Understanding the impact of the COVID-19-related lockdown in university workers. Identifying groups through cluster analysis

Objective

To analyse the COVID-19-related lockdown impact on University workers, to identify groups based on this information, and to study the factors associated with each group.

Study design

Cross-sectional study.

Methods

A survey was conducted 3.5 weeks after COVID-19-related lockdown in University workers in Spain. Sociodemographic variables, housing, work, health conditions, levels of anxiety, stress and depression (DASS-21), and social support (MSPSS) were collected. A cluster analysis was performed to identify groups depending on the impact of the lockdown. Differences between groups were tested using Chi-square and Mann-Whitney-U tests, and associated factors with binary logistic regression.

Results

We identified two groups of workers. "G1: Consequences in the daily life routine" was mainly composed of men, Research and Teaching Personnel (RTP) with more stable professional categories, higher income level, and bigger houses than people in G2. Participants in "G2: Concerns for the current and future well-being" presented worse intensity of pain than before the lockdown, more anxiety, depression, stress and less social support than people in G1. ASP (Administration and Services Personnel) had more risk of belonging to G2 than RTP (OR = 5.863). A higher number of people living at home decreased the risk of being in G2 (OR = 0.439). People with lower pain intensity had less risk of being in G2 (OR = 0.014), and this risk decreased as friends support increased (OR = 0.833).

Conclusions

In G1, the consequences were immediately reflected in the stress resulting from changes in their daily work routine. In G2, the concerns were related to their professional future, with worse mental health, greater intensity of pain and less social support.

Understanding the different relationships between mood and sleep disorders in several groups of non-oncological patients with chronic pain

OBJECTIVE

To compare sleep dimensions in patients suffering from chronic pain of different origins, and with a group of pain-free subjects. To analyze the relationship between depression and/or anxiety and sleep disorders in musculoskeletal, neuropathic, and fibromyalgia patients.

METHODS

This cross-sectional study included patients diagnosed with neuropathic pain (NP) (n = 104), musculoskeletal pain (MSK) (n = 99), or fibromyalgia (FM) (n = 51), and pain free subjects (n = 72). Information about sleep dimensions (MOS-sleep), duration and intensity of pain (Visual Analog Scale), and anxiety and depression (Hospital Anxiety and Depression scale) was collected.

RESULTS

Of the 254 patients with chronic pain (PCP) studied, the mean pain intensity was 6.6 (SD = 1.9), with an average duration of 9 years. The scores in all sleep dimensions of the MOS-sleep were higher in CPP (more disturbances) compared to pain free patients, and differences were observed among the three groups of PCP, with FM most severely affected. Anxiety (β = 1.3), depression (β = 1.1), intensity (β = 1.7), and duration of pain (β = 0.04) were associated with more sleep problems in MSK patients. In contrast, anxiety (β = 2.5) and duration of pain (β = 0.05) were negatively related to sleep in the NP patients, and only depression (β = 1.3) affected FM patients.

CONCLUSIONS

The sleep pattern differs among groups of PCP in the presence or absence of mood disorders. Understanding these disorders in each specific group of PCP is fundamental, and it can contribute to improve the clinical situation of the patients and better orientating therapeutic strategies.

Presence of somatic symptoms (especially pain) in patients with depresive disorder and its impact on quality of life, and possible involvement with anhedonia

Depressive Disorder, according to WHO will be one of the most disabling causes in the world. Depression includes psychological and somatic symptoms, like anhedonia or pain, and both have a bidirectional relationship, so that the presence and severity of one of them directly affects the other one, and both leads to a disruption in quality of life and increase health resources. The relationship between major depression and chronic pain has been widely investigated but few studies have focused on other depressive spectrum disorders, and never the possible relationship between pain and anhedonia in DD. Our aim is to analyse the presence of somatic symptoms (especially pain) in patients with DD and its impact on quality of life, and involvement with anhedonia. We analysed the correlation between the scores of the HADS, SSI-28, SHAPS and SF-36 scales. Results showed a significant correlation between SSI-28 and HADS-A(r = 0.45; P < 0.001), HADS-D(r = 0.35; P < 0.001) and with 7 of the 8 domains of SF-36: Bodily Pain(r = –0.62; P < 0.001), General Health(r = –0.29; P = 0.003), Role Physical(r = –0.45; P < 0.001) Mental Health(r = –0.34; P = 0.003), Vitality(r = –0.403; P < 0.001), Social Functioning(r = –0.37; P < 0.001). In addition, SHAPS correlates with 6 of the 8 domains of SF-36: PF(r = –0.33; P = 0.001), GH(r = –0.27; P = 0.006), Vit (r = –0.41; P < 0.001), SF(r = –0.52; P < 0.001), RE(r = –0.24; P < 0.001) and MH(r = –0.49; P < 0.001). The results demonstrate that both anhedonia and somatic symptoms negatively correlate with HRQoL, and that a bidirectional relationship between depression and somatic symptoms is clearly proven, which means that depression may be related with the presence of somatic symptoms, especially pain, and also somatic symptoms lead to an increase of depressive symptoms. This could impact on the diagnosis and treatment of depressed patients with somatic symptoms and anhedonia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Factors related to the evolution of Health Related Quality of Life in coronary patients. A longitudinal approach using Weighted Generalized Estimating Equations with missing data

