLUSIONS: Smoking controlactivities should inform on the worse subjective health of youngsmokers, for whom other effects of tobacco smoking are less relevant because they appear to happen in the distant future.

Adolescent↗
PubMed2001

[The transition from acute to chronic ischemic heart disease in Spain, 1980-1994].

BACKGROUND AND OBJECTIVES: The remarkable increase in hospital admissions from heart failure in Spain in the last few years may result paradoxical because it coincides with a decrease in ischemic heart disease mortality, the leading cause of heart failure. A plausible explanation is the increase in ischemic heart disease survival, derived from the recent therapeutic advances, which will translate into an increase in the chronic forms of disease. Thus, an analysis was made of mortality and hospital admission trends due to acute and chronic ischemic heart diseases in the 1980-1994 period in Spain. METHODS: Population-based study of temporal trends with data of primary diagnosis of acute (CIE-9: 410-411) and chronic (CIE-9: 412-414) ischemic heart disease obtained from the National Vital Statistics and the National Survey of Hospital Morbidity. RESULTS: The number of deaths due to acute ischemic heart disease has increased by 8.3%, from 18,559 in 1980 to 20,101 in 1994. Deaths due to chronic ischemic heart disease increased by 49.3%, from 4,703 in 1980 to 7,020 in 1994. As a result, chronic forms accounted for 20.2% of all deaths attributable to ischemic heart disease in 1980 and 25.8% in 1994. The age-adjusted acute ischemic heart disease mortality rates decreased by 20.1%, whereas those due to chronic increased by 14.6%. The number and rate of age-adjusted hospital admissions increased remarkably for both acute and chronic ischemic heart disease. Nevertheless, the increase observed with chronic form was higher, from 39.4% of all hospital admissions due to ischemic heart disease in 1980 to 58.4% in 1994. This classification of ischemic heart disease was more notorious among males and younger patients. CONCLUSION: Currently, we are witnessing a transition from acute to chronic ischemic heart disease. That partly explains the increase in hospital care for heart diseases, particularly ischemic heart disease and heart failure.

Adult↗
PubMed2001

Consumption of alcoholic beverages and subjective health in Spain.

STUDY OBJECTIVE: To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN: Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING: The 1993 Spanish National Health Survey. PARTICIPANTS: A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS: Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1-2 drinks per day) or moderate consumption (3-4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p<0.001 for total alcohol, p=0.023 for wine, and p=0.030 for beer). In contrast, for consumption of spirits the prevalence of ill health in moderate drinkers was lower than in non-drinkers, with no clear relation at higher consumption. While persons reporting a preference for wine had a lower frequency of suboptimal health than did abstainers, they showed no difference in frequency of subjective ill health with respect to persons with preference for other types of drink or no preference whatsoever. CONCLUSIONS: The higher the consumption of total alcohol, wine and beer, the lower the prevalence of suboptimal health. These results differ from those obtained in several Nordic countries, where a "J shaped" relation has been observed for total alcohol and wine, and suggest that the relation between alcohol consumption and subjective health may be different in Mediterranean countries.

Adolescent↗
PubMed2000

Alzheimer's risk associated with human apolipoprotein E, alpha-2 macroglobulin and lipoprotein receptor related protein polymorphisms: absence of genetic interactions, and modulation by gender.

Apolipoprotein E (apoE), the lipoprotein receptor related protein (LRP) and alpha-2 macroglobulin (alpha2M) have been proposed as a functional complex involved in amyloid clearance, a crucial event for Alzheimer's disease development. In this work, we present an epidemiological approach aimed to study the interactions among these genes, age and gender. This approach did not reveal significant associations between the genes; however, the present study indicated that the risk associated with APOE promoter and LRP gene polymorphisms is modulated by gender.

Age Factors↗
PubMed2000

The association of tobacco and alcohol consumption with the use of health care services in Spain.

