PublicationDoes Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome.(2022-10-05) Konieczna, Jadwiga; Fiol, Miguel; Colom, Antoni; Martínez-González, Miguel Ángel; Salas-Salvadó, Jordi; Corella, Dolores; Soria-Florido, María Trinidad; Martínez, J Alfredo; Alonso-Gómez, Ángel M; Wärnberg, Julia; Vioque, Jesús; López-Miranda, José; Estruch, Ramon; Bernal-López, M Rosa; Lapetra, José; Serra-Majem, Lluís; Bueno-Cavanillas, Aurora; Tur, Josep A; Martín Sánchez, Vicente; Pintó, Xavier; Gaforio, José J; Matía-Martín, Pilar; Vidal, Josep; Vázquez, Clotilde; Daimiel, Lidia; Ros, Emilio; Bes-Rastrollo, Maira; Pascual, María; Sorlí, Jose V; Goday, Albert; Zulet, María Ángeles; Moreno-Rodriguez, Anai; Carmona González, Francisco Jesús; Valls-Enguix, Rafael; Janer, Juana M; Garcia-Rios, Antonio; Casas, Rosa; Gomez-Perez, Ana M; Santos-Lozano, José Manuel; Basterra-Gortari, F Javier; Martínez, María Ángeles; Ortega-Azorin, Carolina; Bayó, Joan; Abete, Itziar; Salaverria-Lete, Itziar; Ruiz-Canela, Miguel; Babio, Nancy; Carres, Lourdes; Romaguera, DoraNon-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (β 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values PublicationUse of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models.(2022-11-17) Mateo-Abad, Maider; Vrotsou, Kalliopi; Padilla Ruiz, María; Montiel-Luque, Alonso; Saucedo Figueredo, María Del Carmen; Machón, Mónica; Rivas Ruiz, Francisco; Vergara, ItziarFunctional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults. PublicationComponents of case management in caring for patients with dementia: a mixed-methods study.(2022-06-23) Jerez-Barranco, Desirée; Gutiérrez-Rodríguez, Laura; Morilla-Herrera, Juan Carlos; Cuevas Fernandez-Gallego, Magdalena; Rojano-Perez, Remedios; Camuñez-Gomez, María Dolores; Sanchez-Del Campo, José Luis; García-Mayor, SilviaCase management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers. Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register. This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving. PublicationThe implications of the foot health status in Parkinson patients: A case-control study.(2022-05-17) Jiménez-Cebrián, Ana María; López-López, Luis; Losa-Iglesias, Marta Elena; Becerro-de-Bengoa-Vallejo, Ricardo; Romero-Morales, Carlos; López-López, Daniel; Montiel-Luque, Alonso; Navarro-Flores, Emmanuel; de Labra, CarmenParkinson's disease (PD) is a neurodegenerative disorder that affects both health of the feet, as to gait patterns. This study aimed to find out about foot problems and their impact on self-perceived quality of life and related to foot health in Parkinson's patients compared to a group of healthy subjects and to measure it with Spanish Podiatry Health Questionnaire (PHQ-S). It is about a case-control study in a sample of Parkinson's patients n = 62, healthy controls n = 62. The PHQ-S was reported, it describes perception the subject has in each of podiatric 6 dimensions consulted, assessing appreciation of health status of interviewee's feet and a self-rated the foot health score on the visual analog scale (VAS). There were statistically significant differences (P PublicationOne-year changes in fruit and vegetable variety intake and cardiometabolic risk factors changes in a middle-aged Mediterranean population at high cardiovascular risk.(2022-04-11) López-González, Leyre; Becerra-Tomás, Nerea; Babio, Nancy; Martínez-González, Miguel Ángel; Nishi, Stephanie K; Corella, Dolores; Goday, Albert; Romaguera, Dora; Vioque, Jesús; Alonso-Gómez, Ángel M; Wärnberg, Julia; Martínez, J Alfredo; Serra-Majem, Luís; Estruch, Ramon; Bernal-López, M Rosa; Lapetra, José; Pintó, Xavier; Tur, Josep A; López-Miranda, José; Bueno-Cavanillas, Aurora; Delgado-Rodríguez, Miguel; Matía-Martín, Pilar; Daimiel, Lidia; Martín-Sánchez, Vicente; Vidal, Josep; Vázquez, Clotilde; Ros, Emilio; Vázquez-Ruiz, Zenaida; Martín-Luján, Francisco M; Sorlí, José V; Castañer, Olga; Zulet, M Angeles; Tojal-Sierra, Lucas; Carabaño-Moral, Rosa; Román-Maciá, Josefa; Rayó, Elena; García-Ríos, Antonio; Casas, Rosa; Gómez-Pérez, Ana M; Santos-Lozano, José M; Buil-Cosiales, Pilar; Asensio, Eva M; Lassale, Camille; Abete, Itziar; Salaverria-Lete, Itziar; Sayón-Orea, Carmen; Schröder, Helmut; Salas-Salvadó, Jordi; PREDIMED-Plus InvestigatorsPrevious studies have shown beneficial associations between fruit and vegetable (FV) consumption and cardiometabolic risk factors. However, variety