Does Tension Headache Have a Central or Peripheral Origin? Current State of Affairs.

PURPOSE OF REVIEW: The aim of this narrative review is to analyze the evidence about a peripheral or central origin of a tension headache attack in order to provide a further clarification for an appropriate approach. RECENT FINDINGS: Tension headache is a complex and multifactorial pathology, in which both peripheral and central factors could play an important role in the initiation of an attack. Although the exact origin of a tension headache attack has not been conclusively established, correlations have been identified between certain structural parameters of the craniomandibular region and craniocervical muscle activity. Future research should focus on improving our understanding of the pathology with the ultimate goal of improving diagnosis. The pathogenesis of tension-type headache involves both central and peripheral mechanisms, being the perpetuation over time of the headache attacks what would favor the evolution of an episodic tension-type headache to a chronic tension-type headache. The unresolved question is what factors would be involved in the initial activation in a tension headache attack. The evidence that favors a peripheral origin of the tension headache attacks, that is, the initial events occur outside the brain barrier, which suggests the action of vascular and musculoskeletal factors at the beginning of a tension headache attack, factors that would favor the sensitization of the peripheral nervous system as a result of sustained sensory input.

Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study.

BACKGROUND: The prevalence of overweight/obesity and related manifestations such as metabolic syndrome (MetS) is increasing worldwide. High energy density diets, usually with low nutrient density, are among the main causes. Some high-quality dietary patterns like the Mediterranean diet (MedDiet) have been linked to the prevention and better control of MetS. However, it is needed to show that nutritional interventions promoting the MedDiet are able to improve nutrient intake. OBJECTIVE: To assess the effect of improving MedDiet adherence on nutrient density after 1 year of follow-up at the PREDIMED-Plus trial. METHODS: We assessed 5777 men (55-75 years) and women (60-75 years) with overweight or obesity and MetS at baseline from the PREDIMED-Plus trial. Dietary changes and MedDiet adherence were evaluated at baseline and after 1 year. The primary outcome was the change in nutrient density (measured as nutrient intake per 1000 kcal). Multivariable-adjusted linear regression models were fitted to analyse longitudinal changes in adherence to the MedDiet and concurrent changes in nutrient density. RESULTS: During 1-year follow-up, participants showed improvements in nutrient density for all micronutrients assessed. The density of carbohydrates (- 9.0%), saturated fatty acids (- 10.4%) and total energy intake (- 6.3%) decreased. These changes were more pronounced in the subset of participants with higher improvements in MedDiet adherence. CONCLUSIONS: The PREDIMED-Plus dietary intervention, based on MedDiet recommendations for older adults, maybe a feasible strategy to improve nutrient density in Spanish population at high risk of cardiovascular disease with overweight or obesity.

The Mitochondria-Targeted Antioxidant MitoQ Modulates Mitochondrial Function and Endoplasmic Reticulum Stress in Pancreatic ß Cells Exposed to Hyperglycaemia.

BACKGROUND/AIMS: Mitochondria-targeted antioxidants such as mitoquinone (MitoQ) have demonstrated protective effects against oxidative damage in several diseases. The increase in reactive oxygen species (ROS) production during glucose metabolism in ß cells can be exacerbated under hyperglycaemic conditions such as type 2 diabetes (T2D), thus contributing to ß cell function impairment. In the present work, we aimed to evaluate the effect of MitoQ on insulin secretion, oxidative stress, endoplasmic reticulum (ER) stress and nuclear factor kappa B (NFκB) signalling in a pancreatic ß cell line under normoglycaemic (NG, 11.1 mM glucose), hyperglycaemic (HG, 25 mM glucose) and lipidic (palmitic acid (PA), 0.5mM) conditions. METHODS: We incubated the pancreatic ß cell line INS-1E with or without MitoQ (0.5µM) under NG, HG and PA conditions. We then assessed the following parameters: glucose-induced insulin secretion, O2 consumption (with a Clark-type electrode); mitochondrial function, oxidative stress parameters and calcium levels (by fluorescence microscopy); ER stress markers and NFκB-p65 protein levels (by western blotting). RESULTS: MitoQ increased insulin secretion and prevented the enhancement of ROS production and O2 consumption and decrease in GSH levels that are characteristic under HG conditions. MitoQ also reduced protein levels of ER stress markers (GRP78 and P-eIF2α) and the proinflammatory nuclear transcription factor NFκB-p65, both of which increased under HG. MitoQ did not significantly alter ER stress markers under lipidic conditions. CONCLUSION: Our findings suggest that treatment with MitoQ modulates mitochondrial function, which in turn ameliorates endoplasmic reticulum stress and NFκB activation, thereby representing potential benefits for pancreatic ß cell function.

