SAS - D.S.A.P. Valle del Guadalhorce

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Vol. 30, nº 26. Oportunidades perdidas y diagnostico tardío de VIH en el distrito de salud Málaga-Valle del Guadalhorce.
(Consejería de Salud y Consumo, 2025-07-11) Servicio de Vigilancia y Salud Laboral
Enfermedades de Declaración Obligatoria por provincias. Semana 27/2025 y acumulado desde la semana 01/2025. Datos provisionales. Incluye además el artículo titulado “Oportunidades perdidas y diagnostico tardío de VIH en el distrito de salud Málaga-Valle del Guadalhorce”, de “Mishel Renata Heredia Ruiz, María Ángeles Fernández Gómez”.
Fibrilación y flutter auricular: proceso asistencial.
(Consejería de Salud y Consumo, 2025) Pérez Cabeza, Alejando Isidoro; Fernández Gutiérrez, Beatriz; Castillo Moraga, Maria José; Del Río Lechuga, Ana; Gil Pérez, Rocío; Montecatine Alonso, Elena; Morano Venegas, Francisco José; Moya Roldán, Susana; Pérez Sánchez, Soledad; Rodríguez Martorell, Francisco Javier; Romero Ruiz, Adolfo; Suero Méndez, Coral; Forcada Falcón, Mercedes; [Pérez Cabeza,AI; Romero Ruiz,A] Hospital Universitario Virgen de la Victoria.; [Fernández Gutiérrez,B; Suero Méndez,C] Hospital Axarquía.; [Castillo Moraga,MJ] Zona básica Sanlúcar de Barrameda. Jerez-Costa Noroeste de Cádiz.; [Del Río Lechuga,A] Hospital Universitario de Jerez de la Frontera.; [Gil Pérez,R] Distrito Guadalhorce. Málaga.; [Montecatine Alonso,E; Rodríguez Martorell,FJ] Hospital Universitario Virgen del Rocío.; [Morano Venegas,FJ] DCCU Móvil Condado Campiña. Huelva.; [Moya Roldán,S] Hospital Universitario San Cecilio.; [Pérez Sánchez,S] Hospital Universitario Virgen Macarena.; [Forcada Falcón,M] Consejería de Salud y Consumo.
Los Procesos Asistenciales son las herramientas que desde la Consejería de Salud y Consumo se ponen a disposición de las personas y profesionales para conseguir disminuir la variabilidad y facilitar la coordinación mediante una serie de recomendaciones que aportan calidad a la asistencia sanitaria. Fibrilación y flutter auricular ya fueron incluidos en el Proceso Asistencial Integrado Arritmias en 2003 como un subproceso. Actualmente debido a la evolución de los conocimientos y evidencias surgidas en los últimos años, se ha considerado necesaria la elaboración de un Proceso Asistencial específico.
[ANALES DE PEDIATRÍA: We take over].
(2021-09-02) Antón Gamero, Montserrat; Ávila Álvarez, Alejandro; Balaguer-Martínez, Josep Vicent; Bueno Campaña, Mercedes; Navas López, Víctor Manuel
[Comprehensive approach to children with cerebral palsy].
(2021-08-27) Peláez Cantero, María José; Moreno Medinilla, Esther Eugenia; Cordón Martínez, Ana; Gallego Gutiérrez, Silvia
Infantile cerebral palsy is one of the most prevalent diseases and the most frequent cause of disability in paediatrics. Children with cerebral palsy have complex health care needs and often require the care of a multidisciplinary team. However, in many cases there is no paediatrician with overall responsibility for coordinating follow-up. We have produced a support document intended for paediatricians coordinating the care of children with cerebral palsy. Our aim is to provide an ordered compilation of the main issues these patients may develop, to know how to identify and address them if necessary, and to establish criteria for referring these patients to other specialists.