in FV, which may play an important role on cardiovascular health due to the different nutrient and phytochemical content among the different groups and subgroups of FV has been poorly investigated. We longitudinally investigated associations between 1-year changes in variety and quantity of FV and concurrent changes in cardiometabolic risk factors in elderly subjects with overweight/obesity and metabolic syndrome. a one-year data longitudinal analysis of 6647 PREDIMED-plus study participants (48% women) was conducted. Data were collected at baseline, six months and 1-year of follow-up. Variety and quantity of FV were estimated using a food frequency questionnaire and continuous scores for variety were created based on items/month of FV. Linear mixed-models adjusted for potential confounders were performed to estimate associations (β-coefficients and 95% confidence interval) between 1-year changes in FV variety and/or quantity and concurrent changes in cardiometabolic risk factors. Two points increment in the FV variety score over one year was associated with a concurrent decrease in glucose (-0.33 mg/dL (0.58, -0.07)), body weight (-0.07 kg (-0.13, -0.02)) and waist circumference (WC) (-0.08 cm (-0.16, -10.01)). An increment of 100 g/d of FV over one year was associated with a concurrent decrease in triglycerides (-0.50 mg/dL (-0.93, -0.08)), glucose (-0.21 mg/dL (-0.32, -0.11)), body weight (-0.11 kg (-0.15, -0.07)) and WC (-0.10 cm (-0.14, -0.06)) over 1-year. Changes in FV consumption which led to higher quantity and variety over one year were associated with downward changes in glucose (-1.26 mg/dL (-2.09, -0.43)), body weight (-0.40 kg (-0.58, -0.23)) and WC (-0.50 cm (-0.73, -0.28)). Greater variety, in combination with higher quantity of FV was significantly associated with a decrease in several cardiometabolic risk factors among elderly subjects at high cardiovascular risk. PublicationHow to live with COPD: patient's perception.(Univ murcia, 2016-01-01) Munoz-Cobos, Francisca; Acero-Guasch, Nieves; Cuenca-del-Moral, Rebeca; Barnestein-Fonseca, Pilar; Leiva-Fernandez, Francisca; Garcia-Ruiz, Antonio; [Munoz-Cobos, Francisca] Dist Sanitario Malaga, Ctr Salud El Palo, Malaga, Spain; [Acero-Guasch, Nieves] Area Salud Ibiza & Formentera, Illes Balears, Spain; [Cuenca-del-Moral, Rebeca] Dist Sanitario Costa del Sol, Ctr Salud Albarizas, Malaga, Spain; [Barnestein-Fonseca, Pilar] Dist Sanitario Malaga, Unidad Docente Multiprofes Atenc Familiar & Comun, Malaga, Spain; [Leiva-Fernandez, Francisca] Dist Sanitario Malaga, Unidad Docente Multiprofes Atenc Familiar & Comun, Malaga, Spain; [Garcia-Ruiz, Antonio] Univ Malaga, Fac Med, Dept Farmacol & Terapeut, E-29071 Malaga, SpainThe aim of this study is to determine the mental model that patients with COPD (chronic obstructive pulmonary disease) have about their illness analyzed by the Leventhal's Common Sense of Self-Regulation Model. An exploratory-descriptive study using qualitative methodology was performed. We included COPD-diagnosed patients attending three urban and a rural primary care centres. We used video-taped group interviews and transcribed them using Atlas.Ti 5.2 program. 22 group interviews (2009 - 2011) and 58 patients were included. There were 3 additional sessions to final inform validation. The results show that patients did not have a defined mental model about COPD: this disease was insufficiently recognized; diagnosis was made in exacerbations and it was confused with other diseases; the cause of illness was related to tobacco consumption and to "something else": fumes, colds and hard work. Patients tended to minimize their symptoms and limitations. Participants had wrong beliefs about colds, smoking only a few cigarettes effects and damage of inhaled treatment. Emotions as despair, resignation and fear were reported. We conclude that COPD patients showed confusion about many aspects of the disease (causes, symptoms, treatments). It was difficult to identify a mental model of the disease among COPD patients. PublicationRelationship between perceived emotional intelligence and professional quality of life with the achievement of occupational objectives in the costa del sol primary health care district(Ediciones doyma s a, 2016-05-01) Macias Fernandez, Antonio Jose; Gutierrez-Castaneda, Carlos; Carmona Gonzalez, Francisco Jesus; Crespillo Vilchez, Daniel; [Macias Fernandez, Antonio