BACKGROUND

The aim is to know the factors related to the evolution of Health Related Quality of Life (HRQL) in Coronary Patients (CP) from a longitudinal perspective using an appropriate method that handles missing data adequately when the mechanism of missingness is uncertain.

METHODS

Prospective study with repeated measures at baseline, 3 and 6months. 250 patients with acute myocardial infarction or unstable angina were studied. Sociodemographic and clinical data were collected at baseline. Mental health (GHQ-28) and HRQL (SF-36v1) were assessed during the follow-up. The missingness mechanism was tested. Friedman test and partial eta-squared were used to analyse changes in SF-36 scores and WGEE were used to identify the predictors of the evolution of HRQL.

RESULTS

95 dropped out after 3months and 72 after 6months. The missingness was likely to be at random. All the dimensions of the SF-36 improved over time, except PF. The factors related to the evolution of HRQL were: being woman (B=-23.9 in RE; B=-6.9 in MCS), older age (B=-0.5 in BP; B=-0.3 in VT), being single/separated (B=-14.5 in GH; B=-14.1 in SF; B=-23.3 in MH) and widow(er) (B=-23.2 PF; B=-29.8 in SF), hypertensive (B=-19.8 in RP; B=-8.9 in VT), worse mental health (B=-3 in PF; B=-2.8 in RP; B=-3.1 in BP; B=-1.2 in PCS; B=-3.8 in VT; B=-2.6 in SF), previous history of CHD (B=-12.5 in PF; B=-5.2 in PCS), and performing heart-healthy physical activities (B=13.9 in PF).

CONCLUSIONS

HRQL improves over time. A global approach, including age, marital status, performing physical activities or hypertension, is required to improve HRQL in CP.

Assessing the Construct Validity and Internal Reliability of the Screening Tool Test Your Memory in Patients with Chronic Pain

Patients with chronic pain often complain about cognitive difficulties, and since these symptoms represent an additional source of suffering and distress, evaluating the cognitive status of these patients with valid and reliable tests should be an important part of their overall assessment. Although cognitive impairment is a critical characteristic of pain, there is no specific measure designed to detect these effects in this population. The objective was to analyze the psychometric properties of the “Test Your Memory” (TYM) test in patients with chronic pain of three different origins. A cross-sectional study was carried out on 72 subjects free of pain and 254 patients suffering from different types of chronic pain: neuropathic pain (104), musculoskeletal pain (99) and fibromyalgia (51). The construct validity of the TYM was assessed using the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADs), Index-9 from MOS-sleep, SF-12, and through the intensity (Visual Analogical Scale) and duration of pain. An exploratory factor analysis was also performed and internal reliability was assessed using Cronbach’s alpha. After adjusting for potential confounders the TYM could distinguish between pain and pain-free patients, and it was correlated with the: MMSE (0.89, p<0.001); HAD-anxiety (-0.50, p<0.001) and HAD-depression scales (-0.52, p<0.001); MOS-sleep Index-9 (-0.49, p<0.001); and the physical (0.49, p < .001) and mental components (0.55, p < .001) of SF-12. The exploratory structure of the TYM showed an 8-factor solution that explained 53% of the variance, and Cronbach’s alpha was 0.66. The TYM is a valid and reliable screening instrument to assess cognitive function in chronic pain patients that will be of particular value in clinical situations.

