Objective: To analyse the in¯uence of social and cultural factors in the prevalence of obesity in the Spanish adult population aged 25 ± 60 y based on available population data. Design: Pooled analysis of four cross-sectional nutrition surveys. Subjects: A total of 5388 free-living subjects aged 25 ± 60 y, respondents of the Nutritional Surveys carried out in four Spanish regions (Catalunya, Basque Country, Madrid and Valencia) from 1990 to 1994. The samples were pooled together and weighted to build a national random sample. Measurements: Weight and height were measured on each individual by trained observers. Age, gender, educational level, occupation, habitat (ruralaurban) and region were considered. Obesity was de®ned as body mass index !30 kgam 2 . The protocol used in each survey was in accordance with the recommendations of the Spanish Society for the Study of Obesity (SEEDO). Logisitic regression models were designed to analyse the in¯uence of sociodemographic factors in the prevalence of obesity in men and women. Results: The prevalence of obesity was higher in older age groups in men and women, odds ratio (OR) for every 10 y OR 1.40 (95% CI 1.39 ± 1.41) for men and OR 1.86 (95% CI 1.85 ± 1.87) for women. Logisitic regression analysis adjusted for age showed higher obesity rates among low educated people, OR 1.80 (95% CI 1.78 ± 1.81) in men and OR 2.36 (95% CI 2.29 ± 2.42) in women (P`0.001). Among men the odds ratio for the prevalence of obesity in rural areas was OR 1.87 (95% CI 1.86 ± 1.89), compared to cities. The geographical distribution showed higher obesity rates in the southeast. Conclusion: This study supports that obesity is a multifactorial problem. Older women with low educational level and low income seem to be the most susceptible group to weight gain. Therefore, Public Health Programs should consider this type of environmental factor when planning strategies aimed at preventing or reducing the problem of obesity in western societies.

Objective: To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18-75 years, and the influence of socio-economic determinants on these prevalence trends. Design: Analysis based on data from two representative population-based cross-sectional surveys. Setting: Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992-93 and ENCAT 2002-03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria. Subjects: In total, 1015 men and 1233 women from ENCAT 1992-93, and 791 men and 924 women from ENCAT 2002-03. Results: Mean BMI and mean WC were higher in males in 2002-03 as compared to 1992-93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992-93 survey. Conclusions: Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

Postpartum thyroiditis (PPT) presents in approximately 5% of women. Its incidence, clinical characteristics, and evolution were studied in a nonselected population of Mediterranean women. Six hundred five healthy women, recruited between the 36th week of pregnancy and the 4th postpartum day, underwent initial clinical and biological evaluation and postpartum at 1 (n = 605), 3 (n = 552), 6 (n = 574), 9 (n = 431), and 12 (n = 444) months. PPT was diagnosed in women with transient hyperthyroidism between 1 and 3 months postpartum and/or hypothyroidism between 3 and 6 months postpartum. Permanent hypothyroidism was considered if it was overt and persisted one year after diagnosis. The incidence rate of PPT was 7.8%. Eighty-two percent of PPT patients had hormone abnormalities at the 6th month postpartum, 8.8% showed depression and 51% goiter. PPT was manifest as hyperthyroidism plus hypothyroidism in 35.5% of patients, because only transient hyperthyroidism in 22.2% and as hypothyroidism alone in 42.3%. Five patients with hypothyroidism during PPT (0.82% of the initial population, 11.1% of PPT patients, and 15.6% of hypothyroidism PPT patients) presented permanent hypothyroidism after a follow-up of 39.8 (4.2) months. PPT was found in 7.8% of general Mediterranean population. We recommend evaluation at the 6th postpartum month to diagnose the majority of PPT women and indefinite follow-up of hypothyroid PPT patients to detect permanent hypothyroidism.

Active epidemiologic surveillance significantly improved detection of cases and allowed us to observe that meningococcal disease still causes much morbidity and mortality, especially among children living in the inner city. Hemorrhagic diathesis, focal neurologic signs, and age were independent predictors of dismal prognosis, whereas preadmission antibiotic therapy had a protective effect.

This is a prospective study of 108 patients in two distinct groups undergoing real-time ultrasonography (US) and ascending conventional venography within the same day. The two patient groups consisted of the following: Those patients evaluated because of suspicion of deep venous thrombosis of lower limbs (69 patients) and those at high risk for venous thrombosis (19 patients with a recent hip fracture, 20 with a suspected pulmonary embolism). In the diagnosis group 48 patients had venographic evidence of thrombosis. The predictive value of abnormal findings from real-time US was 97%, and that of a negative study was 75%. Thus, real-time US may have a role as a diagnostic procedure, to be followed by x-ray venography in patients with negative US results. By contrast, real-time US is far less sensitive as a screening test in patients without clinical evidence of thrombosis. Only 3 of 9 patients with thrombosis were detected, with a 50% sensitivity for proximal vein thrombosis. Therefore, the use of real-time US for screening high-risk patients must be limited to very high risk patients in whom other tests are ineffective (as in hip surgery).