1
|
Salvado R, Santos-Minguez S, Lugones-Sánchez C, Gonzalez-Sánchez S, Tamayo-Morales O, Quesada-Rico JA, Benito R, Rodríguez-Sánchez E, Gómez-Marcos MA, Casado-Vicente V, Guimarães-Cunha P, Hernandez-Rivas JM, Mira A, García-Ortiz L. Gut microbiota and its relationship with early vascular ageing in a Spanish population (MIVAS study). Eur J Clin Invest 2024:e14228. [PMID: 38655910 DOI: 10.1111/eci.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Gut microbiota and its by-products are increasingly recognized as having a decisive role in cardiovascular diseases. The aim is to study the relationship between gut microbiota and early vascular ageing (EVA). METHODS A cross-sectional study was developed in Salamanca (Spain) in which 180 subjects aged 45-74 years were recruited. EVA was defined by the presence of at least one of the following: carotid-femoral pulse wave velocity (cf-PWV), cardio-ankle vascular index (CAVI) or brachial-ankle pulse wave velocity (ba-PWV) above the 90th percentile of the reference population. All other cases were considered normal vascular ageing (NVA). MEASUREMENTS cf-PWV was measured by SphygmoCor® System; CAVI and ba-PWV were determined by Vasera 2000® device. Gut microbiome composition in faecal samples was determined by 16S rRNA Illumina sequencing. RESULTS Mean age was 64.4 ± 6.9 in EVA group and 60.4 ± 7.6 years in NVA (p < .01). Women in EVA group were 41% and 53% in NVA. There were no differences in the overall composition of gut microbiota between the two groups when evaluating Firmicutes/Bacteriodetes ratio, alfa diversity (Shannon Index) and beta diversity (Bray-Curtis). Bilophila, Faecalibacterium sp.UBA1819 and Phocea, are increased in EVA group. While Cedecea, Lactococcus, Pseudomonas, Succiniclasticum and Dielma exist in lower abundance. In logistic regression analysis, Bilophila (OR: 1.71, 95% CI: 1.12-2.6, p = .013) remained significant. CONCLUSIONS In the studied Spanish population, early vascular ageing is positively associated with gut microbiota abundance of the genus Bilophila. No relationship was found between phyla abundance and measures of diversity.
Collapse
Affiliation(s)
- Rita Salvado
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Sandra Santos-Minguez
- Instituto de Investigación del Cáncer, Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca-CSIC, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
| | - Susana Gonzalez-Sánchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
| | - Olaya Tamayo-Morales
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
| | - José A Quesada-Rico
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
- Facultad de Medicina, Universidad Miguel Hernández de Elche, Sant Joan, D'Alacant, Spain
| | - Rocío Benito
- Instituto de Investigación del Cáncer, Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca-CSIC, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Verónica Casado-Vicente
- Centro de Salud Parquesol. Gerencia de Salud Valladolid Oeste, Gerencia Regional de Salud de Castilla y Leon (SACyL), Valladolid, Spain
- Departamento de Medicina, Dermatología and Toxicología, Universidad de Valladolid, Valladolid, Spain
| | - Pedro Guimarães-Cunha
- Life and Health Sciences Research Institute (IICVS) and School of Medicine, Universidade do Minho, Braga, Portugal
- Center for the Research and Treatment of arterial Hypertension and cardiovascular Risk, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Jesús M Hernandez-Rivas
- Instituto de Investigación del Cáncer, Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca-CSIC, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
- Departamento de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Alex Mira
- Departamento de Salud y Genómica, Fundación FISABIO, Valencia, Spain
- CIBER Centro de Epidemiología y Salud Pública, Madrid, Spain
| | - Luis García-Ortiz
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Red de Investigación en Cronicidad Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Barcelona, Spain
- Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
2
|
Vicente-Gabriel S, Lugones-Sánchez C, Tamayo-Morales O, Vicente Prieto A, González-Sánchez S, Conde Martín S, Gómez-Sánchez M, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Sánchez L, Gómez-Marcos MA. Relationship between addictions and obesity, physical activity and vascular aging in young adults (EVA-Adic study): a research protocol of a cross-sectional study. Front Public Health 2024; 12:1322437. [PMID: 38344236 PMCID: PMC10853417 DOI: 10.3389/fpubh.2024.1322437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Background Behavioral and substance addictions are prevalent health problems that, alongside obesity, are linked to reduced physical activity and increased sedentary time. Similarly, arterial stiffness and vascular aging are processes that begin gradually at an early age and are closely associated with morbidity and mortality from cardiovascular diseases. The main objective of this study is to analyze how addictions are related to obesity and body fat distribution, physical activity, sedentary time, arterial stiffness and vascular aging, as well as sleep quality, cognitive function and gender differences in young adults aged between 18 and 34 years. Methods This cross-sectional descriptive observational study will analyze data from 500 subjects (250 men and 250 women) aged 18-34 without cardiovascular disease, selected by simple random sampling with replacement from the urban population of the city center of Salamanca (34,044 people aged 18-34, with 18,450 women and 15,594 men). Behavioral and substance addictions, as well as sleep quality and cognitive impairment will be assessed using questionnaires. The Pittisburg Sleep Quality Index (PSQI) will be used to measure sleep quality and the Ford questionnaire will be used to measure insomnia in response to stress. For obesity, weight, height, waist and hip circumference, body composition will be measured with the Inbody 230® impedance meter. For physical activity and sedentary time, we will use the Actigraph® accelerometer alongside the international physical activity questionnaire (IPAQ) and the Marshall questionnaire. The Sphygmocor System® will be used for pulse wave analysis and carotid-femoral pulse wave velocity (cfPWV), while the Vasera VS-2000® will measure cardio ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Vascular aging will be calculated with the 10th and 90th percentiles of cfPWV or baPWV. Demographic, analytical variables will be collected, as will data to assess vascular, cardiac, renal, and brain injury. Discussion Addictions are on the rise in today's society, affecting the mental health and well-being of those who suffer from them, generating important social problems such as job loss, family dysfunction, debt and social isolation. Together with obesity, they are prevalent health problems in young adults and are associated with lower physical activity and higher sedentary time. Meanwhile, arterial stiffness and vascular aging are processes that begin gradually at an early age and determine morbidity and mortality caused by cardiovascular diseases. The results of this project will allow us to understand the situation regarding behavioral and substance addictions in young adults. Better understanding of these addictions will in turn facilitate the development of more effective prevention strategies and intervention programs, which can then reduce the negative impact at both the individual and societal levels. Clinical trial registration [ClinicalTrials.gov], identifier [NCT05819840].
Collapse
Affiliation(s)
- Sara Vicente-Gabriel
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Intensive Care Unit, Salamanca University Hospital, Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
- Salamanca Primary Care Management, Castilla and León Health Service–SACYL, Salamanca, Spain
| | - Olaya Tamayo-Morales
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Alberto Vicente Prieto
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Salamanca Primary Care Management, Castilla and León Health Service–SACYL, Salamanca, Spain
| | - Susana González-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Sandra Conde Martín
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Salamanca Primary Care Management, Castilla and León Health Service–SACYL, Salamanca, Spain
| | - Marta Gómez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Home Hospitalization Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Emiliano Rodríguez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
- Salamanca Primary Care Management, Castilla and León Health Service–SACYL, Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
- Salamanca Primary Care Management, Castilla and León Health Service–SACYL, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Leticia Gómez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Emergency Department, La Paz University Hospital, Madrid, Spain
| | - Manuel A. Gómez-Marcos
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
- Salamanca Primary Care Management, Castilla and León Health Service–SACYL, Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | | |
Collapse
|
3
|
Llamas-Ramos I, Llamas-Ramos R, Lugones-Sánchez C, González-García S, Tamayo-Morales O, Alvarado-Omenat JJ, Pablos-Hernández C, Gómez-Marcos MA, García-Ortiz L, Rodríguez-Sánchez E. Effect of a lifestyle-integrated functional exercise (LiFE) group intervention (sLiFE) to falls prevention in non-institutionalized older adults. Protocol of a randomised clinical trial. Front Public Health 2024; 11:1304982. [PMID: 38259747 PMCID: PMC10801183 DOI: 10.3389/fpubh.2023.1304982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Personalized programs of integrated strength and balance activities have been shown their effectiveness in falls reduction in the older adults. Objective To measure whether a group intervention with the strength and balance principles of the sLiFE program is more effective than standard health advice in reducing the incidence of falls. Methods The study will comprise 650 participants with more than 65 years who live at home, observing established inclusion and exclusion criteria. Participants will be randomly assigned in two groups: group intervention (n = 325) and standard health advice (n = 325). The intervention group will follow the balance and strength activities described in the LiFE program manual. The group intervention will be carried out in groups of 12-14 and will consist of seven one-hour sessions over 12 weeks in health centres. Incidence of falls and quality of life will be assessed as primary outcome variables. Fear of falling and exercise adherence will be analysed as secondary outcome variables. Discussion Physical activity has been put forward as an effective treatment technique for these patients; however, long-term adherence to these programs remains a challenge. Group interventions could reduce dropout rates. Conclusion Falls represent a major health problem globally due to the disability they cause in older people. Prevention would help reduce not only their incidence but also the health costs derived from their treatment. Group intervention helps clinicians to save resources and time, being able to attend more people with the same quality of care. Clinical trial registration https://clinicaltrials.gov/study/NCT05912088?distance=50&term=NCT05912088&rank=1, identifier NCT05912088.
Collapse
Affiliation(s)
- Inés Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - Rocío Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - Susana González-García
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | | | - Carmen Pablos-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Universidad de Salamanca, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
4
|
Domínguez-Gómez M, Mora-Simón S, Rodríguez-Sánchez E. [Mortality associated with neurocognitive disorder and dependence in people over 55 years of age. Systematic review]. Rev Esp Geriatr Gerontol 2024; 59:101411. [PMID: 37820397 DOI: 10.1016/j.regg.2023.101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The increasing aging of the population brings with it an increase in the incidence of neurocognitive disorder (NCD) as well as various situations that generate dependence. OBJECTIVE To analyze by means of a systematic review the relationship between NCD and dependence with the risk of mortality in the elderly. METHODS A bibliographic search of longitudinal studies published in Pubmed and Scopus addressing the relationship between NCI, dependence for basic activities of daily living (ADL) and mortality published between 1995 and 2021 was performed. Of the 1040 articles found, 10 studies were selected. RESULTS It was observed that cohorts of elderly people with NCI presented mortality risk associated with ABVD impairment (Barthel test) and Mini-Mental State Examination scores following a significant linear trend. Other factors associated with mortality risk were low levels of education, living alone, and frailty. CONCLUSIONS The results underline the importance of performing assessments of cognitive and functional status using validated scales, since both areas are associated with mortality. The link between the three terms used in the search for this work is clear, but it is noteworthy that there are few longitudinal studies that analyze them together. The assessment of dependence and cognitive function in older adults should be considered in both research and clinical practice as it would provide information on their possible relationship with mortality.
Collapse
Affiliation(s)
- Manuel Domínguez-Gómez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Salamanca, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS) (RD21/0016)
| | - Sara Mora-Simón
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Salamanca, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS) (RD21/0016); Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Salamanca, Salamanca, España
| | - Emiliano Rodríguez-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Salamanca, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS) (RD21/0016); Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, Salamanca, España.