Somatic Symptoms As Measured By Ssi-26 (somatic Symptom Inventory) Correlate With Social And Physical Functioning (sf36) In Depressed Patients. The Relative Contribution Of Anhedonia

According to the DSM5, Somatic Symptom Disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning. These criteria are significantly different compared with previous editions of DSM. For example, the DSM-IV diagnosis of somatization disorder required a specific number of complaints from among four symptom groups, however the SSD criteria no longer have such a requirement. Nevertheless somatic symptoms must be significantly distressing or disruptive to daily life. Very few studies have focussed on the influence of suffering anhedonia on the perception of somatic symptoms and how this impact on Health Related Quality of Life (HRQoL), particularly physical functioning. We studied the relative impact of somatic symptoms on the social and physical functioning in depressed patients. Moreover we have explored the influence of anhedonia as measured by the Snaith-Hamilton Anhedonia Pleasure Scale (SHAPS). We analysed the correlations between the scores of the 8 dimensions of the SF-36, the SSI-26 and the SHAPS questionnaires. The results show a significant correlation between SSI-26 score and physical functioning (r = –0.565; P < 0.001), role physical (r = –0.551; P < 0.001), bodily pain (r = –0.659; P < 0.001), general health (r = –0.534; P < 0.001), vitality (r = –0.481; P = 0.001), social functioning (r = –0.302; P = 0.044) and mental health (r = –0.461; P = 0.001). Additionally, SHAPS score correlates with vitality (r = –0.371; P = 0.012), social functioning (r = –0.574; P < 0.001) and mental health (r = –0.445; P = 0.002). The results demonstrated that both somatic symptoms and level of anhedonia negatively correlate with HRQoL, suggesting a potential relationship between level of anhedonia and some somatic symptoms. This could impact on the diagnosis and treatment of depressed patients with somatic symptoms and anhedonia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Unexplained pain complaints and depression in older people in primary care

OBJECTIVE

Chronic pain and depression are frequent conditions in primary care patients. Depression is frequently overlooked in the presence of pain of uncertain origin. The aim is to measure the prevalence and clinical correlates of unrecognized comorbid mood disorders and chronic pain of uncertain origin in older primary care patients, and to elucidate the differences with younger adults with the same conditions.

DESIGN

Cross-sectional study.

SETTING

Primary care centres in Spain.

PARTICIPANTS

Patients (n= 2720) with persistent pain of uncertain origin.

MEASUREMENTS

Pain characteristics, sites and intensity (Visual Analogical Scales), depression (PRIME-MD interview), clinical characteristics and health services use.

RESULTS

We observed a similarly high (80.5%) prevalence of undiagnosed mood disorders (especially major depressive disorders) among older and younger adult patients with comorbid chronic pain complaints of uncertain origin. Older patients suffered pain that was more intense, longer lasting and located in a higher number of different areas, when compared to younger patients. Pain intensity was a factor associated with suffering from mood disorders among patients above 65 years, whilst the number of pain sites was a more important factor among younger patients.

CONCLUSIONS

Depression is highly associated with pain of uncertain origin in older patients with differences in pain characteristics when compared to younger patients. The robust comorbid relationship between both conditions should alert clinicians to specifically look for depression in the presence of poorly explained painful symptoms.

[Automated detection of microaneurysms by using region growing and Fuzzy Artmap neural network]

OBJECTIVE

To assess whether the methodological changes of this new algorithm improves the results of a previously presented strategy.

METHODS

We enhance the image and filter out the green channel of the digital color retinography. Multitolerance thresholding was applied to obtain candidate points and make a seed growing region by varying intensities. We took 15 characteristics from each region to train a Fuzzy Artmap neural network using 42 retinal photographs. This network was then applied in the study of 11 good quality retinal photographs included in the diabetic retinopathy early detection screening program, with initial stages of retinopathy, obtained with the Topcon NW200 non-mydriatic retinal camera.

RESULTS

Two experienced ophthalmologists detected 52 microaneurysms in 11 images. The algorithm detected 39 microaneurysms and 3,752 more regions, confirming 38 microaneurysm and 135 false positives. The sensitivity is improved compared to the previous algorithm, from 60.53 to 73.08%. False positives have dropped from 41.8 to 12.27 per image.

CONCLUSIONS

The new algorithm is better than the previous one, but there is still room for improvement, especially in the initial determination of seeds.

Fibromyalgia and psychiatric comorbidity: their effect on the quality of life patients

Patients with fibromyalgia (FM) often have associated mental disorders. As well as being very prevalent, the two conditions also have sociodemographic and clinical similarities. If both of these clinical conditions lead independently to a limitation of the health-related quality of life (HRQL) of the patients, it may be thought that their conjunction could have a greater adverse effect on this parameter. Equally, it could be assumed that the factors that worsen the HRQL of patients with FM or with mental illness could have a more serious effect on the HRQL of those in whom the two clinical conditions coexist. Although this conclusion seems evident, as far as we know there have been no studies to assess how much or in what way psychiatric comorbidity affects the HRQL of patients with FM, or any studies to analyze the particular factors that may affect their HRQL. This study approaches the importance of psychiatric comorbidity in patients with fibromyalgia and analyzes the combined effect that these two conditions have on the overall HRQL of these patients.

Women, Mental Health and Health-Related Quality of Life in Coronary Patients

OBJECTIVE

To establish clusters of Health-Related Quality of Life (HRQL) in a population of patients hospitalised for suspected Coronary Heart Disease (CHD), and to examine the relationship between mental health and other sociodemographic and clinical variables associated with worse HRQL.

METHODS

We conducted a cross-sectional study of 185 patients admitted to the Cardiology Service. We used the General Health Questionnaire (GHQ-28) to assess the mental status, and the SF-36 to assess Health Related Quality Life (HRQL). Using the patients' scores obtained from the SF-36, we performed a cluster analysis and used a logistic model for the analysis of the variables associated with HRQL clusters.

RESULTS

We identified two HRQL clusters: good quality of life, for which the patients scored highest in all the dimensions of SF-36, and worse quality of life, for which patients had lower scores in all dimensions. The variables associated with the worse quality of life group were: female gender, previous history of Coronary Heart Disease (CHD), and poor mental health.

CONCLUSIONS

Being female, having poor mental health and a previous history of CHD were identified as representing a vulnerable group with worse HRQL.

[Ethical attitudes in Spanish pediatric critical care units]

OBJECTIVES

To assess physicians' awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs).

MATERIAL AND METHODS

Questionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain.

RESULTS

Ninety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs. The occurrence of ethical dilemmas in the PICU was recognized by 96.8 % of the respondents. The most frequent method of solving these problems was through medical consensus (80 %), while family participation in the decision making process was highly variable. A total of 95.8 % of respondents stated that decisions to limit therapy were made in their PICU, although only one third of these decisions were written in the medical record. The most frequent form of therapeutic limitation was the do not resuscitate order. One third (32.6 %) of participants considered there were ethical differences between withdrawal and withholding of treatment. Attending physicians had greater experience of therapeutic limitation than did residents, but their opinions on the subject were similar.

CONCLUSIONS

Ethical dilemmas are common in the PICU. In this setting, decisions about limitation of therapy are frequent, although many physicians admit to not being clear on this issue or on other aspects of clinical ethics. Family members' participation in the decision making process is insufficient in Spanish PICUs.

Predictive factors of mental disorders in patients with suspected ischaemic cardiopathy

OBJECTIVE

To identify the predictive factors of mental disorders in patients with suspected Ischaemic Cardiopathy (IC).

METHOD

The patients admitted to the Cardiology Service of an University Hospital (SW Spain) for acute thoracic pain with suspected IC were studied. Patients were classified into four diagnostic groups (acute myocardial infarction, unstable angina, non-ischaemic cardiological process, non-cardiological) based on clinical, electrocardiographical and biochemical data. The sociodemographic and clinical variables were obtained by a 'ad hoc' questionnaire and the clinical records of the patient. The GHQ-28 questionnaire was used to assess the status of mental health, and a score of > or = 6 was taken as the cut-off point for being a 'probable psychiatric case'. Crude odds ratios (OR +/- 95% CI), and adjusted OR according to a logistic model, were calculated in order to study the variables associated with the mental disorders. The tabulation and analysis of data was carried out with the SPSS v.8 (for Windows) program.

RESULTS

From June 1996 to November 1997, 185 patients were studied; 72% were males and the mean age was 60.2 years (SD = 10.4). 49.2% of the patients were scored at > or = 6 on the GHQ-28, and the sub-scale accounting for the highest scores was that of somatic symptoms of psychological origin. The adjusted ORs showed that female sex (OR: 2.5; 95% CI: 1.2-5.0), previous personal history of IC (OR: 2.3; 95% CI: 1.1-4.4), and the presence of arterial hypertension (OR: 2.0; 95% CI: 1.1-3.9), were the predictive variables for being a 'probable psychiatric case', whereas neither age nor comorbidity were predictive.