BACKGROUND: Information on the impact of tobacco and alcohol consumption on the use of health services is scant and partially inconsistent. This paper examines the relationship between tobacco and alcohol consumption and the use of health care services in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a random 21,120-person representative sample of Spain's noninstitutionalized population ages 16 years and older. Information was obtained through home-based interviews. RESULTS: Compared with never smokers, male smokers of more than 20 cigarettes/day tend to be hospitalized more frequently (odds ratio (OR) 1.31; 95% confidence limits (CL) 0.89-1.93) and make greater use of hospital emergencies (OR 1.51; 95%CL 1.13-2.01; P < 0.01). Among female smokers of more than 20 cigarettes/day, hospitalizations (OR 1.62; 95%CL 0.80-3.26) and medical visits (OR 1. 35; 95%CL 0.79-2.30) are also higher than among never smokers, although the associations do not reach statistical significance. Compared with never smokers, ex-smokers of both sexes make greater use of health care services (P < 0.01 for most services). There is a negative dose-response relationship (P < 0.001) between alcohol consumption and utilization of hospital and ambulatory services, for both sexes. Results are reasonably consistent across all age groups and are observed after adjustment for the principal confounding factors. We have found no evidence of a tobacco-alcohol interaction with the use of health care services. CONCLUSIONS: Smokers and ex-smokers make greater use of health care services. Control of smoking might reduce the use of such services and the ensuing human and economic costs. However, as alcohol consumption increases, the use of health care services decreases. This finding should not be used to promote even the moderate consumption of alcoholic drinks.

Adolescent↗
PubMed2000

[Geographic variation in hospitalizations and mortality related to congestive heart failure in Spain, 1980-1993].

BACKGROUND AND OBJECTIVES: Geographical differences in hospitalizations and mortality for heart failure serve to estimate the potential for reducing the associated hospital and demographic burden on the population. Accordingly, the objective of this paper is to analyze the geographic variation in heart failure hospitalizations and mortality in Spain during the period of 1980-1993, and to examine their potential determinants. METHODS: Data on the primary diagnosis of heart failure were taken from the National Hospital Morbidity Survey and National Vital Statistics. Information on determinants of heart failure were obtained from large-scale nationally representative surveys conducted by the National Statistics Office. RESULTS: The period of 1980-1993 witnessed a decrease in geographical differences in heart failure hospitalizations and mortality. Theoretically, however, heart failure hospitalizations and mortality among persons aged > or = 45 years could still be further reduced by 60% and 30% respectively. In the period of 1989-1993 heart failure hospitalizations were correlated (p < 0.05) with ischaemic heart disease hospitalizations and the number of beds/1,000 inhabitants. Heart failure mortality showed a statistically significant correlation (p < 0.05) with ischaemic heart disease mortality, illiteracy and unemployed status. CONCLUSIONS: There is a great potential for a reduction in the hospital and demographic burden of heart failure in Spain. Control of ischaemic heart disease and a reduction in the geographical differences in socio-economic status would probably contribute to lessening the healthcare burden of heart failure in Spain.

Aged↗
PubMed2000

The association between mortality from ischaemic heart disease and mortality from leading chronic diseases.

AIMS: Coronary risk factors raise the risk of other chronic disorders. We therefore tested the hypothesis that the geographic distribution of ischaemic heart disease mortality is associated with that of other chronic diseases with which it shares risk factors. METHODS AND RESULTS: For the 50 provinces of Spain, we collected mortality data for the period 1980-1995 from the national vital statistics. We calculated age-adjusted mortality rates for the leading causes of death in quintiles of provincial distribution of ischaemic heart disease mortality, and correlation coefficients with respect to provincial ischaemic heart disease mortality. As expected, because they share risk factors with ischaemic heart disease, mortality from cerebrovascular disease, malignant tumours, lung cancer, respiratory diseases, chronic obstructive pulmonary disease, diseases of the digestive system, cirrhosis of the liver and all causes, increase with the rise from lower to higher quintiles of ischaemic heart disease mortality. Ischaemic heart disease mortality registered correlations over 0.5 (P<0.001) with mortality from many of the above diseases in the periods 1980-1984 and 1991-1995. Expectations were similarly borne out for disorders not sharing risk factors with ischaemic heart disease, in that mortality from prostate and breast cancer, injury and poisoning, traffic accidents and ill-defined causes in most cases did not show a provincial association with ischaemic heart disease mortality. In general, these results were observed for both sexes and across all age groups. CONCLUSION: Ischaemic heart disease mortality is associated with mortality from chronic diseases which share coronary risk factors, across provinces of Spain over the period 1980-1995. This suggests that the geographic variation in such chronic diseases is due to common factors, potentially susceptible to similar preventive interventions.

Adult↗
PubMed2000

[A form for the notification of cases of child abuse in Spain].

