http://hdl.handle.net/10366/3983 2026-05-02T16:58:35Z http://hdl.handle.net/10366/171122 [ENG]The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD).  METHODS: Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45-75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor's office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9-17.5; p < 0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the final visit. Moreover, the effect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p < 0.001) in IG. A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice. ClinicalTrials.gov Identifier: NCT03136211. Retrospectively registered on 02/05/2017 https://clinicaltrials.gov/ct2/show/NCT03136211. 2022-11-19T00:00:00Z http://hdl.handle.net/10366/171114 Nomophobia is a specific phobia characterized by the appearance of anxiety, nervousness, discomfort and distress when the mobile phone is not used and is considered an emerging public health problem because of the negative consequences on the physical and mental health of young people and adolescents, especially women. Neurofeedback-Assisted Mindfulness Training Programs may prove beneficials for improving self-control abilities, a key ability in addressing addictive behaviors. The main objective of this study is to evaluate the impact, in a young population aged 18-35 years, of an intervention based on Neurofeedback-Assisted Mindfulness Training Program (NAMTP) on disorders associated with problematic use of mobile phones. The effect of the intervention on the total score in the nomophobia test and habits of internet and social network use, as well as on signs of depression, anxiety and stress will be analyzed. As a secondary objective, the effect of the intervention on signs of insomnia will be analyzed. Randomized, controlled clinical-trial with two-parallel groups. 40 young adults (18-35 years) will be included and randomly assigned to Intervention Group-NAMTP or Control Group (CG). The NAMTP will include a total of 25 sessions (2-3/week) during 3-months. Each session will have a duration of 10/15 min. The instrument to be used for the neurofeedback sessions is MUSE® (InteraXon Inc.). Study variables will be collected at the baseline visit and at the final visit (3-months after randomization). During these visits, questionnaires will be administered to evaluate the main and secondary variables that will include the Smartphone Addiction Scale-Short Version, Nomophobia Questionnaire, Depression, Anxiety and Stress Scale 21-item (DASS-21) and Athens Insomnia Scale. This trial will make an important contribution to the need for evidence of effective education programs and other primary care interventions through new non-invasive interventions in reducing the risk of developing addictions to new technologies and alleviating the symptoms of discomfort associated with this problem. The project was approved by the Clinical Research Ethics Committee of the Salamanca Health Area (CEIm Code: PI 2023 071340). ClinicalTrials.gov, http://www.Clinicaltrials.gov/ct2/show/NCT06188910. 2024-01-01T00:00:00Z http://hdl.handle.net/10366/171113 Atherosclerosis, a leading cause of mortality, necessitates effective management of hypercholesterolemia, specifically elevated low-density lipoprotein cholesterol (LDL-C). The emergence of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has revolutionised lipid-lowering. PCSK9i demonstrates substantial LDL-C reduction and cardiovascular benefits, particularly in statin-intolerant or nonresponsive individuals. However, the potential pleiotropic effects of PCSK9i, especially on arterial stiffness, remain a subject of investigation. This systematic review and meta-analysis seek to provide a nuanced understanding of the potential pleiotropic effects of PCSK9i, specifically on arterial health. The primary objective was to analyse the influence of PCSK9i on arterial stiffness, extending beyond traditional lipid-lowering metrics and contributing to a more comprehensive approach to cardiovascular risk reduction. A systematic search was conducted across major databases, clinical trial registries and grey literature. Inclusion criteria comprised adults in prospective cohort studies undergoing PCSK9i augmentation in lipid-lowering therapy, with a focus on arterial stiffness measured by pulse wave velocity (PWv). Random-effects meta-analyses, sensitivity analyses and meta-regression models were employed to assess the pooled effect of adding PCSK9i to lipid-lowering interventions on arterial stiffness. Five studies (158 participants) met the inclusion criteria, demonstrating a significant reduction in PWv (mean difference: -2.61 m/s [95% CI: -3.70, -1.52]; ES: -1.62 [95% CI: -2.53, -.71]) upon adding PCSK9i to lipid-lowering interventions. Subgroup analysis and meta-regression models suggested potential sex-based and baseline PWv-dependent variations, emphasising patient-specific characteristics. The meta-analysis provides robust evidence that adding PCSK9i to lipid-lowering interventions significantly improves arterial stiffness, indicating broader vascular benefits beyond LDL-C reduction. 