Dietary weight loss intervention improves subclinical atherosclerosis and oxidative stress markers in leukocytes of obese humans.

BACKGROUND: The relationship between caloric restriction-mediated weight loss and the generation of ROS and its effects on atherosclerotic markers in obesity is not fully understood. Therefore, we set out to investigate whether dietary weight loss intervention improves markers of oxidative stress in leukocytes and subclinical parameters of atherosclerosis. SUBJECTS AND METHODS: This was an interventional study of 59 obese subjects (BMI > 35 kg/m2) who underwent 6 months of dietary therapy, including a 6-week very-low-calorie diet (VLCD) followed by an 18-week low-calorie diet (LCD). We determined clinical parameters, inflammatory markers-hsCRP, TNFα and NFκB -, oxidative stress parameters-total superoxide, glutathione, catalase activity and protein carbonyl groups-, soluble cellular adhesion molecules-sICAM, sP-selectin, sPSGL-1 -, myeloperoxidase (MPO), leukocyte-endothelium cell interactions-rolling flux, velocity and adhesion-and LDL subfractions, before and after the dietary intervention. RESULTS: After losing weight, an improvement was observed in the patients' anthropometric, blood pressure and metabolic parameters, and was associated with reduced inflammatory response (hsCRP, TNFα and NFκB). Oxidative stress parameters improved, since superoxide production and protein carbonyl content were reduced and antioxidant systems were enhanced. In addition, a significant reduction of subclinical markers of atherosclerosis-small and dense LDL particles, MPO, sP-selectin and leukocyte adhesion-and an increase in soluble PSGL-1 were reported. CONCLUSIONS: Our findings reveal that the improvement of subclinical atherosclerotic markers after dietary weight loss intervention is associated with a reduction of oxidative stress in leukocytes and inflammatory pathways, suggesting that these are the underlying mechanisms responsible for the reduced risk of cardiovascular disease in obese subjects after losing weight.

Downregulation of miR-31 in Diabetic Nephropathy and its Relationship with Inflammation.

BACKGROUND/AIMS: There is a lack of reliable biological markers for the early diagnosis of diabetic nephropathy (DN) during type 2 diabetes. In this pilot study we aim to assess whether miR-31 levels are modulated by the presence of DN and whether the expression of this miRNA is related to leukocyte-endothelial interactions and inflammation. METHODS: Thirty-one T2D patients were enrolled in this pilot study; 18 with no diabetic complications and 13 with diabetic nephropathy. 24 non-diabetic subjects and 13 T2D patients with retinopathy (absent of other complications) were included to test the specificity of miR-31. Following anthropometric and biochemical evaluation, serum miR-31 levels were assessed by Real Time-PCR. Leukocyte-endothelial interactions were evaluated by a parallel flow chamber in vitro model. Serum TNFα, IL-6 and ICAM-1 levels were determined by XMAP-technology in a flow cytometry-based Luminex 200 instrument. RESULTS: Serum miR-31 levels were similar between control and T2D subjects. However, T2D patients with DN displayed reduced levels of miR-31 with respect to patients without complications. This decrease in miR-31 was more pronounced in patients with macroalbuminuria than in those with microalbuminuria and was specific for DN, since patients with retinopathy displayed unaltered miR-31 levels. The presence of DN involved a lower leukocyte rolling velocity and an increased rolling flux and adhesion. miR-31 levels were positively correlated with leukocyte rolling velocity and negatively associated to leukocyte adhesion, TNFα, IL-6 and ICAM-1 levels. CONCLUSION: Serum miR-31 may be a biomarker for DN in T2D patients. The regulation of this miRNA seems to be related to the recruitment of leukocytes to vascular walls induced by pro-inflammatory and adhesion molecules.

