Objective To estimate physical activity (PA) in healthy women before and during pregnancy and to evaluate the features associated with moderate PA (MPA). Methods A prospective cohort study was conducted on women selected 14 weeks of pregnancy during 2013–2015 in primary public health service centers in southern Spain. Type, duration, and frequency of PA (IPAQ questionnaire in first, second, and third trimesters [T1, T2, T3]) were measured. Variables associated with MPA were evaluated using multiple logistic regressions controlling for age, pre‐pregnancy obesity, level of education, number of living children, pre‐pregnancy PA, and adherence to Mediterranean diet (AMD). Results Out of 463 women, MPA was estimated in 64% pre‐pregnancy, and 54%, 61%, and 59% in T1, T2, and T3, respectively. MPA was associated with greater AMD in T2 (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI] 1.04–1.33) and T3 (aOR 1.16, 95% CI 1.02–1.31), previous PA (aOR 13.5, 95% CI 8.12–22.5 in T1; aOR 2.61, 95% CI 1.72–3.96 in T2; aOR 2.59, 95% CI 1.65–4.05 in T3), and pre‐pregnancy obesity (aOR 2.97, 95% CI 1.28–6.89 in T1; aOR 2.69, 95% CI 1.23–3.60 in T3). Conclusion PA decreased at the beginning of pregnancy, but compliance remained over 50%. MPA was associated with diet, pre‐pregnancy PA, and obesity.

BackgroundThis ecological study aimed i) to quantify the association of age and gender with the three components of pedestrians’ death rates after a pedestrian-vehicle crash: exposure, risk of crash and fatality, and ii) to determine the contribution of each component to differences in death rates according to age and gender in Spain.MethodsWe analyzed data for 220 665 pedestrians involved in road crashes recorded in the Spanish registry of road crashes with victims from 1993 to 2011, and a subset of 39 743 pedestrians involved in clean collisions (in which the pedestrian did not commit an infraction). Using decomposition and quasi-induced exposure methods, we obtained the proportion of increase in death rates for each age and gender group associated with exposure, risk of collision and fatality.ResultsDeath rates increased with age. The main contributor to this increase was fatality, although exposure also increased with age. In contrast, the risk of collision decreased with age. Males had higher death rates than females, especially in the 24–54 year old group. Higher fatality rates in males were the main determinant of this difference, which was also related with a higher risk of collision in males. However, exposure rates were higher in females.ConclusionsThe magnitude and direction of the associations between age and gender and each of the three components of pedestrians’ death rates differed depending on the specific component explored. These differences need to be taken into account in order to prioritize preventive strategies intended to decrease mortality among pedestrians.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-016-0079-2) contains supplementary material, which is available to authorized users.

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BackgroundDifferent diets during pregnancy might have an impact on the health, reflected in the birthweight of newborns. The consumption of fruits and vegetables during pregnancy and the relationship with newborn health status have been studied by several authors. However, these studies have shown inconsistent results. Purpose: We assessed whether certain foods were related to the risk of small for gestational age (SGA).MethodsA matched by age (± 2 years) and hospital 1:1 case-control study of 518 pairs of pregnant Spanish women in five hospitals was conducted. The cases were women with an SGA newborn at delivery (neonates weighting less than the 10th percentile, adjusted for gestational age at delivery and sex, were diagnosed as SGA). The control group comprised women giving birth to babies adequate for gestational age (AGA). Mothers who gave birth to babies large for gestational age (LGA) were excluded. Data were gathered concerning demographic characteristics, socioeconomic status, toxic habits and diet. A food frequency questionnaire (FFQ) comprising 137 items was completed by all participants. The intake of vegetables, legumes and fruits was categorized in quintiles (Q1–Q5). Crude values and and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The variables for adjustment were as follows: preeclampsia, education, smoking, weight gain per week during pregnancy, fish intake and previous preterm/low birthweight newborns.ResultsTotal pulse intake showed an inverse association with the risk of SGA (trend p = 0.02). Women with an intake of fruits above 420 g/day (Q5), compared with women in Q1 (≤ 121 g/day) showed a decreased risk of SGA (AOR = 0.63, 95% CI = 0.40–0.98). The total consumption of vegetables was not associated with the risk of SGA. The intake of selenium was assessed: a protective association was observed for Q3–5; a daily intake above 60 μg was associated with a lower risk of SGA (AOR = 0.39, 95% CI: 0.22–0.69).ConclusionsFruits, pulses and selenium reduce the risk of SGA in Spanish women.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2123-4) contains supplementary material, which is available to authorized users.

Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.

Objective: This systematic review assessed whether physician–patient language concordance, compared with discordance, is associated with better health outcomes.Methods: A systematic literature search was conducted, without language restrictions, using PubMed, EMBASE, Web of Science, and PsycINFO, from inception to July 2020. We included studies that evaluated the effects of physician–patient language concordance on health outcomes. Articles were screened, selected, and data-extracted in duplicate. Review protocol was prospectively registered (PROSPERO, CRD42020157229).Results: There were 541 citations identified through databases and eight citations through reverse search and Google Scholar. A total of 15 articles (84,750 participants) were included reporting outcomes within five domains: diabetes care (four studies), inpatient care (five studies), cancer screening (three studies), healthcare counseling (two studies), and mental health care (one study). Ten studies were of good quality, four were fair, and one was poor, according to the modified Newcastle-Ottawa Scale. Eight studies (53%) showed a significant negative association between language discordance and at least one clinical outcome. Five studies (33%) found no association.Conclusion: Over half the evidence collated showed that physician–patient language concordance was associated with better health clinical outcomes.