Analysis of Madrid Primary Health-Care staff for the implementation of exercise prescription.

OBJECTIVE: To assess the self-perception of nurses and general practitioners (GPs) toward Physical Activity on Prescription (PAP) in Madrid Primary Health-Care (PHC). DESIGN: A survey-cohort study. SITE: Nurses and GPs of Madrid PHC System. PARTICIPANTS: A total of 319 GPs and 285 nurses' responders. MEASUREMENTS: Data were analyzed under a classification tree analysis by four predictor variables: (i) Health professional (Nurses/GPs); (ii) Exercise prescription collaboration with all health professionals: physicians, nurses, psychologists, physical therapists, sports medicine physicians, sports scientists, nutritionists, and teachers (Yes/No); (iii) PA promotion collaboration with Sports Scientists (Yes/No); and (iv) The stage of change of PHC staff to PA promotion (0-4 Likert scale). RESULTS: Regarding the predictor variable (i), responders without PA guidelines knowledge and positive attitude to collaborate with nurses in PA promotion are more GPs of female sex (nurses n=33 and GPs n=175) than male sex (nurses n=3 and GPs n=59) (p<.001). For the predictor variable (ii) only 9.30% of PHC staff with a positive attitude to collaborate with all health professionals in PA promotion and exercise prescription. For the predictor variable (iii) was shown low collaboration with sports physicians and sports scientists under a multidisciplinary PAP approach (26.50% responders). Finally, in the predictor variable (iv) Staff maintaining PAP for at least 6 months, self-considered active, and with PAP knowledge want to collaborate with Sports scientists (Yes=233; No=133). CONCLUSIONS: Nurses and GPs are conscious of health-related PA benefits despite the lack of PAP knowledge and lack of willingness to collaborate with other health personnel, exercise professionals, and community resources available.

Design and validity of the spanish version of two questionnaires related to adverse reactions to foodstuffs / Diseño y validación de la versión española de dos cuestionarios relacionados con reacciones adversas a alimentos

Introduction: there is an emerging current necessity of valid questionnaires, encompassing most of food, beverages, diseases, signs and symptoms currently related to the pathogenesis of adverse reactions to foodstuffs (ARFS) in the Spanish population. Objectives: this study aimed to design and validate two questionnaires to assess ARFS in the Spanish population, Food and Beverages Frequency Consumption Questionnaire to Identify Adverse Reactions to Foodstuffs (FBFC-ARFSQ-18); and Pathologies and Symptomatology Questionnaire associated with Adverse Reactions to Foodstuffs (PSIMP-ARFSQ-10). Methods: both questionnaires were designed adapting questionnaires from the literature; and validated, using the expert judgment method, in five phases: questionnaires development, pilot test and reliability, content validity, face validity, and ethical considerations. Questionnaires were developed using the REDCap™ tool hosted at the Universidad Politécnica de Madrid. A total of 20 Spanish experts evaluated the questionnaires. Cronbach’s alpha reliability coefficients were calculated using SPSS version 25.0 (IBM Corp., Armonk, NY-USA) and Aiken’s V coefficient values were calculated using ICaiken.exe (Visual Basic 6.0, Lima-Perú). Results: a final construct of questions was designed, ensuring no overlap, for FBFC-ARFSQ-18 and PSIMP-ARFSQ-10. Cronbach’s alpha reliability coefficients were 0.93 and 0.94; and Aiken’s V coefficient values were 0.90 (0.78-0.96 CI) and 0.93 (0.81-0.98 CI) for FBFC-ARFSQ-18 and PSIMP-ARFSQ-10, respectively. Conclusions: both validated questionnaires could be used to analyze the association between certain food and beverages consumption with ARFS, such as food allergies and food intolerances; also, to investigate the link between some specific diseases, signs and symptoms with ARFS.(AU)

Introducción: actualmente, existe una necesidad emergente de cuestionarios validados que abarquen la mayor parte de los alimentos, bebidas,enfermedades, signos y síntomas relacionados con la patogénesis de las reacciones adversas a los alimentos (RAA).Objetivos: diseñar y validar dos cuestionarios para evaluar las RAA en población española, el Cuestionario de Frecuencia de Consumo de Ali-mentos y Bebidas para Identificar Reacciones Adversas de Origen Alimentario (CFCAB-RAA-18); y el Cuestionario de Patologías y SintomatologíaAsociadas a Reacciones Adversas a Alimentos (PSIMP-RAA-10).Métodos: ambos cuestionarios se diseñaron adaptando cuestionarios de la literatura y se validaron, utilizando el método de juicio de expertos,en cinco fases: desarrollo de cuestionarios, prueba piloto y confiabilidad, validez de contenido, validez aparente y consideraciones éticas. Loscuestionarios se desarrollaron utilizando la herramienta REDCap™. Un total de 20 expertos evaluaron los cuestionarios. Se calcularon coefi-cientes de confiabilidad alfa de Cronbach con SPSS versión 25.0 (IBM Corp., Armonk, NY-Estados Unidos) y valores del coeficiente V de Aikencon ICaiken.exe (Visual Basic 6.0, Lima-Perú).Resultados: se diseñó una construcción final de preguntas, evitando solapamiento entre ambas herramientas. Los coeficientes de confiabilidadalfa de Cronbach fueron 0,93 y 0,94, y los valores del coeficiente V de Aiken fueron 0,90 (IC: 0,78-0,96) y 0,93 (IC: 0,81-0,98) (CFCAB-RAA-18y PSIMP-RAA-10, respectivamente).Conclusiones: ambos cuestionarios fueron validados y podrían utilizarse para analizar la asociación entre el consumo de determinados alimentosy bebidas con las RAA, como alergias e intolerancias alimentarias, así como para investigar el vínculo entre algunas enfermedades, signos ysíntomas específicos con las RAA.(AU)

Design and validity of the Spanish version of two questionnaires related to adverse reactions to foodstuffs.

Introduction: Introduction: there is an emerging current necessity of valid questionnaires, encompassing most of food, beverages, diseases, signs and symptoms currently related to the pathogenesis of adverse reactions to foodstuffs (ARFS) in the Spanish population. Objectives: this study aimed to design and validate two questionnaires to assess ARFS in the Spanish population, Food and Beverages Frequency Consumption Questionnaire to Identify Adverse Reactions to Foodstuffs (FBFC-ARFSQ-18); and Pathologies and Symptomatology Questionnaire associated with Adverse Reactions to Foodstuffs (PSIMP-ARFSQ-10). Methods: both questionnaires were designed adapting questionnaires from the literature; and validated, using the expert judgment method, in five phases: questionnaires development, pilot test and reliability, content validity, face validity, and ethical considerations. Questionnaires were developed using the REDCap™ tool hosted at the Universidad Politécnica de Madrid. A total of 20 Spanish experts evaluated the questionnaires. Cronbach's alpha reliability coefficients were calculated using SPSS version 25.0 (IBM Corp., Armonk, NY-USA) and Aiken's V coefficient values were calculated using ICaiken.exe (Visual Basic 6.0, Lima-Perú). Results: a final construct of questions was designed, ensuring no overlap, for FBFC-ARFSQ-18 and PSIMP-ARFSQ-10. Cronbach's alpha reliability coefficients were 0.93 and 0.94; and Aiken's V coefficient values were 0.90 (0.78-0.96 CI) and 0.93 (0.81-0.98 CI) for FBFC-ARFSQ-18 and PSIMP-ARFSQ-10, respectively. Conclusions: both validated questionnaires could be used to analyze the association between certain food and beverages consumption with ARFS, such as food allergies and food intolerances; also, to investigate the link between some specific diseases, signs and symptoms with ARFS.

Introducción: Introducción: actualmente, existe una necesidad emergente de cuestionarios validados que abarquen la mayor parte de los alimentos, bebidas, enfermedades, signos y síntomas relacionados con la patogénesis de las reacciones adversas a los alimentos (RAA). Objetivos: diseñar y validar dos cuestionarios para evaluar las RAA en población española, el Cuestionario de Frecuencia de Consumo de Alimentos y Bebidas para Identificar Reacciones Adversas de Origen Alimentario (CFCAB-RAA-18); y el Cuestionario de Patologías y Sintomatología Asociadas a Reacciones Adversas a Alimentos (PSIMP-RAA-10). Métodos: ambos cuestionarios se diseñaron adaptando cuestionarios de la literatura y se validaron, utilizando el método de juicio de expertos, en cinco fases: desarrollo de cuestionarios, prueba piloto y confiabilidad, validez de contenido, validez aparente y consideraciones éticas. Los cuestionarios se desarrollaron utilizando la herramienta REDCap™. Un total de 20 expertos evaluaron los cuestionarios. Se calcularon coeficientes de confiabilidad alfa de Cronbach con SPSS versión 25.0 (IBM Corp., Armonk, NY-Estados Unidos) y valores del coeficiente V de Aiken con ICaiken.exe (Visual Basic 6.0, Lima-Perú). Resultados: se diseñó una construcción final de preguntas, evitando solapamiento entre ambas herramientas. Los coeficientes de confiabilidad alfa de Cronbach fueron 0,93 y 0,94, y los valores del coeficiente V de Aiken fueron 0,90 (IC: 0,78-0,96) y 0,93 (IC: 0,81-0,98) (CFCAB-RAA-18 y PSIMP-RAA-10, respectivamente). Conclusiones: ambos cuestionarios fueron validados y podrían utilizarse para analizar la asociación entre el consumo de determinados alimentos y bebidas con las RAA, como alergias e intolerancias alimentarias, así como para investigar el vínculo entre algunas enfermedades, signos y síntomas específicos con las RAA.

Psychosocial factors related to physical activity in frail and prefrail elderly people.

BACKGROUND: Increased physical activity (PA) is a very important factor in a healthy aging lifestyle. Psychosocial factors have also a main role in the initiation and maintenance of this behavior, but nowadays its implications for frailty elderly people are unknown, therefore, the aim of this study was to identify the psychosociological variables of behavior change that influence the practice of (PA) in frail and prefrail elderly. METHODS: A total of 103 frail and pre-frail elderly people (72 females) participated in this cross-sectional study, on the framework of the EXERNET-Elder3.0 project. Age ranged from 68-94 years (mean = 80.4 ± 5.9 years). Individualized face-to-face interviews according to the constructs of the Transtheoretical Model of Change (TTM) [(decisional balance (DB) and self-efficacy (SE)], social support (SS) (family and friends) and outcome expectations (OE) were administered to all participants. RESULTS: Significant differences were found in DB, perceived benefits (PBn), SE, family-related SS and OE as a function of stages of change (SoC) (p < 0.005), but no significant were found in perceived barriers (PBrr) (p = 0.259) and friends-related SS (p = 0.068). According to the Scheffé post-hoc test, those in advanced SoC (Action-Maintenance), scored higher than those in lower SoC (Precontemplation-Contemplation and Preparation). CONCLUSION: The scores obtained from the study variables differed according to the SoC, supporting the external validity for the use of the TTM in frailty elderly. Further research is needed to determine the impact of PBrr and friends-related SS on this people, as well as to identify the validity of this model in the long-term in this population.

Physical exercise training in the syllabus of Bachelor of Science in nursing degrees: an environmental scan.

Background: Scientific evidence regarding the effectiveness of physical activity (PA) in the prevention and treatment of chronic diseases is increasing. Healthcare systems are trying to increase exercise prescription treatments. However, it is not clear if health professionals are sufficiently trained. Aim: to analyze the contents related to PA and exercise in the prevention and treatment of chronic diseases in the syllabus of the Bachelor of Science in Nursing at all Spanish universities. Methods: A systematic environmental scan that included a web page search of curricular guide programs of all Spanish universities offering the Bachelor of Science in Nursing was undertaken for the 2017-2018 academic course. The assessment of the European Credit Transfer System (ECTS) about physical activity and/or exercise health-related benefits in the prevention or treatment of chronic diseases was performed by two experts in a peer-review process. ECTS of Practicum and Bachelor thesis were not included in the analysis. Results: In the mean, the Bachelor of Science in Nursing dedicated 5.82% (5.01% mandatory and 0.82% voluntary) of a total of 240 ECTS (ranging from 0 to 45 ECTS). The majority of contents were related to PA promotion; in contrast, contents related to exercise prescription are neglectable. Five Spanish universities do not offer any academic teaching to physical activity on prescription. Conclusions: A great disparity between universities was identified. In general, acquired knowledge seems scarce for PA promotion and exercise prescription in primary healthcare staff. Nurses would need additional physical activity on prescription training to improve PA promotion and exercise prescription knowledge as a coadjutant non-pharmacological treatment for non-communicable chronic diseases in Primary Healthcare settings.

Adherence Factors Related to Exercise Prescriptions in Healthcare Settings: A Review of the Scientific Literature.

Purpose: Physical activity on prescription (PAP) is being introduced in healthcare systems around the world. To apply a successful treatment is as important as to know if the patient is able to follow-up. In order to contribute to the development of effective PAP strategies, we have analyzed PAP-related adherence factors with a multi-dimensional approach. Methods PAP adherence factors in studies published in the WoS, Pubmed, and PsycInfo were reviewed, according to the WHO five dimensions adherence model. In a setting of prediction or adherence analysis of adults with high-risk factors or chronic diseases, the methods used to measure physical activity (PA), PAP treatments, PAP adherence, and mentioned theories related to human behavior change were analyzed. Results A total of 32 studies fulfilled our inclusion criteria. According to the WHO five dimensions adherence model, these total clustered adherence variables were observed: social/economic (n = 100), healthcare system/healthcare team (n = 18), condition-related (n = 61), therapy-related (n = 20), and patient-related (n = 47). PAP adherence has mainly been measured by adherence to measurement methods and by calculating attended versus total sessions scheduled. PA level was measured mainly by questionnaires and exercise referrals were the most frequent PAP resource in analyzed studies. Transtheoretical model of behavior change was the theory most referenced. Conclusion A lack of considering health system/healthcare-team factors and therapy-related factors has been identified, as most studies only analyze social/economic factors in non-pharmacological PAP adherence studies in healthcare settings. A multidimensional approach should be adopted to analyze PAP adherence in healthcare settings.

Is Energy Expenditure or Physical Activity Considered When Energy Intake Is Measured? A Scoping Review 1975-2015.

The health-transitions humans have delivered during the 20th Century associated with the nutrition is that from undernutrition to obesity, which perseveres in the current years of the 21st Century. Energy intake (EI) is a contributing factor and therefore a fascination in nutritional sciences. However, energy expenditure (EE) has not been usually considered as a conjoint factor. Thus, this study aimed to review if studies on adults consider data on dietary intake, specifically EI, and included data on EE and physical activity (PA). A search of MEDLINE from 1975 to December 2015 was managed. Our scoping review consisted of keywords related to EI, dietary allowances, and nutritional requirements. From 2229 acknowledged articles, 698 articles were finally taken fulfilling inclusion and quality criteria. A total of 2,081,824 adults (53.7% females) were involved, and most studies had been conducted in EEUU (241), Canada (42), Australia (30), Japan (32), and Brazil (14). In Europe, apart from UK (64), the Netherlands (31) and France (26) led the classification, followed by Sweden (18), Denmark (17), and France (26). Mediterranean countries are represented with 27 studies. A total of 76.4% did not include EE and 93.1% did not include PA. Only 23.6% of the studies contained both EI and EE. A large methodological diversity was perceived, with more than 14 different methods regarding EI, and more than 10 for EE. PA was only analyzed in scarce articles, and scarcely considered for interpretation of data and conclusions. Moreover, PA was often measured by subjective questionnaires. Dietary surveys show a large diversity regarding methodology, which makes comparability of studies difficult. EE and PA are missing in around 80% of studies or are not included in the interpretation of results. Conclusions regarding EI or diet adequacy in adults should not be taken without analyzing EE and PA.

Design and Validity of a Choice-Modeling Questionnaire to Analyze the Feasibility of Implementing Physical Activity on Prescription at Primary Health-Care Settings.

Worldwide health policies are trying to implement physical activity on prescription (PAP) at healthcare settings. However, there is not a proper methodology to analyze PHC organizational staff factors. This study aims to validate two questionnaires to assess the self-perception of nurses and general practitioners to implement PAP at primary healthcare (PHC) settings. The designed choice-modeling Google-form questionnaire was sent to 11 expert nurses and 11 expert sports medicine physicians. Experts evaluated each question on a 1-5 points Likert-type scale according to their expertise. Aiken's V coefficient values ≥0.75 were used to validate separately each question using the Visual Basic-6.0 software. A total of 10 sports medicine physicians and 10 nurses with 28.4 ± 5.1 y and 16.3 ± 11.8 y of PAP experience, respectively, validated the questionnaire. One expert in each group was not considered for offering 3 ± SD answers in ≥2 questions respect to the mean of the rest of experts. Final Aiken's V coefficient values were 0.89 (0.77-1.00) for the nurses' questionnaire and 0.84 (0.77-0.95) for the physicians' one. The questionnaires designed to assess the PAP self-perception of PHC nurses and physicians were validated. This methodology could be used to analyze PHC organizational staff factors in order to achieve an efficient PAP implementation in other PHC contexts.

[Physical activity as prevention and treatment resource of chronic diseases in the syllabus of Medicine and Sport Sciences at Spanish universities]. / La actividad física en el currículo universitario español de los grados de Medicina y Ciencias de la Actividad Física y del Deporte como recurso en la prevención y tratamiento de las enfermedades crónicas.

INTRODUCTION: Currently, there is scientific evidence about the benefits of physical exercise over human health. The aim of this study was to review the curricula of Medicine and Sport Sciences at Spanish universities, specifically regarding the contents related to physical exercise in the promotion, prevention and treatment of non-communicable chronic diseases (NCDs). MATERIAL AND METHODS: In a systematic way, all syllabus, programs and contents of the different subjects were reviewed for all Spanish universities which offer the Bachelors of Medicine and Sport Sciences. Total, compulsory and optional European Credit Transfer System (ECTS) were analyzed and added for each university. Practicum and Bachelor thesis were not considered. RESULTS: In the mean, Medicine studies dedicate 3.62% (2.38% mandatory and 1.20% optional) of the total 360 ECTS to these contents. In Sport Sciences studies, of the total 240 ECTS, 17.78% (9.87% mandatory and 7.92% optional) were identified as related to these areas of knowledge. Contents ranged from 36 to 4.5 ECTS in Medicine and from 48 to 28 ECTS in Sport Sciences. CONCLUSION: There is a great disparity between universities for both degrees among Spanish universities. Contents related to the efficient use of physical exercise for the prevention and treatment of non-communicable chronic diseases are scarce, especially in Medicine. Results indicate the need of increasing these contents in undergraduate studies and/or include them in Master or other programs.

INTRODUCCIÓN: la evidencia científica ha acreditado los beneficios que posee la actividad física sobre la salud. El objetivo de esta revisión fue analizar la formación curricular de los estudiantes de Medicina y de Ciencias de la Actividad Física y del Deporte (CAFYD) en las universidades españolas, en relación a la prevención y el tratamiento de enfermedades crónicas a través de la actividad y el ejercicio físico. MATERIAL Y MÉTODOS: de manera sistemática, se han revisado los planes de estudio de todas las universidades españolas que tienen capacidad legal para impartir de forma presencial los grados de Medicina y CAFYD, contabilizando el promedio de créditos ECTS (European Credit Transfer System) totales, obligatorios y optativos de las asignaturas que abordan la promoción, la prevención y el tratamiento de las enfermedades crónicas a través del ejercicio físico, excluyendo practicum y trabajos fin de grado (TGF). RESULTADOS: el grado de Medicina dedica un promedio del 3,62% (2,38% y 1,20% créditos obligatorios y optativos, respectivamente) (360 ECTS) y el grado de CAFYD un 17,78% (9,87% y 7,92%) (240 ECTS) a contenidos relacionados con la actividad física como herramienta en la prevención y tratamiento de las enfermedades crónicas no trasmisibles. El rango va de 36 a 4,5 ECTS en Medicina y de 48 a 28 ECTS en CAFYD. CONCLUSIÓN: se observa cierta disparidad entre los planes de estudio de las universidades españolas para los dos grados. Los créditos ECTS relacionados con actividad física y salud resultan escasos en el currículo de ambos grados, especialmente en Medicina. Los resultados indican la necesidad de aumentar estos contenidos en los estudios de grado y/o incluirlos en programas de postgrado.

La actividad física en el currículo universitario español de los grados de Medicina y Ciencias de la Actividad Física y del Deporte como recurso en la prevención y tratamiento de las enfermedades crónicas / No disponible

Introducción: la evidencia científica ha acreditado los beneficios que posee la actividad física sobre la salud. El objetivo de esta revisión fue analizar la formación curricular de los estudiantes de Medicina y de Ciencias de la Actividad Física y del Deporte (CAFYD) en las universidades españolas, en relación a la prevención y el tratamiento de enfermedades crónicas a través de la actividad y el ejercicio físico. Material y métodos: de manera sistemática, se han revisado los planes de estudio de todas las universidades españolas que tienen capacidad legal para impartir de forma presencial los grados de Medicina y CAFYD, contabilizando el promedio de créditos ECTS (European Credit Transfer System) totales, obligatorios y optativos de las asignaturas que abordan la promoción, la prevención y el tratamiento de las enfermedades crónicas a través del ejercicio físico, excluyendo practicum y trabajos fin de grado (TGF). Resultados: el grado de Medicina dedica un promedio del 3,62% (2,38% y 1,20% créditos obligatorios y optativos, respectivamente) (360 ECTS) y el grado de CAFYD un 17,78% (9,87% y 7,92%) (240 ECTS) a contenidos relacionados con la actividad física como herramienta en la prevención y tratamiento de las enfermedades crónicas no trasmisibles. El rango va de 36 a 4,5 ECTS en Medicina y de 48 a 28 ECTS en CAFYD. Conclusión: se observa cierta disparidad entre los planes de estudio de las universidades españolas para los dos grados. Los créditos ECTS relacionados con actividad física y salud resultan escasos en el currículo de ambos grados, especialmente en Medicina. Los resultados indican la necesidad de aumentar estos contenidos en los estudios de grado y/o incluirlos en programas de postgrado (AU)

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Actividad física: algo más que gasto energético / Physical activity is more than energy expenditure

Tradicionalmente, se ha considerado el balance energético como la diferencia entre consumo y gasto calórico, asociando resultados positivos a un incremento del índice de masa corporal, que puede conducir hacia sobrepeso u obesidad en casos extremos. En la actualidad, se conocen diversos factores genéticos, metabólicos y ambientales (regulación del apetito, intensidad del ejercicio, sedentarismo), que afectan al balance energético y están induciendo hacia una pandemia de enfermedades crónicas, como la obesidad. El avance del conocimiento científico viene indicando que el ejercicio físico planificado que cumpla con las recomendaciones de actividad física, hace aumentar el nivel de condición física, reduce el sedentarismo y provoca una disminución del índice de masa corporal con un descenso asociado del porcentaje de masa grasa, factores que inducen sobre el bienestar físico, psicológico y socio-emocional (AU)

Traditionally, energy balance has only been shown as result between energy intake and energy expenditure, associating positive results with increase of body mass index and with overweight and obesity in extreme cases. Recently, several environmental, metabolic and genetic factors have been identified, such as regulation of appetite, exercise intensity and sedentary lifestyle, all of them affecting energy balance and inducing a pandemic of chronic diseases, including obesity. There is scientific evidence that physical activity, better if systematically planned, at recommended levels, reduces body mass index and fat mass levels, improves physical fitness and has consequently physical, social, emotional and cognitive benefits (AU)