Obesity impairs leukocyte-endothelium cell interactions and oxidative stress in humans.

BACKGROUND: To evaluate the relationship between leukocyte-endothelial cell interactions and oxidative stress parameters in non-diabetic patients with different grades of obesity. MATERIAL AND METHODS: For this cross-sectional study, 225 subjects were recruited from January 1, 2014 to December 31, 2016 and divided into groups according to BMI (<30 kg/m2 , 30-40 kg/m2 and >40 kg/m²). We determined clinical parameters, systemic inflammatory markers, soluble cellular adhesion molecules, leukocyte-endothelium cell interactions-rolling flux, velocity and adhesion-, oxidative stress parameters-total ROS, total superoxide, glutathione-and mitochondrial membrane potential in leukocytes. RESULTS: We verified that HOMA-IR and hsCRP increased progressively as obesity developed, whereas A1c, IL6 and TNFα were augmented in the BMI > 40 kg/m² group. The cellular adhesion molecule sP-selectin was increased in patients with obesity, while sICAM, total ROS, total superoxide and mitochondrial membrane potential were selectively higher in the BMI > 40 kg/m² group. Obesity induced a progressive decrease in rolling velocity and an enhancement of rolling flux and leukocyte adhesion. CONCLUSION: Our findings reveal that endothelial dysfunction markers are altered in human obesity and are associated with proinflammatory cytokines and increased oxidative stress parameters.

Encapsulated Ionic Liquids for CO2 Capture: Using 1-Butyl-methylimidazolium Acetate for Quick and Reversible CO2 Chemical Absorption.

The potential advantages of applying encapsulated ionic liquid (ENIL) to CO2 capture by chemical absorption with 1-butyl-3-methylimidazolium acetate [bmim][acetate] are evaluated. The [bmim][acetate]-ENIL is a particle material with solid appearance and 70 % w/w in ionic liquid (IL). The performance of this material as CO2 sorbent was evaluated by gravimetric and fixed-bed sorption experiments at different temperatures and CO2 partial pressures. ENIL maintains the favourable thermodynamic properties of the neat IL regarding CO2 absorption. Remarkably, a drastic increase of CO2 sorption rates was achieved using ENIL, related to much higher contact area after discretization. In addition, experiments demonstrate reversibility of the chemical reaction and the efficient ENIL regeneration, mainly hindered by the unfavourable transport properties. The common drawback of ILs as CO2 chemical absorbents (low absorption rate and difficulties in solvent regeneration) are overcome by using ENIL systems.

The association between academic engagement and achievement in health sciences students.

BACKGROUND: Educational institutions play an important role in encouraging student engagement, being necessary to know how engaged are students at university and if this factor is involved in student success point and followed.To explore the association between academic engagement and achievement. METHODS: Cross-sectional study. The sample consisted of 304 students of Health Sciences. They were asked to fill out an on-line questionnaire. Academic achievements were calculated using three types of measurement. RESULTS: Positive correlations were found in all cases. Grade point average was the academic rate most strongly associated with engagement dimensions and this association is different for male and female students. The independent variables could explain between 18.9 and 23.9% of the variance (p < 0.05) in the population of university students being analyzed. CONCLUSIONS: Engagement has been shown to be one of the many factors, which are positively involved, in the academic achievements of college students.