| |
Collapse
|
5
|
Navarro Cáceres A, Navarro-Matías E, Gómez-Sánchez M, Tamayo-Morales O, Lugones-Sánchez C, González-Sánchez S, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Sánchez L, Gómez-Marcos MA. Increase in Vascular Function Parameters According to Lifestyles in a Spanish Population without Previous Cardiovascular Disease-EVA Follow-Up Study. Nutrients 2023; 15:4614. [PMID: 37960267 PMCID: PMC10648779 DOI: 10.3390/nu15214614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this longitudinal descriptive observational study was to analyze the influence of different lifestyles on arterial stiffness (AS) throughout five years of follow-up and to describe the differences by sex in a Spanish adult population without cardiovascular disease at the start of the study. A random stratified sampling by age and sex was used to obtain 501 subjects included in the initial assessment. No cardiovascular disease was allowed in the subjects. The average age was 55.9 years, and 50.3% were women. A total of 480 subjects were analyzed again five years later. Alcohol and tobacco consumption were collected with standardized questionnaires. Adherence to the Mediterranean diet was assessed with the Mediterranean diet adherence screener (MEDAS) questionnaire. Physical activity was assessed with the short version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and sedentary time was assessed with the Marshall Sitting Questionnaire (MSQ). AS was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central augmentation index (CAIx) with SphygmoCor System®, and ankle pulse wave velocity (baPWV) and cardio ankle vascular index (CAVI) with Vasera VS-1500®. Increases in vascular function measures per year of follow-up were: cfPWV = 0.228 ± 0.360 m/s, baPWV = 0.186 ± 0.308 m/s, CAVI = 0.041 ± 0.181 m/s, and CAIx = 0.387 ± 2.664 m/s. In multiple regression analysis, positive association was shown between an increase in baPWV and tobacco index (β = 0.007) and alcohol consumption (β = 0.005). Negative association was shown between CAVI and Mediterranean diet score (β = -0.051). In multinomial logistic regression analysis, the OR of tobacco index of subjects with a cfPWV increase >P75 was OR = 1.025 and of subjects classified between P25 and P75 was OR = 1.026 regarding subjects classified with an increase P75 was OR = 1.006 regarding subjects classified with an increase P75, and an OR = 0.841 was found of subjects classified between P25-75 regarding subjects classified with an increase
Collapse
Affiliation(s)
- Alicia Navarro Cáceres
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
| | - Elena Navarro-Matías
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
| | - Marta Gómez-Sánchez
- Home Hospitalization Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Olaya Tamayo-Morales
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
| | - Susana González-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
- Department of Medicine, University of Salamanca, 28046 Salamanca, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37007 Salamanca, Spain
| | - Leticia Gómez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Emergency Service, University Hospital of La Paz, 37007 Madrid, Spain
| | - Manuel A. Gómez-Marcos
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
- Department of Medicine, University of Salamanca, 28046 Salamanca, Spain
| | | |
Collapse
|
6
|
Lugones-Sánchez C, Santos-Mínguez S, Salvado R, González-Sánchez S, Tamayo-Morales O, Hoya-González A, Ramírez-Manent JI, Magallón-Botaya R, Quesada-Rico JA, Garcia-Cubillas MD, Rodríguez-Sánchez E, Gómez-Marcos MA, Benito-Sanchez R, Mira A, Hernandez-Rivas JM, Garcia-Ortiz L. Lifestyles, arterial aging, and its relationship with the intestinal and oral microbiota (MIVAS III study): a research protocol for a cross-sectional multicenter study. Front Public Health 2023; 11:1164453. [PMID: 37457284 PMCID: PMC10344706 DOI: 10.3389/fpubh.2023.1164453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Background The microbiota is increasingly recognized as a significant factor in the pathophysiology of many diseases, including cardiometabolic diseases, with lifestyles probably exerting the greatest influence on the composition of the human microbiome. The main objectives of the study are to analyze the association of lifestyles (diet, physical activity, tobacco, and alcohol) with the gut and oral microbiota, arterial aging, and cognitive function in subjects without cardiovascular disease in the Iberian Peninsula. In addition, the study will examine the mediating role of the microbiome in mediating the association between lifestyles and arterial aging as well as cognitive function. Methods and analysis MIVAS III is a multicenter cross-sectional study that will take place in the Iberian Peninsula. One thousand subjects aged between 45 and 74 years without cardiovascular disease will be selected. The main variables are demographic information, anthropometric measurements, and habits (tobacco and alcohol). Dietary patterns will be assessed using a frequency consumption questionnaire (FFQ) and the Mediterranean diet adherence questionnaire. Physical activity levels will be evaluated using the International Physical Activity Questionnaire (IPAQ), Marshall Questionnaire, and an Accelerometer (Actigraph). Body composition will be measured using the Inbody 230 impedance meter. Arterial aging will be assessed through various means, including measuring medium intimate carotid thickness using the Sonosite Micromax, conducting analysis with pulse wave velocity (PWA), and measuring pulse wave velocity (cf-PWV) using the Sphygmocor System. Additional cardiovascular indicators such as Cardio Ankle Vascular Index (CAVI), ba-PWV, and ankle-brachial index (Vasera VS-2000®) will also be examined. The study will analyze the intestinal microbiota using the OMNIgene GUT kit (OMR-200) and profile the microbiome through massive sequencing of the 16S rRNA gene. Linear discriminant analysis (LDA), effect size (LEfSe), and compositional analysis, such as ANCOM-BC, will be used to identify differentially abundant taxa between groups. After rarefying the samples, further analyses will be conducted using MicrobiomeAnalyst and R v.4.2.1 software. These analyses will include various aspects, such as assessing α and β diversity, conducting abundance profiling, and performing clustering analysis. Discussion Lifestyle acts as a modifier of microbiota composition. However, there are no conclusive results demonstrating the mediating effect of the microbiota in the relationship between lifestyles and cardiovascular diseases. Understanding this relationship may facilitate the implementation of strategies for improving population health by modifying the gut and oral microbiota. Trial registration clinicaltrials.gov/ct2/show/NCT04924907, ClinicalTrials.gov, identifier: NCT04924907. Registered on 21 April 2021.
Collapse
Affiliation(s)
- Cristina Lugones-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
| | - Sandra Santos-Mínguez
- Cancer Research Centre, Institute of Biomedical Research of Salamanca (IBSAL), Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, Salamanca, Spain
| | - Rita Salvado
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Susana González-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
| | - Olaya Tamayo-Morales
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
| | - Amaya Hoya-González
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - José I. Ramírez-Manent
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Calvià Primary Care Center, Balearic Islands Health Research Institute (IDIBSA), Health Service of Balearic Islands, Calvià, Spain
- Department of Medicine, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Rosa Magallón-Botaya
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - José A. Quesada-Rico
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Sant Joan d'Alacant, Spain
| | - Miriam D. Garcia-Cubillas
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Rocío Benito-Sanchez
- Cancer Research Centre, Institute of Biomedical Research of Salamanca (IBSAL), Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, Salamanca, Spain
| | - Alex Mira
- Department of Health and Genomics, FISABIO Foundation, Valencia, Spain
- CIBER Center for Epidemiology and Public Health, Madrid, Spain
| | - Jesus M. Hernandez-Rivas
- Department of Medicine, University of Salamanca, Salamanca, Spain
- Haematology Department, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Luis Garcia-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Healthcare Management, Castilla y León Regional Health Authority (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | | |
Collapse
|
7
|
Bellón JA, Rodríguez-Morejón A, Conejo-Cerón S, Campos-Paíno H, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Rodríguez-Sánchez E, Mendive JM, López del Hoyo Y, Luna JD, Tamayo-Morales O, Moreno-Peral P. A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study. Front Psychiatry 2023; 14:1163800. [PMID: 37333911 PMCID: PMC10275079 DOI: 10.3389/fpsyt.2023.1163800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
The predictD is an intervention implemented by general practitioners (GPs) to prevent depression, which reduced the incidence of depression-anxiety and was cost-effective. The e-predictD study aims to design, develop, and evaluate an evolved predictD intervention to prevent the onset of major depression in primary care based on Information and Communication Technologies, predictive risk algorithms, decision support systems (DSSs), and personalized prevention plans (PPPs). A multicenter cluster randomized trial with GPs randomly assigned to the e-predictD intervention + care-as-usual (CAU) group or the active-control + CAU group and 1-year follow-up is being conducted. The required sample size is 720 non-depressed patients (aged 18-55 years), with moderate-to-high depression risk, under the care of 72 GPs in six Spanish cities. The GPs assigned to the e-predictD-intervention group receive brief training, and those assigned to the control group do not. Recruited patients of the GPs allocated to the e-predictD group download the e-predictD app, which incorporates validated risk algorithms to predict depression, monitoring systems, and DSSs. Integrating all inputs, the DSS automatically proposes to the patients a PPP for depression based on eight intervention modules: physical exercise, social relationships, improving sleep, problem-solving, communication skills, decision-making, assertiveness, and working with thoughts. This PPP is discussed in a 15-min semi-structured GP-patient interview. Patients then choose one or more of the intervention modules proposed by the DSS to be self-implemented over the next 3 months. This process will be reformulated at 3, 6, and 9 months but without the GP-patient interview. Recruited patients of the GPs allocated to the control-group+CAU download another version of the e-predictD app, but the only intervention that they receive via the app is weekly brief psychoeducational messages (active-control group). The primary outcome is the cumulative incidence of major depression measured by the Composite International Diagnostic Interview at 6 and 12 months. Other outcomes include depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7), depression risk (predictD risk algorithm), mental and physical quality of life (SF-12), and acceptability and satisfaction ('e-Health Impact' questionnaire) with the intervention. Patients are evaluated at baseline and 3, 6, 9, and 12 months. An economic evaluation will also be performed (cost-effectiveness and cost-utility analysis) from two perspectives, societal and health systems. Trial registration ClinicalTrials.gov, identifier: NCT03990792.
Collapse
Affiliation(s)
- Juan A. Bellón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- ‘El Palo' Health Centre, Servicio Andaluz de Salud (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Henar Campos-Paíno
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Centro de Salud San José, Distrito Sanitario Jaén Norte, Servicio Andaluz de Salud (SAS), Linares, Jaén, Spain
| | - María I. Ballesta-Rodríguez
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Centro de Salud Federico del Castillo, Distrito Sanitario Jaén, Servicio Andaluz de Salud (SAS), Jaén, Spain
| | - Emiliano Rodríguez-Sánchez
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
| | - Juan M. Mendive
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- ‘La Mina' Health Centre, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Yolanda López del Hoyo
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), Universidad de Zaragoza (UNIZAR), Zaragoza, Spain
| | - Juan D. Luna
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Statistics and Operational Research, University of Granada (UGR), Granada, Spain
| | - Olaya Tamayo-Morales
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
| |
Collapse
|
8
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
Tapias-Merino E, De Hoyos-Alonso MDC, Contador-Castillo I, Rodríguez-Sánchez E, Sanz-Cuesta T, Becerro-Muñoz CM, Hernández-Gallego J, Vega-Quiroga S, Bermejo-Pareja F. Cardiovascular risk in subjects over 55 years of age and cognitive performance after five years. NEDICES2-RISK study. Study protocol. PLoS One 2022; 17:e0274589. [PMID: 36441718 PMCID: PMC9704606 DOI: 10.1371/journal.pone.0274589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cognitive impairment and dementia have a high prevalence among the elderly and cause significant socio-economic impact. Any progress in their prevention can benefit millions of people. Current data indicate that cardiovascular risk (CVR) factors increase the risk of developing cognitive impairment and dementia. Using models to calculate CVR specific for the Spanish population can be useful for estimating the risk of cognitive deterioration since research on this topic is limited and predicting this risk is mainly based on outcomes in the Anglo-Saxon population. The aim of this study is to assess the relationship between CVR in the Spanish population, as calculated using the FRESCO (Función de Riesgo Española de acontecimientos Coronarios y Otros) and REGICOR (Registre Gironí del Cor) CVR tables, and the change in cognitive performance at a 5-year follow-up. METHODS Design: Observational, analytic, prospective cohort study, with a 5-year follow-up. Ambit: Population. Population: Subjects 55 to 74 years of age, included in the NEDICES2 (2014-2017) cohort, who did not present dementia and had undergone the neuropsychological evaluation (N = 962). Variables: Exposure factors (CVR factors and estimated risk according to the CVR predictors by REGICOR and FRESCO), dependent variables (change in the score of the brief neuropsychological test in the study NEDICES2 five years after the first evaluation), and clinical and socio-demographic variables. Statistical analysis: Analysis of data quality. Descriptive analysis: socio-demographic and clinical variables of subjects. Bivariate analysis: relationship between basal CVR and change in neuropsychological tests. Multivariate analysis: relationship between basal CVR and change in neuropsychological tests adjusted by co-variables. Analysis and comparison of the reliable change in independent samples. DISCUSSION The Spanish population can benefit from determining if individuals with high CVR, which is commonly detected in usual clinical practice, will present decreased cognitive performance compared to subjects with lower CVR. This study can affect how to address CVR factors and the design of effective prevention strategies for cognitive deterioration. TRIAL REGISTRATION Clinicaltrials.gov, NCT03925844.
Collapse
Affiliation(s)
- Ester Tapias-Merino
- Healthcare Centre Comillas, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (REDIAPP), Spain
- Research Institute Hospital 12 de Octubre i+12, Group for Research in Health Services and Results, Madrid, Spain
- Faculty of Medicine, Department of Medicine, Complutense University of Madrid, Madrid, Spain
- * E-mail:
| | | | - Israel Contador-Castillo
- Faculty of Psychology, Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (REDIAPP), Spain
- Research Unit for Primary Health Care, Institute for Biomedical Research of Salamanca (IBSAL), Castilla y León Health Service, Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Teresa Sanz-Cuesta
- Research Unit, Gerencia Asistencial de Atención Primaria (GAAP), Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto Salud Carlos III, Madrid, Spain
| | - Concepción María Becerro-Muñoz
- Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (REDIAPP), Spain
- Research Unit for Primary Health Care, Institute for Biomedical Research of Salamanca (IBSAL), Castilla y León Health Service, Salamanca, Spain
| | - Jesús Hernández-Gallego
- Faculty of Medicine, Department of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Neurology, Hospital Universitario 12 de Octubre (Madrid, Spain)
- Research Institute Hospital 12 de Octubre i+12, Neurosciences Group CIBERNED, Madrid, Spain
| | - Saturio Vega-Quiroga
- Healthcare Centre Arévalo, Gerencia Asistencial Atención Primaria, Sanidad de Castilla y León, Arévalo, Spain
| | - Félix Bermejo-Pareja
- Department of Neurology, Hospital Universitario 12 de Octubre (Madrid, Spain)
- Research Institute Hospital 12 de Octubre i+12, Neurosciences Group CIBERNED, Madrid, Spain
- Consulting Neurologist, Hospital 12 de Octubre, Madrid, Spain
| | | |
Collapse
|
10
|
Gómez-Sánchez L, Rodríguez-Sánchez E, Ramos R, Marti R, Gómez-Sánchez M, Lugones-Sánchez C, Tamayo-Morales O, Sánchez SG, Rigo F, García-Ortiz L, Gómez-Marcos MA, Ramos R, Ramos R, Martí R, Parramon D, Ponjoan A, Quesada M, Garcia-Gil M, Sidera M, Camós L, Montesinos F, Montoya I, López C, Agell A, Pagès N, Gil I, Maria-Castro A, Rigo F, Frontera G, Rotger A, Feuerbach N, Pons S, Garcia N, Guillaumet J, Llull M, Gutierrez M, Agudo-Conde C, Gómez-Sanchez L, Castaño-Sanchez C, Rodriguez-Martín C, Sanchez-Salgado B, de Cabo-Laso A, Gómez-Sánchez M, Rodriguez-Sanchez E, MaderueloFernandez JA, Ramos-Delgado E, Patino-Alonso C, Recio-Rod-riguez JI, Gomez-Marcos MA, Garcia-Ortiz L. Association of physical activity with vascular aging in a population with intermediate cardiovascular risk, analysis by sex: MARK study. Biol Sex Differ 2022; 13:46. [PMID: 35987700 PMCID: PMC9392339 DOI: 10.1186/s13293-022-00456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to analyze the association of physical activity and its intensity with arterial stiffness and vascular aging and differences by sex in a Spanish population with intermediate cardiovascular risk. Methods Cross-sectional study. A total of 2475 individuals aged 35–75 years participated in the study. Brachial–ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500® device. Based on the age and sex percentile presented by the participants, the latter were classified as follows: those with a percentile above 90 and presenting established cardiovascular disease were classified as early vascular aging (EVA); those with a percentile between 10 and 90 were classified as normal vascular aging (NVA) and those with a percentile below 10 were classified as healthy vascular aging (HVA). Physical activity was analyzed through the short version of the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ). Results The mean age of the participants was 61.34 ± 7.70 years, with 61.60% men. Of the total sample, 86% were sedentary (83% men vs 90% women). The total physical activity showed a negative association with baPWV (β = − 0.045; 95% CI − 0.080 to − 0.009). Intense physical activity showed a negative relationship with baPWV (β = − 0.084; 95% CI − 0.136 to − 0.032). The OR of the total physical activity and the intense physical activity carried out by the subjects classified as NVA with respect to those classified as HVA was OR = 0.946; (95% CI 0.898 to 0.997) and OR = 0.903; (95% CI 0.840 to 0.971), and of those classified as EVA it was OR = 0.916; (95% CI 0.852 to 0.986) and OR = 0.905; (95% CI 0.818 to 1.000). No association was found with moderate- or low-intensity physical activity. Conclusions The results of this study suggest that, when intense physical activity is performed, the probability of presenting vascular aging is lower. In the analysis by sex, this association is only observed in men. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-022-00456-w. This study is the first to find a negative association between total physical activity and arterial stiffness and vascular aging in adults with intermediate cardiovascular risk. This study also shows that the association of physical activity with arterial stiffness and vascular aging in adults with intermediate cardiovascular risk varies depending on its intensity, with a negative association being found only with intense physical activity. In the analysis by sex, the results found suggest that the association is greater in men.
