Jokin de Irala-Estévez

Universidad de Pamplona, Памплона, Norte de Santander, Colombia

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Publications (32)121.7 Total impact

  • Medicina Clínica. 08/2013; 114(6):237–238.
  • Medicina Clínica. 07/2013; 115(7):279.
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    ABSTRACT: Background In spite of the social concern about eating disorders (ED), information of its prevalencein Spain is limited. Further studies in communities are needed to estimate the frequencyof this problem in representative samples of the population. Subjects and methods To estimate the prevalence of anorexia nervosa (AN), bulimia nervosa(BN), and partial syndromes of the «non specified eating disorders» (NOSED) type, a representativesample of the female population of Navarre was selected using a random multistage samplingscheme. A sample of 2862 participants aged 12 to 21 was studied. The screening procedurewas performed using the Eating Attitudes Test (EAT) (values over 30 as the cutoff point)and each diagnosis was confirmed using a semi-structured interview performed by a psychiatryaccording to DSM-IV criteria. Results The overall prevalence of ED in this female population was 4.1% (95% CI: 3.45–4.95). The disorder specific prevalences being NOSED 3.1% (95% CI: 2.5–3.8), BN 0.8 (95%CI: 0.5–1.2) and AN 0.3 (95% CI: 0.1–0.6). Conclusions Our results show a slight lower prevalence than what other Spanish authors havereported, although we found higher prevalences of incomplete syndromes and suggest that ahigh social burden does exist and primary prevention strategies are needed.
    Medicina Clínica. 07/2013; 114(13):481–486.
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    ABSTRACT: To estimate the overall annual incidence and age group distribution of eating disorders in a representative sample of adolescent female residents of Navarra, Spain. We studied a representative sample of 2734 adolescent Navarran females between 13 and 22 years of age who were free of any eating disorder at the start of our study. Eighteen months into the study, we visited the established centers and the eating attitudes test (EAT-40) and eating disorder inventory (EDI) Questionnaires were administered to the entire study population. We obtained a final response of 92%. All adolescents whose EAT score was over 21 points and a randomized sample of those who scored 21 or below, were interviewed. Any person meeting the DSM-IV diagnostic criteria for Anorexia Nervosa (AN), Bulimia Nervosa (BN) or eating disorder not otherwise specified (EDNOS) was considered a case. We detected 90 new cases of eating disorders. Taking into consideration the randomly selected group whose EAT score was 21 points or below, we estimated the overall weighted incidence of eating disorders to be 4.8% (95% CI: 2.8-6.8), after 18 months of observation, in which EDNOS predominated with an incidence of 4.2% (95% CI: 2.0-6.3). The incidence of AN was 0.3% (95% CI: 0.2-0.5), while that of BN was also found to be 0.3% (95% CI: 0.2-0.5). The highest incidence was observed in the group of adolescents between 15 and 16 years of age. The overall incidence of ED in a cohort of 2509 adolescents after 18 months of follow-up was 4.8% (95% CI: 2.8-6.8), with EDNOS outweighing the other diagnoses. The majority of new cases of eating disorders were diagnosed between ages 15 and 16.
    European Psychiatry 04/2005; 20(2):179-85. · 3.29 Impact Factor
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    ABSTRACT: To estimate the risk reduction for re-infarction achieved in primary health care centres. This was a case-control study nested in a cohort of coronary patients. Nine hundred and eighty-five coronary patients, aged less than 76 years who had survived for more than 6 months after their first acute myocardial infarction (AMI), were recruited from two public hospitals in Navarre, Spain. Cases (repeated myocardial infarction, n = 137) and controls (patients with one AMI who had not had a second infarction, [n = 137) who had not been treated with invasive procedures were extracted from this cohort and matched by gender, age, hospital and the secondary prevention time frame. Re-infarction. In total, 31.4% of cases and 51.8% of controls attended the primary care nurse clinic regularly. This difference accounted for a significant reduction of the risk of re-infarction, even after adjustment for regular visits to the family physician, life styles (smoking, walking habit and dietary changes) and drug treatments (odds ratio: 0.48; 95% confidence interval: 0.26-0.89). A regular schedule of visits to the family physician showed no association with further coronary risk reduction. Regular attendance of coronary patients at a primary care nurse clinic is associated with a lower risk for re-infarction. Psychological rehabilitation could be the main reason for this benefit, since protection persists after adjustments for other known risk factors.
