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Chen Y, Ye C, Lin Y, Ma Y, Zhang X, Wang J. Home Anxiety Assessment and Influencing Factors among Adolescent Athletes in Yantai City. CHILDREN (BASEL, SWITZERLAND) 2024; 11:628. [PMID: 38929208 PMCID: PMC11201604 DOI: 10.3390/children11060628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/08/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To understand the prevalence of home-related anxiety among adolescent athletes during the novel coronavirus pandemic and to ascertain the factors influencing this anxiety. METHODS We employed cluster sampling to select 1150 adolescent athletes (aged 8-18 years) from six sports training schools in Yantai City, Shandong Province. Mental health status was assessed and recorded. Chi-square tests and multivariable logistic regression were used to analyze the factors contributing to athletes' anxiety. RESULTS The survey revealed a COVID-19 infection rate of 38.23% (437 individuals) with an anxiety score of 40.98 ± 8.20 and an anxiety detection rate of 11.29% (129 individuals) during the COVID-19 epidemic. Female athletes exhibited a higher anxiety rate of 14.40% compared to 8.40% in male athletes. Multivariate analysis identified female gender as a risk factor for anxiety (OR = 1.64), while participation in aquatics emerged as a protective factor (OR = 0.24, 95% CI: 1.08-2.48). Professional training duration exceeding three years increased anxiety risk (OR = 3.05, 95% CI: 1.67-5.58), as did not seeking help during difficulties (OR = 2.59, 95% CI: 1.33-5.01). Interestingly, parental care was linked to increased anxiety risk (OR = 2.44, 95% CI 1.34-4.44), while care from friends was protective (OR = 0.60, 95% CI: 0.36-1.01), which was possibly due to the pressure associated with parental expectations. CONCLUSIONS Adolescent athletes, particularly females and those with extended training durations, exhibit a heightened susceptibility to anxiety. This study also highlights that athletes who proactively seek assistance during challenging situations tend to experience lower anxiety levels. Additionally, a lack of COVID-19 infection and the involvement of concerned parents contribute to reduced anxiety among these young athletes.
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Affiliation(s)
- Yuxi Chen
- School of Public Health, Binzhou Medical University, Yantai 264003, China; (Y.C.); (Y.L.); (Y.M.)
| | - Chunming Ye
- Yantai Sports Industry Development Service Center, Yantai 264003, China;
| | - Yang Lin
- School of Public Health, Binzhou Medical University, Yantai 264003, China; (Y.C.); (Y.L.); (Y.M.)
| | - Yongjie Ma
- School of Public Health, Binzhou Medical University, Yantai 264003, China; (Y.C.); (Y.L.); (Y.M.)
| | - Xingyu Zhang
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jiu Wang
- School of Public Health, Binzhou Medical University, Yantai 264003, China; (Y.C.); (Y.L.); (Y.M.)
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Gómez-Gómez I, Barquero-Jiménez C, Johnson E, Conejo-Cerón S, Moreno-Peral P, Bellón JÁ, Motrico E. Effectiveness of multiple health behavior change interventions in reducing symptoms of anxiety in the adult population: A systematic review and meta-analysis of randomized controlled trials. Prev Med 2024; 180:107847. [PMID: 38199592 DOI: 10.1016/j.ypmed.2024.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/30/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
There is limited evidence regarding the effectiveness of preventive interventions for anxiety disorders. We aim to test the effectiveness of multiple health behavior change (MHBC) interventions in the reduction of symptoms of anxiety in the adult population. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching the most relevant databases and registry platforms in the area. Reference lists of included articles and relevant systematic reviews and meta-analyses of MHBC interventions that examined anxiety or depression as outcomes were also manually searched. To identify RCTs that evaluated preventive interventions, we excluded studies in which the target population included only patients meeting the diagnostic criteria for anxiety disorders. To pool results, the standardized mean difference (SMD) was calculated using the random effects model. Sensitivity, subgroup and meta-regression analyses were performed. Forty-six RCTs were included in the qualitative synthesis, and 34 RCTs were included in the meta-analysis. Thirty RCTs were focused on promoting healthy diet and physical activity, whereas the other 16 studies also focused on smoking cessation. The pooled SMD was small (-0.183; 95% CI -0.276 to -0.091) but significant (p < 0.001). The effect became non-significant when only studies with a low risk of bias were included. There was substantial and significant heterogeneity between the studies. There is currently insufficient evidence regarding the effectiveness of MHBC interventions to reduce symptoms of anxiety in the adult population.
