San Pablo de la Moraleja, Spain
San Pablo de la Moraleja, Spain

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Diaz E.,University of Bergen | Diaz E.,Minority | Kumar B.N.,Minority | Kumar B.N.,University of Oslo | And 8 more authors.
Tropical Medicine and International Health | Year: 2015

Objectives: International migration is rapidly increasing worldwide. However, the health status of migrants differs across groups. Information regarding health at arrival and subsequent periodic follow-up in the host country is necessary to develop equitable health care to immigrants. The objective of this study was to determine the impact of the length of stay in Norway and other sociodemographic variables on the prevalence of multimorbidity across immigrant groups (refugees, labour immigrants, family reunification immigrants and education immigrants). Methods: This is a register-based study merging data from the National Population Register and the Norwegian Health Economics Administration database. Sociodemographic variables and multimorbidity across the immigrant groups were compared using Persons' chi-square test and anova as appropriate. Several binary logistic regression models were conducted. Results: Multimorbidity was significantly lower among labour immigrants (OR (95% CI) 0.23 (0.21-0.26) and 0.45 (0.40-0.50) for men and women, respectively) and education immigrants (OR (95% CI) 0.40 (0.32-0.50) and 0.38 (0.33-0.43)) and higher among refugees (OR (95% CI) 1.67 (1.57-1.78) and 1.83 (1.75-1.92)), compared to family reunification immigrants. For all groups, multimorbidity doubled after a five-year stay in Norway. Effect modifications between multimorbidity and sociodemographic characteristics across the different reasons for migration were observed. Conclusions: Multimorbidity was highest among refugees at arrival but increased rapidly among labour immigrants, especially females. Health providers need to ensure tailor-made preventive and management strategies that take into account pre-migration and post-migration experiences for immigrants in order to address their needs. © 2015 John Wiley & Sons Ltd.


PubMed | Rovira i Virgili University, San Pablo Health Center, CIBER ISCIII, University of Valencia and 3 more.
Type: Journal Article | Journal: PloS one | Year: 2014

Studies of associations between plasma GSH-Px activity and cardiovascular risk factors have been done in humans, and contradictory results have been reported. The aim of our study was to assess the association between the scavenger antioxidant enzyme glutathione peroxidase (GSH-Px) activity in plasma and the presence of novel and classical cardiovascular risk factors in elderly patients.We performed a cross-sectional study with baseline data from a subsample of the PREDIMED (PREvencin con DIeta MEDiterrnea) study in Spain. Participants were 1,060 asymptomatic subjects at high risk for cardiovascular disease (CVD), aged 55 to 80, selected from 8 primary health care centers (PHCCs). We assessed classical CVD risk factors, plasma oxidized low-density lipoproteins (ox-LDL), and glutathione peroxidase (GSH-Px) using multilevel statistical procedures.Mean GSH-Px value was 612 U/L (SE: 12 U/L), with variation between PHCCs ranging from 549 to 674 U/L (Variance = 013.5; P<0.001). Between-participants variability within a PHCC accounted for 89% of the total variation. Both glucose and oxidized LDL were positively associated with GSH-Px activity after adjustment for possible confounder variables (P = 0.03 and P = 0.01, respectively).In a population at high cardiovascular risk, a positive linear association was observed between plasma GSH-Px activity and both glucose and ox-LDL levels. The high GSH-Px activity observed when an oxidative stress situation occurred, such as hyperglycemia and lipid oxidative damage, could be interpreted as a healthy defensive response against oxidative injury in our cardiovascular risk population.


Salas-Salvado J.,Rovira i Virgili University | Bullo M.,Rovira i Virgili University | Ros E.,Institute dInvestigacions Biomediques August Pi i Sunyer | Covas M.-I.,Institute Of Recerca Hospital Del Mar | And 14 more authors.
Annals of Internal Medicine | Year: 2014

Background: Interventions promoting weight loss can reduce the incidence of type 2 diabetes mellitus. Whether dietary changes without calorie restriction also protect from diabetes has not been evaluated. Objective: To assess the efficacy of Mediterranean diets for the primary prevention of diabetes in the Prevención con Dieta Mediterránea trial, from October 2003 to December 2010 (median follow-up, 4.1 years). Design: Subgroup analysis of a multicenter, randomized trial. (Current Controlled Trials: ISRCTN35739639) Setting: Primary care centers in Spain. Participants: Men and women without diabetes (3541 patients aged 55 to 80 years) at high cardiovascular risk. Intervention: Participants were randomly assigned and stratified by site, sex, and age but not diabetes status to receive 1 of 3 diets: Mediterranean diet supplemented with extra-virgin olive oil (EVOO), Mediterranean diet supplemented with nuts, or a control diet (advice on a low-fat diet). No intervention to increase physical activity or lose weight was included. Measurements: Incidence of new-onset type 2 diabetes mellitus (prespecified secondary outcome). Results: During follow-up, 80, 92, and 101 new-onset cases of diabetes occurred in the Mediterranean diet supplemented with EVOO, Mediterranean diet supplemented with mixed nuts, and control diet groups, respectively, corresponding to rates of 16.0, 18.7, and 23.6 cases per 1000 person-years. Multivariate-adjusted hazard ratios were 0.60 (95% CI, 0.43 to 0.85) for the Mediterranean diet supplemented with EVOO and 0.82 (CI, 0.61 to 1.10) for the Mediterranean diet supplemented with nuts compared with the control diet. Limitations: Randomization was not stratified by diabetes status. Withdrawals were greater in the control group. Conclusion: A Mediterranean diet enriched with EVOO but without energy restrictions reduced diabetes risk among persons with high cardiovascular risk. © 2014 American College of Physicians.