    Public Health 03/2005; 119(2):112-7. · 1.35 Impact Factor
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    ABSTRACT: To assess the role of neuroticism and low self-esteem as risk factors for eating disorders (ED). A representative sample of girls 12-21 years old from Navarre, Spain. Girls free from any ED in 1997 were followed up for 18 months and reevaluated using DSM-IV criteria. Multivariable logistic models were used to examine associations between neuroticism (Eysenck Inventory) or low self-esteem (36-item scale) and incident ED. Higher levels of neurotic personality increased the risk of ED (adjusted odds ratio [OR] for the highest quartile, 3.3; 95% Cl; 1.6-4.8). High levels of self-esteem were protective (OR, 0.32; 95% CI, 0.16-0.66). Neuroticism was a more powerful predictor than low self-esteem. Our results provide prospective evidence supporting the role of neuroticism and low self-esteem as major determinants of ED.
    International Journal of Eating Disorders 05/2003; 33(3):271-80. · 3.03 Impact Factor
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    ABSTRACT: To identify risk factors for eating disorders. A community cohort study was conducted in Navarra, Spain. A region-wide representative sample of 2862 girls who were 12 to 21 years of age completed the Eating Attitudes Test (40-item version) and other questionnaires in 1997. Girls who scored high in the Eating Attitudes Test-40 were interviewed by a psychiatrist who applied Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria to diagnose prevalent cases of eating disorders. Girls who were free of any eating disorder in 1997 were reassessed after 18 months of follow-up using the same methods. Ninety new cases of eating disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were identified during the follow-up. In the multivariate logistic analysis, a higher risk of incident eating disorder was found for several exposures assessed at the beginning of follow-up, such as younger age, usually eating alone (odds ratio [OR]: 2.9; 95% confidence interval: 1.9-4.6), and frequently reading girls' magazines or listening to radio programs (OR: 2.1; 1.2-3.8 for those most frequently using both media). No independent association was found for television viewing or socioeconomic status. A marital status of parents different from "being married" was associated with a significantly higher risk in the multivariate analysis (OR: 2.0; 1.1-3.5). Our results support the role of mass media influences and parental marital status in the onset of eating disorders. The habit of eating alone should be considered as a warning sign of eating disorders.
    PEDIATRICS 03/2003; 111(2):315-20. · 4.47 Impact Factor
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    ABSTRACT: Many studies have shown the health burden of a sedentary lifestyle. The main goal of this study was to determine the prevalence of sedentary lifestyles in the 15 Member States of the European Union (EU) and to identify the main correlates of a sedentary lifestyle. Nationally representative samples (n approximately 1000 subjects in each country; >15 years) completed a questionnaire concerning attitudes to physical activity, body weight, and health; in total 15 239 subjects. Sedentary people were defined in two ways: (1) those expending less than 10% of their leisure time expenditure in activities involving >/=4 metabolic equivalents (MET). (2) Those who did not practice any leisure-time physical activity and who also were above the median in the number of hours spent sitting down during leisure time. Logistic regression models were fitted to analyse the association between sedentary lifestyles and gender, age, body mass index (BMI), educational level, weight change in the last 6 months, and marital and smoking status. Percentages of sedentary lifestyles across European countries ranged between 43.3% (Sweden) and 87.8% (Portugal) according to the first definition. According to both definitions, a lower prevalence of sedentary lifestyle was found in Northern countries (especially Scandinavian countries) as compared with Mediterranean countries, whereas the prevalence was higher among older, obese, less educated, widowed/divorced individuals, and current smokers. Similar relative differences between countries and socio-demographic groups were found independently of the method used to define a sedentary lifestyle. Prevalence of sedentary lifestyle in the EU is high, especially among inhabitants of some Mediterranean countries, obese subjects, less-educated people, and current smokers. This high prevalence involves important public health burdens and preventive strategies are urgently needed.
    International Journal of Epidemiology 02/2003; 32(1):138-46. · 6.98 Impact Factor
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    ABSTRACT: To ascertain the major dietary patterns in the cohort 'SUN' and to assess the association of several sociodemographic (including age and gender) and lifestyle variables with the adherence to these dietary patterns. This study is a cross-sectional analysis of 3847 subjects (1587 men and 2260 women) belonging to a prospective cohort study based on self-reported questionnaires. A factor analysis based on 30 predefined food groups was conducted to ascertain the major dietary patterns in the cohort. Multiple regression models were fitted to assess the relationship between several sociodemographic and lifestyle variables and the adherence to these dietary patterns (measured using two scores with observed values ranging from -3.2 to +4.6 for the Western pattern and -3.1 to +5.5 for the Mediterranean pattern). Two major dietary patterns were found. The first pattern was labelled as a 'Western' dietary pattern and the other as a 'Spanish-Mediterranean' dietary pattern. Younger subjects were more likely to follow a 'Western' dietary pattern; the coefficient representing the change for every 10 y increase in age was b=-0.24 (P<0.001) for men and b=-0.12 (P<0.001) for women. More physically active subjects were less likely to follow a 'Western' dietary pattern and more likely to follow a 'Spanish-Mediterranean' dietary pattern. An association between a higher level of physical activity during leisure time and adherence to a 'Spanish-Mediterranean' diet was apparent. However, the profile of being a young, sedentary and single male was identified as the most likely to exhibit a departure from the traditional 'Spanish-Mediterranean' diet and follow a 'Western' dietary pattern.