2024-10-01T00:00:00Z http://hdl.handle.net/10366/171112 [ENG]Postpartum is a critical phase for women's health, characterized by physical, psychological, and social changes. Social networks have emerged as a predominant communication channel, offering support and quick access to information about motherhood. However, their use can also negatively influence body image and dietary behavior, especially in a context of pro-slimness beauty standards. Postpartum women are particularly vulnerable to body dissatisfaction, but there are still few studies that specifically analyze the impact of social networks at this stage. This scoping review aims to map and describe the available evidence on how the possible influence of exposure to social media content on body image perception and the adoption of eating and exercise-related habits in women during the postpartum period has been investigated. This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, adapted for exploratory reviews. We searched for studies published in the last 10-years in databases such as PubMed, Scopus, Web of Science, CINAHL, and BVS, using terms related to social networks, body image, diet, exercise, and the postpartum period. Eight studies were included after applying eligibility criteria based on the PIO framework. An assessment of the quality of methodological reporting was performed using best practice guidelines such as SRQR, STROBE, CONSORT, and PRISMA, for descriptive purposes. We analyzed 8 studies suggesting that social networks may negatively influence the body image, eating and exercise habits of postpartum women. The publications represent unrealistic aesthetic standards, associated with body dissatisfaction, restrictive diets, and intensive exercise, with prevalent nutritional misinformation. Although positive messages of body acceptance were identified, they were scarce, suggesting the need for regulation and media education. Social networks could exert a relevant influence on women's body image and self-care habits in the postpartum period, promoting unrealistic aesthetic standards that could have a negative impact on their physical and emotional well-being. It is essential to implement media literacy strategies, promote inclusive content, and regulate misinformation on these platforms to mitigate their adverse effects and promote a healthy and sustainable recovery. 2025-07-12T00:00:00Z http://hdl.handle.net/10366/170954 Introducción: El control del fósforo (P) sérico en hemodiálisis (HD) sigue siendo un reto, condicionado por la adherencia a los captores y la implicación del paciente. Estrategias educativas estructuradas pueden mejorar el autocuidado y optimizar los resultados clínicos. Objetivo: Evaluar la eficacia de una intervención educativa centrada en el paciente para el control del P en HD. Material y métodos: Ensayo clínico multicéntrico, prospectivo y aleatorizado en los pacientes con hiperfosfatemia o altas dosis de captores, asignados a intervención (educación estructurada + herramienta Empower-PHOS) o control (manejo habitual). Se midieron P sérico, dosis de captores y adherencia (SMAQ) a 0, 3, 6 y 12 meses. Resultados: Ambos grupos fueron comparables al inicio. Se incluyeron 122 pacientes de 14 centros. El grupo intervención logró reducciones significativas del P a los 3 meses (de 6,1 a 5,4 mg/dl; p < 0,001) y a los 12 meses (de 6,2 a 5,2 mg/dl; p = 0,010), sin cambios en el número de comprimidos ni en la dosis diaria. La mejora se observó tanto en los pacientes adherentes como en no adherentes, con reducciones especialmente relevantes en estos últimos (de 6,4 ± 1,2 a 5,8 ± 1,2 mg/dl; p = 0,015). La adherencia según SMAQ no varió significativamente. Conclusiones: Una intervención educativa estructurada centrada en el paciente mejora el control del P en HD, incluso en los pacientes con baja adherencia, sin aumentar la carga farmacológica. Estos resultados respaldan el uso de estrategias educativas personalizadas como