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Gómez-Gómez I, Rodero-Cosano ML, Bellón JÁ, Zabaleta-Del-Olmo E, Maderuelo-Fernandez JA, Moreno-Peral P, Magallón-Botaya R, Oliván-Blázquez B, Casajuana-Closas M, López-Jiménez T, Bolíbar B, Llobera J, Clavería A, Sanchez-Perez A, Motrico E. Examining the influence of mental health and structural determinants of health on the stage of motivational readiness for health behaviour changes: A path analysis study. J Health Psychol 2024:13591053241241015. [PMID: 38605575 DOI: 10.1177/13591053241241015] [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] [Indexed: 04/13/2024] Open
Abstract
This study explores the influence of mental health and structural determinants of health on motivational readiness for health behaviour change in 1462 Spanish primary healthcare users. Chi-square test and structural equation modelling were performed. Results showed that depression and anxiety were negatively associated with being in the action stages of motivational readiness for a healthy diet and physical activity. This association was statistically significant only for motivational readiness for a healthy diet and depression (β = - 0 . 076 ; p = 0 . 046 ). Furthermore, women and workers were more likely to be in the action stages of motivational readiness for a healthy diet while older adults and adults with higher health-related quality of life were more likely to be in the action stages of motivational readiness for physical activity. The present study suggests that structural (being older, being a woman and being employed) and intermediary (suffering from depression and higher health-related quality of life) determinants of health influence motivational readiness for health behaviour changes.
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Affiliation(s)
- Irene Gómez-Gómez
- Universidad Loyola Andalucía, Spain
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
| | | | - Juan Á Bellón
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Biomedical Research Institute of Málaga (IBIMA), Spain
- Andalusian Health Service (SAS), Spain
- University of Málaga, Spain
| | - Edurne Zabaleta-Del-Olmo
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Institut Català de la Salut, Spain
- Universitat de Girona, Spain
| | - José A Maderuelo-Fernandez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Spain
- Instituto de investigación Biomédica de Salamanca (IBSAL), Spain
- Gerencia de Atención Primaria de Salamanca, Spain
- Gerencia Regional de salud de Castilla y León (SACyL), Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Biomedical Research Institute of Málaga (IBIMA), Spain
| | - Rosa Magallón-Botaya
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Universidad de Zaragoza, Spain
- Institute for Health Research Aragón (IISA), Spain
| | - Bárbara Oliván-Blázquez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Universidad de Zaragoza, Spain
- Institute for Health Research Aragón (IISA), Spain
| | - Marc Casajuana-Closas
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Tomàs López-Jiménez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Bonaventura Bolíbar
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Joan Llobera
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Servei de Salut de les Illes Balears, Spain
| | - Ana Clavería
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Área de Vigo, SERGAS, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - Alvaro Sanchez-Perez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- BioCruces Bizkaia Health Research Institute, Basque Healthcare Service - Osakidetza, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Sevilla, Spain
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Spain
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Recio-Rodriguez JI, Garcia-Yu IA, Alonso-Dominguez R, Maderuelo-Fernandez JA, Patino-Alonso MC, Agudo-Conde C, Sanchez-Aguadero N, Ramos R, Marti R, Rodriguez-Sanchez E, Gómez-Marcos MA, Garcia-Ortiz L. Diet quality and carotid atherosclerosis in intermediate cardiovascular risk individuals. Nutr J 2017; 16:40. [PMID: 28673286 PMCID: PMC5494789 DOI: 10.1186/s12937-017-0266-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/26/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- Jose I Recio-Rodriguez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Department of Nursing and Physiotherapy (University of Salamanca), Salamanca, Spain. .,Primary Care Research Unit. Alamedilla Health Center, 37003, Salamanca, Spain.
