PublicationSpanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care.(2021-09-04) Lopez-Campos, José Luis; Almagro, Pere; Gómez, José Tomás; Chiner, Eusebi; Palacios, Leopoldo; Hernández, Carme; Navarro, M Dolores; Molina, Jesús; Rigau, David; Soler-Cataluña, Juan José; Calle, Myriam; Cosío, Borja G; Casanova, Ciro; Miravitlles, Marc; en nombre del equipo de trabajo de GesEPOC 2021The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD. PublicationMedication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions.(2022-09-23) Gil-Guillen, Vicente F; Balsa, Alejandro; Bernárdez, Beatriz; Valdés Y Llorca, Carmen; Márquez-Contreras, Emilio; de la Haba-Rodríguez, Juan; Castellano, Jose M; Gómez-Martínez, JesúsMedication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients. PublicationBarriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians.(2022-03-11) Carratalá-Munuera, Concepción; Cortés-Castell, Ernesto; Márquez-Contreras, Emilio; Castellano, José Maria; Perez-Paramo, María; López-Pineda, Adriana; Gil-Guillen, Vicente FTo identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician's opinion of primary care and hospital settings. An observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement. A total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas. A consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians' opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease. PublicationBreastfeeding experiences during the COVID-19 pandemic in Spain:a qualitative study.(2022-02-22) Rodríguez-Gallego, Isabel; Strivens-Vilchez, Helen; Agea-Cano, Irene; Marín-Sánchez, Carmen; Sevillano-Giraldo, María Dolores; Gamundi-Fernández, Concepción; Berná-Guisado, Concepción; Leon-Larios, FatimaThe pandemic caused by COVID-19 has affected reproductive and perinatal health both through the infection itself and, indirectly, as a consequence of changes in medical care, social policy or social and economic circumstances. The objective of this study is to explore the impact of the pandemic and of the measures adopted on breastfeeding initiation and maintenance. A qualitative descriptive study was conducted by means in-depth semi-structured interviews, until reaching data saturation. The study was conducted between the months of January to May 2021. Participants were recruited by midwives from the Primary Care Centres of the Andalusian provinces provinces of Seville, Cádiz, Huelva, Granada, and Jaén. The interviews were conducted via phone call and were subsequently transcribed and analysed by means of reflexive inductive thematic analysis, using Braun and Clarke's thematic analysis. A total of 30 interviews were conducted. Five main themes and ten subthemes were developed, namely: Information received (access to the information, figure who provided the information), unequal support from the professionals during the pandemic (support to postpartum hospitalization, support received from Primary Health Care during the postpartum period), social and family support about breastfeeding (support groups, family support), impact of confinement and of social restriction measures (positive influence on breastfeeding, influence on bonding with the newborn), emotional effect of the pandemic (insecurity and fear related to contagion by coronavirus, feelings of loneliness). The use of online breastfeeding support groups through applications such as WhatsApp®, Facebook® or Instagram® has provided important breastfeeding information and support sources. The main figure identified that has provided formal breastfeeding support during this period was that of the midwife. In addition, the social restrictions inherent to the pandemic have exerted a positive effect for women in bonding and breastfeeding, as a consequence of the increase in the time spent at their homes and in the family nucleus co-living. PublicationHeterogeneity in the association between prediabetes categories and reduction on glomerular filtration rate in a 5-year follow-up.