complemento clave en el manejo integral de la hiperfosfatemia que pueden integrarse en la práctica clínica habitual de las unidades de HD. 2026-03-01T00:00:00Z http://hdl.handle.net/10366/170918 Background: Unhealthy lifestyles and poor dietary habits pose a major challenge to global public health, contributing significantly to the burden of disease and mortality. This phenomenon has been connected to various sociodemographic and economic factors that negatively affect diet quality, particularly among older adults. Objective: To evaluate the relationship between socioeconomic status and diet intake among community-dwelling adults aged ≥ 60 years enrolled in a municipal active aging program (PReGe) in Northwestern Spain. Methods: A cross-sectional observational study was conducted in adults aged 60 years and older residing in Salamanca, Spain. Data collection included sociodemographic variables such as age, sex, and postal address, as well as nutritional variables assessed through a food frequency questionnaire. Results: The sample consisted of 192 individuals. A positive association was observed between socioeconomic status and the intake of cereals and vegetables. In contrast, a negative association was observed with total fat and saturated fat intake (p < 0.05 for all). Conclusion: A significant association is closely related between socioeconomic status and dietary quality, highlighting a higher intake of saturated fats among individuals with lower socioeconomic status and a greater intake of vegetables and cereals among those with higher socioeconomic status in community-dwelling adults aged ≥ 60 years enrolled in a municipal active aging program in Northwestern Spain (Salamanca). 2026-01-01T00:00:00Z http://hdl.handle.net/10366/170830 Cerebral palsy is a neurological condition that is associated with multiple motor alterations and dysfunctions in children. Robotic systems are new devices that are becoming increasingly popular as a part of the treatment for cerebral palsy. A systematic review of the Pubmed, Web of Science, MEDLINE, Cochrane, Dialnet, CINAHL, Scopus, Lilacs and PEDro databases from November 2021 to February 2022 was conducted to prove the effectiveness of these devices for the treatment of motor dysfunctions in children who were diagnosed with cerebral palsy. Randomized clinical trials in Spanish and English were included. In total, 653 potential manuscripts were selected but only 7 of them met the inclusion criteria. Motor dysfunctions in the lower limbs and those that are specifically related to gait are the main parameters that are affected by cerebral palsy and the robotic systems Lokomat, Innowalk, Robogait and Waltbox-K are the most commonly used. There is no consensus about the effectiveness of these devices. However, it seems clear that they have presented a good complement to conventional physical therapies, although not a therapy as themselves. Unfortunately, the low quality of some of the randomized clinical trials that were reviewed made it difficult to establish conclusive results. More studies are needed to prove and test the extent to which these devices aid in the treatment of children with cerebral palsy. 2022-04-22T00:00:00Z http://hdl.handle.net/10366/170720 [ENG]Background/Objectives: University students frequently engage in risky alcohol consumption, making them a priority population for targeted interventions. Motivational interventions (MIs) have been widely implemented to address this issue, but evidence of their effectiveness remains heterogeneous. This study aimed to evaluate the efficacy of MIs in reducing alcohol consumption and related harm among university students through a systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Scopus, and BVS Library, including randomized controlled trials (RCTs) published up to April 2025. The PRISMA and RoB-2 tools guided reporting and risk of bias assessment. Random-effects models were applied to pool effect sizes for changes in alcohol consumption patterns and related consequences. Results: Fifteen RCTs were included. MIs significantly reduced daily alcohol intake (-0.55 drinks/day; 95% CI: -0.78 to -0.32), with additional reductions in weekly consumption and binge drinking episodes, though these were not statistically significant. Positive effects were also observed in reducing alcohol-related consequences and blood alcohol concentration levels. Short, single-session formats (45-90 min) showed consistent efficacy across studies, with effects sustained at 2-3 months and, in some cases, up to one year post-intervention. Conclusions: MIs are effective, brief, and adaptable strategies for reducing harmful alcohol use and associated negative outcomes among university students. Their simplicity, feasibility, and sustained effects make them valuable tools for university health programs. Future research should focus on optimizing intervention components and evaluating their effectiveness in diverse cultural and socioeconomic contexts. 