AIM: To design a form to collect national data on child abuse, which could be used by the autonomous communities and which could supply valid information for the investigation, intervention and prevention of child abuse in Spain. METHODS: A Delphi study was carried out with three questionnaires in which 59 experts from 16 autonomous communities participated. Of the experts, 53 answered the second questionnaire (89.9%) and 44 the third (74.6%). Each expert indicated whether, in his/her opinion, a specific item should be incorporated in a national register of child abuse. A consensus was considered to have been reached for a particular item when agreement between the experts was equal or higher than 85%. RESULTS: The final notification form agreed on by the participants has 29 items. It contains information on the identity of the child and the child's parents and details of the composition of the family unit and of the event that caused the notification. It also contains details of the reasons for suspecting abuse and the type of child abuse. CONCLUSIONS: We present a form agreed by consensus for the notification of child abuse that, when distributed nationally, will provide valid data for the whole of Spain.

Child↗
PubMed1999

[Environmental factors during early life and socioeconomic status in the present: which is more important for cardiovascular mortality in Spain?].

BACKGROUND: To examine whether provincial mortality from ischaemic heart disease and cerebrovascular disease in Spain in 1991-1995 is associated with infant mortality in 1930-1934, independently of illiteracy (an estimator of socioeconomic status) in 1991. MATERIAL AND METHODS: Population-correlation study. RESULTS: Infant mortality is correlated with mortality from ischaemic heart disease (r = 0.38; p < 0.01) and cerebrovascular disease (r = 0.41; p < 0.01). When adjusting for illiteracy rate in 1991, the correlation of infant mortality with ischaemic heart disease mortality is r = 0.01 (p = 0.93), and with cerebrovascular disease mortality is r = 0.25 (p = 0.08). CONCLUSIONS: Ischaemic heart disease and cerebrovascular disease mortality are moderately associated with infant mortality during the 1930s. This association might be explained by present socioeconomic status.

Adult↗
PubMed1999

[The decline in moderate alcohol consumption has been associated with a decrease in heavy drinkers in Spain in the 1987-1993 period].

BACKGROUND: To examine whether the decline in alcohol consumption among moderate drinkers, which has occurred in Spain in the period 1987-1993, has been associated with changes in the proportion of heavy drinkers and abstainers. SUBJECTS AND METHODS: The units of analysis have been the 17 administrative regions of Spain. Alcohol consumption data have been taken from the 1987 and 1993 National Health Interview Surveys. RESULTS: A decrease of 10 g/week in mean alcohol consumption among male moderate drinkers has been associated with a decrease of 1.2% (95% CI: 0.7-1.7%) in the proportion of heavy drinkers. The association was also observed among women, those over and below 45 years of age, and was stronger for wine than for other alcoholic beverages. CONCLUSION: The decrease in moderate consumption of alcohol has probably had a beneficial effect on the health of the Spanish population.

Adult↗
PubMed1999

Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care-based study. Monitorización Ambulatoria de la Presión Arterial (MAPA)-Area 5 Working Group.

Most of the previous studies on white coat hypertension were performed in hypertension clinics or academic settings and included relatively small series of patients. Consequently, the prevalence of white coat hypertension in primary care settings and the clinical and epidemiologic characteristics of this subgroup of patients are not well known. We performed this study to estimate the frequency of white coat hypertension in a population of mildly to moderately hypertensive subjects attended in a primary care setting and to examine possible epidemiologic and clinical factors that may identify these patients. Patients included in the study underwent clinical interview, measurement of clinic blood pressure (BP) on three visits, determination of serum lipids, glucose, uric acid, and urinary albumin excretion, 24-h ambulatory BP monitoring, and M-mode and Doppler echocardiography. Patients were classified as white coat hypertensives if their daytime ambulatory BP were < 135/85 mm Hg. We studied 345 patients, 136 (39%) of whom were diagnosed with white coat hypertension. The frequency of white coat hypertension was inversely proportional to the severity of clinic BP values. The diagnosis of white coat hypertension was independently associated with female gender and low educational level. Left ventricular mass index and urinary albumin excretion were lower in the white-coat hypertensive group compared with the group with sustained hypertension. Our results show that a high proportion of patients with mild to moderate hypertension attended in a primary care setting have white coat hypertension. Some clinical characteristics may be helpful in the identification of this group of subjects. White coat hypertensives show less target-organ damage than sustained hypertensive patients.

Adult↗