Estruch R.,Institute Salud Carlos III | Estruch R.,University of Barcelona | Ros E.,Institute Salud Carlos III | Ros E.,University of Barcelona | And 24 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. METHODS: In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. RESULTS: A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. CONCLUSIONS: Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639.) Copyright © 2013 Massachusetts Medical Society.


Domenech M.,Institute dInvestigacions Biomediques August Pi Sunyer IDIBAPS | Domenech M.,CIBER ISCIII | Roman P.,CIBER ISCIII | Roman P.,San Pablo Health Center | And 21 more authors.
Hypertension | Year: 2014

The PREvención con DIeta MEDiterránea (PREDIMED) trial showed that Mediterranean diets (MedDiets) supplemented with either extravirgin olive oil or nuts reduced cardiovascular events, particularly stroke, compared with a control, lower fat diet. The mechanisms of cardiovascular protection remain unclear. We evaluated the 1-year effects of supplemented MedDiets on 24-hour ambulatory blood pressure (BP), blood glucose, and lipids. Randomized, parallel-design, controlled trial was conducted in 2 PREDIMED sites. Diets were ad libitum, and no advice on increasing physical activity or reducing sodium intake was given. Participants were 235 subjects (56.5% women; mean age, 66.5 years) at high cardiovascular risk (85.4% with hypertension). Adjusted changes from baseline in mean systolic BP were -2.3 (95% confidence interval [CI], -4.0 to -0.5) mm Hg and -2.6 (95% CI, -4.3 to -0.9) mm Hg in the MedDiets with olive oil and the MedDiets with nuts, respectively, and 1.7 (95% CI, -0.1 to 3.5) mm Hg in the control group (P<0.001). Respective changes in mean diastolic BP were -1.2 (95% CI, -2.2 to -0.2), -1.2 (95% CI, -2.2 to -0.2), and 0.7 (95% CI, -0.4 to 1.7) mm Hg (P=0.017). Daytime and nighttime BP followed similar patterns. Mean changes from baseline in fasting blood glucose were -6.1, -4.6, and 3.5 mg/dL (P=0.016) in the MedDiets with olive oil, MedDiets with nuts, and control diet, respectively; those of total cholesterol were -11.3, -13.6, and -4.4 mg/dL (P=0.043), respectively. In high-risk individuals, most with treated hypertension, MedDiets supplemented with extravirgin olive oil or nuts reduced 24-hour ambulatory BP, total cholesterol, and fasting glucose. © 2014 American Heart Association, Inc.


Diaz E.,University of Bergen | Diaz E.,Minority | Gimeno-Feliu L.-A.,University Institute of Health Sciences | Gimeno-Feliu L.-A.,San Pablo Health Center | And 7 more authors.
Scandinavian Journal of Primary Health Care | Year: 2014

To compare the likelihood of being a frequent attender (FA) to general practice among native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated with being a FA for natives and immigrants. Design, setting and subjects. Linked register data for all inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933 persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC), and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the top 10% (cut-off point > 7 visits). Main outcome measures. FAs were compared with other GP users by means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors. Results. Among GP users during the daytime, immigrants had a higher likelihood of being a FA compared with natives (OR (95% CI): 1.13 (1.09-1.17) and 1.15 (1.12-1.18) for HIC, 1.84 (1.78-1.89) and 1.66 (1.63-1.70) for MIC, and 1.77 (1.67-1.89) and 1.65 (1.57-1.74) for LIC for men and women respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric problems were the main factors associated with being a FA. Among immigrants, labour immigrants and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric, gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent among immigrant FA compared with natives. Conclusion. Although immigrants account for a small percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and morbidity profiles to provide equality of health care. © 2014 The Author(s).