Bioaccessibility and Genoprotective Effect of Melanoidins Obtained from Common and Soft Bread Crusts: Relationship between Melanoidins and Their Bioactivity.

Bread crust constitutes an important by-product of the bakery industry, and its utilization for the isolation of melanoidins to be used as a functional ingredient can enhance its added value and contribute to health. The aim of this study was to evaluate the bioaccessibility, bioactivity, and genoprotective effect of melanoidins derived from bread crust. Bioaccessibility was assessed in gastric, intestinal digestion, and colonic fermentation fractions. The results revealed a relationship between bioaccessible melanoidins and their type (common or soft bread). No cytotoxicity effects were observed for bioaccessible fractions, as assessed by MTT and RTA methods, and they did not affect the distribution of E-cadherin in Caco-2 cells, confirming their ability to maintain membrane integrity. Furthermore, our study demonstrated that the gastrointestinal and colonic fermentation fractions successfully transported across the intestinal barrier, without affecting cell permeability, and showed antioxidant activity on the basolateral side of the cell monolayer. Remarkably, both fractions displayed a significant genoprotective effect in Caco-2 cells. Our findings provide crucial insights into the relationship between the melanoidins and their bioactivity and genoprotective effect. These results demonstrated the potential of bioaccessible melanoidins as valuable bioactive compounds for the development of functional foods, without showing toxic effects on gastrointestinal cells.

Renal sympathetic activity: A key modulator of pressure natriuresis in hypertension.

Hypertension is a complex disorder ensuing necessarily from alterations in the pressure-natriuresis relationship, the main determinant of long-term control of blood pressure. This mechanism sets natriuresis to the level of blood pressure, so that increasing pressure translates into higher osmotically driven diuresis to reduce volemia and control blood pressure. External factors affecting the renal handling of sodium regulate the pressure-natriuresis relationship so that more or less natriuresis is attained for each level of blood pressure. Hypertension can thus only develop following primary alterations in the pressure to natriuresis balance, or by abnormal activity of the regulation network. On the other hand, increased sympathetic tone is a very frequent finding in most forms of hypertension, long regarded as a key element in the pathophysiological scenario. In this article, we critically analyze the interplay of the renal component of the sympathetic nervous system and the pressure-natriuresis mechanism in the development of hypertension. A special focus is placed on discussing recent findings supporting a role of baroreceptors as a component, along with the afference of reno-renal reflex, of the input to the nucleus tractus solitarius, the central structure governing the long-term regulation of renal sympathetic efferent tone.

Virtual reality to improve low-back pain and pelvic pain during pregnancy: a pilot RCT for a multicenter randomized controlled trial.

A significant proportion of women experience low back and pelvic pain during and after pregnancy, which can negatively impact their daily lives. Various factors are attributed to these complaints, and many affected women do not receive adequate healthcare. However, there is evidence to support the use of different physiotherapeutic interventions to alleviate these conditions. Virtual reality is a promising complementary treatment to physiotherapy, particularly in improving pain perception and avoidance. The primary objective of this study is to evaluate the efficacy of a four-week program combining VR and physiotherapy compared to standard physiotherapy in pregnant women with low back and pelvic pain, in terms of improving pain avoidance, intensity, disability, and functional level. The study also aims to investigate patient satisfaction with the VR intervention. This research will be conducted through a multi-center randomized controlled clinical trial involving pregnant patients residing in the provinces of Seville and Malaga with a diagnosis of low back and pelvic pain during pregnancy. The alternative hypothesis is that the implementation of a Virtual Reality program in combination with standard physiotherapy will result in better clinical outcomes compared to the current standard intervention, which could lead to the development of new policies and interventions for these pathologies and their consequences. Clinical trial registration: clinicaltrials.gov, identifier NCT05571358.