Collapse
|
11
|
Gómez-Sánchez L, Gómez-Sánchez M, Rodríguez-Sánchez E, Patino-Alonso C, Alonso-Dominguez R, Sanchez-Aguadero N, Lugones-Sánchez C, Llamas-Ramos I, García-Ortiz L, Gómez-Marcos MA. Relationship of Different Anthropometric Indices with Vascular Ageing in an Adult Population without Cardiovascular Disease-EVA Study. J Clin Med 2022; 11:jcm11092671. [PMID: 35566797 PMCID: PMC9105296 DOI: 10.3390/jcm11092671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
The objectives of this study were to analyse the capacity of different anthropometric indices to predict vascular ageing and this association in Spanish adult population without cardiovascular disease. A total of 501 individuals without cardiovascular disease residing in the capital of Salamanca (Spain) were selected (mean age: 55.9 years, 50.3% women), through stratified random sampling by age and sex. Starting from anthropometric measurements such as weight, height, and waist circumference, hip circumference, or biochemical parameters, we could estimate different indices that reflected general obesity, abdominal obesity, and body fat distribution. Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (cf-PWV) using a SphygmoCor® device. Vascular ageing was defined in three steps: Step 1: the participants with vascular injury were classified as early vascular ageing (EVA); Step 2: classification of the participants using the 10 and 90 percentiles of cf-PWV in the study population by age and sex in EVA, healthy vascular ageing (HVA) and normal vascular ageing (NVA); Step 3: re-classification of participants with arterial hypertension or type 2 diabetes mellitus included in HVA as NVA. The total prevalence of HVA and EVA was 8.4% and 21.4%, respectively. All the analysed anthropometric indices, except waist/hip ratio (WHpR), were associated with vascular ageing. Thus, as the values of the different anthropometric indices increase, the probability of being classified with NVA and as EVA increases. The capacity of the anthropometric indices to identify people with HVA showed values of area under the curve (AUC) ≥ 0.60. The capacity to identify people with EVA, in total, showed values of AUC between 0.55 and 0.60. In conclusion, as the values of the anthropometric indices increased, the probability that the subjects presented EVA increased. However, the relationship of the new anthropometric indices with vascular ageing was not stronger than that of traditional parameters. Therefore, BMI and WC can be considered to be the most useful indices in clinical practice to identify people with vascular ageing in the general population.
Collapse
Affiliation(s)
- Leticia Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Marta Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Department of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Carmen Patino-Alonso
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Statistics Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Rosario Alonso-Dominguez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain
| | - Natalia Sanchez-Aguadero
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Ines Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37008 Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (E.R.-S.); (C.P.-A.); (R.A.-D.); (N.S.-A.); (C.L.-S.); (I.L.-R.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Department of Medicine, University of Salamanca, 37008 Salamanca, Spain
- Correspondence: ; Tel.: +34-923-124465
| | | |
Collapse
|
12
|
Llamas-Ramos I, Llamas-Ramos R, Alonso-Domínguez R, Gómez-Sánchez L, Tamayo-Morales O, Lugones-Sánchez C, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA. Sedentary Behaviour and Its Relationship with Early Vascular Ageing in the General Spanish Population: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19095450. [PMID: 35564843 PMCID: PMC9101612 DOI: 10.3390/ijerph19095450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Sedentary behaviour is associated with a greater predisposition to developing cardiovascular diseases. The aim of the study was to analyse the relationship between sedentary time and early vascular ageing. A total of 501 participants (49.70% men) were recruited through random sampling stratified by age group and sex. Vascular ageing was evaluated considering three criteria: (1) the vascular ageing index (VAI); (2) the carotid−femoral pulse wave velocity (cfPWV) 10th and 90th percentiles of the reference values in the European population by age; and (3) the Framingham’s heart age. The carotid intima−media thickness was measured using a Sonosite Micromaxx ultrasound, the presence of peripheral artery disease was assessed by calculating the ankle−brachial index using a VaSera VS-1500, and the cfPWV was measured with a SphygmoCor® device. Weekly sedentary hours were evaluated through a sitting time questionnaire. The average age of the population was 55.90 ± 14.24 years. The men spent more hours sitting per week (47.6 ± 16.6 vs. 36.8 ± 17.3 h/W), at work (16.7 ± 16.2 vs. 9.73 ± 14.9 h/W), and watching TV (21.6 ± 12.5 vs. 18.7 ± 11.9 h/W). In the logistic regression analysis, the individuals with early vascular aging (EVA), with respect to those with healthy vascular aging (HVA), spent more hours sitting per week (OR = 1.03 vs. OR = 1.02; p < 0.05) and watching TV (OR = 1.03 vs. OR = 1.03; p < 0.05), using the criteria of the European guideline and VAI, and more hours sitting when commuting (OR = 1.04; p < 0.05), using Framingham’s heart age to define EVA. The results of this study indicate that sedentary time is associated with early vascular ageing. Therefore, reducing sedentary time would improve vascular health.
Collapse
Affiliation(s)
- Inés Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Department of Nursing and Physiotherapy, Universidad de Salamanca, 37007 Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- University Hospital of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-663005052
| | - Rocío Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Department of Nursing and Physiotherapy, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Rosario Alonso-Domínguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Department of Nursing and Physiotherapy, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Leticia Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, 37007 Salamanca, Spain
| |
Collapse
|
13
|
Gómez-Sánchez L, Gómez-Sánchez M, Patino-Alonso C, Recio-Rodríguez JI, González-Sánchez J, Agudo-Conde C, Maderuelo-Fernández JA, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA. Retinal blood vessel calibre and vascular ageing in a general Spanish population: A EVA study. Eur J Clin Invest 2022; 52:e13684. [PMID: 34582566 DOI: 10.1111/eci.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/10/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this work was to analyse the association of the retinal arteriolar calibre and the arteriole/venule index (AV index) with vascular ageing in a general population without previous cardiovascular disease. MATERIALS AND METHODS Descriptive cross-sectional study. A total of 482 individuals without cardiovascular disease (mean age: 55.6 ± 14.2 years) were selected by random sampling, stratified by age and sex. The retinal arteriolar calibre was measured using digital fundus images of the back of the eye captured with a validated, semiautomatized and computer-assisted software (Index calculator). Vascular ageing was defined using three criteria based on the values of: (1) Carotid-femoral Pulse Wave Velocity (cfPWV), (2) Brachial-ankle Pulse Wave Velocity (baPWV) and (3) Carotid Intima-Media Thickness. RESULTS The AV index and arteriolar calibre show a negative correlation with age, arterial pressure, cardiovascular risk and parameters of vascular structure and function (p < 0.001 in all cases). We found lower mean values of the AV index and arteriolar calibre in the individuals with early vascular ageing compared to those with healthy vascular ageing. AV index was negatively correlated with cfPWV ((β=-2.9; 95% CI (-4.7; -1.1)), baPWV ((β=-3.2; 95% CI (-5.4; -0.9)) and vascular ageing index ((β=-1.7; 95% CI (-2.7; -0.7)). Arteriolar calibre showed a negative correlation with baPWV (β=-0.1; 95% CI (-0.2; -0.1)). In the logistic regression analysis, lower values of AV index ((OR=0.01; 95% CI (0.01-0.10), OR=0.03; 95% CI (0.01-0.11) and OR=0.09; 95% CI (0.01-0.67)) were associated with EVA defined with cfPWV, baPWV and vascular ageing index respectively, and lower values of arteriolar calibre ((OR=0.71; 95% CI (0.55-0.91)) were associated with EVA defined with vascular ageing index. CONCLUSIONS Lower values of AV index and retinal arteriolar calibre were associated with vascular ageing in a general Spanish population without previous cardiovascular disease.
Collapse
Affiliation(s)
- Leticia Gómez-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Marta Gómez-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Carmen Patino-Alonso
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,Departamento de Estadística, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, Salamanca, España
| | - Jose I Recio-Rodríguez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,Departamento de Enfermería y Fisioterapia, Universidad de Salamanca, Calle Donantes de Sangre, s/n, Salamanca, España
| | - Jesús González-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,Departamento de Enfermería y Fisioterapia, Universidad de Salamanca, Calle Donantes de Sangre, s/n, Salamanca, España
| | - Cristina Agudo-Conde
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,GERENCIA de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España
| | - José A Maderuelo-Fernández
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,GERENCIA de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España
| | - Emiliano Rodríguez-Sánchez
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,GERENCIA de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España.,Departamento de Medicina, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, Salamanca, España
| | - Luis García-Ortiz
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,GERENCIA de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España.,Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, Salamanca, España
| | - Manuel A Gómez-Marcos
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España.,GERENCIA de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España.,Departamento de Medicina, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, Salamanca, España
| | | |
Collapse
|
14
|
Gómez-Sánchez L, Gómez-Sánchez M, Lugones-Sánchez C, Tamayo-Morales O, González-Sánchez S, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA. Association of Insulin Resistance with Vascular Ageing in a General Caucasian Population: An EVA Study. J Clin Med 2021; 10:jcm10245748. [PMID: 34945044 PMCID: PMC8707603 DOI: 10.3390/jcm10245748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
The data on the relationship between insulin resistance and vascular ageing are limited. The aim of this study was to explore the association of different indices of insulin resistance with vascular ageing in an adult Caucasian population without cardiovascular disease. We selected 501 individuals without cardiovascular disease (mean age: 55.9 years, 50.3% women) through random sampling stratified by sex and age. Arterial stiffness was evaluated by measuring the carotid-to-femoral pulse wave velocity (cfPWV) and brachial-to-ankle pulse wave velocity (baPWV). The participants were classified into three groups according to the degree of vascular ageing: early vascular ageing (EVA), normal vascular ageing (NVA) and healthy vascular ageing (HVA). Insulin resistance was evaluated with the homeostatic model assessment of insulin resistance (HOMA-IR) and another five indices. The prevalence of HVA and EVA was 8.4% and 21.4%, respectively, when using cfPWV, and 7.4% and 19.2%, respectively, when using baPWV. The deterioration of vascular ageing, with both measurements, presented as an increase in all the analysed indices of insulin resistance. In the multiple regression analysis and logistic regression analysis, the indices of insulin resistance showed a positive association with cfPWV and baPWV and with EVA.
Collapse
Affiliation(s)
- Leticia Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Marta Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Susana González-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-923-124465
| | | |
Collapse
|
15
|
Alonso-Domínguez R, Sánchez-Aguadero N, Patino-Alonso MC, Agudo-Conde C, de Cabo-Laso Á, Gómez-Sánchez M, Gómez-Sánchez L, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA. Association between measurements of arterial stiffness and target organ damage in a general Spanish population. Ann Med 2021; 53:345-356. [PMID: 33533280 PMCID: PMC7877984 DOI: 10.1080/07853890.2021.1881812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Little is known about the relationship between arterial stiffness and cardiovascular target organ damage (TOD) in the general population. The aim was to analyse the relationship between different measurements of arterial stiffness and TOD, in a general Spanish population without a history of cardiovascular event. MATERIALS AND METHODS Transversal descriptive study. Through stratified random sampling, a total of 501 individuals were included. Carotid-femoral pulse wave velocity (cf-PWV) was measured using a SphygmoCor System®, the cardio-ankle vascular index (CAVI) was determined with aVasera VS-1500® and brachial-ankle pulse wave velocity (ba-PWV)was calculated through a validated equation. RESULTS The average age was 55.84 ± 14.26.The percentage of vascular TOD, left ventricular hypertrophy (LVH) and renal TOD was higher in men (p < .001). A positive correlation was obtained between carotid intima-media thickness (c-IMT) and the measurements of vascular function. In the model 1 of the logistic regression analysis, cf-PWV was associated with vascular TOD (OR = 1.15, p = .040), ba-PWV was associated with vascular TOD (OR = 1.20, p = .010) and LVH (OR = 1.12, p = .047). CONCLUSIONS The different measurements of arterial stiffness are highly associated with each other. Moreover, cf-PWV and ba-PWV were associated with vascular TOD, and ba-PWV with LVH, although they disappear when adjusting for cardiovascular risk factors. Key Messages There is a strong correlation between the different measurements of vascular structure and function. Carotid-femoral and brachial-ankle pulse wave velocity were positively associated with vascular target organ damage, the latter was also positively associated with left ventricular hypertrophy. This associations disappear when adjusting for cardiovascular risk factors.