2025-09-24T00:00:00Z http://hdl.handle.net/10366/170719 [ENG]Background and Clinical Significance: Understanding early brain development in infants is essential as identifying an abnormal pattern could accelerate the start of early interventions. There is still limited evidence on how external stimuli (such as tactile, auditory, and visual inputs) influence cortical electrical activity, underscoring the need for integrative studies comparing these modalities in the first months of life. The objective of this paper is to determine the effects of different stimuli (tactile, auditory, and visual) in cortical electrical activity to take advantage of its use in individualized protocols and treatments. Case Presentation: An 8-channel electroencephalography cap was placed on the infant's head to analyze 10 different conditions depending on the selected stimuli: Kangaroo Care with mother and father, rest, tactile stimuli, visual stimuli, acoustic stimuli, and sleep for 5 min. The environment was the same in all conditions to ensure comparison. All conditions have been able to modify the cortical electrical activity presenting different patterns of electrical activity. Tactile stimuli (massage) showed increased activity in the left parietal region. Acoustic stimuli showed increased activity in the frontal region. Visual stimuli presented different patterns, but with a higher occurrence of artifacts due to baby's movement. Conclusions: Acoustic stimuli with music increased cortical electrical activity in frontal region, while tactile stimuli increased the left cerebral hemisphere activity. Future studies are needed to support these exploratory results to establish early interventions in pathological conditions. 2025-12-02T00:00:00Z http://hdl.handle.net/10366/170718 [ENG]Objectives: Motor imagery (MI) may enhance post-stroke recovery, but evidence of its benefit over conventional rehabilitation therapy (CRT) is inconsistent. This study evaluated the effect of MI combined with CRT on upper-limb recovery, accounting for methodological quality and publication bias. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in multiple databases up to July 2025. Methodological quality and risk of bias were assessed using the PEDro scale and Cochrane RoB 2 tool, respectively. Analyses included the calculation of effect sizes (ES), heterogeneity, sensitivity, publication bias, and GRADE-based certainty assessment. Results: From 4074 records, 10 randomized controlled trials (n = 255) were included. The initial pooled analysis showed a small-to-moderate effect of MI + CRT versus CRT alone (ES = 0.45; 95% CI: 0.16-0.74). However, the overall ES calculated with a robust variance estimator was -0.06 (95% CI: -0.21, 0.08). Most trials had methodological limitations (mean PEDro = 6.0; high risk of bias in 7/10 studies). The GRADE evaluation indicated a very low certainty of evidence. Conclusions: The initially observed positive effect of MI combined with CRT is not robust. When accounting for statistical dependencies and potential biases, the effect vanishes and is no different from zero. Current evidence does not support the use of MI as a standalone adjunct to CRT. Larger, high-quality RCTs with standardized protocols are required to establish any potential clinical relevance. 2025-11-06T00:00:00Z http://hdl.handle.net/10366/170717 [ENG]Background: Mild cognitive impairment (MCI) is a clinical stage between the expected cognitive decline of healthy ageing and dementia. People with MCI experience functional decline, social isolation and emotional symptoms that may increase suicidal thoughts and behaviours (STB). We aimed to explore the relationship between MCI and STB, as well as clinical and socioeconomic factors that may contribute to it. Methods: To achieve our aims we carried out a comprensive systematic review of the existing scientific literature. We searched the following electronic databases up to June 2024: PubMed, Scopus, Cochrane Library, Web Of Science (WOS) and EMBASE. We employed the Cochrane Risk of Bias In Non-randomized Studies - of Exposure (ROBINS-E) and the