Jose] Serv Andaluz Salud, Unidad Gest Clin Torrequebrada, Malaga, Spain; [Carmona Gonzalez, Francisco Jesus] Serv Andaluz Salud, Unidad Gest Clin Torrequebrada, Malaga, Spain; [Gutierrez-Castaneda, Carlos] Univ Malaga, Inst Invest Biomed Malaga IBIMA, Serv Andaluz Salud, Unidad Gest Clin La Lobilla, Estepona, Spain; [Crespillo Vilchez, Daniel] Serv Andaluz Salud, Unidad Salud Mental Torrequebrada, Malaga, SpainTo examine the relationship between "Quality of Professional Life" and "Perceived Emotional Intelligence" and the relationship of both of these with the level of achievement of occupational objectives in the Costa del Sol Primary Health Care District. Multicentre descriptive cross-sectional observational study. The Costa del Sol Primary Health Care District in the province of Málaga. Sample of Employees of all categories in fixed and contracted employment in the Management Units of the Costa del Sol District. (N=303). Respondents 247 (81.5%) The data collected was that of the percentage of achievement of objectives in 2010 and the socio-demographic data of the participants, using ad hoc designed self-report questionnaires. The TMMS -24 questionnaire was used to measure the "Perceived Emotional Intelligence", with the following dimensions: Perception, comprehension, and emotional control, and the CVP-35 measuring: management support, work demands, and intrinsic motivation. Significant correlationas were observed between Quality of Professional Life and Emotional Intelligence in the Regulation (p The perceived quality of professional life is related to perception and regulation dimensions of Emotional Intelligence. Knowledge of emotion management methods should be promoted by management organisations for all employees. PublicationFruit and Vegetable Consumption is Inversely Associated with Plasma Saturated Fatty Acids at Baseline in Predimed Plus Trial.(2021-07-28) Domínguez-López, Inés; Marhuenda-Muñoz, María; Tresserra-Rimbau, Anna; Hernáez, Álvaro; Moreno, Juan José; Martínez-González, Miguel Ángel; Salas-Salvadó, Jordi; Corella, Dolores; Fitó, Montserrat; Martínez, José Alfredo; Alonso-Gómez, Ángel M; Wärnberg, Julia; Vioque, Jesús; Romaguera, Dora; López-Miranda, José; Bernal-Lopez, M Rosa; Lapetra, José; Serra-Majem, J Luís; Bueno-Cavanillas, Aurora; Tur, Josep A; Martín-Sánchez, Vicente; Pintó, Xavier; Delgado-Rodríguez, Miguel; Matía-Martín, Pilar; Vidal, Josep; Vázquez, Clotilde; Daimiel, Lidia; Serra-Mir, Mercè; Vázquez-Ruiz, Zenaida; Nishi, Stephanie K; Sorli, Jose V; Castañer, Olga; Abete, Itziar; Luna, Jessica Vaquero; Carabaño-Moral, Rosa; Asencio, Alberto; Prohens, Lara; Garcia-Rios, Antonio; Casas, Rosa; Gomez-Perez, Ana Maria; Santos-Lozano, José Manuel; Razquin, Cristina; Martínez, María Ángeles; Saiz, Carmen; Robledo-Pastor, Vanesa; Zulet, María Angeles; Salaverria, Itziar; Eguaras, Sonia; Babio, Nancy; Malcampo, Mireia; Ros, Emilio; Estruch, Ramon; López-Sabater, M Carmen; Lamuela-Raventós, Rosa MPlasma fatty acids (FAs) are associated with the development of cardiovascular diseases and metabolic syndrome. The aim of our study is to assess the relationship between fruit and vegetable (F&V) consumption and plasma FAs and their subtypes. Plasma FAs are assessed in a cross-sectional analysis of a subsample of 240 subjects from the PREDIMED-Plus study. Participants are categorized into four groups of fruit, vegetable, and fat intake according to the food frequency questionnaire. Plasma FA analysis is performed using gas chromatography. Associations between FAs and F&V consumption are adjusted for age, sex, physical activity, body mass index (BMI), total energy intake, and alcohol consumption. Plasma saturated FAs are lower in groups with high F&V consumption (-1.20 mg cL-1 [95% CI: [-2.22, -0.18], p-value = 0.021), especially when fat intake is high (-1.74 mg cL-1 [95% CI: [-3.41, -0.06], p-value = 0.042). Total FAs and n-6 polyunsaturated FAs tend to be lower in high consumers of F&V only in the high-fat intake groups. F&V consumption is associated with lower plasma saturated FAs when fat intake is high. These findings suggest that F&V consumption may have different associations with plasma FAs depending on their subtype and on the extent of fat intake. Publication[SARS-CoV-2 infection: implications for sexual and reproductive health. A position statement of the Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA)].