    European Journal of Clinical Nutrition 02/2003; 57(2):285-92. · 2.76 Impact Factor
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    ABSTRACT: Diet and life-styles are considered as the main factors that determine the high prevalence of obesity in Western societies. Although some countries have registered a decrease in fat intake, the percentage of overweight and obesity has increased. Therefore, it is thought that fat intake may not be the main factor that determines the current epidemic of obesity. The objective of this study was to determine the role of a sedentary life-style and eating between meals (snacking) as major determinants of a recent weight change (over last 5 years). By using cross-sectionally baseline data of the SUN cohort, we adjusted non-conditional logistic regression models to estimate the odds ratio (OR) of gaining weight according to age, physical activity in leisure time, watching television, taking a nap, smoking, snacking and the intake of macronutrients. A statistically significant inverse association between leisure-time physical activity and the probability of gaining weight was found for men (OR = 0.93; CI 95%, 0.88-0.98) and a trend was also present among women. Snacking was positively associated with a higher probability of gaining weight among men (OR = 1.88; CI 95%, 1.40-2.53) and among women (OR = 1.38; CI 95%, 1.10-1.73). Our data suggest a direct association between snacking and weight gain in middle-aged people.
    Medicina Clínica 07/2002; 119(2):46-52. · 1.40 Impact Factor
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    ABSTRACT: To study the relationship of self-esteem and personality factors with eating disorders (ED). A region-wide representative sample of 2862 girls 12-21 years old from Navarre (Spain) participated in the baseline assessment of a prospective study. A two-stage procedure was used, consisting in a first screening phase followed by a psychiatrist interview (DSM-IV criteria). Multivariable logistic regression models were used to examine the association of self-esteem (36-item scale) and personality characteristics (Eysenck inventory) with psychiatrist-diagnosed ED while controlling for potential confounders. Strong associations for ED were found with low self-esteem (adjusted odds ratio [adjOR] for the lowest quartile: 7.98, 95% CI: 3.4-18.8) and high levels of neuroticism (adjOR for the highest quartile: 9.49, 95% Cl: 3.7-24.5). Our results, although based on a cross-sectional design, support the potential role of neuroticism and low self-esteem in the onset of ED.
    International Journal of Eating Disorders 05/2002; 31(3):261-73. · 3.03 Impact Factor
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    ABSTRACT: Female genital mutilation (FGM) is practiced in Egypt, despite its recent ban, generally in rural and uneducated communities, under unsanitary conditions and by non-medical personnel. Immediate and long-term complications are frequent. The aim of this study was to gain insight into what beliefs or knowledge are conducive to supporting FGM. One thousand and seventy university students in Cairo, Egypt were randomly selected. A 32-item questionnaire was used to interview students regarding their knowledge and attitudes toward FGM. Multivariable analyses were performed to find factors associated with being against the abolishment of FGM.The response rate was 95% (n=1020). Twenty-eight percent of the students support FGM. The most significant factors associated with the condoning of FGM were believing FGM has a religious basis (OR=2.53), disagreeing that FGM is a custom with no other basis (OR=2.59), not believing it is harmful (OR=4.11), and ignoring that it is usually followed by complications (OR=5.14). Even in an educated population, a considerable amount of ignorance concerning FGM exists. Widespread education about FGM is important to dispel the myths that surround its practice and to bring the practice to an end.
    Public Health 10/2001; 115(5):350-5. · 1.35 Impact Factor
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    ABSTRACT: Comparison of statistical methods and measurement scales to identify nosocomial infection risk factors in intensive care units (ICU). Prospective study in 558 patients admitted to the ICU of a referral hospital between February and November 1994. Analysis using three logistic regression models, three standard Cox regression models, and two Cox regression models with time-dependent extrinsic factors. Different scales were used to measure exposures to risk factors (dichotomous, ordinal, quantitative, and time-dependent variables). The most appropriate models were those that measured exposure using dichotomous variables. Models using ordinal or quantitative variables estimated biased coefficients and/or failed to comply with the statistical assumptions underlying the analyses. The Cox regression model with quantitative time-dependent variables met all the statistical assumptions, obtained a precise assessment of risk by exposure time, and estimated unbiased coefficients. The Cox regression analysis with quantitative time-dependent variables is the most valid alternative for assessing the risk of nosocomial infection per day of exposure to an extrinsic risk factor in the ICU.