Spanish validation of the national league for nursing questionnaires for clinical simulation
(Elsevier science inc, 2022-03-11) Roman-Cereto, Montserrat; Marti-Garcia, Celia; Garcia-Mayor, Silvia; Kaknani-Uttumchandani, Shakira; Garcia-Gamez, Marina; Fernandez Ordonez, Eloisa; Leon-Campos, Alvaro; Gutierrez-Rodriguez, Laura; Miguel Morales-Asencio, Jose; [Roman-Cereto, Montserrat] Univ Malaga, Fac Ciencias Salud, Dist Sanitario Malaga Guadalhorce, Dept Enfermeria, Malaga, Spain; [Marti-Garcia, Celia] Univ Malaga, Fac Ciencias Salud, Dept Enfermeria, Malaga, Spain; [Garcia-Gamez, Marina] Univ Malaga, Fac Ciencias Salud, Dept Enfermeria, Malaga, Spain; [Fernandez Ordonez, Eloisa] Univ Malaga, Fac Ciencias Salud, Dept Enfermeria, Malaga, Spain; [Gutierrez-Rodriguez, Laura] Univ Malaga, Fac Ciencias Salud, Dept Enfermeria, Malaga, Spain; [Garcia-Mayor, Silvia] Univ Malaga, Fac Ciencias Salud, Inst Invest Biomed Malaga IBIMA, Dept Enfermeria, Malaga, Spain; [Kaknani-Uttumchandani, Shakira] Univ Malaga, Fac Ciencias Salud, Inst Invest Biomed Malaga IBIMA, Dept Enfermeria, Malaga, Spain; [Leon-Campos, Alvaro] Univ Malaga, Fac Ciencias Salud, Inst Invest Biomed Malaga IBIMA, Dept Enfermeria, Malaga, Spain; [Miguel Morales-Asencio, Jose] Univ Malaga, Fac Ciencias Salud, Inst Invest Biomed Malaga IBIMA, Dept Enfermeria, Malaga, Spain; University of Malaga
Introduction: Learning by clinical simulation enables students to experience the nuances often encountered in clinical settings before experiencing actual real-world patient scenarios. Valid and reliable assessment tools are required to measure clinical competence. The aim of this study was to validate the National League for Nursing satisfaction instruments for its use in the Spanish context.Methods: Psychometric and cultural adaptation study. Student Satisfaction and Self-Confidence in Learning Scale, the Simulation Design Scale and the Educational Practices Questionnaire were adapted culturally, and their psychometric properties were tested empirically.Results: Fourth-year undergraduate nursing students participated in the study (n = 173). The Cronbach's alpha scores obtained ranged from 0.90 to 0.95. Confirmatory factor analysis revealed adequate goodness of fit values (RMSEA: 0.04 to 0.08).Conclusions: The Spanish-language version of the National League of Nursing instruments obtains satisfactory results. Further study is needed to determine the factorial invariance and whether any modifications in the instruments are needed. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of Organization for Associate Degree Nursing.
Validity of the classification of emergency service requests related to suicidal behavior
(Inst nac psiquiatria ramon fuente muniz, 2021-07-08) Ramos-Martin, Javier; Lourdes Rueda-Artero, Evelin; del Campo-Avila, Jose; Martinez-Garcia, Ana I.; Castillo-Jimenez, Pilar; Moreno-Kustner, Berta; [Ramos-Martin, Javier] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Malaga, Spain; [Lourdes Rueda-Artero, Evelin] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Malaga, Spain; [Moreno-Kustner, Berta] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Malaga, Spain; [del Campo-Avila, Jose] Univ Malaga, Dept Lenguajes & Ciencias Computac, Malaga, Spain; [Martinez-Garcia, Ana I.] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Castillo-Jimenez, Pilar] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Martinez-Garcia, Ana I.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, Berta] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, Berta] Inst Biomed Malaga IBIMA, Malaga, Spain; Consejería de Salud, Junta de Andalucía
Introduction. Suicide attempts are the most predictive risk factor for suicide deaths. Most people who attempt suicide receive care from out-of-hospital Emergency Services (OES), where these requests are managed and classified. Objective. Validate the Emergency Coordination Center (ECC) classification for the detection of suicidal behavior requests. Method. A descriptive, cross-sectional study of requests to the ECC of M??laga (Spain) during 2013 and 2014 was conducted. To classify the requests, the authors considered the ECC categorization when answering the call and the clinical assessment of the healthcare professional when attending the person who had made the call at the scene, which was considered the reference standard. To analyze the validity of the ECC classification system, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results. The total number of requests for medical assistance analyzed was 112,599. The validity indicators of the classification system for suicidal behavior were sensitivity = 44.78%, specificity = 99.34%, PPV = 46.91% and NPV = 99.28%. Discussion and conclusion. The ECC classification system has a lower capacity to detect the presence of suicidal behavior and a higher capacity to identify its absence in the requests received. OES provide key information on suicidal behavior requests as they can be one of the first places people with this problem go to. It would therefore be extremely useful to improve the classification systems for requests related to suicidal behavior.
Neuroprotective Effect of 3',4'-Dihydroxyphenylglycol in Type-1-like Diabetic Rats-Influence of the Hydroxytyrosol/3',4'-dihydroxyphenylglycol Ratio.
(MDPI, 2022-03-07) Rodriguez-Perez, Maria Dolores; Perez de Algaba, Inmaculada; Martin-Aurioles, Esther; Arrebola, Maria Monsalud; Ortega-Hombrados, Laura; Verdugo, Cristina; Fernandez-Prior, Maria Africa; Bermudez-Oria, Alejandra; De La Cruz, Jose Pedro; Gonzalez-Correa, Jose Antonio; Consejería de Salud. Junta de Andalucía (Spain)
The aim of this study was to assess the possible neuroprotective effect of 3',4'-dihydroxyphenylglycol (DHPG), a polyphenol from extra virgin olive oil (EVOO), in an experimental model of diabetes and whether this effect is modified by the presence of another EVOO polyphenol, hydroxytyrosol (HT). The neuroprotective effect was assessed in a hypoxia-reoxygenation model in brain slices and by quantifying retinal nerve cells. The animals were distributed as follows: (1) normoglycemic rats (NDR), (2) diabetic rats (DR), (3) DR treated with HT (5 mg/kg/day p.o.), (4) DR treated with DHPG (0.5 mg/kg/day), or (5) with 1 mg/kg/day, (6) DR treated with HT plus DHPG 0.5 mg/kg/day, or (7) HT plus 1 mg/kg/day p.o. DHPG. Diabetic animals presented higher levels of oxidative stress variables and lower numbers of neuronal cells in retinal tissue. The administration of DHPG or HT reduced most of the oxidative stress variables and brain lactate dehydrogenase efflux (LDH) as an indirect index of cellular death and also reduced the loss of retinal cells. The association of DHPG+HT in the same proportions, as found in EVOO, improved the neuroprotective and antioxidant effects of both polyphenols.
How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention.
(2022-05-06) Del Cura-González, Isabel; López-Rodríguez, Juan A; Leiva-Fernández, Francisca; Gimeno-Miguel, Antonio; Poblador-Plou, Beatriz; López-Verde, Fernando; Lozano-Hernández, Cristina; Pico-Soler, Victoria; Bujalance-Zafra, Mª Josefa; Gimeno-Feliu, Luis A; Aza-Pascual-Salcedo, Mercedes; Rogero-Blanco, Marisa; González-Rubio, Francisca; García-de-Blas, Francisca; Polentinos-Castro, Elena; Sanz-Cuesta, Teresa; Castillo-Jimena, Marcos; Alonso-García, Marcos; Calderón-Larrañaga, Amaia; Valderas, José M; Marengoni, Alessandra; Muth, Christiane; Prados-Torres, Juan Daniel; Prados-Torres, Alexandra; Multi-Pap Group
(1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65-74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was -2.42 (95% CI from -4.27 to -0.59) and, between baseline and a 12-month follow-up was -3.40 (95% CI from -5.45 to -1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799.
Prevalence and Clinical Conditions Related to Sarcopaenia among Older Persons Living in the Community.
(MDPI, 2022-07-01) Blanco-Reina, Encarnacion; Ocaña-Riola, Ricardo; Ariza-Zafra, Gabriel; Garcia-Merino, Maria Rosa; Aguilar-Cano, Lorena; Valdellos, Jenifer; Torres-Blanco, Claudia; Bellido-Estevez, Inmaculada
(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary care and to analyse the factors associated with this age-related clinical condition; (2) Methods: A multicentre cross-sectional study was conducted of 333 community-dwelling Spanish adults aged 65 years or more. Sociodemographic, clinical, functional, anthropometric, and pharmacological data were collected. Sarcopaenia was defined following European Working Group on Sarcopaenia in Older People (EWGSOP) criteria; (3) Results: Sarcopaenia was present in 20.4% of the study sample, and to a severe degree in 6%. The intensity of the association between sarcopaenia and frailty was weak-moderate (Cramer V = 0.45). According to the multinomial logistic regression model performed, sarcopaenia was positively associated with age and with the presence of psychopathology (OR = 2.72; 95% CI = 1.30-5.70) and was inversely correlated with body mass index (OR = 0.73, 95% CI = 0.67-0.80; (4) Conclusions: Sarcopaenia commonly affects community-dwelling older persons and may be associated with age, body mass index, and psychopathology. The latter factor may be modifiable or treatable and is therefore a possible target for intervention.
The Experiences of Home Care Nurses in Regard to the Care of Vulnerable Populations: A Qualitative Study.
(2021-12-23) Fernández-Medina, Isabel María; Ruíz-Fernández, María Dolores; Gálvez-Ramírez, Felisa; Martínez-Mengíbar, Evangelina; Ruíz-García, Manuel Eduardo; Jiménez-Lasserrotte, María Del Mar; Ortega-Galán, Ángela María; Hernández-Padilla, José Manuel
Home care nurses have become the main references in home care for vulnerable patients. In patients' homes they offer comprehensive and continuous care to both the vulnerable population and their families. The aim of this qualitative study was to explore experiences and perspectives of home care nurses regarding the care of vulnerable patients in Spain. We conducted in-depth semi-structured interviews with 15 home care nurses working with a vulnerable population. From a data analysis, two themes and four subthemes emerged: (1) "barriers to providing home care to vulnerable populations", with the following subthemes: "the particularities of the patient and their home caregivers" and "perceived barriers for the involvement of home care nurses in the care"; and (2) "the emotional cost of home care" with the subthemes "home care is draining for caregivers" and "the impact of home care on the home care nurses". These findings show us that nurses face a number of difficulties in home care for vulnerable patients. The training of nurses in certain competencies and skills by the social health services would enhance the quality of care offered to these patients.
Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial.
(2022-06-09) Del Cura-González, Isabel; López-Rodríguez, Juan A; Leiva-Fernández, Francisca; Gimeno-Feliu, Luis A; Pico-Soler, Victoria; Bujalance-Zafra, Mª Josefa; Domínguez-Santaella, Miguel; Polentinos-Castro, Elena; Poblador-Plou, Beatriz; Ara-Bardají, Paula; Aza-Pascual-Salcedo, Mercedes; Rogero-Blanco, Marisa; Castillo-Jiménez, Marcos; Lozano-Hernández, Cristina; Gimeno-Miguel, Antonio; González-Rubio, Francisca; Medina-García, Rodrigo; González-Hevilla, Alba; Gil-Conesa, Mario; Martín-Fernández, Jesús; Valderas, José M; Marengoni, Alessandra; Muth, Christiane; Prados-Torres, J Daniel; Prados-Torres, Alexandra; MULTIPAP PLUS Group
The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. Patients aged 65-74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. n = 1148 patients (574 per study arm). Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. ClinicalTrials.gov NCT04147130 . Registered on 22 October 2019.
The influence of symptom severity of palliative care patients on their family caregivers.
(BMJ Group, 2022-02-14) Valero-Cantero, Inmaculada; Casals, Cristina; Carrion-Velasco, Yolanda; Baron-Lopez, Francisco Javier; Martinez-Valero, Francisco Javier; Vazquez-Sanchez, Maria Angeles; Regional Health Ministry of “Junta de Andalucia”
This study anlyzed whether family caregivers of patients with advanced cancer suffer impaired sleep quality, increased strain, reduced quality of life or increased care burden due to the presence and heightened intensity of symptoms in the person being cared for. A total of 41 patient-caregiver dyads (41 caregivers and 41 patients with advanced cancer) were recruited at six primary care centres in this cross-sectional study. Data were obtained over a seven-month period. Caregiver's quality of sleep (Pittsburgh Sleep Quality Index), caregiver's quality of life (Quality of Life Family Version), caregiver strain (Caregiver Strain Index), patients' symptoms and their intensity (Edmonton Symptom Assessment System), and sociodemographic, clinical and care-related data variables were assessed. The associations were determined using non-parametric Spearman correlation. Total Edmonton Symptom Assessment System was significantly related to overall score of the Pittsburgh Sleep Quality Index (r = 0.365, p = 0.028), the Caregiver Strain Index (r = 0.45, p = 0.005) and total Quality of Life Family Version (r = 0.432, p = 0.009), but not to the duration of daily care (r = -0.152, p = 0.377). Family caregivers for patients with advanced cancer suffer negative consequences from the presence and intensity of these patients' symptoms. Therefore, optimising the control of symptoms would benefit not only the patients but also their caregivers. Thus, interventions should be designed to improve the outcomes of patient-caregiver dyads in such cases.
Cross-cultural adaptation and psychometric validation of a Spanish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire.
(BMJ, 2022-03-22) de Juan-Roldan, Jose Ignacio; Castillo-Jimena, Marcos; Gonzalez-Hevilla, Alba; Sanchez-Sanchez, Clara; Garcia-Ruiz, Antonio J; Gavilan-Moral, Enrique; Spanish Society of Family and Community Medicine (SEMFYC); Andalusian Society of Family and Community Medicine (SAMFYC)
Successful deprescribing depends largely on factors related to the patient. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed with the objective of evaluating the beliefs and attitudes of older adults and caregivers towards deprescribing. The present study was designed to validate a Spanish version of the rPATD questionnaire, both the versions for older adults and for caregivers, through a qualitative validation phase and the analysis of its psychometric properties. Cross-sectional validation study. Primary care settings in Málaga (Spain). A sample of 120 subjects (60 patients with polypharmacy and 60 caregivers of patients with polypharmacy) were enrolled in the study. In the qualitative validation stage, the rPATD questionnaire was translated/back-translated and subjected to a cross-cultural adaptation to evaluate its face validity and feasibility. Next, its psychometric properties were assessed. Confirmatory factor analysis was used to evaluate construct validity. Internal consistency was determined using Cronbach's alpha test. Criterion validity through pre-established hypotheses from the Beliefs about Medicines Questionnaire (BMQ) Specific-Concerns Scale, and test-retest reliability were analysed. Confirmatory factor analysis verified the four-factor structure of the original rPATD questionnaire, with items loading into four factors: involvement, burden, appropriateness and concerns about stopping. The Cronbach's alpha coefficient of the factors ranged from 0.683 to 0.879. The burden, appropriateness and concerns about stopping factors were significantly correlated with the BMQ Specific-Concerns Score, except for the concerns about stopping factor in the older adults' version. The consistency of the items between administration times (test-retest reliability) showed weighted Cohen's kappa values ranging from moderate (>0.4) to very good (>0.8). The Spanish version of the rPATD questionnaire is a feasible, valid and reliable instrument to evaluate attitudes towards deprescribing in Spanish-speaking patients and caregivers.
Body mass index interacts with a genetic-risk score for depression increasing the risk of the disease in high-susceptibility individuals.
(Nature Publishing Group, 2022-01-04) Anguita-Ruiz, Augusto; Zarza-Rebollo, Juan Antonio; Perez-Gutierrez, Ana M; Molina, Esther; Gutierrez, Blanca; Bellon, Juan Angel; Moreno-Peral, Patricia; Conejo-Ceron, Sonia; Aiarzagüena, Jose Maria; Ballesta-Rodriguez, M Isabel; Fernandez, Anna; Fernandez-Alonso, Carmen; Martin-Perez, Carlos; Monton-Franco, Carmen; Rodriguez-Bayon, Antonina; Torres-Martos, Alvaro; Lopez-Isac, Elena; Cervilla, Jorge; Rivera, Margarita; Spanish Ministry of Health, the Institute of Health Carlos III (ISCIII), and the European Regional Development Fund; Andalusian Council of Health; Spanish Network of Primary Care Research, redIAPP; Mental Health, Services and Primary Care Málaga group
Depression is strongly associated with obesity among other chronic physical diseases. The latest mega- and meta-analysis of genome-wide association studies have identified multiple risk loci robustly associated with depression. In this study, we aimed to investigate whether a genetic-risk score (GRS) combining multiple depression risk single nucleotide polymorphisms (SNPs) might have utility in the prediction of this disorder in individuals with obesity. A total of 30 depression-associated SNPs were included in a GRS to predict the risk of depression in a large case-control sample from the Spanish PredictD-CCRT study, a national multicentre, randomized controlled trial, which included 104 cases of depression and 1546 controls. An unweighted GRS was calculated as a summation of the number of risk alleles for depression and incorporated into several logistic regression models with depression status as the main outcome. Constructed models were trained and evaluated in the whole recruited sample. Non-genetic-risk factors were combined with the GRS in several ways across the five predictive models in order to improve predictive ability. An enrichment functional analysis was finally conducted with the aim of providing a general understanding of the biological pathways mapped by analyzed SNPs. We found that an unweighted GRS based on 30 risk loci was significantly associated with a higher risk of depression. Although the GRS itself explained a small amount of variance of depression, we found a significant improvement in the prediction of depression after including some non-genetic-risk factors into the models. The highest predictive ability for depression was achieved when the model included an interaction term between the GRS and the body mass index (BMI), apart from the inclusion of classical demographic information as marginal terms (AUC = 0.71, 95% CI = [0.65, 0.76]). Functional analyses on the 30 SNPs composing the GRS revealed an over-representation of the mapped genes in signaling pathways involved in processes such as extracellular remodeling, proinflammatory regulatory mechanisms, and circadian rhythm alterations. Although the GRS on its own explained a small amount of variance of depression, a significant novel feature of this study is that including non-genetic-risk factors such as BMI together with a GRS came close to the conventional threshold for clinical utility used in ROC analysis and improves the prediction of depression. In this study, the highest predictive ability was achieved by the model combining the GRS and the BMI under an interaction term. Particularly, BMI was identified as a trigger-like risk factor for depression acting in a concerted way with the GRS component. This is an interesting finding since it suggests the existence of a risk overlap between both diseases, and the need for individual depression genetics-risk evaluation in subjects with obesity. This research has therefore potential clinical implications and set the basis for future research directions in exploring the link between depression and obesity-associated disorders. While it is likely that future genome-wide studies with large samples will detect novel genetic variants associated with depression, it seems clear that a combination of genetics and non-genetic information (such is the case of obesity status and other depression comorbidities) will still be needed for the optimization prediction of depression in high-susceptibility individuals.
Las demandas por conducta suicida a los servicios de urgencias prehospitalarios de Málaga: características y factores asociados
(Gobierno de Navarra * Fondo de Publicaciones, 2017-10-02) Jimenez-Hernandez, M.; Castro-Zamudio, S.; Guzman-Parra, J.; Martinez-Garcia, A. I.; Guillen-Benitez, C.; Moreno-Kustner, B.; [Jimenez-Hernandez, M.] Univ Malaga, Dept Personal Evaluac & Tratamiento Psicol, Malaga, Spain; [Castro-Zamudio, S.] Univ Malaga, Dept Personal Evaluac & Tratamiento Psicol, Malaga, Spain; [Moreno-Kustner, B.] Univ Malaga, Dept Personal Evaluac & Tratamiento Psicol, Malaga, Spain; [Jimenez-Hernandez, M.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Castro-Zamudio, S.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Guzman-Parra, J.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Martinez-Garcia, A. I.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, B.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Guzman-Parra, J.] Hosp Reg Malaga, Unidad Gest Clin Salud Mental, Malaga, Spain; [Guzman-Parra, J.] Inst IBIMA, Red Maristan, Malaga, Spain; [Moreno-Kustner, B.] Inst IBIMA, Red Maristan, Malaga, Spain; [Martinez-Garcia, A. I.] Dist Sanit Malaga Guadalhorce, Disposit Cuida Crit & Urgencias, Unidad Gest Clin, Malaga, Spain; [Guillen-Benitez, C.] Dist Sanit Malaga Guadalhorce, Disposit Cuida Crit & Urgencias, Unidad Gest Clin, Malaga, Spain
Fundamento. El comportamiento suicida, mortal y no mortal, se ha convertido en un problema grave de salud pública en muchos países. El objetivo de este estudio es describir las características diferenciales de las llamadas al Centro Coordinador de Urgencias y Emergencias de la provincia de Málaga por conducta suicida, frente a las llamadas por problemas físicos o psiquiátricos. Material y métodos. Esta investigación consiste en un estudio observacional retrospectivo de las demandas registradas en la base de datos de la Empresa Pública de Emergencias Sanitarias durante un año. Las comparaciones y análisis de regresión logística multivariante se realizaron respecto a la edad y sexo de los demandantes y respecto a las siguientes características de las demandas: horas del día, días laborables o festivos, meses del año y trimestres, número de recursos movilizados y tipos de resolución. Resultados. Los análisis se realizaron sobre un total de 163.331 llamadas. 1.380 fueron por conducta suicida (0,8%), 9.951 por motivos psiquiátricos (6,1%) y 152.000 por motivos físicos (93%). Las llamadas por conducta suicida fueron realizadas preferentemente por mujeres jóvenes, que solicitan atención durante la tarde y la noche, requiriendo traslado al hospital y la movilización de más de un recurso sanitario. Las demandas por suicidio consumado las realizaron más frecuentemente varones en edades más avanzadas. En el primer trimestre del año se dan más demandas por ideación que por amenaza/intento, mientras que en el tercer trimestre ocurre lo contrario. Conclusión. Los resultados indicaron características diferenciales de las llamadas por conducta suicida potencialmente relevantes para la prevención del suicidio.