Bread melanoidins as potential new sustainable bakery ingredients: a study using fat and fat-free bakery food models.

Melanoidins isolated from bakery by-products are proposed as new sustainable ingredients for bakery products. The colour, odour profile, texture, water activity, and antioxidant capacity of two bakery food models, fat and fat-free, enriched with 2% and 4% soft bread and common bread melanoidins, were analysed. The colour of the bakery food models with melanoidins was darker than that of the respective control; the fat-free models with melanoidins showed higher values of hardness than the control, while no significant effect was observed in the fat models; the water activity did not change compared to the control; the odour profile was significantly modified with different effects depending on the type of melanoidin quantity added and the food model (fat or fat-free); and the antioxidant capacity increased proportionally to the quantity of melanoidin added. In general, melanoidins from soft bread exhibited a higher effect than the melanoidins from common bread. The melanoidins isolated from both fat and fat-free bakery food models did not show cytotoxicity nor did they modify the levels of reactive oxygen species in Caco-2 cells. Therefore, the results seem to indicate the favourable potential of bread melanoidins as new sustainable ingredients for bakery products.

Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials.

(1) Objective: The aim of this study is to synthesize the effects of physical therapy on pain, frequency, or duration management in the short, medium, and long term in adult patients diagnosed with Tension-type headache (TTH). (2) Background: Tension-type headache (TTH) is the most common headache with migraine and its pathophysiology and treatment has been discussed for years without reaching a consensus. (3) Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42020175020). The systematic search for clinical trials was performed in the databases PubMed, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, Scopus, SciELO and Dialnet. Articles were selected according to the inclusion and exclusion criteria, regarding the effectiveness of physical therapy interventions on adult patients with TTH published in the last 11 years with a score ≥ 6 in the PEDro Scale (Physiotherapy Evidence Database). (4) Results: In total, 120 articles were identified, of which 15 randomized controlled trials were finally included in order to determine the inclusion criteria. Changes in pain intensity, headache frequency or headache duration of individual studies were described (5) Conclusions: This systematic review shows that there is no standardized physical therapy protocol for the approach to tension headache, although all the techniques studied to date address in one way or another the cranio-cervical-mandibular region. The approach to the cranio-cervical-mandibular region reports significant effects in terms of decreasing the intensity of pain and frequency of headache episodes in the short and medium term. More long-term longitudinal studies are needed.

Antimicrobial properties and volatile profile of bread and biscuits melanoidins.

This work gives novel information about the antimicrobial effect and volatiles of melanoidins isolated from Maria biscuit, common and soft bread. Melanoidins were isolated from scraped and sieved crusts (1 mm), after gluten digestion, 10 kDa ultrafiltration, and diafiltration. Finally, they were freeze-dried. Headspace solid-phase dynamic extraction coupled with a gas chromatograph with a mass spectrometer was used to determine the volatile profiles. The antimicrobial effect was evaluated against isolated strains of the most relevant food spoilage and pathogen microorganisms, together with some molds and yeasts. Melanoidins from common bread exhibited the most extensive antimicrobial activities and showed the most composite volatile profile. No undesirable compounds, such as furfural and 5-hydroxy-methyl-furfural, were found in any of the melanoidins studied. The obtained data pointed out that bakery melanoidins can exert effective food technological properties as natural antimicrobials that can improve shelf-life and security of foodstuffs, together with a possible contribution to food aroma.

Digital physiotherapy intervention in children in a low resource setting in Anantapur (India): Study protocol for a randomized controlled trial.