    Intensive Care Medicine 09/2001; 27(8):1254-62. · 5.26 Impact Factor
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    ABSTRACT: This study assessed several methodological aspects related to the quality of published controlled clinical trials (CCTs) in relation to the participation of an epidemiologist/biostatistician (E/B). Handsearch of CCTs published in four medical leading journals for 1993-1995. Quality variables, abstracted from a review, were related to authors' specialties. Five hundred and ninety four CCTs were identified via a hand search. The department/unit membership was used to attribute authors' specialties. Of 594 CCTs identified, in 127 the authors' specialties could not be known, leaving 467 trials for analysis. E/B participation occurred in 178 trials (38.1%). This participation was more frequent in multicentric, bigger, and in those trials describing any funding agency. These factors were controlled for in the analysis. E/B participation was positively associated with pre-study sample size estimation (OR = 1.5, 95% confidence intervals (CI) 1.0, 2.3), with reporting the dates for starting/ending the study (OR = 2.1, 95% CI 1.4, 3.3), with using an objectively assessed outcome (OR = 2.4, 95% CI 1.2, 4.6) and with the intention to treat principle (OR = 2.0, 95% CI 1.3, 3.0). The overall quality score was higher in trials where E/B participated. The results suggest that E/B improve the quality (at least of reports) of clinical trials. Given that quality of research is frequently used to evaluate potential sources of heterogeneity between trials, these results are relevant for meta-analysis.
    Journal of Epidemiology &amp Community Health 09/2001; 55(8):569-72. · 3.39 Impact Factor
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    ABSTRACT: The assessment of the methodological quality of controlled clinical trials (CCTs) carried out in Spain and published in international journals and the comparison with those published in widely read general journals of medicine (N Engl J Med, Lancet, JAMA, BMJ) may help establishing their limitations and improving quality in future studies. Search in Medline of CCTs. Studies were evaluated according to a structured questionnaire (J Clin Epidemiol 1992; 45:225-265). The odds ratio and their 95% confidence intervals were used to compare spanish studies with the remaining studies. The following variables were considered as confounders and controlled for by logistic regression analysis: number of participating centers, sample size, funding source, and the inclusion of epidemiologists in the research team. The journal's impact factor was taken into account. Spanish CTTs had a smaller sample size, were mostly monocentric, reported les frequently the source of funding, and exhibited a lower participation of epidemiologists. The informed consent and the approval by the ethics committee were more frequently omitted. The major methodological differences with the other studies were: lack of pre-study sample size and statistical power estimation, lack of inclusion criteria, poor explanation of patients' flow in the selection process, lack of explanation for unmasked procedures, poor description of methods to assess intervention compliance, under-reporting confidence intervals, and less frequent use of the intention-to-treat principle. The quality score of spanish studies was lower (9.4 +/- 1.7 vs 10.7 +/- 1.5; p < 0.001). These limitations improved with higher journal's impact factor, the quality score was 8.5 in journals with an impact factor < 1.5, and 10.6 in those with an impact factor > 4.5. This last figure is almost identical to the average of CCTs published in general journals of medicine. Most spanish studies achieved a good quality score. Nevertheless, there are still issues which can be overcome easily. If this goal is achieved, the results will obtain a higher repercussion, as a better quality is observed in those published in journals with the highest impact factor.
    Revista Clínica Española 08/2001; 201(8):437-43. · 2.01 Impact Factor
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    ABSTRACT: To assess the relationship between the approval of trials by a research ethics committee (REC) and the fact that informed consent from participants (ICP) was obtained, with the quality of study design and methods. Systematic review using a standardised checklist. Methodological and ethical issues of all trials published between 1993 and 1995 in the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association and the British Medical Journal were studied. In addition, clinical trials conducted in Spain and published by at least one Spanish author during the same period in any other journal were also included. We studied the published articles of 767 trials and found the following indicators of lower methodological quality to be independent predictors for failure to disclose REC approval or ICP: absence of concealment of allocation, lack of justification for unblinded trials, not using a treatment for the patients in the control group, absent information on statistical methods, not including sample size estimation, not establishing the rules to stop the trial, and omitting the presentation of a baseline comparison of groups. Trials of higher methodological and scientific quality were more likely to provide information about their ethical aspects.