Newcastle-Ottawa Scale to assess the quality of the eligible studies. Results: An initial search retrieved 1,176 publications; however, only 11 studies met eligibility criteria to be included in the final analysis. The quality of these studies ranged from 3 to 8 out of a maximum score of 9 in the Newcastle-Ottawa Scale, with a median score of 6. People with a formal diagnosis of MCI showed a higher prevalence of STB than those without such condition or with a more severe cognitive impairment. Comorbid psychiatric disorders, such as depression, other health problems, such as cardiovascular diseases, and a low socioeconomic status and/or poor educational background seemed to contribute to suicide risk in people with MCI. Conclusion: Our systematic review suggests that people suffering MCI may be at an increased risk of presenting STB. Suicide prevention programmes for older populations with MCI should advocate for integrated health and social care models to tackle the clinical and social burden of suffering MCI. 2025-08-12T00:00:00Z http://hdl.handle.net/10366/170716 [ENG]Physical exercise is an effective measure for preventing the onset of cognitive decline and has a direct influence on the aging process. The purpose of this study was to assess the effect of a 6-month physical exercise program on cognition and telomere length in adults over 65 years of age. Seventy-four healthy women were separated into two groups: 41 were included in the intervention group (IG) (72.70 ± 4.127 years and 8.18 ± 1.551 years of education) and 33 in the control group (CG) (71.21 ± 4.127 years and 8.42 ± 2.562). The participants included within the IG carried out three sessions of physical exercise per week for six months. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the Stroop test and the Trail Making Test (TMT). Saliva samples were taken and analyzed and relative telomere length was calculated. Those conducting the analysis were blind to the group to which the participants had been assigned. An improvement was observed in global cognitive function, in both attentional and executive functions, in the group of adults doing physical exercise as compared to the control group. Six months after the physical exercise program had finished, relative telomere length was found to have increased in the participants in the intervention group. Physical exercise programs can lead to an improvement in both cognitive functions and telomere length. 2021-10-27T00:00:00Z http://hdl.handle.net/10366/170715 [ENG]Clinical evidence gathered in recent years indicates that elderly individuals more frequently display cognitive changes. These age-related changes refer, above all, to memory functions and to the speed of thinking and reasoning. A number of studies have shown that physical activity can be used as an important mechanism for protecting the cognitive functions. To test the hypothesis that physical exercise is able to bring about changes in the cognitive functions of healthy elderly adults without cognitive impairment, thereby improving their quality of life. The study population included participants in the University of Salamanca geriatric revitalisation programme. The sample initially consisted of a total of 44 subjects of both sexes, with a mean age of 74.93 years. The neuropsychological evaluation of the subjects included a series of validated neuropsychological tests: Mini-Mental State Examination, Benton Visual Retention Test, Rey Auditory Verbal Learning Test, Stroop Test and Trail Making Test. The results show that more physical activity is related to better performance in the cognitive functions of the subjects included in this study, after applying the geriatric revitalisation programme. The geriatric revitalisation programme can be a valuable tool for improving cognition in adults over 60 years of age, resulting in enhanced well-being in their quality of life. 2018-04-01T00:00:00Z http://hdl.handle.net/10366/170579 [EN]Background: This article presents the protocol for a randomized controlled trial designed to develop and evaluate a psychoeducational intervention aimed at preparing individuals for the challenges and opportunities of the retirement transition. The protocol was developed through a literature review and expert consultation. Methods: The study will be conducted at the Faculty of Psychology of the University of Salamanca (Spain). It will recruit individuals aged 60 years or older who are already retired or who will retire within the next five years. The participants will be randomly assigned to