Introduction: In rural India the scarcity of physiotherapists and inequalities complicate the recovery of traumatized children. This study protocol will explore a digital physiotherapy intervention in children with ankle fracture in a low-resource setting to improve functional independence and quality of life. Methods and analysis: A randomized clinical trial with a mixed quantitative-qualitative design will be carried out. It is a single-blind study, where the evaluator does not know the nature of the intervention. Sixty subjects will be enrolled and randomly divided into two groups: the experimental group (EG) will receive a 4-week digital physiotherapy intervention through an app in a recycled mobile device after hospital discharge; the control group (CG) will receive the physiotherapy standard care recommended for patients discharged from the hospital. Subjects will receive a baseline (T0-pre) assessment of Functional Independence and Quality of Life. At the end of the 4-week intervention (T1-post) a new assessment of the outcome will be performed adding data on adherence, satisfaction (ad hoc questionnaire and TSQ), and barriers of use. Qualitative outcomes will also be explored. The author's hypothesized that the implementation of a digital physiotherapy intervention is feasible and effective to improve functional independence and quality of life. This study protocol is the first to explore the effect of digital physiotherapy intervention in children's patients in a low resource setting (Anantapur). Discussion: The successful delivery of the intervention, an optimal adherence records, the absence of significant adverse effects, user satisfaction level and the qualitative analysis of limitations, will demonstrate the effectiveness of these procedure. This study will add more evidence in support the use of digital physiotherapy practice as an effective tool. User particularities, provider's capacity, technological and cultural limitations, and considerations for vulnerable populations will be taken into account. Clinical trial registration: NCT04946695 (https://clinicaltrials.gov/).

Metformin modulates mitochondrial function and mitophagy in peripheral blood mononuclear cells from type 2 diabetic patients.

Type 2 diabetes is a chronic metabolic disease that affects mitochondrial function. In this context, the rescue mechanisms of mitochondrial health, such as mitophagy and mitochondrial biogenesis, are of crucial importance. The gold standard for the treatment of type 2 diabetes is metformin, which has a beneficial impact on the mitochondrial metabolism. In this study, we set out to describe the effect of metformin treatment on mitochondrial function and mitophagy in peripheral blood mononuclear cells (PBMCs) from type 2 diabetic patients. We performed a preliminary cross-sectional observational study complying with CONSORT requirements, for which we recruited 242 subjects, divided into 101 healthy volunteers, 93 metformin-treated type 2 diabetic patients and 48 non-metformin-treated type 2 diabetic patients. Mitochondria from the type 2 diabetic patients not treated with metformin displayed more reactive oxygen species (ROS) than those from healthy or metformin-treated subjects. Protein expression of the electron transport chain (ETC) complexes was lower in PBMCs from type 2 diabetic patients without metformin treatment than in those from the other two groups. Mitophagy was altered in type 2 diabetic patients, evident in a decrease in the protein levels of PINK1 and Parkin in parallel to that of the mitochondrial biogenesis protein PGC1α, both of which effects were reversed by metformin. Analysis of AMPK phosphorylation revealed that its activation was decreased in the PBMCs of type 2 diabetic patients, an effect which was reversed, once again, by metformin. In addition, there was an increase in the serum levels of TNFα and IL-6 in type 2 diabetic patients and this was reversed with metformin treatment. These results demonstrate that metformin improves mitochondrial function, restores the levels of ETC complexes, and enhances AMPK activation and mitophagy, suggesting beneficial clinical implications in the treatment of type 2 diabetes.

Stabilisation of betalains and phenolic compounds extracted from red cactus pear (Opuntia ficus-indica) by spray and freeze-drying using oca (Oxalis tuberosa) starch as drying aid.

The objective of this work was to evaluate the stabilisation of betalains and phenolic compounds extracted from red cactus pear by spray and freeze-drying. After hydroethanolic extraction and partial solvent removal under reduced pressure, the highly coloured extracts were enriched with oca starch and maltodextrin as drying aids in different ratios (100:0, 70:30, and 50:50, oca starch: maltodextrin) prior to spray and freeze-drying. The obtained microencapsulated extract powders were characterised by moisture content, hygroscopicity, solubility and morphology. In addition, the stability of the encapsulated betalains and phenolics was evaluated during storage at room temperature for 105 days. All microcapsules showed high retentions of betacyanins (69.9-86.5% after 105 days), betaxanthins (72.2-81.9%), phenolic compounds (46.5-63.5%) and antioxidant capacity (60.1-64.9%, FRAP method; 49.7-57.5%, ABTS method). The system with 70:30 starch:maltodextrin ratio as drying aids showed the highest values of retention regarding the polyphenol content (63.5%), antioxidant capacity (64.9% to FRAP method) and betacyanin content (86.5%), as well as a low degradation rate constant of betacyanins (1.23 × 10-3 days-1) and a long half-life (563 days). Oca starch used alone or in combination with maltodextrin has been shown to work adequately as a microencapsulating agent and stabilizer of pigments and antioxidants derived from red cactus pear.

Cytotoxicity study of bakery product melanoidins on intestinal and endothelial cell lines.

Melanoidins contribute to organoleptic properties of processed foods and exert benefits in health. The aim of this study was to isolate and characterize melanoidins from baked products (common bread, soft bread and biscuits), evaluate their cytotoxicity and determine their suitability as functional additives. Extraction yield, spectrophotometric characteristics, colorimetric properties, antioxidant capacity, and cytotoxicity of melanoidins were assessed. Among the studied products, soft bread had the highest extraction throughput. Melanoidins from biscuit showed the highest antioxidant capacity, closely followed by those of soft bread. Melanoidins did not exert cytotoxic effects on Caco-2 and HUVEC cells (viability was >80%). Nevertheless, incubation of HUVEC cells with melanoidins from common bread and biscuit slightly decreased viability, whereas gastrointestinal digestion of such melanoidins softened the decrease in cell viability. This study point to soft bread as a safe and efficient source of melanoidins, that could be potentially used in the future as functional ingredient.

Occupation and Sickness Absence in the Different Autonomous Communities of Spain.

The occupation of a worker is a determining factor of sickness absence (SA) and can influence both the beginning and continuation of the latter. This study describes SA in Spain, separately in the different Autonomous Communities (AC) in relation to the occupation of workers, with the aim of determining the possible differences in its frequency and duration, relating it also to the diagnosis. A total of 6,543,307 workers, aged 16 years and older, who had at least one episode of SA in the year 2019, constituted the study sample. The obtained results indicate that SA is more frequent and shorter in more elemental occupations. The average duration increases with age and is longer in women, except in technical and administrative occupations, where there is no gender divide. Sickness absences caused by musculoskeletal and mental disorders are more frequent in the lower occupational classes, although their average duration is shorter than in other, more qualified groups. The ACs with shorter duration in almost all the occupational groups are Madrid, Navarre and the Basque Country. In conclusion, SA is more frequent and shorter in lower occupational classes.

Service Quality in Early Intervention Centres: An Analysis of Its Influence on Satisfaction and Family Quality of Life.

Early Intervention (EI) is a set of interventions focused on responding to the needs of children with or at risk of developmental problems. This study aimed to investigate the relationships between the perceived quality of service, satisfaction and family quality of life. METHODS: to conduct a multi-centre, transversal study with a non-probabilistic sample. The participants (N = 1551) were families from 24 Early Intervention Centres (EICs) located in Spain. RESULTS: The results indicated an adequate fit of the measurement and structural models, with the latter showing a capacity of 73% to predict the family quality of life. The structural model established that the perceived service quality was a positive and significant predictor of satisfaction (ß = 0.85; p < 0.001). Both the perceived quality of service (ß = 0.28; p < 0.001) and satisfaction (ß = 0.33; p < 0.001) obtained a similar positive and significant relationship with family quality of life, which was slightly stronger than satisfaction. CONCLUSIONS: This study provided a better understanding of the importance of the services offered in EICs and their influence on the satisfaction and family quality of life of their users. Thus, delving into these relationships was highly relevant for decision-making in the context of EI.