Saving lives: Evidence from a conditional food supplementation program

Many governments in developing countries implement programs that aim to address nutrionalfailures in early childhood, yet evidence on the effectiveness of these interventions is scant. Thispaper evaluates the impact of a conditional food supplementation program on child mortality inEcuador. The Programa de Alimentaci?n y Nutrici?n Nacional (PANN) 2000 was implementedby regular staff at local public health posts and consisted of offering a free micronutrient-fortifiedfood, Mi Papilla, for children aged 6 to 24 months in exchange for routine health check-ups forthe children. Our regression discontinuity design exploits the fact that at its inception, the PANN2000 was running for about 8 months only in the poorest communities (parroquias) of certainprovinces. Our main result is that the presence of the program reduced child mortality in cohortswith 8 months of differential exposure from a level of about 2.5 percent by 1 to 1.5 percentagepoints.

Hàbits alimentaris en nens de 8 a 12 anys de la comarca d'Osona

Introducció: La dieta mediterrània és considerada un dels patrons alimentaris més saludables ja que diversos estudis epidemiològics mostren que protegeix front diverses malalties cròniques com ara les malalties cardiovasculars, la diabetis i alguns càncers. Malauradament al nostre país els patrons alimentaris estan canviant a conseqüència de la modernització de la societat i estan portant a l’allunyament del patró de dieta mediterrània. Això és especialment crític entre la població infantil i juvenil, fet que predisposa a que en un futur augmenti la prevalença de malalties cròniques entre la població adulta. Objectiu: avaluar els hàbits alimentaris i l’estat nutricional d’escolars de 8 a 12 anys de la comarca d’Osona. Mètodes: estudi de disseny observacional i transversal. La mostra estava constituïda per 191 escolars de 4rt i 5è d’ensenyança primària d’escoles de la comarca d’Osona. La informació sobre la dieta es va recollir a través d’una enquesta alimentària, un recordatori de 24 hores, un qüestionari de freqüència de consum alimentari i el test KIDMED. Les determinacions antropomètriques que es van realitzar van ser talla, pes, IMC (Índex de Massa Corporal), plec tricipital, perímetre braquial i perímetre abdominal. L’anàlisi estadística de totes les dades es va portar a terme mitjançant el programa estadístic SPSS per Windows versió 12.0. Resultats: quan es valora la qualitat de l’esmorzar, s’observa que només en el 16.8% dels casos la qualitat era bona, en el 68.6% dels casos la qualitat havia de millorar i en el 12.6% era de qualitat insuficient i en el 2.1% era de mala qualitat. També s’observa que la dieta que segueixen és desequilibrada quantitativament, concretament és baixa en hidrats de carboni, rica en greixos i lleugerament elevada en proteïnes. L’anàlisi qualitativa mostra que hi ha un molt baix consum de verdures i hortalisses i de fruita, mentre que s’arriba a les racions recomanades de carnis i d’olis i greixos. El test KIDMED mostra una puntuació mitjana de 7.21±1.96 punts, el que indica que la dieta de la població és de qualitat millorable. Pel que fa a l’estat nutricional s’observa que un 24,6% presenta valors de baix pes i un 17,8% sobrepès o obesitat, el que indica que un 42,4% de la població estudiada presenta un estat nutricional incorrecte. Conclusions: La dieta del col·lectiu estudiat s’allunya de les recomanacions de la SENC (Sociedad Española de Nutrición Comunitaria). Els resultats del test KIDMED indiquen que només un 44% de la població segueix un patró òptim de Dieta mediterrània i l’anàlisi de l’estat nutricional mostra que un 42,4% presenta un estat nutricional incorrecte, sigui per excés o per defecte de pes. Per tant, es fa necessari dissenyar estratègies d’educació alimentària adequades per millorar els hàbits alimentaris dels escolars i aconseguir en un futur un estat òptim de salut.

The impact of clinical maternal chorioamnionitis on neurological and pshicological sequelae in very-low-birthweight infants: a case-control study

Aims: To assess the relationship between clinically maternal chorioamnionitis and outcome in preterm very-low-birth weight (VLBW) infants. Methods: An observational case-control study was conducted in the neonatology departments of 12 acute care teaching hospitals in Spain. Between January 2004 and December 2006, all consecutive VLBW (F1500 g) infants who were born to a mother with clinical chorioamnionitis were enrolled. The controls included infants who were born to mothers without chorioamnionitis, matched by gestational age, and immediately born after each index case. At a corrected age of 24 months, a neurological examination and a psychological assessment of the surviving children were performed.Results: Sixty-six of the newborn infants died; therefore, 262 infants from the original sample were available for the study. Follow-up data were obtained at a corrected age of 24 months from a total of 209 children (106 cases and 103 controls, 80% of the original sample size). Seventy children (33.5%) were diagnosed with some type of sequelae. The following conditions were all more prevalent in infants born to mothers with chorioamnionitis in comparison to controls: low development quotient (98.3'12.15 vs. 95.9'15.64; Ps0.497), cerebral palsy (4.9% vs. 10.4%; Ps0.138), seizures (1.0% vs. 3.8%; Ps0.369), and other neurological or sensorial sequelae (32.0% vs. 34.9%; Ps0.611). Conclusions: After controlling for gestational age, the study population demonstrated that the neurological outcomes in infants at a corrected age of 24 months was not worsened by chorioamnionitis.

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): a 6-months prospective observational study

Background: There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations. Methods: Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex. Results: The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure. Conclusion: Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

The transtheoretical model in weight management: Validation of the Processes of Change Questionnaire

Objective: The processes of change implied in weight management remain unclear. The present study aimed to identify these processes by validating a questionnaire designed to assess processes of change (the P-Weight) in line with the transtheoretical model. The relationship of processes of change with stages of change and other external variables is also examined. Methods: Participants were 723 people from community and clinical settings in Barcelona. Their mean age was 32.07 (SD = 14.55) years; most of them were women (75.0%), and their mean BMI was 26.47 (SD = 8.52) kg/m2. They all completed the P-Weight and the stages of change questionnaire (SWeight), both applied to weight management, as well as two subscales from the Eating Disorders Inventory-2 and Eating Attitudes Test-40 questionnaires about the concern with dieting. Results: A 34-item version of the PWeight was obtained by means of a refinement process. The principal components analysis applied to half of the sample identified four processes of change. A confirmatory factor analysis was then carried out with the other half of the sample, revealing that the model of four freely correlated first-order factors showed the best fit (GFI = 0.988, AGFI = 0.986, NFI = 0.986, and SRMR = 0.0559). Corrected item-total correlations (0.322-0.865) and Cronbach"s alpha coefficients (0.781-0.960) were adequate. The relationship between the P-Weight and the S-Weight and the concern with dieting measures from other questionnaires supported the validity of the scale. Conclusion: The study identified processes of change involved in weight management and reports the adequate psychometric properties of the P-Weight. It also reveals the relationship between processes and stages of change and other external variables.

Effectiveness of a primary care-based intervention to reduce sitting time in overweight and obese patients (SEDESTACTIV): a randomized controlled trial; rationale and study design

Background: There is growing evidence suggesting that prolonged sitting has negative effects on people's weight, chronic diseases and mortality. Interventions to reduce sedentary time can be an effective strategy to increase daily energy expenditure. The purpose of this study is to evaluate the effectiveness of a six-month primary care intervention to reduce daily of sitting time in overweight and mild obese sedentary patients. Method/Design: The study is a randomized controlled trial (RCT). Professionals from thirteen primary health care centers (PHC) will randomly invite to participate mild obese or overweight patients of both gender, aged between 25 and 65 years old, who spend 6 hours at least daily sitting. A total of 232 subjects will be randomly allocated to an intervention (IG) and control group (CG) (116 individuals each group). In addition, 50 subjects with fibromyalgia will be included. Primary outcome is: (1) sitting time using the activPAL device and the Marshall questionnaire. The following parameters will be also assessed: (2) sitting time in work place (Occupational Sitting and Physical Activity Questionnaire), (3) health-related quality of life (EQ-5D), (4) evolution of stage of change (Prochaska and DiClemente's Stages of Change Model), (5) physical inactivity (catalan version of Brief Physical Activity Assessment Tool), (6) number of steps walked (pedometer and activPAL), (7) control based on analysis (triglycerides, total cholesterol, HDL, LDL, glycemia and, glycated haemoglobin in diabetic patients) and (8) blood pressure and anthropometric variables. All parameters will be assessed pre and post intervention and there will be a follow up three, six and twelve months after the intervention. A descriptive analysis of all variables and a multivariate analysis to assess differences among groups will be undertaken. Multivariate analysis will be carried out to assess time changes of dependent variables. All the analysis will be done under the intention to treat principle. Discussion: If the SEDESTACTIV intervention shows its effectiveness in reducing sitting time, health professionals would have a low-cost intervention tool for sedentary overweight and obese patients management.