(2020) José, Ferran García; González, Juan G Álvarez; Molina, Juan Manuel Corral; Arnau, Lluis Bassas; Iribarren, Ignacio Moncada; Jabaloyas, José Maria Martínez; Rico, Fernando Meijide; García-Baquero, Rodrigo; Gayá, Mariano Rosselló; García, Enrique Lledó; López, Carmen Luque; Castro, Rafael Prieto; Salamanca, Juan Ignacio MartinezThe main objective of this revision is to summarize the current existing evidence of the potential adverse effects of SARS-CoV-2 on the male reproductive system and provide the recommendations of the Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA) concerning the implications of COVID-19 infection in the management of male infertilty patients and testicular endocrine dysfunction. A comprehensive systematic literature search of the databases of PubMed, Web of Science, Embase, Medline, Cochrane and MedRxiv, was carried out. The presence of orchitis as a potential complication of the infection by SARS-CoV-2 has not yet been confirmed. One study reported that 19% of males with COVID-19 infection had scrotal symptoms suggestive of viral orchitis which could not be confirmed. It is possible that the virus, rather than infecting the testes directly, may induce a secondary autoimmune response leading to autoimmune orchitis. COVID-19 has been associated with coagulation disorders and thus the orchitis could be the result of segmental vasculitis. Existing data concerning the presence of the virus in semen are contradictory. Only one study reported the presence of RNA in 15.8% of patients with COVID-19. However, the presence of nucleic acid or antigen in semen is not synonyms of viral replication capacity and infectivity. It has been reported an increase in serum levels of LH in males with COVID-19 and a significant reduction in the T/LH and FSH/LH ratios, consistent with subclinical hypogonadism. The findings of recent reports related to the potential effects of COVID-19 infection on the male reproductive system are based on poorly designed, small sample size studies that provide inconclusive, contradictory results. Since there still exists a theoretical possibility of testicular damage and male infertilty as a result of the infection by COVID-19, males of reproductive age should be evaluated for gonadal function and semen analysis. With regard to the sexual transmission of the virus, there is not sufficient evidence to recommend asymptomatic couples to abstein from having sex in order to protect themselves from being infected by the virus. Additional studies are needed to understand the long-term effects of SARS-CoV-2 on male reproductive function, including male fertility potential and endocrine testicular function. PublicationTackling frailty at primary care: evaluation of the effectiveness of a multicomponent intervention through a randomised controlled trial: study protocol.(2020-02-20) Rivas-Ruiz, Francisco; Machón, Mónica; Mateo-Abad, Maider; Contreras-Fernández, Eugenio; Güell, Carolina; Baro-Rodríguez, Luis; Vrotsou, Kalliopi; Quirós-López, Raúl; Vergara, Itziar; InFrAP investigatorsThis project focuses on how frailty is addressed in primary healthcare (PHC) and will evaluate the effectiveness of a multifactorial intervention (considering the appropriateness of the pharmaceutical prescription, the nutritional care provided and the exercise intervention) for persons with frailty, in terms of improving their functional capacity and reducing the incidence of adverse events related to frailty. The final evaluation will be made at 12 months' follow-up. Pragmatic multicentre cluster randomised controlled clinical trial, single blind with two arms: multifactorial intervention in PHC versus usual follow-up. The randomisation unit is the patient list and the analysis unit is the patient. In addition, a cost-effectiveness study and a qualitative study will be carried out, the latter based on semistructured interviews and focus groups. Two hundred persons (100 per study branch) all aged ≥70 years, presenting frailty, but functionally independent and resident in the community, will be recruited. A baseline evaluation will be carried out prior to the intervention, with follow-up at 6 and 12 months. The main study variables considered will be functional capacity and incidence of adverse events; the secondary variables considered will be the patients' sociodemographic characteristics, nutritional status, level of physical activity and drug consumption, together