(2022-05-05) Manouchehri, Marjan; Cea-Soriano, Lucía; Franch-Nadal, Josep; Ruiz, Antonio; Goday, Albert; Villanueva, Rosa; Diez-Espino, Javier; Mata-Cases, Manel; Giraldez-García, Carolina; Regidor, Enrique; PREDAPS Study GroupPrediabetes and not just diabetes can cause kidney damage. This study assess the association of prediabetes with development of impaired renal function (IRF). We used data from PREDAPS prospective study a cohort of 1072 subjects with prediabetes and another cohort of 772 subjects without prediabetes were follow-up from 2012 to 2017. Prediabetes was defined according to American Association of Diabetes criteria. IRF was defined as having a glomerular filtration rate PublicationAlternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review(Mdpi, 2020-09-01) Fernandez-Costa, Damian; Gomez-Salgado, Juan; Fagundo-Rivera, Javier; Martin-Pereira, Jorge; Prieto-Callejero, Blanca; Garcia-Iglesias, Juan Jesus; [Fernandez-Costa, Damian] Univ Huelva, Fac Nursing, Dept Nursing, Huelva 21071, Spain; [Garcia-Iglesias, Juan Jesus] Univ Huelva, Fac Nursing, Dept Nursing, Huelva 21071, Spain; [Gomez-Salgado, Juan] Univ Huelva, Dept Sociol Social Work & Publ Hlth, Fac Labour Sci, Huelva 21007, Spain; [Garcia-Iglesias, Juan Jesus] Univ Huelva, Dept Sociol Social Work & Publ Hlth, Fac Labour Sci, Huelva 21007, Spain; [Gomez-Salgado, Juan] Univ Espiritu Santo, Safety & Hlth Postgrad Programme, Guayaquil 091650, Ecuador; [Fagundo-Rivera, Javier] Univ Huelva, Hlth Sci Doctorate Sch, Primary Care Emergency Serv, Andalusian Hlth Serv, Huelva 21007, Spain; [Martin-Pereira, Jorge] Isla Cristina Hlth Ctr, Hosp Transport Consortium, Huelva 21410, Spain; [Prieto-Callejero, Blanca] Hosp Virgen Bella, Huelva 21440, SpainCoercive measures are a highly controversial issue in mental health. Although scientific evidence on their impact is limited, they are frequently used. Furthermore, they lead to a high number of ethical, legal, and clinical repercussions on both patients, and professionals and institutions. This review aims to assess the impact of the main alternative measures to prevent or limit the use of coercive measures with restraints in the management of agitated psychiatric patients. The research was conducted following the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in Medline, Cochrane Library, CINAHL, Web of Science, PsycInfo, LILACS, and Health Database of records between 2015 and 2020. After a critical reading, 21 valid articles were included. Both simple interventions and complex restraint programs were evaluated. Training in de-escalation techniques, risk assessment, and implementation of the "six core strategies" or "Safewards" program were the most assessed and effective interventions to reduce aggressive behaviors and the use of coercive measures. According to the revised literature, it is possible to reduce the use of restraints and coercive measures and not increase the number of incidents and violent behaviors among the patients through a non-invasive and non-pharmacological approach. However, further research and further randomized clinical trials are needed to compare the different alternatives and provide higher quality evidence. PublicationCommunication skills of tutors and family medicine physician residents in Primary Care clinics(Ediciones doyma s a, 2016-12-01) Valverde Bolivar, Francisco Javier; Pedregal Gonzalez, Miguel; Perez Fuentes, Maria Francisca; Alcalde Molina, Maria DoloreS; Torio Durantez, Jesus; Delgado Rodriguez, Miguel; [Valverde Bolivar, Francisco Javier] Dist Sanitario Jaen Jaen Sur, Teaching Unit Family & Community Med Jaen, Ave Ejercito Espanol 10, Jaen 23007, Spain; [Valverde Bolivar, Francisco Javier] Andalusian Res Grp, Dev & Innovat Plan CTS 982, Malaga, Spain; [Pedregal Gonzalez, Miguel] Dist Sanitario Huelva Costa, Teaching Unit Family & Community Med Huelva, Calle Cuesta Tres Caidas S-N, Huelva 21001, Spain; [Perez Fuentes, Maria Francisca] Area Sanitaria Norte Jaen, Linares Hlth Care Ctr Virgen Linarejos, Ave San Sebastian S-N, Jaen 23700, Spain; [Alcalde Molina, Maria DoloreS] Dist Sanitario Jaen Jaen Sur, Hlth Ctr Virgen Capilla, Calle Arquitecto Berges 10, Jaen 23007, Spain; [Torio Durantez, Jesus] Territorial Delegat Equal Hlth & Social Policies, Med Examinat, Paseo Estn 15, Jaen 23071, Spain; [Delgado Rodriguez, Miguel] Univ Jaen, Dept Preventat Med & Publ Hlth, Campus Lagunillas, Jaen 23071, Spain; [Delgado Rodriguez, Miguel] Minist Hlth, Biomed Res Ctr Epidemiol & Publ Hlth Net Biomed R, ISCIII Minist Sci & Innovat, C Sinesion Delgado 6, Madrid 29071, Spain; Junta de Andalusia (Regional Government of Andalusia)Aim: To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient.Design: A descriptive multicentre study.Location: Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva.Participants: 119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients.Principal measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed.Results: There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43 +/- 5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: 0.1).Conclusion: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient. (C) 2016 Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) PublicationThe effect of physical activity on asthma incidence over 10 years: population-based study.