Factores asociados a las demandas psiquiátricas a los servicios de urgencias prehospitalarios de Málaga (España)
(Editorial Laser S.A, 2016-10-24) Guzman-Parra, Jose; Martinez-Garcia, Ana Isabel ; Guillen-Benitez, Cristobalina; Castro-Zamudio, Serafina; Jimenez-Hernandez, Manolo; Moreno-Kustner, Berta; [Guzman-Parra, Jose] Hosp Reg Malaga, Unidad Gest Clin, Malaga, Spain; [Guzman-Parra, Jose] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Isabel Martinez-Garcia, Ana] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Castro-Zamudio, Serafina] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Jimenez-Hernandez, Manolo] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, Berta] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Guzman-Parra, Jose] Inst IBIMA, Malaga, Spain; [Moreno-Kustner, Berta] Inst IBIMA, Malaga, Spain; [Isabel Martinez-Garcia, Ana] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Guillen-Benitez, Cristobalina] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Castro-Zamudio, Serafina] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Campus Teatinos S-N, E-29071 Malaga, Spain; [Jimenez-Hernandez, Manolo] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Campus Teatinos S-N, E-29071 Malaga, Spain; [Moreno-Kustner, Berta] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Campus Teatinos S-N, E-29071 Malaga, Spain; Junta de Andalucía; Grupo Andaluz de Investigación Psicosocial
Introducción En los últimos años se ha producido un importante aumento de la demanda asistencial de urgencias a nivel prehospitalario. Objetivo El presente estudio tiene como objetivo principal identificar las variables asociadas a las demandas clasificadas como psiquiátricas a los Servicios de Urgencia y Emergencias Médicos Prehospitalarios (SUEMP) de la provincia de Málaga. Método Estudio observacional retrospectivo de las demandas registradas en la base de datos informatizada (computarizada) del Centro Coordinador de Urgencias y Emergencias durante un año (N = 163 331). Se han considerado: 1) variables sociodemográficas: la edad y el sexo, y 2) variables relacionadas con la demanda: la franja horaria, el tipo de día, el trimestre del año, el sujeto alertante, el número de recursos movilizados, el número de personas atendidas y si hubo trasporte sanitario. Para la comparación de las variables se empleó la prueba χ2. También se realizó un análisis de regresión logística multivariante. Resultados El 7% de las demandas a los SUEMP se clasificaron como psiquiátricas. Entre las variables relacionadas con las demandas psiquiátricas se encontraron tener menor edad, ser mujer, demanda realizada por la noche y la tarde, menor número de personas atendidas, que la alerta no fuera efectuada por el propio usuario y la no realización de traslado sanitario. Discusión y conclusión Las demandas por problemas de salud mental presentan características diferenciales al resto de demandas a los SUEMP, lo que hay que tener en cuenta para mejorar la atención a dichos pacientes.
[Validation of the living with osteoarthritis in Spanish population].