Collapse
Affiliation(s)
- Rosario Alonso-Domínguez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Natalia Sánchez-Aguadero
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - María C. Patino-Alonso
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Cristina Agudo-Conde
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
| | - Ángela de Cabo-Laso
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
| | - Marta Gómez-Sánchez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
| | - Leticia Gómez-Sánchez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Iberian Network on Arterial Structure, Central Hemodynamics and Neurocognition, Portugal and Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Iberian Network on Arterial Structure, Central Hemodynamics and Neurocognition, Portugal and Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Biomedical Research Institute of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Iberian Network on Arterial Structure, Central Hemodynamics and Neurocognition, Portugal and Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | | |
Collapse
|
16
|
Bellón JÁ, Conejo-Cerón S, Sánchez-Calderón A, Rodríguez-Martín B, Bellón D, Rodríguez-Sánchez E, Mendive JM, Ara I, Moreno-Peral P. Effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2021; 219:578-587. [PMID: 33533706 DOI: 10.1192/bjp.2021.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In most trials and systematic reviews that evaluate exercise-based interventions in reducing depressive symptoms, it is difficult to separate treatment from prevention. AIMS To evaluate the effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression. METHOD We searched PubMed, PsycINFO, Embase, WOS, SPORTDiscus, CENTRAL, OpenGrey and other sources up to 25 May 2020. We selected randomised controlled trials (RCTs) that compared exclusively exercise-based interventions with control groups, enrolling participants without clinical depression, as measured using validated instruments, and whose outcome was reduction of depressive symptoms and/or incidence of new cases of people with depression. Pooled standardised mean differences (SMDs) were calculated using random-effect models (registration at PROSPERO: CRD42017055726). RESULTS A total of 14 RCTs (18 comparisons) evaluated 1737 adults without clinical depression from eight countries and four continents. The pooled SMD was -0.34 (95% CI -0.51 to -0.17; P < 0.001) and sensitivity analyses confirmed the robustness of this result. We found no statistical evidence of publication bias and heterogeneity was moderate (I2 = 54%; 95% CI 22-73%). Only two RCTs had an overall low risk of bias and three had long-term follow-up. Multivariate meta-regression found that a larger sample size, country (Asia) and selective prevention (i.e. people exposed to risk factors for depression) were associated with lower effectiveness, although only sample size remained significant when adjustment for multiple tests was considered. According to the Grading of Recommendations Assessment, Development and Evaluation tool, the quality of evidence was low. CONCLUSIONS Exercise-based interventions have a small effect on the reduction of depressive symptoms in people without clinical depression. It could be an alternative to or complement psychological programmes, although further higher-quality trials with larger samples and long-term follow-up are needed.
Collapse
Affiliation(s)
- Juan Ángel Bellón
- 'El Palo' Health Centre, Health District of Primary Care Málaga-Guadalhorce, Andalusian Health Service (SAS); Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); Biomedical Research Institute of Malaga (IBIMA); and Faculty of Medicine, Department of Public Health and Psychiatry, University of Málaga (UMA), Spain
| | - Sonia Conejo-Cerón
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); and Biomedical Research Institute of Malaga (IBIMA), Spain
| | | | - Beatriz Rodríguez-Martín
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); and Faculty of Health Sciences, Talavera de la Reina, Toledo, University of Castilla-La Mancha (UCLM), Spain
| | - Darío Bellón
- Faculty of Sport Sciences, University of Castilla-La Mancha (UCLM), Spain
| | - Emiliano Rodríguez-Sánchez
- Prevention and Health Promotion Research Network (redIAPP); Institute of Biomedical Research of Salamanca (IBSAL); Primary Care Research Unit of Salamanca (APISAL); and Department of Medicine, University of Salamanca, Spain
| | - Juan Manuel Mendive
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); and 'La Mina' Health Centre, Institute of Health Català (ICS), Spain
| | - Ignacio Ara
- Faculty of Sport Sciences, University of Castilla-La Mancha (UCLM); GENUD Toledo Research Group, University of Castilla-La Mancha (UCLM), Spain; and CIBER of Frailty and Healthy Aging (CIBERFES), Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); and Biomedical Research Institute of Malaga (IBIMA), Spain
| |
Collapse
|
17
|
Patino-Alonso C, Gómez-Sánchez M, Hernández-Rivas JM, González-Porras JR, Bastida-Bermejo JM, Martín AA, Rodríguez-Sánchez E, Recio-Rodríguez JI, González-Sánchez J, Maderuelo-Fernández JA, García-Ortiz L, Gómez-Marcos MA. Vascular target organ damage in patients with Philadelphia negative myeloproliferative syndrome: A propensity score analysis. Med Clin (Barc) 2021; 158:503-508. [PMID: 34399987 DOI: 10.1016/j.medcli.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess whether subjects with Philadelphia negative myeloproliferative neoplasms (Ph-MPNs) show differences in the presence of vascular, cardiac or renal target organ damage (TOD) and other vascular function parameters as compared to individuals without this condition. METHODS An observational study was conducted. Fifty-seven subjects diagnosed with Ph-MPNs used as cases and 114 subjects without Ph-MPNs as controls. We matched the subjects with and without Ph-MPNs using the propensity scores in a 1:2 ratio using the variables gender, type 2 diabetes mellitus, high blood pressure, hyperlipidaemia and smoking. Vascular, cardiac and renal TOD were established according to the criteria of the European Society of Hypertension and Cardiology guidelines. Arterial stiffness was also assessed using the cardio-ankle vascular index (CAVI). RESULTS Mean age was 63.50±11.70 and 62.90±8.32 years in subjects with and without Ph-MPNs, 32 females (56%) in the first group and 62 (54%) in the second. Subjects with Ph-MPNs have a higher percentage of carotid injury than subjects without Ph-MPNs (35.1% vs. 21.1%) and higher albumin/creatinine ratio. In the logistic regression analysis, subjects with Ph-MPNs had an OR=2.382 (IC95% 1.066-5.323) for carotid injury versus those without haematological disease. CONCLUSIONS Subjects with Ph-MPNs have twice the risk of by carotid injury than those without haematological disease.
Collapse
Affiliation(s)
- Carmen Patino-Alonso
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain; Department of Statistics, University of Salamanca, Salamanca, Spain.
| | - Marta Gómez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain
| | - Jesús M Hernández-Rivas
- Department of Medicine, University of Salamanca, Salamanca, Spain; Department of Hematology, Hospital Clínico Universitario, Salamanca, Spain; Center of Cancer Research, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Clínico Universitario, Salamanca, Spain; Center of Cancer Research, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - José M Bastida-Bermejo
- Department of Hematology, Hospital Clínico Universitario, Salamanca, Spain; Center of Cancer Research, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Ana-Africa Martín
- Department of Hematology, Hospital Clínico Universitario, Salamanca, Spain; Center of Cancer Research, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain; Department of Medicine, University of Salamanca, Salamanca, Spain
| | - José I Recio-Rodríguez
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain; Department of Nurse and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Jesús González-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain; Department of Nurse and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - José A Maderuelo-Fernández
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain; Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), 37005 Salamanca, Spain; Department of Medicine, University of Salamanca, Salamanca, Spain
| |
Collapse
|
18
|
Tamayo-Morales O, Patino-Alonso MC, Losada A, Mora-Simón S, Unzueta-Arce J, González-Sánchez S, Gómez-Marcos MA, García-Ortiz L, Rodríguez-Sánchez E. Behavioural intervention to reduce disruptive behaviours in adult day care centres users: A randomizsed clinical trial (PROCENDIAS study). J Adv Nurs 2020; 77:987-998. [PMID: 33107645 DOI: 10.1111/jan.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
AIM This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers. DESIGN Randomized controlled clinical trial. METHODS The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8-10 people where caregivers were trained in the Antecedent-Behavior-Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC). RESULTS An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann-Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES-D) (U = -2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = -4.10; p < 0.01; Cohen d = 0.98). CONCLUSION The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver. IMPACT To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.
Collapse
Affiliation(s)
- Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - María C Patino-Alonso
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Andrés Losada
- Psychology Department, Rey Juan Carlos University, Madrid, Spain
| | - Sara Mora-Simón
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Basic Psychology, Psychology and Behavioral Sciences Methodology, University of Salamanca, Salamanca, Spain
| | - Jaime Unzueta-Arce
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Basic Psychology, Psychology and Behavioral Sciences Methodology, University of Salamanca, Salamanca, Spain
| | - Susana González-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Medicine, University of Salamanca, Salamanca, Spain
| |
Collapse
|
19
|
Pablos-Hernández C, González-Ramírez A, da Casa C, Luis MM, García-Iglesias MA, Julián-Enriquez JM, Rodríguez-Sánchez E, Blanco JF. Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models. Orthop Surg 2020; 12:457-462. [PMID: 32167674 PMCID: PMC7189046 DOI: 10.1111/os.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients. Methods We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post‐surgical stay, and in‐hospital mortality according to the healthcare model applied. Results Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A‐B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009). The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in‐hospital follow‐up, there was a reduction in in‐hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance. Conclusions The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically‐treated patients.
Collapse
Affiliation(s)
- Carmen Pablos-Hernández
- Unidad de Ortogeriatría, Hospital Universitario de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Alfonso González-Ramírez
- Unidad de Ortogeriatría, Hospital Universitario de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Maria Margarida Luis
- Servicio de Medicina Interna, Centro Hospitalario de Vila Nova de Gaia, Espinho, Portugal
| | | | | | - Emiliano Rodríguez-Sánchez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Unidad de Investigación en Atención Primaria, Salamanca, Spain
| | - Juan F Blanco
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Salamanca, Salamanca, Spain
| |
Collapse
|
20
|
Gómez-Sánchez M, Patino-Alonso MC, Gómez-Sánchez L, Recio-Rodríguez JI, Rodríguez-Sánchez E, Maderuelo-Fernández JA, García-Ortiz L, Gómez-Marcos MA, Gómez-Marcos MA, García-Ortiz L, Recio-Rodríguez JI, Martínez-Salgado C, Hernández-Rivas JM, González-Sarmiento R, Sánchez-Fernández PL, Rodríguez-Sánchez E, Patino-Alonso MC, Maderuelo-Fernández JA, Gómez-Sánchez L, González-Sánchez J, Alonso-Domínguez R, Rodríguez-Martín C, Gómez-Sánchez M, de Cabo-Laso Á, Sánchez-Salgado B, Aguadero NS, Mora-Simón S, González-Porras JR, Bastida-Bermejo JM, Fuentes-Calvo I. Valores de referencia de parámetros de rigidez arterial y su relación con los factores de riesgo cardiovascular en población española. Estudio EVA. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
21
|
Gómez-Sánchez M, Patino-Alonso MC, Gómez-Sánchez L, Recio-Rodríguez JI, Rodríguez-Sánchez E, Maderuelo-Fernández JA, García-Ortiz L, Gómez-Marcos MA. Reference values of arterial stiffness parameters and their association with cardiovascular risk factors in the Spanish population. The EVA Study. ACTA ACUST UNITED AC 2019; 73:43-52. [PMID: 31521574 DOI: 10.1016/j.rec.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/10/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To describe, for the first time, reference values for the cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (BA-PWV), carotid-femoral pulse wave velocity (CF-PWV), and the central augmentation index and to establish their association with cardiovascular risk factors in the Spanish adult population aged 35 to 75 years without cardiovascular disease. METHODS We conducted a cross-sectional study. Through random sampling stratified by age and sex, we included 501 participants without cardiovascular disease. The mean age was 55.9 years and 50.3% were women. The measurements were taken using the SphigmoCor and Vasera VS-1500 devices. RESULTS Values for all measures, except those for the central augmentation index, were higher in men and increased with age and blood pressure. The mean values were as follows: CAVI, 8.01±1.44; BA-PWV, 12.93±2.68m/s; CF-PWV, 6.53±2.03 m/s, and central augmentation index, 26.84±12.79. On multiple regression analysis, mean blood pressure was associated with the 4 measures, glycated hemoglobin was associated with all measures except the central augmentation index, and body mass index showed an inverse association with CAVI. The explanatory capacity of age, sex, and mean blood pressure was 62% for BA-PWV, 49% for CF-PWV 49%, 54% for the CAVI, and 38% for the central augmentation index. On logistic regression, hypertension was associated with the CAVI (OR=3.45), VOP-BT (OR=3.44), VOP-CF (OR=3.38) and with the central augmentation index (OR=3.73). CONCLUSIONS All arterial stiffness measures increased with age. The CAVI and CF-PWV were higher in men and the central augmentation index was higher in women, with no differences in BA-PWV. This study is registered at ClinicalTrials.gov. Identifier NCT02623894.
Collapse
Affiliation(s)
- Marta Gómez-Sánchez
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain
| | - M Carmen Patino-Alonso
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Departamento de Estadística, Universidad de Salamanca, Salamanca, Spain
| | - Leticia Gómez-Sánchez
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José I Recio-Rodríguez
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Facultad de Ciencias de la Salud, Universidad de Burgos, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Servicio de Salud de Castilla y León (SACyL), Salamanca, Spain; Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - José A Maderuelo-Fernández
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Servicio de Salud de Castilla y León (SACyL), Salamanca, Spain
| | - Luis García-Ortiz
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Servicio de Salud de Castilla y León (SACyL), Salamanca, Spain; Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Unidad de Investigación en Atención Primaria, Centro de Salud La Alamedilla, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Servicio de Salud de Castilla y León (SACyL), Salamanca, Spain; Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain.
| | | |
Collapse
|
22
|
Corbacho-Alonso N, Rodríguez-Sánchez E, Martin-Rojas T, Mouriño-Alvarez L, Sastre-Oliva T, Hernandez-Fernandez G, Padial LR, Ruilope LM, Ruiz-Hurtado G, Barderas MG. Proteomic investigations into hypertension: what's new and how might it affect clinical practice? Expert Rev Proteomics 2019; 16:583-591. [PMID: 31195841 DOI: 10.1080/14789450.2019.1632197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Hypertension is a multifactorial disease that has, thus far, proven to be a difficult target for pharmacological intervention. The application of proteomic strategies may help to identify new biomarkers for the early diagnosis and prompt treatment of hypertension, in order to control blood pressure and prevent organ damage. Areas covered: Advances in proteomics have led to the discovery of new biomarkers to help track the pathophysiological processes implicated in hypertension. These findings not only help to better understand the nature of the disease, but will also contribute to the clinical needs for a timely diagnosis and more precise treatment. In this review, we provide an overview of new biomarkers identified in hypertension through the application of proteomic techniques, and we also discuss the difficulties and challenges in identifying biomarkers in this clinical setting. We performed a literature search in PubMed with the key words 'hypertension' and 'proteomics', and focused specifically on the most recent literature on the utility of proteomics in hypertension research. Expert opinion: There have been several promising biomarkers of hypertension identified by proteomics, but too few have been introduced to the clinic. Thus, further investigations in larger cohorts are necessary to test the feasibility of this strategy for patients. Also, this emerging field would profit from more collaboration between clinicians and researchers.