with data on comorbidity, cognitive and affective status and health-related quality of life. Data will be analysed according to the intention-to-treat principle using a 5% significance level. The study will at all times be conducted in strict accordance with the provisions of the Declaration of Helsinki and with the national legislation regulating patients' autonomy. All patients recruited will be asked to provide written informed consent before taking part in the clinical trial. On completion of the study, the principal investigator expects to publish the results of this research in a peer-reviewed open access scientific journal. ISRCTN17143761. PublicationPrevalence of frailty among community-dwelling elderly persons in Spain and factors associated with it.(2019-10-22) Rivas-Ruiz, Francisco; Machón, Mónica; Contreras-Fernández, Eugenio; Vrotsou, Kalliopi; Padilla-Ruiz, María; Díez Ruiz, Ana Isabel; de Mesa Berenguer, Yolanda; Vergara, Itziar; Group GIFEABackground: For effective prevention and intervention, and reduction of dependency, it is essential to determine the presence of frailty in the community.Objectives: To describe the prevalence of frailty among elderly persons living independently, in two primary healthcare areas in Spain; to identify factors correlated with its presence.Methods: This descriptive cross-sectional study was conducted between May 2015 and July 2016 among non-institutionalized individuals aged ≥70 years living in the primary healthcare areas of Gipuzkoa and Costa del Sol (Spain). The main outcome variable was the prevalence of frailty (determined by modified Fried criteria). The independent study variables were sociodemographic characteristics, anthropometric data and health-related life habits.Results: The study population consisted of 855 individuals (53% women). The overall prevalence of frailty was 26.2% (Gipuzkoa 14.2%, Costa del Sol 38.0%). Using multiple logistic regression, the following factors were associated with frailty: female sex (OR: 1.98; 95%CI: 1.37-2.86); cumulative illness rating scale (OR: 1.05; 95%CI: 1.00-1.10); self-perceived health status (OR: 0.96; 95%CI: 0.95-0.97); self-perceived unhealthy lifestyle (OR: 3.37; 95%CI: 2.05-8.87); dissatisfaction with the domestic environment (OR: 2.11; 95%CI: 1.18-3.76); and cognitive impairment (OR: 4.10; 95%CI: 2.05-8.19). In the multivariable model, 'geographical area' differences persisted, with an OR of 3.51 (95%CI: 2.29-5.36) for the Costa del Sol area, using Gipuzkoa as reference.Conclusion: In this population of community-dwelling persons aged 70 years and over, the prevalence of frailty was 26%. Factors correlated with frailty were female sex, comorbidity, poorer self-perceived lifestyle and health status, and dissatisfaction with the domestic environment. PublicationPsychological factors are associated with local and generalized pressure pain hypersensitivity, pain intensity, and function in people with chronic shoulder pain: A cross-sectional study.(2019-09-21) Martinez-Calderon, Javier; Meeus, Mira; Struyf, Filip; Diaz-Cerrillo, Juan Luis; Clavero-Cano, Susana; Morales-Asencio, Jose Miguel; Luque-Suarez, AlejandroTo explore the association between psychological factors and shoulder pain intensity, function, as well as local and generalized pressure pain hypersensitivity. a cross-sectional study. 90 participants with chronic shoulder pain were included. Pressure pain thresholds determined the presence of pain hypersensitivity. Pain intensity, function, pain self-efficacy, emotional distress, and pain catastrophizing were also assessed. Analyses were adjusted for gender and age. The diagnosis of depression (yes/no answer) was associated with both greater local (standardized β = -0.19[95%CI -0.37 to -0.00]) and generalized (standardized β = -0.20[95%CI -0.39 to -0.01]) pressure pain hypersensitivity. Greater pain self-efficacy was associated with lower local pressure pain hypersensitivity (standardized β = 0.19[95%CI 0.04 to 0.38]). The standardized beta coefficient for the diagnosis of depression indicated that this variable showed the strongest association with pressure pain hypersensitivity. Additionally, greater pain self-efficacy was associated with lower pain intensity (standardized β = -0.34[95%CI -0.51 to -0.17]) and better function (standardized β = -0.47[95%CI -0.63 to -0.30]). Greater pain catastrophizing was associated with more pain intensity (standardized β = 0.35[95%CI 0.18 to 0.52]) and worse function (standardized β = 0.26[95%CI 0.10 to 0.43]). The standardized beta coefficients for pain catastrophizing and pain self-efficacy indicated that both variables showed the strongest association with shoulder pain intensity and function, respectively CONCLUSION: Psychological factors were associated with local and generalized pressure pain hypersensitivity, pain intensity, and function in people with chronic shoulder pain. PublicationDevelopment and Psychometric Validation of an Instrument to Identify Barriers to Self-Care Among Spanish Patients With Type 2 Diabetes on the Basis of Theory of Planned Behavior.(2019-05-31) Caro-Bautista, Jorge; Espinar-Toledo, Milagrosa; Villa-Estrada, Francisca; Lupiáñez-Pérez, Inmaculada; Kaknani-Uttumchandani, Shakira; García-Mayor, Silvia; Salas-Samper, Felipe; Morales-Asencio, José-MiguelSeveral instruments are available to evaluate barriers to self-care in people with type 2 diabetes, but with significant psychometric weaknesses and poor theoretical background. To develop and psychometrically validate a questionnaire to identify barriers to self-care in this population on the basis of the theory of planned behavior. The study was carried out in 15 primary healthcare centers belonging to the Public Health Care System in Andalusia (Spain). After content validity was confirmed, an initial pilot study was undertaken (n = 54) and the model was evaluated in 2 samples of 205 subjects each to test its configural and metric invariance by confirmatory factor analysis. Internal consistency, test-retest reliability, criterion validity, and interpretability were carried out following COSMIN standards. A 4-factor instrument (intention, subjective norms, perceived control, and attitudes) with 15 items was obtained with a good fit: goodness-of-fit index = 0.92, comparative fit index = 0.93, and root mean square error of approximation = 0.043 (90% confidence interval 0.034-0.052). Cronbach α was 0.78, and test-retest reliability was adequate (intraclass correlation coefficient 0.73; P A theory-driven instrument is suitable for its use with Spanish people with type 2 diabetes to assess their self-care needs and make tailored recommendations for lifestyle modifications on the basis of their behavioral determinants. PublicationDietary Diversity and Nutritional Adequacy among an Older Spanish Population with Metabolic Syndrome in the PREDIMED-Plus Study: A Cross-Sectional Analysis.(2019-04-26) Cano-Ibáñez, Naomi; Gea, Alfredo; Martínez-González, Miguel A; Salas-Salvadó, Jordi; Corella, Dolores; Zomeño, M Dolors; Romaguera, Dora; Vioque, Jesús; Aros, Fernando; Wärnberg, Julia; Martínez, J Alfredo; Serra-Majem, Lluis; Estruch, Ramón; Tinahones, Francisco J; Lapetra, José; Pintó, Xavier; Tur, Josep A; García-Ríos, Antonio; Riquelme-Gallego, Blanca; Delgado-Rodríguez, Miguel; Matía, Pilar; Daimiel, Lidia; Martín, Vicente; Vidal, Josep; Vázquez, Clotilde; Ros, Emilio; Buil-Cosiales, Pilar; Díaz-López, Andrés; Fernández-Carrión, Rebeca; Fitó, Montserrat; Konieczna, Jadwiga; Notario-Barandiaran, Leyre; Alonso-Gómez, Ángel M; Contreras-Fernández, Eugenio; Abete, Itziar; Sánchez-Villegas, Almudena; Casas, Rosa; Muñoz-Garach, Araceli; Santos-Lozano, José Manuel; Gallardo-Alfaro, Laura; Basora, Josep; Portoles, Olga; Muñoz, Miguel Ángel; Moñino, Manuel; Miralles Gisbert, Salvador; Moreno Rodríguez, Anai; Ruiz-Canela, Miguel; Palau Galindo, Antoni; Pérez-Vega, Karla Alejandra; Bueno-Cavanillas, AuroraDietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55-75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80-39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55-18.65), fruits OR = 11.62 (95% CI 6.81-19.81), dairy products OR = 6.54 (95% CI 4.64-9.22) and protein foods OR = 6.60 (95% CI 1.96-22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s. PublicationEvaluation of Inappropriate Prescribing in Patients Older than 65 Years in Primary Health Care.