(2021-03-01) Russell, Melissa Anne; Dharmage, Shyamali; Fuertes, Elaine; Marcon, Alessandro; Carsin, Anne-Elie; Pascual Erquicia, Silvia; Heinrich, Joachim; Johannessen, Ane; Abramson, Michael J; Amaral, Andre F S; Cerveri, Isa; Demoly, Pascal; Garcia-Larsen, Vanessa; Jarvis, Deborah; Martinez-Moratalla, Jesus; Nowak, Dennis; Palacios-Gomez, Leopoldo; Squillacioti, Giulia; Raza, Wasif; Emtner, Margareta; Garcia-Aymerich, JudithAlthough there are many health benefits from being active, there was no benefit observed in this study from vigorous physical activity in reducing the risk of asthma onset in middle-aged adults https://bit.ly/3bEtHDn. Publication[Prevalence of excess weight in pregnancy in Andalusia].(2021-03-20) Medero Canela, Rocío; Carrero Morera, María; López Torres, Carolina Raquel; Gil Barcenilla, Begoña PublicationCommunication on Safe Caregiving between Community Nurse Case Managers and Family Caregivers.(2021-02-14) Macías-Colorado, María Eulalia; Rodríguez-Pérez, Margarita; Rojas-Ocaña, María Jesús; Teresa-Morales, CristinaDependent elderly individuals are usually cared for at home by untrained family members who are unaware of the risks involved. In this setting, communication on safe caregiving is key. The aim of this study is to describe the factors influencing the process followed by community nurse case managers to provide communication on safe caregiving to family members caring for dependent elderly individuals. A phenomenological study, by focus group, was done in urban healthcare facilities. Key informants were seven community nurses, case managers with more than 12 years' experience. We did a thematic analysis and we identified the units of meaning to which the most relevant discourses were assigned. The concepts expressed were grouped until subcategories were formed, which were then condensed into categories. Four categories of analysis emerged: communication-related aspects; professional skills of nurse case managers; communication on safety and the caregiving role. To planner interventions, for the prevention of adverse events at home, is essential to consider these aspects: nurses' professional communication skills, factors inherent to safe caregiving, the characteristics of the home where care is provided, the personal and family circumstances of the caregiver, and whether or not the caregiver's role has been assumed by the family caregivers. PublicationCompassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain.(2020-09-15) Ruiz-Fernández, María Dolores; Ramos-Pichardo, Juan Diego; Ibáñez-Masero, Olivia; Cabrera-Troya, José; Carmona-Rega, María Inés; Ortega-Galán, Ángela MaríaTo evaluate compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and perceived stress in healthcare professionals during the coronavirus disease 2019 (COVID-19) health crisis in Spain. Spain has been one of the countries hardest hit by the health crisis caused by the COVID-19 pandemic. Healthcare professionals have had to deal with traumatic and complex situations in the work context. In these particularly stressful situations, many professionals may develop CF or BO, which puts them at risk for mental health problems. Cross-sectional online survey. A total of 506 healthcare professionals (physicians and nurses) who were working in healthcare centres during the COVID-19 pandemic participated. CF, CS and BO were assessed with the Professional Quality of Life Questionnaire, and perceived stress was measured with the Perceived Stress Scale-14. Socio-demographic and occupational variables were also analysed. Data were collected during the period of the highest incidence of cases and highest mortality rates due to COVID-19 in Spain. This article adheres to the STROBE guidelines for the reporting of observational studies. Physicians had higher CF and BO scores, while nurses had higher CS scores. Perceived stress scores were similar in both occupations. Professionals working in specific COVID-19 units and in emergency departments had higher CF and BO scores, while levels of CS and perceived stress were similar regardless of the workplace. Despite the health crisis situation and its implications for healthcare professionals, the levels of CF and BO have remained moderate/high. However, CS seems to be increasing, especially among nurses, possibly due to their motivation to relieve suffering and due to their perceived social recognition. It is necessary to implement interventions that help improve CS and prevent BO and CF among professionals in the long term. PublicationChildhood, families and the Internet: a qualitative approach on health assets.