(2021-04-06) Meneses Monroy, Alfonso; Rodríguez-Blázquez, Carmen; Ursúa, María Eugenia; Caparrós, Neus; Ruiz de Ocenda, Manuel Ignacio; López, Lorena; Caro, Jorge; Elizondo, Nerea; Ambrosio, Leire
Present the psychometric results of the Living with Osteoarthritis (LW-OA) in Spanish population. Observational, cross-sectional and multicenter study, with retest on a fraction of the sample. Public and private centres of primary and secondary healthcare, as well as patient associations from Navarra, La Rioja, Madrid, Valencia and Malaga. The sample was composed by 291 patients with OA with a medical diagnosis in every stage of the disease from primary or secondary healthcare, Spanish nationality and not hospitalized. In addition to LW-OA, a sociodemographic questionnaire was included, as well as scales to evaluate social support perceived from the patient (DUFSS), quality of life (WHOQOL-BREF) and satisfaction with life. Psychometric properties of the LW-OA were measured, as viability and acceptability, reliability (internal consistency and reproducibility), precision and construct validity (convergent, internal and known-groups). 100% of the data were computable. Excellent data quality was obtained. Cronbach's alpha for the scale total was 0.87 and the homogeneity index 0.22. ICC for the scale total was 0.88. As for precision, the SEM was 5.18 ( The LW-OA is a valid and feasible measure to evaluate the process of living with OA in Spain.
Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial.
(2021-01-28) Moreno-Peral, Patricia; Conejo-Cerón, Sonia; de Dios Luna, Juan; King, Michael; Nazareth, Irwin; Martín-Pérez, Carlos; Fernández-Alonso, Carmen; Ballesta-Rodríguez, María Isabel; Fernández, Anna; Aiarzaguena, José María; Montón-Franco, Carmen; Bellón, Juan Ángel
In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26-27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = -2.7% [95% CI = -5.1% to -0.3%]; P = 0.029). A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.
Clinical and genetic differences between bipolar disorder type 1 and 2 in multiplex families.
(Nature Publishing Group, 2021-01-11) Guzman-Parra, Jose; Streit, Fabian; Forstner, Andreas J; Strohmaier, Jana; Gonzalez, Maria Jose; Gil- Flores, Susana; Cabaleiro-Fabeiro, Francisco J; Del-Rio-Noriega, Francisco; Perez- Perez, Fermin; Haro-Gonzalez, Jesus; Orozco-Diaz, Guillermo; de-Diego-Otero, Yolanda; Moreno-Kustner, Berta; Auburger, Georg; Degenhardt, Franziska; Heilmann-Heimbach, Stefanie; Herms, Stefan; Hoffmann, Per; Frank, Josef; Foo, Jerome C; Sirignano, Lea; Witt, Stephanie H; Cichon, Sven; Rivas, Fabio; Mayoral, Fermin; Nothen, Markus M; Andlauer, Till F M; Rietschel, Marcella; Projekt DEAL
The two major subtypes of bipolar disorder (BD), BD-I and BD-II, are distinguished based on the presence of manic or hypomanic episodes. Historically, BD-II was perceived as a less severe form of BD-I. Recent research has challenged this concept of a severity continuum. Studies in large samples of unrelated patients have described clinical and genetic differences between the subtypes. Besides an increased schizophrenia polygenic risk load in BD-I, these studies also observed an increased depression risk load in BD-II patients. The present study assessed whether such clinical and genetic differences are also found in BD patients from multiplex families, which exhibit reduced genetic and environmental heterogeneity. Comparing 252 BD-I and 75 BD-II patients from the Andalusian Bipolar Family (ABiF) study, the clinical course, symptoms during depressive and manic episodes, and psychiatric comorbidities were analyzed. Furthermore, polygenic risk scores (PRS) for BD, schizophrenia, and depression were assessed. BD-I patients not only suffered from more severe symptoms during manic episodes but also more frequently showed incapacity during depressive episodes. A higher BD PRS was significantly associated with suicidal ideation. Moreover, BD-I cases exhibited lower depression PRS. In line with a severity continuum from BD-II to BD-I, our results link BD-I to a more pronounced clinical presentation in both mania and depression and indicate that the polygenic risk load of BD predisposes to more severe disorder characteristics. Nevertheless, our results suggest that the genetic risk burden for depression also shapes disorder presentation and increases the likelihood of BD-II subtype development.
Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors.
(Springer Nature, 2020-11-10) Castillejos Anguiano, Mª Carmen; Martin Perez, Carlos; Bordallo Aragon, Antonio; Sepulveda Muñoz, Jesus; Moreno Küstner, Berta; Instituto Carlos III
Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners. A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: (a) patient variables (sociodemographic and clinical), (b) general practitioner variables, and (c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed. A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners. The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders.

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