CONCLUSIONS

The percentage of subjects considered to be a 'probable psychiatric case' among patients with suspected ischaemic cardiopathy was high. Screening for mental disorders and intervention to control the risk factors associated are measures recommended in these patients.

Psychological and occupational predictive factors for back pain among employees of a university hospital in southern Spain

OBJECTIVES

To identify the individual and occupational factors that are predictors for low back pain among the employees of a university hospital in southern Spain.

METHODS

A transverse study was conducted in which the population used was the hospital employees who volunteered to participate. The information was obtained by using a questionnaire, which included demographic and anthropometric variables, habits, characteristics of the work done, and of any pain experienced. The mental health condition of subjects was measured using the GHQ-28, using a score of > or = 6 as the cut-off point. To study the variables associated with pain, crude odds ratios (ORs) were calculated (+/- 95% CI) and adjusted according to a logistic regression model.

RESULTS

One thousand one hundred and four subjects participated in the study but only 890 of these completed the questionnaire in full (rate of response, 35.7% of total employees). The population studied was notable for the high proportion of women, for subjects > 41 years of age, and subjects who undertook little or no physical exercise. In addition, according to the GHQ-28 test, 29.9% of the total were 'probable psychiatric cases'. The crude ORs were high in all the occupational categories in comparison with the doctors, with the exception of the maintenance, cleaning, and catering group. They were also higher among women, among subjects with poor mental health, and among women with one or more children. The adjusted ORs showed that having a GHQ-28 score of > or = 6, and belonging to the auxiliary technician category, were independent risk factors for suffering low back pain. Being older than 41 years and in temporary employment were protective variables.

CONCLUSIONS

The presence of probable mental illness is the variable most strongly associated with the presence of low back pain in the population studied. Its diagnostic confirmation and appropriate treatment could contribute to reducing the prevalence of vertebral pains in this occupational group.

Comparison between the GHQ-28 and SF-36 (MH 1-5) for the assessment of the mental health in patients with ischaemic heart disease

OBJECTIVE

To assess the mental health of patients admitted to hospital with suspected ischaemic heart disease, by means of two instruments, the General Health Questionnaire (GHQ-28) and the MH (1-5) dimension of the SF-36 Health Survey Questionnaire, and to compare the psychometric properties of both questionnaires in this population.

METHODS

A study was conducted of 185 patients consecutively admitted to hospital with suspected ischaemic heart disease, classified into four groups: Acute Myocardial Infarctus (AMI), unstable angina, non-ischaemic cardiologies, and non-cardiological conditions. Their mental health was assessed by means of the GHQ-28 and the MH 1-5 sub-scales of the SF-36; the validity of the results were analysed by the association of each instrument with socio-demographic (age, sex, social class, and educational level) and clinical (co-morbidity, risk factors, diagnostic groups and background to the illness) variables. The correlation of each instrument with other sub-scales of the SF-36 was studied. The internal consistency was measured by Cronbach's alpha, together with the item-internal consistency and item-discriminant validity.

RESULTS

Of the population studied, 71.9% were males and the mean age was 60.2 years (SD: 10.4). The diagnosis for 33.5% was AMI and for 37.8% unstable angina. For all the variables studied, the scores in the two instruments were ordered in the same way, and were significantly worse for females and for the most disadvantaged social class. None of the scales discriminated in respect of the diagnostic group or the presence of comorbidity. However, a linear relationship was observed with risk factors. Cronbach's alpha was 0.95 for the GHQ-28 and 0.80 for the MH 1-5. Correlations with the other dimensions showed ranges of -0.35 to -0.61 for the GHQ-28 and of 0.26 to 0.61 for the MH 1-5. These were highest for the Vitality and Social Functioning sub-scales in both instruments.

CONCLUSIONS

The subjective perception of mental health is measured in a similar way by both the MH 1-5 scale of the SF-36 and the GHQ-28. However, since the MH 1-5 questionnaire is shorter, it should be administratively easier to introduce into routine cardiological practice.

Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease

The validity and reliability of the SF-36 has been studied in 185 patients hospitalized with suspected ischemic cardiopathy, classified into four groups (AMI, unstable angina, nonischemic cardiologies, and absence of cardiologies). The validity of the construct has been analyzed by means of the association of the SF-36 with sociodemographic and clinical variables, and with diagnostic groups. The correlation of the subscales with GHQ-28 scores and the factorial structure have been studied. Internal consistency was measured by Cronbach's alpha and the item-internal consistency and item-discriminant validity. The validation result was as expected, although the scores were significantly lower in patients with unstable angina, only in the PF, VT, and GH subscales. The correlations with the GHQ-28 were high for MH and VT. The internal consistency was high (Cronbach's alpha 0.72-0.94). Factorial analysis identified eight factors, with the "anxiety" component of subscale MH remaining as an independent factor. These results suggest that the SF-36 is a useful scale for the differentiated clinical forms of ischemic cardiopathy, with the additional capability of reflecting the level of anxiety in these patients.

Evolution and factors associated with biological-risk accidents reported in a university hospital in Spain, 1989 to 1995

BACKGROUND

The objective of this study was to describe the profile and evolution of accidents involving risk of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) reported in a large Spanish hospital, together with the preventive measures administered and the factors associated with high-risk accidents.

METHODS

Data used were the accidents recorded in the hospital during the period from January 1989 to December 1995. A logistic model, using age, gender, service, occupation, and year of accident as independent variables was constructed to study the factors associated with these accidents.

RESULTS

The study included 1,009 accidents. Accidents were more common among nurses, female doctors, younger workers, and persons who worked in surgical settings. Of the total sources of infection studied, 11.6% were positive for HBV, 28.2% for HCV, and 24.4% for HIV. No seroconversions were detected in the partial follow-ups conducted. The factors associated with high-risk accidents were gender (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.24-3.60); occupation as physician (RR, 2.57; CI95, 1.54-4.29) or as nursing staff (RR, 1.80; CI95, 1.12-2.89); and working in a surgical service (RR, 2.01; CI95, 1.27-3.18). Younger workers had more accidents overall, but older workers were more likely to have high-risk exposure. In the multivariate analysis, the occupation (physician and nursing staff) was the most important variable when adjusted by the other factors.

CONCLUSIONS

Our results suggest that a greater effort still is required in the application and evaluation of preventive measures. New safety systems, with clearly proven cost-effectiveness, should be developed and applied.

[Evaluation of nutrition of school children in the population of Sierra de Cádiz (Ubrique)]

BACKGROUND

The aim of the present work was to study the nutritional pattern in the school population of a rural town in Cádiz (Spain), with an important industrial development.

SUBJECTS AND METHODS

We have studied a representative sample of 344 school-children of both sexes between 8 and 15 year-old. Dietary intake was assessed by "24 hour recall" and the CUVALC program was used to transform it in nutrients. In all the age groups daily caloric and nutrients intake was adjusted to that recommended by Spanish people.

RESULTS

The results observed showed that specially protein intake was high in all the age groups. Dietary lipid was high (39%). The saturated fatty acids exceeded the level recommended in 100% school children and the intake of carbohydrates (46%) and crude fiber were low. On the other hand, we observed that vitamin D in girls and calories, calcium and iron in both sexes were lower than recommended allowances in some age groups. In addition, the proportional breakfast calories intake was lower (16.6%) than the 25% recommended.

CONCLUSIONS

The population of Ubrique, a rural town in Cádiz (Spain) with an important industrial development had a more occidental than mediterranean nutritional profile.

Arterial hypertension in the adult population of Guadeloupe, and associated factors in subjects of African origin

This study was designed to estimate the prevalence of hypertension in Guadeloupe, the French West Indies, and to evaluate the risk factors associated with hypertension in the largest ethnic group, that of African origin. Households were randomly selected using a two-stage systematic sample of districts and then of houses; all adults aged 18 years in the household were included. In total, 1043 men and women were studied. Blood pressure, plasma glucose concentrations and gamma-glutamyl transferase activity were measured, hypertensive treatment and lifestyle factors recorded. The prevalence of hypertension, age-standardized to the Guadeloupe population was 21% and 26% in men and women of African origin, 28% and 22% in those of Indian-origin and 18% and 16% for other origins. The vast majority of subjects were unaware of their hypertension (90% of men, 74% of women). After adjustment for age, factors associated with high blood pressure in the 826 adults of African origin were: obesity, hyperglycemia, low educational level and family history of hypertension and of stroke. Additional factors in women were alcohol consumption, gamma-glutamyl transferase activity, physical inactivity, occupational category and a retired status, even after adjustment for age. Measures must be taken to diagnose hypertension early, particularly in individuals of African and Indian origin. An effective education program is needed, with an emphasis on life-style factors associated with obesity: diet and physical activity.