Collapse
Affiliation(s)
- N Corbacho-Alonso
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - E Rodríguez-Sánchez
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - T Martin-Rojas
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - L Mouriño-Alvarez
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - T Sastre-Oliva
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - G Hernandez-Fernandez
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - L R Padial
- c Department of Cardiology , Hospital Virgen de la Salud, SESCAM , Toledo , Spain
| | - L M Ruilope
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain.,d Department of Preventive Medicine and Public Health, School of Medicine , Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP) , Madrid , Spain.,e School of Doctoral Studies and Research , Universidad Europea de Madrid , Madrid , Spain
| | - G Ruiz-Hurtado
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - M G Barderas
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| |
Collapse
|
23
|
Hernández-Gallego J, Llamas-Velasco S, Bermejo-Pareja F, Vega S, Tapias-Merino E, Rodríguez-Sánchez E, Boycheva E, Serrano JI, Gil-García JF, Trincado R, Sánchez-Rodrigo JMV, Cacho J, Contador I, Garcia-Ptacek S, Sierra-Hidalgo F, Cubo E, Carro E, Villarejo-Galende A, García García-Patino R, Benito-León J. Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study. JMIR Res Protoc 2019; 8:e10941. [PMID: 30632964 PMCID: PMC6329894 DOI: 10.2196/10941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank. Objective The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant. Methods A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist. Results In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals. Conclusions Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).
Collapse
Affiliation(s)
- Jesús Hernández-Gallego
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Sara Llamas-Velasco
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain.,Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain
| | - Felix Bermejo-Pareja
- Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain
| | | | - Ester Tapias-Merino
- Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain.,Comillas Health Center, Madrid, Spain
| | | | - Elina Boycheva
- Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain
| | - José Ignacio Serrano
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Spanish National Research Council, Arganda del Rey (Madrid), Spain
| | | | - Rocio Trincado
- Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain
| | | | - Jesús Cacho
- Department of Neurology, University Hospital of Salamanca, Salamanca, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioural Sciences, University of Salamanca, Salamanca, Spain
| | - Sara Garcia-Ptacek
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Esther Cubo
- Department of Neurology, University Hospital "General Yagüe", Burgos, Spain
| | - Eva Carro
- Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain.,Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain
| | - Alberto Villarejo-Galende
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain
| | | | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Spanish Network for Biomedical Research in Neurodegenerative Diseases, Carlos III Research Institute, Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Group of Neurodegenerative Diseases, Research Institute, University Hospital "12 de Octubre", Madrid, Spain
| |
Collapse
|
24
|
Fernández A, Mendive JM, Conejo-Cerón S, Moreno-Peral P, King M, Nazareth I, Martín-Pérez C, Fernández-Alonso C, Rodríguez-Bayón A, Aiarzaguena JM, Montón-Franco C, Serrano-Blanco A, Ibañez-Casas I, Rodríguez-Sánchez E, Salvador-Carulla L, Garay PB, Ballesta-Rodríguez MI, LaFuente P, Del Mar Muñoz-García M, Mínguez-Gonzalo P, Araujo L, Palao D, Gómez MC, Zubiaga F, Navas-Campaña D, Aranda-Regules JM, Rodriguez-Morejón A, de Dios Luna J, Bellón JÁ. A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial. BMC Med 2018; 16:28. [PMID: 29471877 PMCID: PMC5824561 DOI: 10.1186/s12916-018-1005-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/02/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. METHODS Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. RESULTS With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. CONCLUSIONS Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. TRIAL REGISTRATION ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.
Collapse
Affiliation(s)
- Anna Fernández
- ParcSanitariSant Joan de Déu, FundacióSant Joan de Déu, C/Dr. AntoniPujadas, 42, 08830, SantBoi de Llobregat, Barcelona, Spain. .,Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney, Sydney, Australia. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
| | - Juan M Mendive
- Centro de Salud La Mina, C/Mar s/n, 08930, Barcelona, Spain
| | - Sonia Conejo-Cerón
- Distrito de AtenciónPrimariaMálaga-Guadalhorce, Unidad de Investigación, C/Sevilla, 23, 3a Planta, 29009, Málaga, Spain
| | - Patricia Moreno-Peral
- Distrito de AtenciónPrimariaMálaga-Guadalhorce, Unidad de Investigación, C/Sevilla, 23, 3a Planta, 29009, Málaga, Spain
| | - Michael King
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EH, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, Royal Free Site, Rowland Hill Street, London, NW3, UK
| | - Carlos Martín-Pérez
- Centro de SaludMarquesado, Distrito Sanitario Granada Nordeste, Avenida Mariana Pineda s/n, 18500, Granada, Spain
| | - Carmen Fernández-Alonso
- Gerencia Regional de Salud de Castilla y León, Paseo de Zorrilla, 1, 47007, Valladolid, Spain
| | | | | | | | - Antoni Serrano-Blanco
- ParcSanitariSant Joan de Déu, C/Dr. AntoniPujadas, 42, 08830, SantBoi de Llobregat, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Inmaculada Ibañez-Casas
- Centro de InvestigaciónBiomédica en Red de Salud Mental de la Universidad de Granada, Facultad de Medicina PTS Avda.de la Investigación (Departamento de Psiquiatría Torre A Planta 9a), 11, 18016, Granada, Spain
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research.Research School of Population Health, ANU College of Health and Medicine-Australian National University, 63 Eggleston Rd, Acton, ACT, 2601, Australia.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Paola Bully Garay
- Unidad de Investigación de AtenciónPrimaria, C/Luis Power, 18-4o Planta, 48014, Bilbao, Spain
| | | | - Pilar LaFuente
- Centro de Salud Andorra, C/de Huesca, 0, 44500, Teruel, Spain
| | - María Del Mar Muñoz-García
- Distrito de AtenciónPrimariaMálaga-Guadalhorce, Unidad de Investigación, C/Sevilla, 23, 3a Planta, 29009, Málaga, Spain
| | - Pilar Mínguez-Gonzalo
- Gerencia Regional de Salud de Castilla y León, Unidad de Investigación, Paseo de Zorrilla, 1, 47007, Valladolid, Spain
| | - Luz Araujo
- Distrito de AtenciónPrimariaMálaga-Guadalhorce, Unidad de Investigación, C/Sevilla, 23, 3a Planta, 29009, Málaga, Spain
| | - Diego Palao
- Hospital UniversitariParcTaulí, Servei de Salut Mental, ParcTaulí, 1, 08208 Sabadell, UniversitatAutònoma de Barcelona. CIBERSAM, Barcelona, Spain
| | - María Cruz Gómez
- Unidad de Investigación de AtenciónPrimaria, C/Luis Power, 18-4o Planta, 48014, Bilbao, Spain
| | - Fernando Zubiaga
- Centro de SaludArrabal, Unidad de Investigación de AtenciónPrimaria, AndadorAragues Puerto, 2-4, 50015, Zaragoza, Spain
| | - Desirée Navas-Campaña
- Distrito de AtenciónPrimariaMálaga-Guadalhorce, Unidad de Investigación, C/Sevilla, 23, 3a Planta, 29009, Málaga, Spain
| | | | - Alberto Rodriguez-Morejón
- Departamento de Personalidad, Evaluación y TratamientoPsicologico de la Facultad de Psicologia de la Universidad de Málaga, Campus Teatinos s/n, 29590, Málaga, Spain
| | - Juan de Dios Luna
- Departamento de Bioestadística, Facultad de Medicina, Universidad de Granada ParqueTecnológico de Ciencias de la Salud, Avda de la Investigación 11, 18016, Granada, Spain
| | - Juan Ángel Bellón
- Distrito de AtenciónPrimariaMálaga-Guadalhorce, Unidad de Investigación, C/Sevilla, 23, 3a Planta, 29009, Málaga, Spain.,Centro de Salud El Palo, Departamento de MedicinaPreventiva y Psiquiatría, Universidad de Málaga, Malaga, Spain
| |
Collapse
|
25
|
Bellón JÁ, Conejo-Cerón S, Moreno-Peral P, King M, Nazareth I, Martín-Pérez C, Fernández-Alonso C, Rodríguez-Bayón A, Fernández A, Aiarzaguena JM, Montón-Franco C, Ibanez-Casas I, Rodríguez-Sánchez E, Ballesta-Rodríguez MI, Serrano-Blanco A, Gómez MC, LaFuente P, Muñoz-García MDM, Mínguez-Gonzalo P, Araujo L, Palao D, Bully P, Zubiaga F, Navas-Campaña D, Mendive J, Aranda-Regules JM, Rodriguez-Morejón A, Salvador-Carulla L, de Dios Luna J. Intervention to Prevent Major Depression in Primary Care: A Cluster Randomized Trial. Ann Intern Med 2016; 164:656-65. [PMID: 27019334 DOI: 10.7326/m14-2653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Not enough is known about universal prevention of depression in adults. OBJECTIVE To evaluate the effectiveness of an intervention to prevent major depression. DESIGN Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials.gov: NCT01151982). SETTING 10 primary care centers in each of 7 cities in Spain. PARTICIPANTS Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate. INTERVENTION For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression. MEASUREMENTS New cases of major depression, assessed every 6 months for 18 months. RESULTS At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points [CI, -4.18 to 0.16 percentage points]; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities. LIMITATION Potential self-selection bias due to nonconsenting patients. CONCLUSION Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted. PRIMARY FUNDING SOURCE Institute of Health Carlos III.
Collapse
Affiliation(s)
- Juan Ángel Bellón
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Sonia Conejo-Cerón
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Patricia Moreno-Peral
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Michael King
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Irwin Nazareth
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Carlos Martín-Pérez
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Carmen Fernández-Alonso
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Antonina Rodríguez-Bayón
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Anna Fernández
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - José María Aiarzaguena
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Carmen Montón-Franco
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Inmaculada Ibanez-Casas
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - María Isabel Ballesta-Rodríguez
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Antoni Serrano-Blanco
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - María Cruz Gómez
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Pilar LaFuente
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - María del Mar Muñoz-García
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Pilar Mínguez-Gonzalo
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Luz Araujo
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Diego Palao
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Paola Bully
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Fernando Zubiaga
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Desirée Navas-Campaña
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Juan Mendive
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Jose Manuel Aranda-Regules
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Alberto Rodriguez-Morejón
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Luis Salvador-Carulla
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| | - Juan de Dios Luna
- From Centros de Salud El Palo y El Torcal, Distrito de Atención Primaria Málaga-Guadalhorce, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain; University College London, London, United Kingdom; Centro de Salud Marquesado, Área Nordeste de Granada, Centro de Investigaciones Biomédicas de Salud Mental de la Universidad de Granada, Universidad de Granada, Granada, Spain
- Servicio de Programas Asistenciales, Unidad de Investigación de Atención Primaria, Gerencia Regional de Salud, Valladolid, Spain; Centros de Salud San José (Linares) y Federico del Castillo (Jaén), Servicio Andaluz de Salud, Jaén, Spain; Center for Disability Research and Policy and Brain and Mind Research Institute, University of Sydney, Sydney, Australia
- Centro de Salud La Mina, Institut Català de la Salut, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Hospital Parc Taulí, Servei de Salut Mental, Barcelona, Spain; Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
- Centros de Salud Casablanca (Zaragoza), Arrabal (Zaragoza) y Andorra (Teruel), Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain; and Centro de Salud Miguel Armijo, Salamanca, Spain
| |
Collapse
|
26
|
Rodríguez-Sánchez E, Mora-Simón S, Patino-Alonso MC, Pérez-Arechaederra D, Recio-Rodríguez JI, Gómez-Marcos MA, Valero-Juan LF, García-Ortiz L. Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study). BMC Geriatr 2016; 16:33. [PMID: 26832143 PMCID: PMC4736631 DOI: 10.1186/s12877-016-0208-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/26/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We analyzed the associations between diabetes and cognitive impairment (CI) and dependence in a population of patients 65 years or older. METHODS Cross-sectional study. We randomly selected 311 participants over the age of 65 living in an urban area of Spain. The mean age of the cohort was 75.89 ± 7.12 years, and 69 of the individuals (22.2%) had diabetes. Two questionnaires were used to assess cognitive performance (MMSE and Seven Minute Screen Test), and two assessments were used to evaluate patient dependence (Barthel Index and Lawton-Brody Index). Clinical information and sociodemographic data were also gathered. RESULTS Nearly one quarter of patients with diabetes (21.7%) lived alone. Diabetic patients were more sedentary (p = .033) than non-diabetic patients. Roughly one sixth (15.3%) of the diabetics and 10.1% of the non-diabetics were depressed (p = .332). CI was present in 26.1% of the diabetics and 14.5% of non-diabetics (p = .029). Diabetic patients had a MMSE score that was significantly worse than non-diabetics (24.88 ± 4.74 vs 26.05 ± 4.03; p <.05), but no differences were found in the Seven Minute Screen Test. Logistic regressions revealed that the presence of diabetes was independently associated with CI (adjusted for age, gender, years of education, sedentary lifestyle, body mass index, diastolic blood pressure, cholesterol, and depression (OR = 2.940, p = .013). Patients with diabetes showed greater dependence, as measured by the Barthel Index (p = .03) and Lawton-Brody Index (p <.01). Nevertheless, when dependence (dependence or not dependence for each questionnaire) used as a dependent variable in the logistic regression analyses, no significant association with diabetes was found, after adjusting for confounding variables. CONCLUSIONS Diabetic patients over the age of 65 are more likely to present CI but not dependence. These findings support the need to include both a functional and cognitive assessment as necessary components in a standard evaluation in both clinical guides and randomized trials of therapeutic interventions in patients with diabetes.