| | - Irene A Garcia-Yu
- Department of Preventive Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Rosario Alonso-Dominguez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
| | - José A Maderuelo-Fernandez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
| | - Maria C Patino-Alonso
- Department of Statistics, University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
| | - Cristina Agudo-Conde
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
| | - Natalia Sanchez-Aguadero
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
| | - Rafel Ramos
- Research Unit Family Medicine, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Translab Research Group, Medical Sciences Department, School of Medicine, University of Girona, Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain
| | - Ruth Marti
- Research Unit Family Medicine, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Translab Research Group, Medical Sciences Department, School of Medicine, University of Girona, Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), 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), Department of Medicine, University of Salamanca, Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
| | - Luis Garcia-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Department of Biomedical and Diagnostic Sciences, University of Salamanca, Spanish Network for Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain
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Maderuelo-Fernandez JA, Recio-Rodríguez JI, Patino-Alonso MC, Pérez-Arechaederra D, Rodriguez-Sanchez E, Gomez-Marcos MA, García-Ortiz L. Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review. Prev Med 2015; 76 Suppl:S39-55. [PMID: 25524613 DOI: 10.1016/j.ypmed.2014.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 07/18/2014] [Revised: 11/07/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings. METHODS Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached. RESULTS Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups. CONCLUSION Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.
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Affiliation(s)
- José A Maderuelo-Fernandez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
| | - José I Recio-Rodríguez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
| | - Maria C Patino-Alonso
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Statistics Department, University of Salamanca, Salamanca, Spain.
| | - Diana Pérez-Arechaederra
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain.
| | - Manuel A Gomez-Marcos
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain.
| | - Luis García-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain.
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Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Rodrigo-De Pablo E, Cabrejas-Sánchez A, Arietaleanizbeaskoa MS, Repiso-Gento I, Gonzalez-Viejo N, Maderuelo-Fernandez JA, Agudo-Conde C, Garcia-Ortiz L. Glycemic index, glycemic load, and pulse wave reflection in adults. Nutr Metab Cardiovasc Dis 2015; 25:68-74. [PMID: 25315672 DOI: 10.1016/j.numecd.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.
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Affiliation(s)
- J I Recio-Rodriguez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain.
| | - M A Gomez-Marcos
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | | | - E Rodrigo-De Pablo
- Passeig de Sant Joan Health Center, Catalan Health Center, Barcelona, Spain
| | - A Cabrejas-Sánchez
- Cuenca III Health Centre, Castilla La Mancha Health Service-SESCAM, Cuenca, Spain
| | | | - I Repiso-Gento
- Casa del Barco Health Center, Castilla and León Health Service-SACYL, Valladolid, Spain
| | - N Gonzalez-Viejo
- Torre Ramona Health Center, Aragón Health Service-Salud, Zaragoza, Spain
| | - J A Maderuelo-Fernandez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - C Agudo-Conde
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - L Garcia-Ortiz
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
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Gomez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Lasaosa-Medina L, Rodriguez-Sanchez E, Maderuelo-Fernandez JA, García-Ortiz L. Relationship between objectively measured physical activity and vascular structure and function in adults. Atherosclerosis 2014; 234:366-72. [DOI: 10.1016/j.atherosclerosis.2014.02.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
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Rodriguez-Sánchez E, Criado-Gutiérrez JM, Mora-Simón S, Muriel-Diaz MP, Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Valero-Juan LF, Maderuelo-Fernandez JA, García-Ortiz L. Physical activity program for patients with dementia and their relative caregivers: randomized clinical trial in Primary Health Care (AFISDEMyF study). BMC Neurol 2014; 14:63. [PMID: 24684948 PMCID: PMC3972512 DOI: 10.1186/1471-2377-14-63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/25/2014] [Accepted: 03/21/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving.The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed. METHODS/DESIGN DESIGN Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1). VARIABLES The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life. INTERVENTION For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care. ANALYSIS An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result. DISCUSSION If the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02044887.
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Affiliation(s)
- Emiliano Rodriguez-Sánchez
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Medicine Department, University of Salamanca, Salamanca, Spain
- Unidad de Investigación, Centro de Salud La Alamedilla, 37003 Salamanca, Spain
| | | | - Sara Mora-Simón
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Basic Psychology, Psychobiology and Behavioral Sciences Methodology Department, University of Salamanca, Salamanca, Spain
| | - M Paz Muriel-Diaz
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Medicine Department, University of Salamanca, Salamanca, Spain
| | - José I Recio-Rodríguez
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
| | - M Carmen Patino-Alonso
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Statistics Department, University of Salamanca, Salamanca, Spain
| | - Luis F Valero-Juan
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Preventive Medicine, Public Health and Medical Microbiology Department, University of Salamanca, Salamanca, Spain
| | - José A Maderuelo-Fernandez
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
| | - Luis García-Ortiz
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Medicine Department, University of Salamanca, Salamanca, Spain
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