(2019-03-04) Nuñez-Montenegro, Antonio; Montiel-Luque, Alonso; Martin-Aurioles, Esther; Garcia-Dillana, Felicisima; Krag-Jiménez, Monica; González-Correa, Jose ATo asses inappropriate prescribing and its predisposing factors in polymedicated patients over the age of 65 in primary health care. cross-sectional study. Primary care centres in the Costa del Sol Health District and Northern Health Area of Malaga in southern Spain. Patients older than 65 years who use multiple medications. Data collection was conducted during 1 year in a population of 425 individuals who comprised a stratified randomized sample of the population of health care users in the study area. The data were collected by interview on a structured data collection form. Dependent variable: Potentially inappropriate prescribing (PIP) (STOPP/START criteria). Predictor variables: Sociodemographic characteristics, clinical characteristics and medication use. A descriptive analysis of the variables was performed. Statistical inference was based on bivariate analysis (Student's t or Mann-Whitney U test and chi-squared test) and multivariate analysis was used to control for confounding factors. 73.6% of participants met one or more STOPP/START criteria. According to information about prescribed treatments, 48.5% of participants met at least one STOPP criterion and 43.30% of them met at least one START criterion. The largest percentage of inappropriate prescriptions was associated with cardiovascular treatments. More than three-quarters of the participants had one or more inappropriate prescriptions for medicines in primary care, according to STOPP/START criteria. In addition, PIP was directly related to the number of prescribed medications, gender and specific pathologies (diabetes). Publication[LEOPARD syndrome: A variant of Noonan syndrome with lentigines].(2018-03-20) de Santiago García-Caro, Eloísa; Pozo Guzmán, Ana; Moreno Medinilla, Esther PublicationValidation of the Spanish version of the Edinburgh Feeding Evaluation in Dementia Scale for older people with dementia.(2018-02-27) Saucedo Figueredo, María Carmen; Morilla Herrera, Juan Carlos; San Alberto Giraldos, Mercedes; López Leiva, Inmaculada; León Campos, Álvaro; Martí García, Celia; García Mayor, Silvia; Kaknani Uttumchandani, Shakira; Morales Asencio, José MiguelTo adapt the Edinburgh Feeding Evaluation in Dementia Scale (EdFED) for use in a Spanish-speaking population and to assess its validity and reliability in patients with dementia. A cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation (translation, back-translation, review by committee of experts, pilot test and weighting of results); 2. Clinimetric validation comprising interobserver reliability assessment, test-retest reliability and internal consistency. To determine construct validity, confirmatory factorial analysis and principal components analysis were performed by oblique rotations. Criteria validity was analysed using the Pearson correlation (p A version of EdFED culturally adapted to Spanish was obtained. The sample presented the following characteristics: 76.3% women, mean age 82.3 years (SD: 7.9); MNA 18.73 (SD: 4.44); BMI 23.99 (SD: 4.72); serum albumin 3.79 mg/dl (SD: 0.36). A Cronbach's alpha of 0.88 was obtained, with an inter-item global correlation of 0.43 and a homogeneity index ranging from 0.42 to 0.73. The exploratory factor analysis reproduced the three-factor model identified by the original authors, explaining 62.32% of the total variance. The criterion validity showed a good inverse correlation with MNA and a moderate one with albumin, total proteins, transferrin and BMI. The Spanish version of EdFED is reliable and valid for use in elderly people with dementia. The most appropriate for our environment is the three-factor model, which maintains the original factors, with a slight redistribution of the items. Publication[Clinical-demographic factors associated with fear-avoidance in subjects with non-specific chronic low back pain in Primary Care: secondary analysis of intervention study].(2018-02-01) Díaz-Cerrillo, Juan Luis; Rondón-Ramos, Antonio; Clavero-Cano, Susana; Pérez-González, Rita; Martinez-Calderon, Javier; Luque-Suarez, AlejandroTo describe some sociodemographics and clinical characteristics of subjects with Non-specific Chronic Low Back Pain (NCLBP) in Primary Care, as well as to investigate their association with Fear-Avoidance (FA). Cross-sectional. Secondary analysis of an intervention study. Basic Health Areas in Costa del Sol Health District (Málaga, Spain). An analysis was performed on 147 subjects with NCLBP from a previous intervention study database in Primary Care Physiotherapy (PCP). Characteristics: age 18-65; understanding of the Spanish language; absence of cognitive disorders, fibromyalgia or dorsolumbar surgery, and to be able to perform physical exercise. The main variable was FA level (FABQ and the FABQ-PA and FABQ-W) sub-scales. Clinical variables included: pain (NRPS-11), disability (RMQ), evolution, previous treatments and diagnostic imaging. The sociodemographic variables included: gender, age, educational level, and employment status. Just over half (51.7%) of the subjects had high FA on the FABQ-PA sub-scale. Sick leave (SL) [β=24.45 (P=.009*); β=13.03 (P=.016*); β=14.04 (P=.011*) for FABQ, FABQ-PA and FABQ-W, respectively]; primary studies level [β=15.09 (P=.01*); β=9.73 (P=.01*) for FABQ and FABQ-PA], and disability [β=1.45 (P Some sociodemographic and clinical features of the NCLBP population are presented. Imaging tests (81.63%) and previous passive treatments (55.78%) could reflect problems of adherence to recommendations of CPGs. Sick leave, primary studies level, and disability were associated with FA. The findings should be interpreted in the light of possible limitations. Some suggestions for clinical practice are provided. PublicationMedication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy.(2017-02-06) Montiel-Luque, Alonso; Núñez-Montenegro, Antonio Jesús; Martín-Aurioles, Esther; Canca-Sánchez, Jose Carlos; Toro-Toro, Maria Carmen; González-Correa, José Antonio; Polipresact Research GroupObjective: To describe the relationship between medication-related factors and the health-related quality of life in patients older than 65 years who use multiple medications (polypharmacy). Design: Cross-sectional descriptive study. Setting: Primary care. Participants: Patients older than 65 years who use multiple medications (n = 375). Measurements: The main outcome measure was health-related quality of life according to the EuroQol-5D instrument. Sociodemographic, clinical and medication-related variables were recorded during home interviews. Mean age was 74.72 ± 5.59 years, and 65.5% of our participants were women. The global level of health-related quality of life according to the EQ-5D visual analog scale was 59.25 ± 20.92. Of the five EuroQol dimensions, anxiety/depression and pain were the most frequently reported, while mobility and self-care were the dimensions with the greatest impact on self-reported quality of life. Multivariate analysis indicated that functional independence was the factor most strongly associated (β = 14.27 p Factors inherent within the patient such as functional incapacity, cognitive impairment and social and emotional problems were the main constraints to quality of life in our study population. The number of medicines taken was negatively related with quality of life. PublicationActivity Pattern Profiles: Relationship With Affect, Daily Functioning, Impairment, and Variables Related to Life Goals.(2017-01-04) Esteve, Rosa; López-Martínez, Alicia E; Peters, Madelon L; Serrano-Ibáñez, Elena R; Ruíz-Párraga, Gema T; González-Gómez, Henar; Ramírez-Maestre, CarmenThe aim of this cross-sectional study was to identify subgroups of patients on the basis of their activity patterns and to investigate their relationship with life goals, optimism, affect, and functioning. The sample was comprised of 276 patients with chronic musculoskeletal pain. Hierarchical cluster analysis was performed on the activity pattern variables and the resulting clusters were compared using 1-way analysis of variance. The 4-cluster was the optimal solution. The 4 clusters comprised: 1) avoiders: patients with high levels of avoidance and low levels of persistence, who use pacing to reduce pain, 2) doers: patients with high levels of persistence and low levels of pacing and avoidance, 3) extreme cyclers: patients with high levels of avoidance and persistence and low levels of pacing, and 4) medium cyclers: patients with moderately high levels of avoidance and persistence and high levels of pacing. Comparison of the clusters showed that doers had the most adaptive profile, whereas avoiders, followed by extreme cyclers, had unhealthy profiles. Doers showed a high level of optimism and a good balance between goal value, expectancy, and conflict. It is useful to distinguish profiles on the basis of various activity patterns. In contrast to profiles characterized by avoidance, profiles characterized by high persistence and low avoidance were associated with adaptive results. Patients with this profile also showed a high level of optimism and a good balance between goal value, expectancy, and conflict.