Collapse
Affiliation(s)
- Emiliano Rodríguez-Sánchez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain. .,Medicine Department, University of Salamanca, Salamanca, Spain.
| | - Sara Mora-Simón
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain. .,Basic Psychology, Psychobiology and Behavioral Sciences Methodology Department, University of Salamanca, Salamanca, Spain.
| | - María C Patino-Alonso
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain. .,Statistics Department, University of Salamanca, Salamanca, Spain.
| | - Diana Pérez-Arechaederra
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.
| | - José I Recio-Rodríguez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.
| | - Manuel A Gómez-Marcos
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain. .,Medicine Department, University of Salamanca, Salamanca, Spain.
| | - Luis F Valero-Juan
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain. .,Preventive Medicine, Public Health and Medical Microbiology Department, University of Salamanca, Salamanca, Spain.
| | - Luis García-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain. .,Biomedical and Diagnostic Sciences Department, University of Salamanca, Salamanca, Spain.
| | | |
Collapse
|
27
|
Losada A, Márquez-González M, García-Ortíz L, Gómez-Marcos M, Rodríguez-Sánchez E. IS8.01: Loneliness and mental health in a representative sample of community-dwelling Spanish older adults. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70032-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
28
|
García-Ortiz L, Recio-Rodríguez JI, Schmidt-Trucksäss A, Puigdomenech-Puig E, Martínez-Vizcaíno V, Fernández-Alonso C, Rubio-Galan J, Agudo-Conde C, Patino-Alonso MC, Rodríguez-Sánchez E, Gómez-Marcos MA. Relationship between objectively measured physical activity and cardiovascular aging in the general population--the EVIDENT trial. Atherosclerosis 2014; 233:434-440. [PMID: 24530775 DOI: 10.1016/j.atherosclerosis.2014.01.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/08/2014] [Accepted: 01/11/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Aging has been associated with an increase in arterial stiffness. We analyzed the relationship between regular physical activity and cardiovascular aging evaluated by the radial augmentation index (rAIx), ambulatory arterial stiffness index (AASI), pulse pressure (PP) and heart age in subjects without atherosclerotic disease. METHODS A cross-sectional study was performed including 1365 subjects from the EVIDENT trial (mean age 54.9±13.7 years; 60.3% women). As a measure of total volume of physical activity we used counts/minute recorded in an accelerometer (Actigraph GT3X) that participants wore for seven days, collecting data in 60-sec epochs, and respondents with ≥4 valid days were retained for the analysis. Arterial stiffness was evaluated using measures of rAIx, AASI, and central and peripheral PP on the B-pro device. rAIx was adjusted to 75 heart rate(rAIx75). Cardiovascular risk and heart age was estimated by the Framingham Risk Score. RESULTS The median (IQR) of counts/min was 236.9 (176.3-307.8), rAIx75 90 (77-100), sleep PP 40 mmHg (33-47), central PP 39 mmHg (32-47) and heart age 57 years (45-73) and the mean±SD of the ASSI was 0.44±0.07. We found an inverse correlation between counts/minute and rAIx75 (r=-0.086; p<0.01), AASI (r=-0.146; p<0.001), heart age (r=-0.163; p<0.001) and peripherals PP. These associations were remained after controlling for potential confounders, except for rAIx75. In the multiple regression analysis, after adjustment, an inverse association persisted between counts/minute and AASI, sleep PP and heart age, but not with rAIx75. Accordingly, for every 100 higher counts/minute of accelerometer measures, both AASI and sleep PP would be lower by one measurement unit (beta=-0.979 and -1.031 respectively, p<0.001) and the estimated heart age by half year (beta=-0.525, p=0.023). CONCLUSIONS Regular physical activity was inversely associated with parameters related to advanced cardiovascular aging after adjustment for potentially influencing variables. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01083082.
Collapse
Affiliation(s)
- Luis García-Ortiz
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - José I Recio-Rodríguez
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - Arno Schmidt-Trucksäss
- Division Sports and Exercise Medicine, Institute of Exercise and Health Sciences, University of Basel, Switzerland.
| | - Elisa Puigdomenech-Puig
- Primary Health care Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain.
| | | | | | | | - Cristina Agudo-Conde
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - Maria C Patino-Alonso
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | | | - Manuel A Gómez-Marcos
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | | |
Collapse
|
29
|
Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA, Recio-Rodríguez JI, Mora-Simón S, Pérez-Arechaederra D, Agudo-Conde C, Escribano-Hernández A, Patino-Alonso MC. [Prevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study]. Aten Primaria 2013; 45:349-57. [PMID: 23528294 PMCID: PMC6985525 DOI: 10.1016/j.aprim.2013.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of cardiovascular diseases, cardiovascular risk factors, and the psychosocial characteristics associated with them in an urban population aged 65 years and older. DESIGN Descriptive cross-sectional study of the population. SETTING City of Salamanca (Spain). PARTICIPANTS A total of 480 participants aged 65 and older were selected using a stratified randomized sampling method. A health questionnaire was completed in the participants' homes. MAIN MEASUREMENTS Weight, height, waist circumference, arterial pressure, blood glucose and cholesterol, were measured, and the standardized prevalence for a European population was estimated. RESULTS A total of 327 participants were interviewed (68.10% of those selected), mean age of participants was 76 (SD: 7.33). Of the total, 64.5% were women and 20.2% (15.8-24.5) had some cardiovascular disease. In males, the most prevalent cardiovascular disease was ischemic heart disease (12.1% [6.1-18]), while in females it was heart failure (10.4% [6.3-14.6]). Hypertension was the most frequent cardiovascular risk factor for males (63.8% [53.2-70.9]) and females (69.7%.[63.5-75.9]), followed by diabetes in males (36.2% [27.5-45]), and sedentary lifestyle in females (36.0% [29.5-42.5]). Those with cardiovascular diseases were more dependent and had a worse prognosis (Charlson's Comorbility Index). CONCLUSIONS Ischemic heart disease is the most prevalent heart disease in males, while heart failure is the most prevalent disease for females. Almost 80% of the population aged 65 and older did not suffer any of the three cardiovascular diseases that are the main causes of mortality in this group of age. Participants who had a CVD were more dependent for activities of daily living.
Collapse
|
30
|
Bellón JÁ, Conejo-Cerón S, Moreno-Peral P, King M, Nazareth I, Martín-Pérez C, Fernández-Alonso C, Ballesta-Rodríguez MI, Fernández A, Aiarzaguena JM, Montón-Franco C, Ibanez-Casas I, Rodríguez-Sánchez E, Rodríguez-Bayón A, Serrano-Blanco A, Gómez MC, LaFuente P, del Mar Muñoz-García M, Mínguez-Gonzalo P, Araujo L, Palao D, Espinosa-Cifuentes M, Zubiaga F, Navas-Campaña D, Mendive J, Aranda-Regules JM, Rodriguez-Morejón A, Salvador-Carulla L, de Dios Luna J. Preventing the onset of major depression based on the level and profile of risk of primary care attendees: protocol of a cluster randomised trial (the predictD-CCRT study). BMC Psychiatry 2013; 13:171. [PMID: 23782553 PMCID: PMC3698147 DOI: 10.1186/1471-244x-13-171] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 'predictD algorithm' provides an estimate of the level and profile of risk of the onset of major depression in primary care attendees. This gives us the opportunity to develop interventions to prevent depression in a personalized way. We aim to evaluate the effectiveness, cost-effectiveness and cost-utility of a new intervention, personalized and implemented by family physicians (FPs), to prevent the onset of episodes of major depression. METHODS/DESIGN This is a multicenter randomized controlled trial (RCT), with cluster assignment by health center and two parallel arms. Two interventions will be applied by FPs, usual care versus the new intervention predictD-CCRT. The latter has four components: a training workshop for FPs; communicating the level and profile of risk of depression; building up a tailored bio-psycho-family-social intervention by FPs to prevent depression; offering a booklet to prevent depression; and activating and empowering patients. We will recruit a systematic random sample of 3286 non-depressed adult patients (1643 in each trial arm), nested in 140 FPs and 70 health centers from 7 Spanish cities. All patients will be evaluated at baseline, 6, 12 and 18 months. The level and profile of risk of depression will be communicated to patients by the FPs in the intervention practices at baseline, 6 and 12 months. Our primary outcome will be the cumulative incidence of major depression (measured by CIDI each 6 months) over 18 months of follow-up. Secondary outcomes will be health-related quality of life (SF-12 and EuroQol), and measurements of cost-effectiveness and cost-utility. The inferences will be made at patient level. We shall undertake an intention-to-treat effectiveness analysis and will handle missing data using multiple imputations. We will perform multi-level logistic regressions and will adjust for the probability of the onset of major depression at 12 months measured at baseline as well as for unbalanced variables if appropriate. The economic evaluation will be approached from two perspectives, societal and health system. DISCUSSION To our knowledge, this will be the first RCT of universal primary prevention for depression in adults and the first to test a personalized intervention implemented by FPs. We discuss possible biases as well as other limitations. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01151982.
Collapse
Affiliation(s)
- Juan Ángel Bellón
- Centro de Salud El Palo, Unidad de Investigación del Distrito de Atención Primaria de Málaga Departamento de Medicina Preventiva, Universidad de Málaga, Málaga, Spain,Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Málaga, Campus de Teatinos 29071, Málaga, Spain
| | - Sonia Conejo-Cerón
- Fundación IMABIS, Unidad de Investigación del Distrito de Atención Primaria de Málaga, Málaga, Spain
| | - Patricia Moreno-Peral
- Fundación IMABIS, Unidad de Investigación del Distrito de Atención Primaria de Málaga, Málaga, Spain
| | - Michael King
- Mental Health Sciences, Faculty of Brain Sciences, UCL, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, UCL, London, UK
| | | | | | | | - Anna Fernández
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | - José María Aiarzaguena
- Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
| | - Carmen Montón-Franco
- Centro de Salud Casablanca. Instituto Aragonés de Ciencias de la Salud. IIS Aragón. Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Spain
| | - Inmaculada Ibanez-Casas
- “Centro de Investigación Biomédica en Red de Salud Mental” CIBERSAM, Universidad de Granada, Granada, Spain
| | | | | | | | - María Cruz Gómez
- Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
| | - Pilar LaFuente
- Centro de Salud Andorra, Teruel, Instituto Aragonés de Ciencias de la Salud, Teruel, Zaragoza, Spain
| | | | | | - Luz Araujo
- Fundación IMABIS, Unidad de Investigación del Distrito de Atención Primaria de Málaga, Málaga, Spain
| | - Diego Palao
- Hospital Parc Taulí, Servei de Salut Mental, Sabadell, Barcelona, Spain
| | | | - Fernando Zubiaga
- Unidad de Investigación de Atención Primaria, Centro de Salud Arrabal, Zaragoza, Spain
| | - Desirée Navas-Campaña
- Fundación IMABIS, Unidad de Investigación del Distrito de Atención Primaria de Málaga, Málaga, Spain
| | - Juan Mendive
- Centro de Salud La Mina, Institut Català de la Salut, Barcelona, Spain
| | | | - Alberto Rodriguez-Morejón
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Málaga, Spain
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Juan de Dios Luna
- Departamento de Bioestadística, Universidad de Granada, Granada, Spain
| |
Collapse
|
31
|
Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Rodríguez-Sánchez E, Gómez-Sánchez L, Gómez-Sánchez M, García-Ortiz L. Relationship between uric acid and vascular structure and function in hypertensive patients and sex-related differences. Am J Hypertens 2013; 26:599-607. [PMID: 23443729 DOI: 10.1093/ajh/hps097] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We sought to analyze the relationship between uric acid (UA) and vascular structure and function based on the carotid intima-media thickness, the pulse-wave velocity (PWV), the central arterial pressure, and the augmentation index in hypertensive patients and to evaluate the sex-related differences. METHODS A cross-sectional study was performed with 366 hypertensive individuals aged 34-75 years (men = 61.74%). The vascular structure was assessed based on the carotid intima-media thickness, the arterial stiffness was assessed by PWV, and the vascular function was assessed using hemodynamic parameters such as the central and peripheral augmentation index and the ambulatory arterial stiffness index (AASI). RESULTS In the bivariable analysis, the PWV (r = 0.28; P < 0.01) and AASI (r = 0.25; P < 0.01) were positively correlated with UA in women. The central augmentation index (r = -0.16; P < 0.05) and peripheral augmentation index (r = -0.18; P < 0.05) were negatively correlated with UA, whereas the maximum carotid intima-media thickness (r = 0.11; P < 0.05) was positively correlated with UA in the global analysis. In the multiple linear regression analysis, a positive association between PWV and UA was observed after adjusting for classical risk factors (β = 0.27; P = 0.01) in women only. In turn, a negative association was observed between the AASI and UA after adjusting for confounders in men (β = -0.06; P = 0.04), with a positive association in women (β = 0.11; P = 0.03). CONCLUSIONS Serum UA showed a positive correlation with the mean maximum intima-media thickness and PWV, and this parameter showed a negative correlation with the central and peripheral augmentation indices, although this relationship was lost after adjusting for confounding factors. AASI showed a positive association in women and a negative association in men after adjusting for confounding factors. CLINICAL TRIALS REGISTRATION Clinical Trials.gov Identifier: NCT01325064.
Collapse
|
32
|
García-Ortiz L, Recio-Rodríguez JI, Rodríguez-Sánchez E, Patino-Alonso MC, Agudo-Conde C, Rodríguez-Martín C, Castaño-Sánchez C, Runkle I, Gómez-Marcos MA. Sodium and potassium intake present a J-shaped relationship with arterial stiffness and carotid intima-media thickness. Atherosclerosis 2012; 225:497-503. [DOI: 10.1016/j.atherosclerosis.2012.09.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 01/27/2023]
|
33
|
Losada A, Márquez-González M, García-Ortiz L, Gómez-Marcos MA, Fernández-Fernández V, Rodríguez-Sánchez E. Loneliness and Mental Health in a Representative Sample of Community-Dwelling Spanish Older Adults. The Journal of Psychology 2012; 146:277-92. [DOI: 10.1080/00223980.2011.582523] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
34
|
Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Rodríguez-Sánchez E, García-Ortiz L. Parámetros de rigidez arterial en sujetos hipertensos y diabéticos comparados con controles. Rev Esp Cardiol (Engl Ed) 2012; 65:384-7. [DOI: 10.1016/j.recesp.2011.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/29/2011] [Indexed: 11/28/2022]
|
35
|
García-García A, Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Rodríguez-Sánchez E, Agudo-Conde C, García-Ortiz L. Office and 24-hour heart rate and target organ damage in hypertensive patients. BMC Cardiovasc Disord 2012; 12:19. [PMID: 22439900 PMCID: PMC3326700 DOI: 10.1186/1471-2261-12-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/22/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We investigated the association between heart rate and its variability with the parameters that assess vascular, renal and cardiac target organ damage. METHODS A cross-sectional study was performed including a consecutive sample of 360 hypertensive patients without heart rate lowering drugs (aged 56 ± 11 years, 64.2% male). Heart rate (HR) and its standard deviation (HRV) in clinical and 24-hour ambulatory monitoring were evaluated. Renal damage was assessed by glomerular filtration rate and albumin/creatinine ratio; vascular damage by carotid intima-media thickness and ankle/brachial index; and cardiac damage by the Cornell voltage-duration product and left ventricular mass index. RESULTS There was a positive correlation between ambulatory, but not clinical, heart rate and its standard deviation with glomerular filtration rate, and a negative correlation with carotid intima-media thickness, and night/day ratio of systolic and diastolic blood pressure. There was no correlation with albumin/creatinine ratio, ankle/brachial index, Cornell voltage-duration product or left ventricular mass index. In the multiple linear regression analysis, after adjusting for age, the association of glomerular filtration rate and intima-media thickness with ambulatory heart rate and its standard deviation was lost. According to the logistic regression analysis, the predictors of any target organ damage were age (OR = 1.034 and 1.033) and night/day systolic blood pressure ratio (OR = 1.425 and 1.512). Neither 24 HR nor 24 HRV reached statistical significance. CONCLUSIONS High ambulatory heart rate and its variability, but not clinical HR, are associated with decreased carotid intima-media thickness and a higher glomerular filtration rate, although this is lost after adjusting for age. TRIAL REGISTRATION ClinicalTrials.gov: NCT01325064.
Collapse
Affiliation(s)
- Angel García-García
- Primary Care Research Unit, La Alamedilla Health Center, REDIAPP, IBSAL, SACyL, Salamanca, Spain
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Recio-Rodríguez JI, Gómez-Marcos MA, Patino-Alonso MC, Agudo-Conde C, Rodríguez-Sánchez E, García-Ortiz L. Cocoa intake and arterial stiffness in subjects with cardiovascular risk factors. Nutr J 2012; 11:8. [PMID: 22325068 PMCID: PMC3299654 DOI: 10.1186/1475-2891-11-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 02/10/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To analyze the relationship of cocoa intake to central and peripheral blood pressure, arterial stiffness, and carotid intima-media thickness in subjects with some cardiovascular risk factor. FINDINGS DESIGN A cross-sectional study of 351 subjects (mean age 54.76 years, 62.4% males). MEASUREMENTS Intake of cocoa and other foods using a food frequency questionnaire, central and peripheral (ambulatory and office) blood pressure, central and peripheral augmentation index, pulse wave velocity, ambulatory arterial stiffness index, carotid intima-media thickness, and ankle-brachial index. RESULTS Higher pulse wave velocity and greater cardiovascular risk were found in non-cocoa consumers as compared to high consumers (p < 0.05). In a multivariate analysis, these differences disappeared after adjusting for age, gender, the presence of diabetes, systolic blood pressure and antihypertensive and lipid-lowering drug use. All other arterial stiffness measures (central and peripheral augmentation index, ambulatory arterial stiffness index, ankle-brachial index, and carotid intima-media thickness) showed no differences between the different consumption groups. CONCLUSIONS In subjects with some cardiovascular risk factors, cocoa consumption does not imply improvement in the arterial stiffness values. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01325064.
Collapse
|
37
|
Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Gómez-Sánchez L, Agudo-Conde C, Gómez-Sánchez M, Rodríguez-Sánchez E, García-Ortiz L. Ambulatory arterial stiffness indices and target organ damage in hypertension. BMC Cardiovasc Disord 2012; 12:1. [PMID: 22284388 PMCID: PMC3305545 DOI: 10.1186/1471-2261-12-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study was designed to evaluate which arterial stiffness parameter - AASI or the home arterial stiffness index (HASI) - correlates best with vascular, cardiac and renal damage in hypertensive individuals. METHODS A cross-sectional study was carried out involving 258 hypertensive patients. AASI and HASI were defined as the 1-regression slope of diastolic over systolic blood pressure readings obtained from 24-hour recordings and home blood pressure over 6 days. Renal damage was evaluated by glomerular filtration rate (GFR) and microalbuminuria; vascular damage by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI); and left ventricular hypertrophy by the Cornell voltage-duration product (VDP) and the Novacode index. RESULTS AASI and HASI were not correlated with microalbuminuria, however AASI and HASI- blood pressure variability ratio (BPVR) showed negative correlation with GRF. The Cornell PDV was positively correlated with AASI- BPVR-Sleep (r = 0.15, p < 0.05) and the left ventricular mass index with HASI-BPVR (r = 0.19, p < 0.01). Carotid IMT and PWV were positively correlated with all the parameters except the HASI, while ABI was negatively correlated with AASI and Awake-AASI. After adjusting for age, gender and 24 hours heart rate, statistical significance remains of the IMT with AASI, Awake AASI and AASI-BPVR. PWV with the AASI, Awake-AASI and Sleep-AASI. ABI with AASI and Awake-AASI. Odd Ratio to presence target organ damage was for AASI: 10.47(IC95% 1.29 to 65.34), Awake-AASI: 8.85(IC95% 1.10 to 71.04), Sleep-AASI: 2.19(IC95% 1.10 to 4.38) and AASI-BPVR-night: 4.09 (IC95% 1.12 to 14.92). CONCLUSIONS After adjusting for age, gender and 24-hour heart, the variables that best associated with the variability of IMT, PWV and ABI were AASI and Awake-AASI, and with GFR was HASI-BPVR.
Collapse
|
38
|
Rodríguez-Sánchez E, Mora-Simón S, Patino-Alonso MC, García-García R, Escribano-Hernández A, García-Ortiz L, Perea-Bartolomé MV, Gómez-Marcos MA. Prevalence of cognitive impairment in individuals aged over 65 in an urban area: DERIVA study. BMC Neurol 2011; 11:147. [PMID: 22093337 PMCID: PMC3226440 DOI: 10.1186/1471-2377-11-147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/17/2011] [Indexed: 11/27/2022] Open
Abstract
Background Few data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors. Methods Design: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia. Results The prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk. Conclusions The observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.
Collapse
Affiliation(s)
- Emiliano Rodríguez-Sánchez
- Primary care research unit of La Alamedilla Health Center, Castilla y León Health Service- SACYL, Salamanca, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Perea-Bartolome MV, García-García R, Ladera-Fernández V, Mora-Simón S, Patino-Alonso MC, Almanza-Guerra TJ, Agudo-Conde C, Muriel-Diez MP, Rodríguez-Sánchez E. Detection of mild cognitive impairment in people older than 65 years of age and its relationship to cardiovascular risk factors (DECRIVAM). BMC Public Health 2011; 11:504. [PMID: 21708036 PMCID: PMC3141464 DOI: 10.1186/1471-2458-11-504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 06/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies centered on the detection of cognitive impairment and its relationship to cardiovascular risk factors in elderly people have gained special relevance in recent years. Knowledge of the cardiovascular risk factors that may be associated to cognitive impairment could be very useful for introducing treatments in early stages - thereby possibly contributing to improve patient quality of life.The present study explores cognitive performance in people over 65 years of age in Salamanca (Spain), with special emphasis on the identification of early symptoms of cognitive impairment, with the purpose of detecting mild cognitive impairment and of studying the relationships between this clinical situation and cardiovascular risk factors. METHODS/DESIGN A longitudinal study is contemplated. The reference population will consist of 420 people over 65 years of age enrolled through randomized sampling stratified by healthcare area, and who previously participated in another study. MEASUREMENT a) Sociodemographic variables; b) Cardiovascular risk factors; c) Comorbidity; d) Functional level for daily life activities; and e) Study of higher cognitive functions based on a neuropsychological battery especially adapted to the evaluation of elderly people. DISCUSSION We hope that this study will afford objective information on the representative prevalence of cognitive impairment in the population over 65 years of age in Salamanca. We also hope to obtain data on the relationship between cognitive impairment and cardiovascular risk factors in this specific population group. Based on the results obtained, we also will be able to establish the usefulness of some of the screening tests applied during the study, such as the Mini-Mental State Examination and the 7 Minute Screen test. TRIAL REGISTRATION ClinicalTrials.gov: NCT01327196.
Collapse
Affiliation(s)
- M Victoria Perea-Bartolome
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Rodríguez-Sánchez E, Pérez-Peñaranda A, Losada-Baltar A, Pérez-Arechaederra D, Gómez-Marcos MÁ, Patino-Alonso MC, García-Ortiz L. Relationships between quality of life and family function in caregiver. BMC Fam Pract 2011; 12:19. [PMID: 21496270 PMCID: PMC3089776 DOI: 10.1186/1471-2296-12-19] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 04/15/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregiver's situation has not been the subject of much evaluation. The aim of this study is to analyse the relationship between the functionality of the family and the QoL of caregivers of dependent relatives. METHODS We conducted a cross-sectional study including 153 caregivers. SETTING Two health centers in the city of Salamanca(Spain). Caregiver variables analysed: demographic characteristics, care recipient features; family functionality (Family APGAR-Q) and QoL (Ruiz-Baca-Q) perceived by the caregiver. Five multiple regressions are performed considering global QoL and each of the four QoL dimensions as dependent variables. The Canonical Correspondence Analysis (CCA) was used to study the influence of the family function questionnaire on QoL. RESULTS Family function is the only one of the variables evaluated that presented an association both with global QoL and with each of the four individual dimensions (p<0.05). Using the CCA, we found that the physical and mental well-being dimensions are the ones which present a closer relationship with family functionality, while social support is the quality dimension that is least influenced by the Family APGAR-Q. CONCLUSION We find an association between family functionality and the caregiver's QoL. This relation holds for both the global measure of QoL and each of its four individual dimensions.
Collapse
|
41
|
García-Ortiz L, García-García A, Ramos-Delgado E, Patino-Alonso MC, Recio-Rodríguez JI, Rodríguez-Sánchez E, Gómez-Marcos MA. Relationships of night/day heart rate ratio with carotid intima media thickness and markers of arterial stiffness. Atherosclerosis 2011; 217:420-6. [PMID: 21514590 DOI: 10.1016/j.atherosclerosis.2011.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/11/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyze the relationship between office and ambulatory heart rate, and its variability, and arterial stiffness in patients with primary arterial hypertension. METHODS A cross-sectional study was conducted in a primary care setting, with the inclusion of 356 hypertensive patients aged 30-80 years. Office and ambulatory blood pressure, heart rate, night/day heart rate ratio and the corresponding standard deviations, were determined. Arterial stiffness was assessed according to carotid intima media thickness, pulse wave velocity, the central and peripheral augmentation index, and the ambulatory arterial stiffness index. RESULTS Carotid intima media thickness, central and peripheral augmentation index, and ambulatory arterial stiffness index were negatively correlated to office and ambulatory heart rate and its standard deviation, and positively correlated to the night/day heart rate ratio. Pulse wave velocity showed a negative correlation to 24 h standard deviation heart rate and a positive correlation to nocturnal heart rate and the night/day heart rate ratio. For each 10 bpm increment in 24 h heart rate, the pulse wave velocity increased 0.42 m/s (95%CI: 0.23-0.60) and ambulatory arterial stiffness index decreased 0.01 (95%CI: 0.01-0.02); in the case of office heart rate, the peripheral augmentation index decreased 4.74 (95%CI: 3.15-6.33) and central augmentation index decreased 3.52 (95%CI: 2.43-4.30), while for 24 h standard deviation heart rate, carotid intima media thickness decreased 0.03 mm (95%CI: 0.01-0.06). CONCLUSIONS Office and ambulatory heart rate, and the corresponding standard deviations, are inversely associated to the arterial stiffness markers, with the exception of pulse wave velocity, where a direct correlation is observed. A greater increase in night/day ratio, i.e., a lesser decrease in nocturnal heart rate, is associated to increased arterial stiffness.
Collapse
|
42
|
López-Viedma B, Lorente-Poyatos R, Domper-Bardají F, De la Santa-Belda E, Hernández-Albújar A, Patón-Arenas R, Verdejo-Gil C, Bohumidi A, Olivencia-Palomares P, Galván-Fernández MD, Rodríguez-Sánchez J, LaBlanca-Alonso M, Olmedo-Camacho J, Rodríguez-Sánchez E. [Usefulness of self-expanding biodegradable prosthesis in the treatment of refractory benign stenosis: a case series study]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2011; 76:81-88. [PMID: 21724482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The use of self-expanding biodegradable prosthesis treatment of refractory benign stenosis is still undefined. OBJECTIVE To determine the utility and safety of biodegradable polydioxanone prostheses as treatment of gastrointestinal tract refractory benign strictures. METHODS Consecutive patients diagnosed with refractory benign stricture of gastrointestinal tract following Kochman's criteria were included. The type of stenosis were anastomotic (n = 5), peptic (n = 1), post-radiotherapy (n = 1) and they were located in proximal esophagus-hypofarynge (n = 2), esophagus medium (n = 1), distal esophagus (n = 2) and rectum (n = 2). The prosthesis was placed under endoscopic and fluoroscopic control under conscious sedation with propofol. RESULTS Seven patients (8 prosthesis) were included. Mean patient age was 49 years-old (range: 37-70). Insertion prosthesis was successful in all cases. Distal migration of prosthesis was observed in both rectal stenosis and was the indication of a second prosthesis placement in one case. At the end of follow-up (median follow-up 30 weeks for esophageal stricture, 33 weeks for rectal stricture) 5 patients remained asymptomatic. Eighty per cent of patients with esophageal stenosis showed partial and transient re-stenosis due to hyperplastic reaction during the degradation of the prosthesis, with transient dysphagia in two patients resolved medically. Complete prosthesis degradation was confirmed by endoscopy in all cases. CONCLUSIONS The use of self-expanding biodegradable polydioxanone prosthesis is a safe and utile therapeutic option for refractory benign gastrointestinal stenosis.
Collapse
Affiliation(s)
- B López-Viedma
- Servicio de Aparato Digestivo, Hospital General Universitario de Ciudad Real, España.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Gómez-Marcos MA, Recio-Rodríguez JI, Rodríguez-Sánchez E, Patino-Alonso MC, Magallón-Botaya R, Martínez-Vizcaino V, Gómez Sánchez L, García-Ortiz L. [Carotid intima-media thickness in diabetics and hypertensive patients]. Rev Esp Cardiol 2011; 64:622-5. [PMID: 21440358 DOI: 10.1016/j.recesp.2010.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 10/17/2010] [Indexed: 12/16/2022]
Abstract
The aims of this study are to describe the mean values of carotid intima-media thickness and how it increases with age, and to compare carotid injury in diabetics and hypertensive patients with that of controls. We included 562 subjects (121 diabetics, 352 hypertensive patients, 89 controls). The mean intima-media thickness was 0.781 mm in diabetics, 0.738 mm in hypertensive patients and 0.686 mm in controls. The difference in intima-media thickness between diabetics and controls and between hypertensive patients and controls, adjusted for age, was 0.040 and 0.026 mm, respectively. We observed an increase in intima-media thickness of 0.005 mm in diabetics and of 0.005 mm in controls with every additional year of age. We found carotid damage in 23% of the diabetics, 12% of the hypertensive patients and 3.4% of the controls. In conclusion, the intima-media thickness is greater in diabetics, but the annual increase in the thickness is greater in hypertensive patients. Full English text available from:www.revespcardiol.org.
Collapse
|
44
|
Gómez-Marcos MA, González-Elena LJ, Recio-Rodríguez JI, Rodríguez-Sánchez E, Magallón-Botaya R, Muñoz-Moreno MF, Patino-Alonso MC, García-Ortiz L. Cardiovascular risk assessment in hypertensive patients with tests recommended by the European Guidelines on Hypertension. Eur J Prev Cardiol 2011; 19:515-22. [DOI: 10.1177/1741826711401981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the usefulness of the diagnostic tests recommended by the European Society of Hypertension/Cardiology Guidelines (ESH-ESC 2007) in hypertensive patients classified as being at low or moderate risk, analyzing the change to high risk classification and the characteristics associated with such change. Methods: A cross-sectional study was made in 391 patients aged between 30 and 80 years recently diagnosed with arterial hypertension in the Primary Care setting. The criteria of the 2007 ESH-ESC Guidelines were followed for the evaluation of risk factors, subclinical organ damage, cardiovascular disease and cardiovascular risk. In addition to the routine tests, echocardiography, carotid ultrasound, albumin/creatinine ratio, estimated glomerular filtration rate, ankle-brachial index, pulse wave velocity and retinography were used. We established four levels of testing performed for risk classification. Results: Using the routine tests to evaluate risk (level 1), 218 (55.8%) patients were classified as being at high risk. Of the 173 patients classified as presenting low or moderate risk, the ankle-brachial index, albumin/creatinine ratio and glomerular filtration rate were determined (level 2), and 18 patients (10.4%) were classified as being at high risk. With echocardiography and carotid ultrasound (level 3), another 16 patients (10%) were raised to high risk. Finally, with pulse wave velocity and retinography (level 4), 10 additional patients (5%) were classified as presenting high risk. Patients with increased blood pressure, advanced age and women showed a 4.28-fold (95%CI: 2.01–9.16), 3.54-fold (95%CI: 1.61–7.77) and 1.36-fold (95%CI: 0.62–3.00) higher probability of being reclassified to high cardiovascular risk, respectively. Conclusions: With the non-routine tests, 25.4% of the low or moderate risk patients were reclassified as presenting high risk.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Maria C Patino-Alonso
- Primary Care Research Unit, La Alamedilla Health Center, REDIAPP, Salamanca, Spain
- Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit, La Alamedilla Health Center, REDIAPP, Salamanca, Spain
| |
Collapse
|
45
|
Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Gómez-Sánchez L, Rodríguez-Sánchez E, Martín-Cantera C, García-Ortiz L. Relationship between intima-media thickness of the common carotid artery and arterial stiffness in subjects with and without type 2 diabetes: a case-series report. Cardiovasc Diabetol 2011; 10:3. [PMID: 21226947 PMCID: PMC3034668 DOI: 10.1186/1475-2840-10-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined the relationship between the intima-media thickness of the common carotid artery (CCA-IMT) and arterial stiffness, assessed by pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI) and the augmentation index (AIx) in subjects with and without type 2 diabetes. METHODS A case-series study was made in 366 patients (105 diabetics and 261-non-diabetics). Ambulatory blood pressure monitoring was performed on a day of standard activity with the SpaceLabs 90207 system. AASI was calculated as "1-slope" from the within-person regression of diastolic-on-systolic ambulatory blood pressure readings. PWV and AIx were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of CCA-IMT. RESULTS PWV, AASI and CCA-IMT were found to be greater in diabetic patients, while no differences in AIx were observed between the two groups. CCA-IMT was independently correlated to the three measures of arterial stiffness in both groups. We found an increase in CCA-IMT of 0.40, 0.24 and 0.36 mm in diabetics, and of 0.48, 0.17 and 0.55 mm in non-diabetics for each unit increase in AASI, AIx and PWV. The variability of CCA-IMT was explained mainly by AASI, AIx and gender in diabetic patients, and by age, gender, AASI and PWV in non-diabetic patients. CONCLUSIONS CCA-IMT showed a positive correlation to PWV, AASI and AIx in subjects with and without type 2 diabetes. However, when adjusting for age, gender and heart rate, the association to PWV was lost in diabetic patients, in the same way as the association to Alx in non-diabetic patients. The present study demonstrates that the three measures taken to assess arterial stiffness in clinical practice are not interchangeable, nor do they behave equally in all subjects.
Collapse
|
46
|
Rodríguez-Sánchez E, Mora-Simón S, Porras-Santos N, Patino-Alonso MC, Recio-Rodríguez JI, Becerro-Muñoz C, Pérez-Arechaederra D, Gomez-Marcos MA, Garcia-Ortiz L. Effectiveness of an intervention in groups of family caregivers of dependent patients for their application in primary health centers. Study protocol. BMC Public Health 2010; 10:559. [PMID: 20849630 PMCID: PMC2954999 DOI: 10.1186/1471-2458-10-559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 09/17/2010] [Indexed: 12/04/2022] Open
Abstract
Background Although Primary Health Care (PHC) Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers. The study aims to evaluate the effectiveness of an intervention of psychotherapy in improving the mental health and Quality of life of caregivers. This intervention is based on theoretical approaches to care adjusted to cognitive theory, in order to be applied in primary health care centres. Methods/Design This is multicentre clinical trials study, randomized in two parallel groups, carry out in two PHC, Study population: 150 caregivers will be included by consecutive sampling and they will be randomized the half to experimental group and the other half to control group. They provide mostly all the assistance to care-dependent familiars receiving attention in PHC Centers. Measurements: Each caregiver will be evaluated on a personal interview. The caregivers' assessment protocol: 1) Assessment of different socio-demographic related to care, and caregiver's personal situation. 2)Care-dependent individuals will also be assessed by Barthel Index and Pfeiffer Questionnaire (SPMSQ). 3)Change in caregivers will be the principal measure: family function (Family APGAR Questionnaire), burden short questionnaire (Short Zarit Burden Interview), quality of life (Ruiz & Baca: 1993 Questionnaire), the Duke-UNK Functional Social Support Questionnaire, the General Health Questionnaire-12, and changes in Dysfunctional Thoughts about caring. 4) Intervention implementation measures will also be assessed. Intervention: A psychotherapeutic intervention will be 8 sessions of 90 minutes in groups. This intervention has been initially developed for family caregivers of patients with dementia. Discussion Psychotherapeutic interventions have been proved to obtain better results to reduce symptomatology and improve emotional state of caregivers. Moreover, this intervention has been proved to be effective in a different setting other than PHC, and was developed by professionals of Mental Health. If we found that this intervention is effective in PHC and with our professionals, it would be an important instrument to offer to caregivers of care-dependent patients. Trial Registration ClinicalTrials.gov Identifier NCT01177696
Collapse
Affiliation(s)
- Emiliano Rodríguez-Sánchez
- Primary care research unit of La Alamedilla Health Center, Castilla y León Health Service, SACYL, Salamanca, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Gómez-Marcos MA, Recio-Rodríguez JI, Rodríguez-Sánchez E, Castaño-Sánchez Y, de Cabo-Laso A, Sánchez-Salgado B, Rodríguez-Martín C, Castaño-Sánchez C, Gómez-Sánchez L, García-Ortiz L. Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol. BMC Public Health 2010; 10:143. [PMID: 20298558 PMCID: PMC2858115 DOI: 10.1186/1471-2458-10-143] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 03/18/2010] [Indexed: 12/31/2022] Open
Abstract
Background Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk. The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome. Methods/Design Design: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up. Setting: The study will be carried out in the urban primary care setting. Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included. Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs. Discussion The results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus. Trial Registration ClinicalTrials.gov Identifier: NCT01065155
Collapse
Affiliation(s)
- Manuel A Gómez-Marcos
- La Alamedilla Health Centre, Primary Care Research Unit, Castilla y León Health Service - SACYL, Salamanca, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
García-Ortiz L, Santos-Rodríguez I, Gómez-Marcos MA, Sánchez-Fernández PL, Rodríguez-Sánchez E, González-Elena LJ. [Cycles of improvement of the hypertensive patient's care: risk-cycle study]. Rev Esp Salud Publica 2008; 82:57-68. [PMID: 18398551 DOI: 10.1590/s1135-57272008000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Frequently we found deficiencies in the management of cardiovascular risk factors on hypertensive patients in primary care. OBJECTIVE This study was to evaluate the effect of a quality improvement intervention in the care of cardiovascular risk factors in hypertensive patients. METHODS Quality assurance study. Two health centres with fourteen family doctors. One centre (seven doctors) was assigned to receive a quality improvement intervention while the other centre was assigned the control group. 482 hypertensive patients were in the study group (64% females, mean age 61,4 years (SD 6,8)), and 360 were in the control group (63% females, mean age 60,7 (SD 7,4)). Quality improvement circles consisting of audit, feedback, training sessions, and guidelines discussion. Process criteria of hypertension control, blood pressure, weight, lipids, smoking, cardiovascular risk and antihypertensive drugs used were measurement before intervention and again one year later. RESULTS The mean improvement in process criteria after the intervention was 5,3 percent points (CI95%:3,7-6,9). Systolic blood pressure was decreased by 3,5 mmHg(IC95%:1,6-5,3) and Diastolic blood pressure by 2,5 mmHg(IC95%:1,3-3,8). Adequate BP control was significantly increased in the intervention group (29,1% to 40,9%;p<0,01), while no effect was achieved in the control group. Absolute cardiovascular risk decreased (15,86 to14,34%, p<0.01) in the study group, with no changes in the control group. Absolute risk decreases 2,07(IC95%:1,21-2,93) and relative risk 0,25 (IC95%:0,14-0,35) percent points. CONCLUSION The quality intervention was effective in improving the quality care process and decreased blood pressure and absolute and relative cardiovascular risk.
Collapse
|
49
|
García-Ortiz L, Gómez-Marcos M, González-Elena L, Rodríguez-Sánchez E, García García Á, Parra-Sánchez J, González García A, Herrero Rodríguez C, Melón Barrientos L. Framingham-Grundy, REGICOR y SCORE en la estimación del riesgo cardiovascular del paciente hipertenso. Concordancias y discrepancias (CICLO-RISK). ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0212-8241(06)71734-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
García-Ortiz L, Gómez-Marcos M, González-Elena L, Rodríguez-Sánchez E, García García Á, Parra-Sánchez J, González García A, Herrero Rodríguez C, Melón Barrientos L. Framingham-Grundy, REGICOR y SCORE en la estimación del riesgo cardiovascular del paciente hipertenso. Concordancias y discrepancias (CICLO-RISK). Hipertensión y Riesgo Vascular 2006. [DOI: 10.1016/s1889-1837(06)71615-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|