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Affiliation(s)
- Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | - Emma Johnson
- Centre for Applied Psychology, School of Psychology, University of Birmingham, UK
| | - Sonia Conejo-Cerón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Patricia Moreno-Peral
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Department of Personality, Assessment and Psychological Treatment, University of Malaga (UMA), Spain
| | - Juan Ángel Bellón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; El Palo Health Centre, Andalusian Health Service (SAS), Spain; Department of Public Health and Psychiatry, University of Málaga (UMA), Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
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Liu S, Mei Y, Huang L, Liu X, Xi Y. Association of habitual physical activity with depression and anxiety: a multicentre cross-sectional study. BMJ Open 2024; 14:e076095. [PMID: 38262655 PMCID: PMC10824028 DOI: 10.1136/bmjopen-2023-076095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Despite the known benefits of physical activity, the effect of habitual physical activity (HPA) on depression and anxiety remains unclear. This study aimed to investigate the association of HPA with the risk of depression and anxiety among Chinese adults, with the consideration of disease severity. METHODS The participants in this multicentre cross-sectional study were from the nationwide survey of the psychology and behaviour of Chinese residents. Depression and anxiety were measured using the nine-item Patient Health Questionnaire and seven-item Generalised Anxiety Disorder scale. HPA was assessed by the short form of the International Physical Activity Questionnaire. Crude and adjusted ORs with their 95% CIs were estimated by using ordinal logistic regression. RESULTS Of the 19 798 participants, 3901 (19.7%) had anxiety and 8914 (45.02%) had depression. Compared with inactive participants, depression risk in individuals reporting low, median and high volume HPA was reduced by 23% (OR 0.77, 95% CI 0.66 to 0.89), 21% (OR 0.79, 95% CI 0.68 to 0.90) and 13% (OR 0.87, 95% CI 0.78 to 0.98), respectively, after adjustment for confounder. No significant association of HPA with anxiety risk was observed. CONCLUSION Participation in HPA, whether low, median or high volume, was associated with a lower risk of depression compared with inactive participation, while no significant association was observed between HPA and anxiety.
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Affiliation(s)
- Sitong Liu
- Yanjing College of Medicine, Capital Medical University, Beijing, China
| | - Yunting Mei
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Li Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Yuandi Xi
- School of Public Health, Capital Medical University, Beijing, China
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Zhang SK, Gu ML, Zhang T, Xu H, Mao SJ, Zhou WS. Effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:513. [PMID: 37468931 DOI: 10.1186/s13018-023-03988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Exercise is an effective treatment in chronic low back pain (CLBP), but there are few studies on CLBP in the elderly, and the intervention effect is controversial. We aimed to compare the efficacy of different exercises therapy on CLBP, dysfunction, quality of life, and mobility in the elderly. METHODS We searched Web of Science, MEDLINE, Cochrane Library, Chinese National Knowledge Infrastructure, EMBASE, and PubMed from the database inception till December 31, 2022. The publication languages were Chinese and English. Randomized controlled trials (RCTs) of exercise intervention in the elderly (≥ 60 years) with CLBP were included. Two reviewers independently extracted the data and evaluated them using the Revised Cochrane Risk of Bias Tool for Randomized Trials 2 (RoB2). The pooled effect sizes on different aspects of outcome measures were calculated. RESULTS Sixteen articles (18 RCTs) were included, comprising a total of 989 participants. The quality of included studies was relatively high. Meta-analysis results indicated that exercise therapy could improve visual analog scale (VAS) (WMD = - 1.75, 95% CI - 2.59, - 0.92, p < 0.05), Oswestry disability index (ODI) (WMD = - 9.42, 95% CI - 15.04, - 3.79, p < 0,005), short-form 36-item health survey physical composite summary (SF-36PCS) (WMD = 7.07, 95% CI 1.01, 13.14, p < 0.05), short-form 36-item health survey mental composite summary (SF-36MCS) (WMD = 7.88, 95% CI 0.09, 15.67, p < 0.05), and timed up and go test (TUG) (WMD = - 0.92, 95% CI - 2.22, 0.38, p < 0.005). CONCLUSION Exercise therapy effectively improved VAS, ODI, and SF-36 indexes in the elderly. Based on the subgroup, when designing the exercise therapy regimen, aerobics, strength, and mind-body exercise (≥ 12 weeks, ≥ 3 times/week, ≥ 60 min) should be considered carefully, to ensure the safety and effectiveness for the rehabilitation of CLBP patients. More high-quality trials are needed in future to confirm the effect of exercise on SF-36 and TUG indexes.
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Affiliation(s)
- Shi-Kun Zhang
- Department of Police Physical Education, Jiangsu Police Institute, Nanjing, Jiangsu Province, China
| | - Mei-Ling Gu
- Nanjing Tian-zheng Primary School, Nanjing, China
| | - Ting Zhang
- Nanjing Tian-zheng Primary School, Nanjing, China
| | - Hong Xu
- Department of Sport & Health Science, College of Natural Science, Sangmyung University, Seoul, Korea
| | - Su-Jie Mao
- Graduate School of Nanjing University of Physical Education, Nanjing Sport Institute, Nanjing, China
| | - Wen-Sheng Zhou
- Department of Physical Education, Nanjing Xiao-Zhuang University, Nanjing, China.
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Bian J, Xiang Z. Do the various leisure forms have equal effects on mental health? A longitudinal analysis of self-selected leisure activities. Front Public Health 2023; 11:1134854. [PMID: 37261235 PMCID: PMC10227434 DOI: 10.3389/fpubh.2023.1134854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/17/2023] [Indexed: 06/02/2023] Open
Abstract
The deteriorating trends of unbalanced income, progressive age-related health problems, and loss of traditional ties necessitate ever-flexible interventions that are helpful to overcome a decline in Chinese adults' mental health. This study aimed to test whether engagement in different domains of leisure is associated with a composite index of mental health, both concurrently and subsequently. Longitudinal data including 10,968 participants (females = 5,804) with a mean age of 46.01 years in the Chinese General Social Survey (CGSS) were analyzed using generalized estimating equations with a logit link. The results showed that face-to-face experiences, such as sports with all ORs of < 1 at the significance level of α = 0.01 and meeting with all ORs of < 1 at the significance level of α = 0.01 except daily in-person meeting frequency, are important for protecting mental health owing to the increasing social support by building close ties. The results also indicate that online leisure with all ORs < 1 at the significance level of α = 0.01 has positive effects on lowering the odds of depression. In addition, receptive cognitive leisure, such as watching television or movies with all ORs < 1 at the significance level of α = 0.05 level, was not consistently associated with depression. However, active cognitive leisure, such as reading with all ORs of < 1 at a significance level of α = 0.01, was associated with lower odds of depression.
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Affiliation(s)
- Junyi Bian
- School of Physical Education, Guangzhou Sport University, Guangzhou, China
- Department of Human Performance and Health Education, Western Michigan University, Kalamazoo, MI, United States
| | - Zubing Xiang
- School of Physical Education, Chongqing University, Chongqing, China
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Kosasih FR, Yee VTS, Toh SHY, Sündermann O. Efficacy of Intellect's self-guided anxiety and worry mobile health programme: A randomized controlled trial with an active control and a 2-week follow-up. PLOS DIGITAL HEALTH 2023; 2:e0000095. [PMID: 37224139 DOI: 10.1371/journal.pdig.0000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.
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Affiliation(s)
| | | | | | - Oliver Sündermann
- Research Department, Intellect Co Pte Ltd, Singapore
- Department of Psychology, National University of Singapore
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de Dios-Rodríguez E, Patino-Alonso C, González-Sánchez S, Tamayo-Morales O, Ripoll J, Mora-Simón S, Unzueta-Arce J, Gómez-Marcos MA, García-Ortiz L, Rodríguez-Sánchez E. Promoting Physical Activity in a Primary Care Practice in People Living with Dementia and Their Family Caregivers. Healthcare (Basel) 2023; 11:healthcare11091255. [PMID: 37174797 PMCID: PMC10178700 DOI: 10.3390/healthcare11091255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
People living with dementia (PLWD) and their family caregivers report higher rates of having a sedentary lifestyle than their non-disabled peers do. This study analyzed the effectiveness of an intervention designed to increase physical activity among PLWD and their family caregivers in primary health care settings. A cluster-randomized multicenter clinical trial was conducted. Participants from four health centers were randomly assigned to the intervention group (IG) or the control group (CG) in a 1:1 ratio using Epidat software. After a seven-day period with a digital pedometer (Omron Hj-321 lay-UPS), participants were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ-SF). PLWD and caregivers allocated to the IG were given brief advice, educational materials and an additional 15 min appointment to prescribe an individualized physical activity plan. Seventy PLWD and 80 caregivers were assigned to the CG and 70 PLWD and 96 caregivers were assigned to the IG. Results of the pedometer assessment show that in PLWD, the IG's activity increased by 52.89 aerobic steps at 6 months and the CG's activity decreased by 615.93 aerobic steps, showing a net increase in the IG of 668.82 (95% CI: -444.27 to 1781.91; p = 0.227). For caregivers in the IG, activity increased by 356.91 aerobic steps and in the CG it decreased by 12.95 aerobic steps, showing a net increase in favor of the IG of 369.86 (95%CI: -659.33 to 1399.05; p = 0.476). The effectiveness of interventions to increase physical activity in this group of people with dementia and their caregivers did not achieved positive results overall but may have provided suggestions for family physicians and physical therapists to improve physical activity among people with dementia and their families.
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Affiliation(s)
- Elena de Dios-Rodríguez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
| | - Carmen Patino-Alonso
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Departamento de Estadística, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Susana González-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
| | - Olaya Tamayo-Morales
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
| | - Joana Ripoll
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Carrer de l'Escola Graduada, 3, 07002 Palma, Spain
- Balearic Islands Health Research Institute (IdISBa), Carrer de l'Escola Graduada, 3, 07002 Palma, Spain
| | - Sara Mora-Simón
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Campus Ciudad Jardín, Universidad de Salamanca, 37005 Salamanca, Spain
| | - Jaime Unzueta-Arce
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Campus Ciudad Jardín, Universidad de Salamanca, 37005 Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Departamento de Medicina, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Luis García-Ortiz
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal 83, 37005 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), 08007 Barcelona, Spain
- Departamento de Estadística, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, 37007 Salamanca, Spain
- Departamento de Medicina, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, 37007 Salamanca, Spain
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