Gimeno-Feliu L.A.,University of Zaragoza | Gimeno-Feliu L.A.,San Pablo Health Center | Calderon-Larranaga A.,University of Zaragoza | Calderon-Larranaga A.,Carlos III Health Institute | And 6 more authors.
Gaceta Sanitaria | Year: 2015

Objective: To compare the morbidity burden of immigrants and natives residing in Aragón, Spain, based on patient registries in primary care, which represents individuals' first contact with the health system. Methods: A retrospective observational study was carried out, based on linking electronic primary care medical records to patients' health insurance cards. The study population consisted of the entire population assigned to general practices in Aragón, Spain (1,251,540 individuals, of whom 12% were immigrants). We studied the morbidity profiles of both the immigrant and native populations using the Adjusted Clinical Group System. Logistic regressions were conducted to compare the morbidity burden of immigrants and natives after adjustment for age and gender. Results: Our study confirmed the "healthy immigrant effect", particularly for immigrant men. Relative to the native population, the prevalence rates of the most frequent diseases were lower among immigrants. The percentage of the population showing a moderate to very high morbidity burden was higher among natives (52%) than among Latin Americans (33%), Africans (29%), western Europeans (27%), eastern Europeans and North Americans (26%) and/or Asians (20%). Differences were smaller for immigrants who had lived in the country for 5 years or longer. Conclusion: Length of stay in the host country had a decisive influence on the morbidity burden represented by immigrants, although the health status of both men and women worsened with longer stay in the host country. © 2014 SESPAS.


Diaz E.,University of Bergen | Diaz E.,Minority | Calderon-Larranaga A.,University Institute of Health Sciences | Calderon-Larranaga A.,University of Zaragoza | And 9 more authors.
European Journal of Public Health | Year: 2015

Background: Immigrant's use of primary health care (PHC) services differs from that of native's, but studies are non-consistent, and the importance of individual explaining variables like socio-economic status, morbidity burden and length of stay in the host country is uncertain. Methods: Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration Database for all immigrants and natives ≥15 years registered in Norway in 2008 (3 739 244 persons), applying the Johns Hopkins ACG® Case-Mix System. Using multivariate binary logistic and negative binomial regression analyses, respectively, we compared overall use of PHC and number of visits to PHC between immigrants and natives, and investigated the significance of socio-economic, immigration and morbidity variables. Results: A significantly lower percentage of immigrants used the general practitioner (GP) compared with natives. Among GP users, however, most immigrants used the GP at a 2-15% significantly higher rate compared with natives. Older immigrants used their GP less and at lower rates than younger immigrants. A significantly lower percentage of immigrants from high-income countries, but a higher percentage of all other immigrants used emergency services compared with natives, with no differences in use rates. Morbidity burden and length of stay were essential explaining variables. Conclusion: Lower use of PHC among immigrants could be due to better health or to access barriers, and should be further studied, especially for the oldest immigrants. Adjusted high frequency of use may be appropriate, but it might also be a signal of non-effective contacts. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


PubMed | University of Zaragoza, University of Bergen, San Pablo Health Center and Charles III University of Madrid
Type: Comparative Study | Journal: Gaceta sanitaria | Year: 2014

To compare the morbidity burden of immigrants and natives residing in Aragn, Spain, based on patient registries in primary care, which represents individuals first contact with the health system.A retrospective observational study was carried out, based on linking electronic primary care medical records to patients health insurance cards. The study population consisted of the entire population assigned to general practices in Aragn, Spain (1,251,540 individuals, of whom 12% were immigrants). We studied the morbidity profiles of both the immigrant and native populations using the Adjusted Clinical Group System. Logistic regressions were conducted to compare the morbidity burden of immigrants and natives after adjustment for age and gender.Our study confirmed the healthy immigrant effect, particularly for immigrant men. Relative to the native population, the prevalence rates of the most frequent diseases were lower among immigrants. The percentage of the population showing a moderate to very high morbidity burden was higher among natives (52%) than among Latin Americans (33%), Africans (29%), western Europeans (27%), eastern Europeans and North Americans (26%) and/or Asians (20%). Differences were smaller for immigrants who had lived in the country for 5 years or longer.Length of stay in the host country had a decisive influence on the morbidity burden represented by immigrants, although the health status of both men and women worsened with longer stay in the host country.


PubMed | University of Zaragoza, University of Bergen and San Pablo Health Center
Type: | Journal: BMC public health | Year: 2016

The healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy.This retrospective, observational study included the total population of Aragon, Spain (1,251,540 individuals, of whom 11.9% were immigrants). Patient-level data on the use of primary, specialised, hospital, and emergency care as well as prescription drug use in 2011 were extracted from the EpiChron Cohort and compared between immigrants and nationals. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.The annual visit rates of immigrants were lower than those of nationals for primary care (3.3 vs 6.4), specialised care (1.3 vs 2.7), planned hospital admissions/100 individuals (1.6 vs 3.8), unplanned hospital admissions/100 individuals (2.7 vs 4.7), and emergency room visits/10 individuals (2.3 vs 2.8). Annual prescription drug costs were also lower for immigrants (47 vs 318). These differences were only partially attenuated after adjusting for age, sex and morbidity burden.In a universal coverage health system offering broad legal access to immigrants, the global use of healthcare services was lower for immigrants than for nationals. These differences may be explained in part by the healthy migration effect, but also reveal possible inequalities in healthcare provision that warrant further investigation.

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