    Journal of Medical Ethics 07/2001; 27(3):172-6. · 1.42 Impact Factor
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    ABSTRACT: To evaluate the differences in the consumption of fruit and vegetables between groups with different socio-economic status (SES) in the adult population of European countries. A systematic review of published and unpublished surveys of food habits conducted between 1985 and 1999 in 15 European countries. Educational level and occupational status were used as indicators of SES. A pooled estimate of the mean difference between the highest and the lowest level of education and occupation was calculated separately for men and women, using DerSimonian and Laird's random effects model. The inclusion criteria of studies were: use of a validated method for assessing intake at the individual level; selection of a nationwide sample or a representative sample of a region; and providing the mean and standard deviation of overall fruit and vegetable consumption for each level of education or occupation, and separately for men and women. Participants in the individual surveys had to be adults (18-85 y). Eleven studies from seven countries met the criteria for being included in the meta-analysis. A higher SES was associated with a greater consumption of both fruit and vegetables. The pooled estimate of the difference in the intake of fruit was 24.3 g/person/day (95% confidence interval (CI) 14.0-34.7) between men in the highest level of education and those in the lowest level of education. Similarly, this difference was 33.6 g/person/day for women (95% CI 22.5-44.8). The differences regarding vegetables were 17.0 g/person/day (95% CI 8.6-25.5) for men and 13.4 g/person/day (95% CI 7.1-19.7) for women. The results were in the same direction when occupation instead of education was used as an indicator of SES. Although we cannot exclude over-reporting of intake by those with highest SES, it is unlikely that this potential bias could fully explain the differences we have found. Our results suggest that an unhealthier nutrition pattern may exist among adults belonging to lower socio-economic levels in Europe. The present study was supported by the European Union's FAIR programme (FAIR-97-3096).
    European Journal of Clinical Nutrition 10/2000; 54(9):706-14. · 2.76 Impact Factor
  • Journal of physiology and biochemistry 07/2000; 56(2):131-2. · 1.65 Impact Factor
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    ABSTRACT: Our purpose was to identify the main barriers and benefits perceived by the European citizens in regard to following a healthy diet and to assess the differences in expected benefits and difficulties between Spain and the remaining countries of the European Union. A cross-sectional study in which quota-controlled, nationally representative samples of approximately 1000 adults from each country completed a questionnaire. The survey was carried out between October 1995 and February 1996 in the 15 member states of the European Union. Participants (aged 15 y and older) were selected and interviewed in their homes about their attitudes towards healthy diets. They were asked to select two options from a list of 22 potential barriers to achieve a healthy diet and the benefits derived from a healthy diet. The associations of the perceived benefits of barriers with the sociodemographic variables within Spain and the rest of the European Union were compared with the Pearson chi-squared test and the chi-squared linear trend test. Two multivariate logistic regression models were also fitted to assess the characteristics independently related to the selection of 'Resistance to change' among the main barriers and to the selection of 'Prevent disease/stay healthy' as the main perceived benefits. The barrier most frequently mentioned in Spain was 'Irregular work hours' (29.7%) in contrast with the rest of the European Union where 'Giving up foods that I like' was the barrier most often chosen (26.2%). In the multivariate logistic regression model studying resistance to change, Spaniards were less resistant to change than the rest of the European Union. The benefit more frequently mentioned across Europe was 'Prevent disease/stay healthy'. In the multivariate logistic regression model women, older individuals, and people with a higher educational level were more likely to choose this benefit. It is apparent that there are many barriers to achieve healthy eating, mostly lack of time. For this reason a higher availability of food in line with the nutrition guidelines could be helpful. The population could have a better knowledge of the benefits derived from a healthy diet.
    European Journal of Clinical Nutrition 07/2000; 54(6):453-9. · 2.76 Impact Factor
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    M Ruiz-Canela, M A Martínez-González, J de Irala-Estévez
    BMJ Clinical Research 05/2000; 320(7240):1007-8. · 14.09 Impact Factor

Publication Stats

893 Citations
121.70 Total Impact Points

Institutions

  • 2002–2005
    • Universidad de Pamplona
      Памплона, Norte de Santander, Colombia
  • 1999–2003
    • Universidad de Navarra
      • • Department of Preventive Medicine and Public Health
      • • School of Medicine
      Iruña, Navarre, Spain
  • 2001
    • Universidad de Jaén
      • Department of Health Sciences
      Jaén, Andalusia, Spain