(2020-05-19) Hernán-García, Mariano; Marcos-Marcos, Jorge; Botello-Díaz, Blanca; Simón-Lorda, Pablo; Gil García, EugeniaTo explore the views of the Internet in childhood, identifying both health assets and risks. A qualitative study was performed using 14 focus groups, eight of which comprised boys and girls, four of which comprised parents and two of which were mixed (children and parents) in primary schools in urban and rural settings in Andalusia (Spain). Teachers in these schools were also asked to complete an online questionnaire using LimeSurvey. This study involved 114 individuals: 64 pupils (33 girls and 31 boys), 28 parents (18 mothers and 10 fathers), and 22 teachers (14 women and 8 men). Analysis of manifest content and underlying meanings was carried out. QSR NVivo 9 software was used to facilitate analysis and make it systematic. Our findings show how the differences in the way parents and children understand health and wellbeing affect the way they discuss the Internet and health. The discussion of results looks at the implications of computer literacy for public health and wellbeing, particularly with regard to health assets. Parents and children understand the contribution of the Internet to health and wellbeing differently. Whilst parents emphasize the risks (unsafe environment, relationships and quality of information, social networks, physical problems and addiction), the children emphasize the assets offered by the Internet. Publication[Differences between institutionalized patients and those included in a home care program in Seville].(2020-02-17) Huesa Andrade, Macarena; Calvo-Gallego, José Luis; Pedregal González, Miguel Ángel; Bohórquez Colombo, PilarTo describe the characteristics and clinical differences between institutionalised patients and those included in a home care program. A descriptive, observational, cross-sectional, and multicentre study. Site Seville, 2016. A total 1857 elderly patients of similar characteristics (1441 institutionalised and 416 at home) in Seville in 2016. The variables studied included gender, age, civil status, family support, pathologies, multiple pathology criteria, and medication prescriptions. Functional and cognitive status was evaluated using the Barthel index, and the Lawton-Brody and Pfeiffer scales. The majority of patients (71.40%) were women. The fact of being institutionalised or being included in a home care program were statistically related to the following pathologies and categories: schizophrenia (p Cognitive impairment was related to institutionalisation, being a result of possible neurological (E3 category) and psychiatric diseases. On the other hand, patient comorbidity was not related to it, because it is very high in patients included in a home care program, in whom functional and cognitive independency status is better. Publication[Severe diabetic ketoacidosis, acute kidney injury and dehydration due to canagliflozin in type 2 diabetes mellitus patient: Atypical clinical presentation].(2019-07-17) Moreno Obregón, Fernando; Espino Montoro, Antonio; Marín Martín, Jorge; León Jiménez, David PublicationEffect of moderate and regular consumption of Cinco Jotas acorn-fed 100% Iberian ham on overall cardiovascular risk: A cohort study.(2018-10-25) Márquez Contreras, Emilio; Vázquez-Rico, Ignacio; Baldonedo-Suárez, Agueda; Márquez-Rivero, Sara; Jiménez, Jesús; Machancoses, Francisco; Morano-Báez, Rocío; León-Justel, AntonioTo evaluate the impact that the moderate and regular consumption of Cinco Jotas acorn-fed 100% Iberian ham has on overall cardiovascular risk, lipid parameters, blood pressure, and weight. A longitudinal, analytical, and quasi-experimental clinical study with repeated measures was carried out with 100 randomly selected individuals in primary care. The sample population included men and women (64%) between the ages of 25 and 55 (42.08, SD 9.6) who were not diagnosed with any cardiovascular illness or diabetes, were not undergoing antihypertensive treatment, nor taking lipid-lowering drugs. There were four visits during a 2-week washout period for the first of three phases. Phases 2 and 3 included an 8-week habitual diet phase followed by an 8-week intervention phase when participants consumed 40 g daily of acorn-fed 100% Cinco Jotas Iberian ham. Measurements of cardiovascular risk factors were taken following the SCORE table. These included total cholesterol, high-density lipoproteins cholesterol (HDL-c), low-density lipoproteins cholesterol (LDL-c), triglycerides (TG), and weight. The average vascular risk (SCORE) was 0.20 (SD 0.49) before the consumption phase and 0.18 (SD 0.48) at the end of the study (p > 0.05). An increase in HDL-c of 5 mg/dl was observed while there was a decrease in LDL-c and TG of 10 mg/dl (p 0.05). An increase in HDL-c of 5 mg/dl was observed while there was a decrease in LDL-c and TG of 10 mg/dl (p 0.05). The daily consumption of 40 g of Cinco Jotas acorn-fed 100% Iberian ham does not increase the risk of cardiovascular disease and has a favorable impact on lipid levels without affecting blood pressure or weight. PublicationCommunication with patients and the duration of family medicine consultations.