two groups: the intervention group, which will undergo a psychoeducational intervention programme, consisting of 12 sessions over 3 months and the control group, which will engage in a controlled follow-up. All participants will undergo an initial and a final assessment, as well as a 3-month follow-up, collecting socio-demographic data and different assessment instruments. Discussion: This protocol describes a comprehensive psychoeducational intervention aimed at improving quality of life and attitudes towards retirement, increasing life satisfaction, psychological flexibility, perceived social support and general health, self-efficacy and self-regulation, and reducing stereotypes about ageing. Reporting method: CONSORT 2010 guidelines for reporting randomised controlled trials.; [ES]Introducción: Este artículo presenta el protocolo de un ensayo controlado aleatorio dise˜ nado para desarrollar y evaluar una intervención psicoeducativa destinada a preparar a las personas para los retos y oportunidades que plantea la transición a la jubilación. El protocolo se elaboró mediante una revisión bibliográfica y consultas a expertos. Método: El estudio se llevará a cabo en la Facultad de Psicología de la Universidad de Salamanca (Espa˜ na). Se reclutarán personas de 60 o más a˜ nos que ya estén jubiladas o que vayan a jubilarse en los próximos cinco a˜ nos. Los participantes serán asignados aleatoriamente a dos grupos: el grupo de intervención, que llevará a cabo un programa psicoeducativo compuesto por 12 sesiones a lo largo de 3 meses; y el grupo control, que participará en un seguimiento controlado. Todos los participantes realizarán una evaluación inicial y una final, así como un seguimiento a los 3 meses, recogiendo datos sociodemográficos y diferentes instrumentos de evaluación. Discusión: Este protocolo describe una intervención psicoeducativa integral destinada a mejorar la calidad de vida y las actitudes hacia la jubilación, aumentando la satisfacción con la vida, la flexibilidad psicológica, el apoyo social percibido y la salud general, la autoeficacia y la autorregulación, y reduciendo los estereotipos sobre el envejecimiento. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/169340 [ES]La escoliosis es una deformidad tridimensional de la columna vertebral que presenta una gran complejidad anatómica y biomecánica. Esta complejidad anatómica y biomecánica representa un reto significativo para la formación de los estudiantes de Ciencias de la Salud, especialmente en el ámbito de la fisioterapia, donde la comprensión profunda de la deformidad es fundamental para el diagnóstico y el abordaje terapéutico adecuado. En este contexto, el presente proyecto de innovación docente surge con el objetivo de desarrollar e implementar modelos 3D de curvas escolióticas que permitan a los estudiantes interactuar con representaciones anatómicas más realistas y manipulables. Se pretende de este modo superar las limitaciones de la docencia tradicional, facilitando la visualización y comprensión de la escoliosis y promoviendo el desarrollo de competencias clínicas esenciales para la práctica profesional. 2025-01-01T00:00:00Z http://hdl.handle.net/10366/169327 During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women daily on body composition. We conducted a 6-month, two-arm randomised, controlled trial. Postmenopausal women (57·2 (sd 3·6) years, n 132) were recruited in primary care clinics. Participants in the control group (CG) did not receive any intervention. Those of the intervention group (IG) received 10 g daily of 99 % cocoa chocolate in addition to their habitual diet for 6 months. This quantity comprises 247 kJ (59 kcal) and 65·4 mg of polyphenols. The primary outcomes were the between-group differences in body composition variables, measured by impendancemetry at the end of the study. The main effect of the intervention showed a favourable reduction in the IG with respect to the CG in body fat mass (-0·63 kg (95 % CI -1·15, -0·11), P = 0·019; Cohen's d = -0·450) and body fat percentage (-0·79 % (95 % CI -1·31, -0·26), P = 0·004; Cohen's d = -0·539). A non-significant decrease was also observed in BMI (-0·20 kg/m2 (95 % CI -0·44, 0·03), P = 0·092; Cohen's d = -0·345). Both the body fat mass and the body fat percentage showed a decrease in the IG for the three body segments analysed (trunk, arms and legs). Daily addition of 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women reduces their body fat mass and body fat percentage without modifying their weight. 2021-03-14T00:00:00Z