(2017-10-18) Valverde Bolívar, Francisco Javier; Pedregal González, Miguel; Moreno Martos, Herminia; Cózar García, Inmaculada; Torío Durántez, JesúsTo determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. Cross-sectional multicentre study. Primary Healthcare Centres in Andalusia, Spain. A total of 119 tutors and family medicine physician residents. Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r2=0.32). There was no correlation between physician or patient gender, or problem type. A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation. Publication[Primary care evaluation of the hypertensive patient management in specialized care after derivation (DERIVA-2 Study)].(2017-10-14) Martell-Claros, Nieves; Galgo Nafría, Alberto; Abad-Cardiel, María; Álvarez-Álvarez, Beatriz; García Donaire, José Antonio; Márquez-Contreras, Emilio; Molino-González, ÁngelTo know the opinion/evaluation of the primary care physicians (PCPH) of the received information about patients that were attended in specialized care (SC). Cross-sectional study. Performed nationwide in primary care centers. Researchers from the primary care network. We used the SEH-LELHA derivation criteria guidelines, plus an ad hoc survey that included demographic and anthropometric data, blood pressure levels, and the main reason for derivation to SC at the baseline and final (post-derivation) visit. In addition, time deployed for the study of every patient, changes in diagnosis and treatment, type of follow-up, issues throughout the derivation process and assessment of the medical referred to the PCPH were evaluated. With participation of 578 researchers from primary, the study included 1715 patients aged 60.7±13.3years, 62.7% male. Patients were taking 2.3±1.2 (range 0-10) antihypertensive drugs pre-referral and 2.5±1.2 (0-9) after derivation. Blood pressure levels changed from 166±21.6 /97.7±12.6mmHg to 143±14.4 /85.5±10.5mmHg. The number of controlled patients (BP Communication between AE and SC in HTA is valued satisfactorily by MAP. However there is still room for improvement in the process. PublicationNew ways for nursing inspired by the works of Michel de Certeau.(2017-08-02) Gonzalez-Sanz, Juan D; Noreña-Peña, Ana; Amezcua, ManuelThe focus of this article is the life and work of the French thinker Michel de Certeau, here presented as a philosopher of special interest for nursing. Although in some countries he is relatively unknown, international authors from scientific disciplines regard his texts as a fundamental source in the opening of new intellectual perspectives on current global problems. Some nurses have also considered his ideas as a useful aid for reflecting on their professional activities, and their most important research is cited. Over these pages, we also examine how Certeau's work can enrich nursing philosophy in regard to three specific issues: resistance practices in nursing in the face of pressure from health institutions; the social configuration of nursing knowledge; and the importance of the body in current nursing practice. Publication[Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors].(2017-01-23) Sánchez González, Soraya; Calvo Lozano, José; Sánchez González, Jessica; Pedregal González, Miguel; Cornejo Castillo, Manuel; Molina Fernández, Eduardo; Barral, Francisco Javier; Pérez Espinosa, José RamónThe aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG). An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist. Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic. A total of 196 patients of both genders, between 40-70years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses. For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC). The retinography for OAG screening has a sensitivity of 21% (95%CI: 0-43%), a specificity of 93% (95%CI: 89-97%), a negative predictive value of 94% (95%CI: 90-97%), and positive of 20% (95%CI: 0-40%); positive probability ratio of 3.07 (95%CI: 0.98-9.62) and negative 0.84 (95%CI: 0.64-1.11). The IC was 0.653 (95%CI: 0.495-0.769) and kappa index of 0.140 (0.106ET). According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved.