Publications by authors named "Jose C Adsuar"

43 Publications

A Multicomponent Program to Improve Self-Concept and Self-Esteem among Intimate Partner Violence Victims: A Study Protocol for a Randomized Controlled Pilot Trial.

Int J Environ Res Public Health 2021 05 6;18(9). Epub 2021 May 6.

Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain.

Background: Intimate Partner Violence (IPV) is a major public health problem that affects one-third of women aged 15 around the world. Interventions for IPV victims are essential for women's self-esteem and self-concept recovery. This project aims to assess the effects of an eight-session multicomponent intervention program based on group psychological therapy and adventure activities in (1) self-esteem, (2) self-concept, (3) body image, (4) self-efficacy and (5) depression symptomatology in IPV victims.

Methods/design: A single-blind, randomized controlled pilot study, with experimental and control group, will be carried out. 34 IPV female victims will be recruited and equally assigned to the experimental ( = 17) or the control ( = 17) group. Primary outcome measures will include self-esteem, while secondary measures will be focused on self-concept, body image, self-efficacy, and depressive symptoms. Intention to treat and efficacy statistical analyses will be also performed.

Discussion: This project will explore the effects of a new multicomponent program which includes cognitive-behavioral therapy sessions and outdoor adventure activities on affective and emotional variables, often affected in IPV victims. In addition, orientations to incorporate the main findings into the community based IPV resources and victims' services will be provided.
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http://dx.doi.org/10.3390/ijerph18094930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125387PMC
May 2021

Concurrent Validity and Reliability of a Novel Visual Analogue Fitness Perception Scale for Adolescents (FP VAS A).

Int J Environ Res Public Health 2021 03 26;18(7). Epub 2021 Mar 26.

Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.

Introduction: Self-reported physical fitness (PF) provides an accurate measure of PF, specifically for young people. The Visual Analogue Scale (VAS) is one of the most used psychosocial measurement methods. The main arguments in favor of VAS are its ease of use and comprehension, particularly for less educated participants. There are some scales that assess self-perception of PF, but the VAS presented in this study covers a higher range of responses and a number of variables than other already validated measures.

Aims: The aim was to determine the concurrent validity of the Visual Analogue Fitness Perception Scale for Adolescents (FP VAS A) (Sub-study 1) and check its reliability (Sub-study 2).

Methods: Anthropometric and body composition measurements were performed, as well as PF tests (manual dynamometry, Course Navette, 4 × 10 m, and sit and reach). The International Fitness Scale (IFIS) and FP VAS A were used to assess self-reported PF.

Results: Two sub-studies were carried out: in sub-study 1 a total of 67 students (26 males and 41 females aged 12-16 years) participated. The results showed a significant direct correlation between the level of PF and self-perception of PF (IFIS and FP VAS A), with the FP VAS A obtaining a higher correlation with PF ( = 0.444 to 0.666) than the IFIS and PF ( = 0.154 to 0.557). In sub-study 2 (test-retest of the FP VAS A), a total of 217 students (120 males and 97 females aged 12-17 years) participated. It showed a moderate reliability for all items; the intraclass correlation coefficient (ICC) was between 0.800 and 0.870, and kappa values ranged from 0.622 (endurance) to 0.458 (flexibility). In addition, Cronbach's α for the total was 0.860.

Conclusion: This study showed good validity and reliability for the FP VAS A in adolescents.
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http://dx.doi.org/10.3390/ijerph18073457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037782PMC
March 2021

Association between 30-s Chair Stand-Up Test and Anthropometric Values, Vibration Perception Threshold, FHSQ, and 15-D in Patients with Type 2 Diabetes Mellitus.

Biology (Basel) 2021 Mar 22;10(3). Epub 2021 Mar 22.

Health Economy Motricity and Education (HEME), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain.

Background: Type 2 diabetes mellitus (T2DM) is a chronic, worldwide disease affecting more than 400 million people. This pathology involves several associated problems, such as diabetic neuropathy complications, obesity, and foot problems, both in terms of health and sensitivity.

Objective: The objective of this study was to explore the relationships of the 30-s chair stand-up test with the Foot Health Status Questionnaire (FHSQ), the vibration perception threshold (VPT), and the 15-dimensional (15-D) questionnaire in T2DM people.

Methodology: Ninety participants with T2DM were assessed in terms of fat mass percentage, VPT, foot health, health-related quality of life (HRQoL), and the 30-s chair stand-up test.

Results: The 30-s chair stand-up test was found to exhibit a moderate relationship with "physical activity" (rho = 0.441; ≤ 0.001) and "vigor" (rho = 0.443; ≤ 0.001) from FHSQ. The 30-s chair stand-up test was also found to be weakly associated with foot pain (rho = 0.358; = 0.001), 15-D total score (rho = 0.376; ≤ 0.001), "sleeping" (rho = 0.371; < 0.001), and "depression" (rho = 0.352; = 0.001).

Conclusions: The 30-s chair stand-up test is associated with "physical activity", "vigor", and "foot pain" from the FHSQ and the 15-D questionnaire total score and its dimensions "sleeping" and "depression" in type 2 diabetes mellitus patients. Therefore, following the results obtained, qualified clinicians can use the 30-s chair stand-up test as a good tool for monitoring and managing type 2 diabetes.
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http://dx.doi.org/10.3390/biology10030246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004132PMC
March 2021

Validation of a Physical Activity and Health Questionnaire Evaluating Knowledge of WHO Recommendations among Colombians.

Int J Environ Res Public Health 2021 03 29;18(7). Epub 2021 Mar 29.

Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.

Knowledge of physical activity (PA) can be considered a predictor of public health for society. Thus, this study aims to show content validity of the "Knowledge Questionnaire on World Health Organization (WHO) Recommendations on PA and Health" (CUAFYS-A) and reference values on adults' knowledge of the WHO recommendations on PA. This is a quantitative, non-experimental, descriptive, and cross-sectional study, in which 579 adults completed an online questionnaire with demographic data. The questionnaire was made up of 9 items to measure PA related to knowledge. For the elaboration of the items of the questionnaire a disciplinary team formed it and for the analysis of results, a descriptive analysis of these was applied. Then an inferential analysis was performed, content validity, construct validity, and reliability were analyzed. The CUAFYS-A after its content analysis, obtained appropriate results in terms of pertinence and relevance; additionally, it showed Cronbach's alpha coefficient of 0.62. Thereby, it was concluded the CUAFYS-A questionnaire proved to be a valid and reliable instrument to show reference values and to evaluate the knowledge of adults of PA and health according to the WHO recommendations.
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http://dx.doi.org/10.3390/ijerph18073526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037879PMC
March 2021

Physical Activity Recommendations during COVID-19: Narrative Review.

Int J Environ Res Public Health 2020 12 24;18(1). Epub 2020 Dec 24.

Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.

Regular practice of physical activity plays a fundamental role in preventing and treating cardiovascular diseases such as obesity, hypertension, diabetes, and metabolic syndrome. During the pandemic caused by COVID-19 and the lockdown established, people have reduced considerably their mobility and motor activity, which has led to an increase in unhealthy lifestyle habits, raising the risk of suffering from diseases. This paper consists of reviewing the existing scientific literature on recommendations of physical activity during the pandemic and to establish specific guidelines according to the type of population to which the activity would be directed. A search strategy has been carried out in the different databases: Embase, PubMed, SCOPUS, SPORTDiscus, and Web of Science (WoS), including all the articles published until 14 May 2020, to find essays with recommendations on aerobic activity, muscle strengthening, flexibility-stretching, meditation-relaxation, and balance exercises. The articles found have been evaluated considering the following criteria: type of publication, proposals for physical exercise, language, and, if it appears, volume of activity, frequency, intensity, and rest. The results obtained 29 articles that discuss patterns of physical activity, although there is no common consensus on such recommendations during confinement, nor are they suitable for all people. From these results, we can conclude that physical activity is widely recommended during the confinement caused by COVID-19, mainly through the performance of aerobic, strength, flexibility, and balance exercises.
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http://dx.doi.org/10.3390/ijerph18010065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796360PMC
December 2020

The effect of two types of combined training on bio-motor ability adaptations in sedentary females.

J Sports Med Phys Fitness 2020 Dec 18. Epub 2020 Dec 18.

Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal.

Background: The purpose of this study was to compare the effects of combined training of high-volume/low intensity vs. low volume/high intensity on different bio-motor adaptations in sedentary women.

Methods: Thirty sedentary healthy females (age, 22.1±3.3 yrs), were randomly assigned into: Control group (CG; n=10), High-Volume/low-intensity training group (HV; n=10); or High-Intensity/low-volume training group (HI; n=10). Training protocols were performed during 8 weeks, on 3 non-consecutive days a week.

Results: Post-intervention, there were significant main effects of time and a group by time interaction for all body composition and performance variables (p ≤ 0.001), while no significant differences were found for changes in maximum heart rate. Pairwise comparisons revealed significant decreases in body fat percentage and speed test in HV and HI (p ≤ 0.001) after intervention, while anaerobic power significantly increased in HV and HI (p ≤ 0.001). The rating of perceived exertion (RPE) was significantly superior in HI than HV (p ≤ 0.05). Additionally, there were significant main effects of time and a group by time interaction for all 1-repetition maximum tests (p ≤ 0.001).

Conclusions: Combined interval training and resistance training were effective for improving bio-motor parameters in sedentary young women. HV training produced less RPE than HI training, which may potentially increase adherence to training protocols postintervention.
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http://dx.doi.org/10.23736/S0022-4707.20.11736-5DOI Listing
December 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Relationship between Health-Related Quality of Life and Physical Activity in Children with Hyperactivity.

Int J Environ Res Public Health 2020 04 18;17(8). Epub 2020 Apr 18.

Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.

The main purpose of this paper was to evaluate the relationship between health-related quality of life (HRQoL) and the frequency of physical activity in Spanish children aged 8 to 14 years with attention deficit hyperactivity disorder (ADHD). Sample selection was performed using the data obtained from the children's questionnaire of the National Health Survey of Spain 2017 that is carried out with the children's parents, and that had an initial size of 6106 participants. After the application of the inclusion and exclusion criteria, the sample size was reduced to 496 subjects. Results show significant differences between the different levels of physical activity frequency, as well as a positive correlation of the average between HRQoL and ADHD. In conclusion, the practice of physical activity may contribute to the improvement of HRQoL in children with ADHD, possibly achieving greater benefits at higher levels of physical activity practice.
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http://dx.doi.org/10.3390/ijerph17082804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216053PMC
April 2020

Effects of 8-Week Whole-Body Vibration Training on the HbA1c, Quality of Life, Physical Fitness, Body Composition and Foot Health Status in People with T2DM: A Double-Blinded Randomized Controlled Trial.

Int J Environ Res Public Health 2020 02 18;17(4). Epub 2020 Feb 18.

Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain.

The aim of this study was to analyze the effects of an 8-week whole-body vibration (WBV) on the quality of life, physical fitness, body composition, glycosylate hemoglobin (HbA1c), lipid profile, and foot health status in people with type II diabetes mellitus (T2DM). It was performed as a double-blinded randomized controlled trial of 90 people with T2DM. Primary care facilities were used. The 8-week WBV training consisted of maintaining a knee flexion at 45° during five to nine series of 30-60 s in a vibration frequency that oscillated between 12.5-18.5 and 30 s of recovery between series. The placebo group had to perform the same protocol but without vibration. Participants performed the protocol three times per week. The WBV training significantly reduced the fat mass (%) of people with T2DM. However, significant effects of WBV training were not found in the quality of life, physical fitness, foot health status, lipid profile, blood pressure, fasting blood glucose, or HbA1c. Nevertheless, within groups enhances were found in HbA1c, blood pressure, fasting blood glucose, foot health status, health-related quality of life, timed-up and go test, and chair-stand test in both WBV and placebo groups. WBV was shown to be beneficial for reducing the fat mass and lipid profile of people with T2DM. The improvements of the placebo group could be due to both the social benefits of enrolling in an intervention and the physical fitness benefits of isometric contractions. Further studies are needed to clarify the effects of WBV and to establish a dose-response relationship in people with T2DM.
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http://dx.doi.org/10.3390/ijerph17041317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068407PMC
February 2020

The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 15;26(Supp 1):i3-i11. Epub 2020 Jan 15.

Department of Hypertension, Pomeranian Medical University, Szczecin, Poland.

Background: Falls can lead to severe health loss including death. Past research has shown that falls are an important cause of death and disability worldwide. The Global Burden of Disease Study 2017 (GBD 2017) provides a comprehensive assessment of morbidity and mortality from falls.

Methods: Estimates for mortality, years of life lost (YLLs), incidence, prevalence, years lived with disability (YLDs) and disability-adjusted life years (DALYs) were produced for 195 countries and territories from 1990 to 2017 for all ages using the GBD 2017 framework. Distributions of the bodily injury (eg, hip fracture) were estimated using hospital records.

Results: Globally, the age-standardised incidence of falls was 2238 (1990-2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017. Age-standardised prevalence was 5186 (4622-5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. Age-standardised mortality rate was 9.2 (8.5-9.8) per 100 000 which equated to 695 771 (644 927-741 720) deaths in 2017. Globally, falls resulted in 16 688 088 (15 101 897-17 636 830) YLLs, 19 252 699 (13 725 429-26 140 433) YLDs and 35 940 787 (30 185 695-42 903 289) DALYs across all ages. The most common injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle. Globally, age-specific YLD rates increased with age.

Conclusions: This study shows that the burden of falls is substantial. Investing in further research, fall prevention strategies and access to care is critical.
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http://dx.doi.org/10.1136/injuryprev-2019-043286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571347PMC
October 2020

Reliability of isokinetic knee strength measurements in children: A systematic review and meta-analysis.

PLoS One 2019 17;14(12):e0226274. Epub 2019 Dec 17.

Health, Economy, Motricity and Education Research Group, Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain.

Measuring muscle strength using isokinetic dynamometry allows evaluating and comparing normal and sick children, establishing recovery and rehabilitation goals, and quantitatively monitoring the course of a disease and the response to treatment. The purpose of this study was to carry out a systematic review and meta-analysis focusing on studies that examined the test-retest reliability of isokinetic knee strength measurements in children. This study is important because isokinetic dynamometry is the gold standard for evaluating muscle strength and it allows comparing muscle performance in children. The databases used were PubMed, Web of Science Scopus, and Embase (up to July 26, 2019). Only studies published in English were included in this review. All studies focused on the reliability of isokinetic knees in healthy children or those with cerebral palsy applied to dynamic contractions (concentric or eccentric) and provided measures of strength, reproducibility, ICC, peak torque, or SEM. We found a total of 143 abstracts and examined 94 articles to determine if they met the inclusion criteria. Finally, 10 articles were included in the systematic review and five studies (96 subjects) formed the meta-analysis sample, all of which focused on the reliability of isokinetic knees in the concentric mode. The CAT and QAREL scales were used to assess the quality of the included studies. The meta-analysis revealed high intra-class correlation coefficients (ICC) (0.84; p < 0.001; n = 96 subjects) in the flexion and excellent intra-class correlation coefficients (ICC 0.90; p < 0.001; n = 96 subjects) in the extension. Isokinetic dynamometry could be indicated as a method for measuring muscle strength training in children. However, the reviewed studies suggest some methodological issues in isokinetic tests, such as the rest days between testing and retesting, using the same speeds, protocols, and evaluators, and the performance of the subjects, so more research is required.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226274PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917261PMC
March 2020

Test-Retest Reliability of Isokinetic Arm Strength Measurements in Competitive Swimmers.

J Hum Kinet 2018 Dec 31;65:5-11. Epub 2018 Dec 31.

Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain.

Swimming motor patterns lead internal rotators to grow stronger than antagonist muscles, what may increase the risk of injury in swimmers. Injury prevention often involves the improvement of external rotators strength, as well as the external rotation/internal rotation ratio. The current research aimed to evaluate the test-retest reliability of shoulder concentric rotation strength in competitive swimmers using an isokinetic dynamometer. The study enrolled 35 competitive swimmers aged between 13 and 19 years. Concentric movements were performed including internal and external rotations of the shoulder joint following the instructions of the standardized protocol. The angular velocity of the test was defined at 60º/s. Outcome measures were peak torque (Nm) and work (J), measured in both, the dominant and non-dominant arms. The external rotation/internal rotation ratio was also calculated. Reliability was excellent for peak torque and work. For the external rotation/internal rotation ratio, the ICC oscillated between 0.744 and 0.860 for the work ratio of the non-dominant arm and the peak torque ratio of the dominant arm, respectively. In general terms, better reliability was observed for peak torque compared with work, for external rotation compared with internal rotation, and for the dominant arm compared with the non-dominant one.
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http://dx.doi.org/10.2478/hukin-2018-0035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341972PMC
December 2018

Effects of Dance on Pain in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis.

Evid Based Complement Alternat Med 2018 1;2018:8709748. Epub 2018 Oct 1.

Faculty of Sport Science, University of Extremadura, Extremadura, Spain.

Objective: The aim of this study was to perform a systematic review on the effectiveness of dance-based programs in patients with fibromyalgia, as well as calculate the overall effect size of the improvements, through a meta-analysis.

Methods: The Cochrane Library, Physiotherapy Evidence Database (PEDro), PubMed, TRIP, and Web of Science (WOS) were selected to identify the articles included in this systematic review and meta-analysis. A total of seven articles fulfilled all inclusion and exclusion criteria. PRISMA guidelines were followed in the data extraction process. The level of evidence was established following guidelines from the Dutch Institute for Healthcare Improvement (CBO).

Results: The studies were all randomized controlled trials, but not double-blind. Duration of dance programs ranged from 12 to 24 weeks. Sessions lasted between 60 and 120 minutes and were performed 1-2 times per week. The overall effect size for pain was -1.64 with a 95% CI from -2.69 to -0.59 which can be interpreted as large. In addition, significant improvements were observed in quality of life, depression, impact of the disease, anxiety, and physical function.

Conclusion: Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia, leading to a significant reduction of the level of pain with an effect size that can be considered as large. However, findings and conclusions from this meta-analysis must be taken with caution due to the small number of articles and the large heterogeneity.
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http://dx.doi.org/10.1155/2018/8709748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188768PMC
October 2018

Converting Parkinson-Specific Scores into Health State Utilities to Assess Cost-Utility Analysis.

Patient 2018 12;11(6):665-675

Department of Applied Economics, Faculty of Economics and Business, University of Murcia, Murcia, Spain.

Objectives: The aim of this study was to compare the Parkinson's Disease Questionnaire-8 (PDQ-8) with three multi-attribute utility (MAU) instruments (EQ-5D-3L, EQ-5D-5L, and 15D) and to develop mapping algorithms that could be used to transform PDQ-8 scores into MAU scores.

Methods: A cross-sectional study was conducted. A final sample of 228 evaluable patients was included in the analyses. Sociodemographic and clinical data were also collected. Two EQ-5D questionnaires were scored using Spanish tariffs. Two models and three statistical techniques were used to estimate each model in the direct mapping framework for all three MAU instruments, including the most widely used ordinary least squares (OLS), the robust MM-estimator, and the generalized linear model (GLM). For both EQ-5D-3L and EQ-5D-5L, indirect response mapping based on an ordered logit model was also conducted. Three goodness-of-fit tests were employed to compare the models: the mean absolute error (MAE), the root-mean-square error (RMSE), and the intra-class correlation coefficient (ICC) between the predicted and observed utilities.

Results: Health state utility scores ranged from 0.61 (EQ-5D-3L) to 0.74 (15D). The mean PDQ-8 score was 27.51. The correlation between overall PDQ-8 score and each MAU instrument ranged from - 0.729 (EQ-5D-5L) to - 0.752 (EQ-5D-3L). A mapping algorithm based on PDQ-8 items had better performance than using the overall score. For the two EQ-5D questionnaires, in general, the indirect mapping approach had comparable or even better performance than direct mapping based on MAE.

Conclusions: Mapping algorithms developed in this study enable the estimation of utility values from the PDQ-8. The indirect mapping equations reported for two EQ-5D questionnaires will further facilitate the calculation of EQ-5D utility scores using other country-specific tariffs.
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http://dx.doi.org/10.1007/s40271-018-0317-5DOI Listing
December 2018

Stair negotiation in women with fibromyalgia: A descriptive correlational study.

Medicine (Baltimore) 2017 Oct;96(43):e8364

Faculty of Sport Science, University of Extremadura, Spain Facultad de Educación, Universidad Autónoma de Chile, Talca, Chile.

Walking up and down stairs is a common and important activity of daily living. Women with fibromyalgia often show a reduced ability to perform this task.The objective of this study was to evaluate the test-retest reliability of stair negotiation tasks and to assess the impact of fibromyalgia symptoms on the ability to negotiate stairs.Forty-two women with fibromyalgia participated in this descriptive correlational study. The relevance of the stair negotiation (both walking up and down) was evaluated by assessing its association with the revised version of the fibromyalgia impact questionnaire (FIQ-R) and other health-related variables. Test-retest reliability was also analyzed. The main outcome measures were time spent walking up and down stairs and impact of fibromyalgia, quality of life, number of falls, weight, and lower limb strength and endurance.The intraclass correlation coefficient (ICC) for stair descent was 0.929 whereas that for ascent was 0.972. The score in these tests correlated significantly with the total score for the FIQ-R and the score for many of dimensions and symptoms: that is, physical function, overall impact of fibromyalgia, pain, energy, stiffness, restorative sleep, tenderness, self-perceived balance problems, and sensitivity.Given the importance of the stair negotiation as activity of daily living and the high reliability, both stair ascent and descent tasks may be useful as outcome measures in studies on patients with fibromyalgia.
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http://dx.doi.org/10.1097/MD.0000000000008364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5671856PMC
October 2017

Chilean population norms derived from the health-related quality of Life SF-6D.

Eur J Health Econ 2018 Jun 19;19(5):675-686. Epub 2017 Jun 19.

Department of Applied Economics, Faculty of Economics and Business, University of Murcia, Murcia, Spain.

Objectives: The Health-Related Quality of Life Short Form 6D (HRQoL SF-6D) provides utility values for health status. Utilities generated have a number of potentially valuable applications in economic evaluations and not only to ensure comparability between studies. Reference values can be useful to estimate the effect on patients' HRQoL as a result of interventions in the absence of control groups. Thus, the purpose of this study was to provide normative values in the SF-6D in relation to the Chilean population.

Methods: A cross-sectional study was conducted evaluating 5293 people. SF-6D utilities were derived from the SF-12 questions.

Results: Mean SF-6D utility index for the whole sample was 0.74. It was better for men (0.78) than for women (0.71). The ceiling effect was much higher for men (11.16%) than for women (5.31%). Women were more likely to show problems in any dimension than were men.

Conclusions: Chilean population norms for the SF-6D help in the decision-making process around health policies. Men reported higher health status than women in all subcategories analyzed. Likewise, men also reported higher scores than women in overall SF-6D dimensions.
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http://dx.doi.org/10.1007/s10198-017-0912-8DOI Listing
June 2018

"Fibromyalgia and quality of life: mapping the revised fibromyalgia impact questionnaire to the preference-based instruments".

Health Qual Life Outcomes 2017 May 30;15(1):114. Epub 2017 May 30.

Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain.

Background: The revised version of the Fibromyalgia Impact Questionnaire (FIQR) is one of the most widely used specific questionnaires in FM studies. However, this questionnaire does not allow calculation of QALYs as it is not a preference-based measure. The aim of this study was to develop mapping algorithm which enable FIQR scores to be transformed into utility scores that can be used in the cost utility analyses.

Methods: A cross-sectional survey was conducted. One hundred and 92 Spanish women with Fibromyalgia were asked to complete four general quality of life questionnaires, i.e. EQ-5D-5 L, 15D, AQoL-8D and SF-12, and one specific disease instrument, the FIQR. A direct mapping approach was adopted to derive mapping algorithms between the FIQR and each of the four multi-attribute utility (MAU) instruments. Health state utility was treated as the dependent variable in the regression analysis, whilst the FIQR score and age were predictors.

Results: The mean utility scores ranged from 0.47 (AQoL-8D) to 0.69 (15D). All correlations between the FIQR total score and MAU instruments utility scores were highly significant (p < 0.0001) with magnitudes larger than 0.5. Although very slight differences in the mean absolute error were found between ordinary least squares (OLS) estimator and generalized linear model (GLM), models based on GLM were better for EQ-5D-5 L, AQoL-8D and 15D.

Conclusion: Mapping algorithms developed in this study enable the estimation of utility values from scores in a fibromyalgia specific questionnaire.
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http://dx.doi.org/10.1186/s12955-017-0690-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450359PMC
May 2017

[Health-related quality of life in Chilean patients with chronic obstructive pulmonary disease].

Rev Med Chil 2017 Feb;145(2):147-155

Departamento de Economía Aplicada, la Universidad de Murcia, Murcia, España.

Background: Chronic obstructive pulmonary disease (COPD) has a relevant impact on health-related quality of life (HRQoL). Short Form 6 dimensions (SF-6D) quality of life tool allows researchers to calculate preference-based utilities using data from SF-12 or SF-36 questionnaires.

Aim: To provide normative values of SF-6D derived from SF-12 for Chilean patients with COPD.

Material And Methods: SF-6D utility index was calculated using data from the 2009/2010 Chilean National Health Survey. Sixty-nine male and 120 female patients with COPD participated in the survey. Data was stratified by gender, age, region, marital status, smoking status, monthly incomes, educational level and area.

Results: The mean (± SD) SF-6D utility index for Chilean patients with COPD was 0.65 ± 0.15. The scores for men and women were 0.68 ± 0.15 and 0.64 ± 0.15, respectively. Patients with high incomes and educational level reported higher SF-6D scores. Ceiling effect was not a limitation when SF-6D was used in these Chilean patients.

Conclusions: The current study provides normative values of SF-6D derived from SF-12 for Chilean patients with COPD.
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http://dx.doi.org/10.4067/S0034-98872017000200001DOI Listing
February 2017

Exergames for women with fibromyalgia: a randomised controlled trial to evaluate the effects on mobility skills, balance and fear of falling.

PeerJ 2017 20;5:e3211. Epub 2017 Apr 20.

Faculty of Sport Science, Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, University of Extremadura, Cáceres, Spain.

Background: Exergames are a new form of rehabilitation that combine the characteristics of physical exercise and the benefits of non-immersive virtual reality (VR). Effects of this novel therapy in women fibromyalgia are still unknown. The objective was to evaluate the effects of exergame-based intervention on mobility skills, balance and fear of falling in women with fibromyalgia.

Methods: This study was a randomized controlled trial with concealed allocation. Seventy-six women with fibromyalgia were divided into two groups: the exercise group received an eight week intervention based on exergames, while the control group continued their usual activities. Mobility skills were evaluated using the timed up and go test, while balance was assessed using the functional reach test, and the CTSIB protocol. Fear of falling was evaluated on a scale of 0-100 (0, no fear; 100, extreme fear). Measurements were performed before and after the intervention. A repeated-measures linear mixed model was used to compare the effects of the intervention between the two groups.

Results: The exercise group was significantly quicker than the control group in the timed up and go test (MD, -0.71; 95% CI [-1.09-0.32];  < 0.001). There were also significant improvements in functional reach and a reduced fear of falling (MD, 4.34; 95% CI [1.39-7.30];  = 0.005 and MD, -9.85; 95% CI [-0.19--0.08];  = 0.048, respectively).

Discussion: The improved TUG observed herein was better than the smallest real difference. Based on the results on mobility skills, balance and fear of falling, exergames may be an effective tool as a therapy for women with fibromyalgia.
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http://dx.doi.org/10.7717/peerj.3211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401622PMC
April 2017

Reliability of the Timed Up and Go Test in Fibromyalgia.

Rehabil Nurs 2018 Jan/Feb;43(1):35-39

Purpose: The aim of the study was to evaluate the test-retest reliability of the timed up and go test using manual and automatic chronometer (chronopic) in women with fibromyalgia.

Design: Cross-sectional study with convenience sample.

Method: A total of 49 women with fibromyalgia, aged 50.20 ± 10.01 participated in the study.

Findings: The intraclass correlation coefficient was .935 with the manual stopwatch and .955 with the chronopic. The smallest real difference using manual stopwatch was 9.327%, whereas for the timed up and go using the chronopic it was 7.708%. Mean of the three repetitions was significantly different (p = .005) between both chronometers.

Conclusion: Timed up and go is a reliable physical fitness test for assessing agility/dynamic balance in women with fibromyalgia.

Clinical Relevance: The reliability is higher when the time is tracked using an automatic chronometer, which is easy to use and not expensive in terms of time and money, the use of this device is recommended in the nursing practice.
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http://dx.doi.org/10.1002/rnj.307DOI Listing
February 2018

Impact of Fibromyalgia in the Sit-to-Stand-to-Sit Performance Compared With Healthy Controls.

PM R 2017 Jun 21;9(6):588-595. Epub 2016 Oct 21.

Faculty of Sport Science, University of Extremadura, Cáceres, Spain(¶).

Background: Fibromyalgia is associated with a reduction in the ability to perform activities of daily living. Sit-to-stand-to-sit performance is one of the most common activities of daily living and often is evaluated by counting the number of repetitions of the 30-second chair-stand test. No study, however, has examined the performance over the 30 seconds of this test of female patients with fibromyalgia on a phase-by-phase basis.

Objective: To evaluate the impact of fibromyalgia on performance of the 30-second chair-stand test and to analyze how the kinematic performance changed over the 30-second test period.

Design: A cross-sectional study.

Setting: Local association of fibromyalgia.

Participants: Fifteen females with fibromyalgia and nine healthy female controls.

Intervention: Participants performed the 30-second chair-stand test while wearing a motion capture device.

Main Outcome Measure: Duration of each sit-to-stand-to-sit phase within the 30-second time limit was compared between groups using repeated measures analysis of variance. The association between duration of phases and scores from the revised version of the Fibromyalgia Impact Questionnaire was tested using bivariate correlations.

Results: The duration of impulse and sit-to-stand phases were gradually increased over the 30 seconds of the chair-stand test for women with fibromyalgia compared with healthy controls (P = .04 and P = .02, respectively). The mean duration of these 2 phases was associated with symptom duration and the function domain of the revised version of the Fibromyalgia Impact Questionnaire (P < .05). Also, stiffness was directly associated with the duration of the stand-up phase (P = .04).

Conclusion: Kinematic performance during the 30-second chair-stand test differed between women with fibromyalgia and healthy controls. Since sit-to-stand from a chair is a common daily activity, women with fibromyalgia may require specific exercises to improve performance of this task.

Level Of Evidence: Not applicable.
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http://dx.doi.org/10.1016/j.pmrj.2016.10.006DOI Listing
June 2017

Performance of women with fibromyalgia in walking up stairs while carrying a load.

PeerJ 2016 1;4:e1656. Epub 2016 Feb 1.

Faculty of Sport Science, University of Extremadura , Cáceres , Spain.

Background. Fibromyalgia is a chronic disease characterized by widespread pain and other associated symptoms. It has a relevant impact on physical fitness and the ability to perform daily living tasks. The objective of the study was to analyze the step-by-step-performance and the trunk tilt of women with fibromyalgia in the 10-step stair climbing test compared with healthy controls. Methods. A cross-sectional study was carried out. Twelve women suffering from fibromyalgia and eight healthy controls were recruited from a local association. Participants were asked to climb 10 stairs without carrying a load and 10 stairs carrying a load of 5 kg in each hand. Mediolateral trunk tilt was assessed using the "Functional Assessment of Biomechanics (FAB)" wireless motion capture device, and the time between steps was assessed via weight-bearing insoles. Results. Trunk tilt in the stair-climbing task carrying a load was significantly higher in women with fibromyalgia when compared to the healthy controls (2.31 (0.63) vs. 1.69 (0.51) respectively). The effect of carrying a load was significantly higher for women with fibromyalgia compared with healthy controls at the intermediate and final part of the task. Discussion. Trunk tilt during stair climbing while carrying a load was higher in women with FM, which could increase the risk of falling. Additionally, women with FM experienced a higher pace slowdown as a consequence of the load, which supports the need of including specific strength and resistance training to physical therapies for this population.
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http://dx.doi.org/10.7717/peerj.1656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741081PMC
February 2016

[NORMATIVE VALUES OF SF-6D QUESTIONNAIRE FOR CHILEAN DIABETES PATIENTS].

Nutr Hosp 2015 Dec 1;32(6):2665-73. Epub 2015 Dec 1.

Universidad de Extremadura, España..

Introduction: diabetes mellitus is a chronic disease with a great prevalence and economic impact worldwide. Diabetes has an impact on health-related quality of life. The SF-6D is a well-known preference-based questionnaire that allows assessing health-related quality of life. It is one of the most used worldwide because it allows knowing the social preferences derived from different states of health. However, to our knowledge, normative values of this questionnaire in Chilean diabetic population are not available.

Objective: to report normative data of the SF-6D in Chilean diabetic population.

Methods: data were taken from the National Health Survey (ENS 2009-2010) of Chile. In this study, 424 people who have diabetes (143 men and 281 women) were included. The data have been presented stratified by sex and age group, and by region, marital status, smoking, income and education.

Results: the global utility index was 0.70 (± 0.15) in men and 0.65 (± 0.15) in women. Only 5% of population declared having a utility "1". The utility index of the SF-6D in patients with diabetes decreases with age, in situations of low-income, low education levels.

Conclusions: this study reports the normative values of the SF-6D utility index in Chilean diabetic population.
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http://dx.doi.org/10.3305/nh.2015.32.6.9826DOI Listing
December 2015

GANODERMA LUCIDUM IMPROVES PHYSICAL FITNESS IN WOMEN WITH FIBROMYALGIA.

Nutr Hosp 2015 Nov 1;32(5):2126-35. Epub 2015 Nov 1.

Faculty of Sport Science, University of Extremadura, Cáceres, Spain..

Introduction: fibromyalgia is a chronic disease characterized by generalized pain, stiffness, poor physical conditioning, non-restorative sleep and poor health-related quality of life. Ganoderma lucidum a type of mushroom that has demonstrated several benefits in different populations. Ceratonia siliqua is a natural therapy rich in antioxidants with potential benefits on health.

Objective: to evaluate the effects of 6-week treatment of Ganoderma lucidum and Ceratonia siliqua on physical fitness in patients suffering from fibromyalgia.

Methods: sixty-four women with fibromyalgia participated in the study. They took 6 g of Ganoderma lucidum or Ceratonia siliqua per day for 6 weeks. Different fitness tests were selected in order to evaluate functional capacity.

Results: after the 6-week treatment period, Ganoderma lucidum significantly improved aerobic endurance, lower body flexibility, and velocity (p < .05). No significant improvement in any physical test was observed in the Ceratonia siliqua group.

Discussion And Conclusion: Ganoderma lucidum may improve physical fitness in women with fibromyalgia, whereas, Ceratonia siliqua seemed to be ineffective at increasing physical fitness. These results may indicate that Ganoderma lucidum might be a useful dietary supplement to enhance physical performance of the patients suffering from fibromyalgia.
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http://dx.doi.org/10.3305/nh.2015.32.5.9601DOI Listing
November 2015

NORMATIVE VALUES OF EQ-5D-5L FOR DIABETES PATIENTS FROM SPAIN.

Nutr Hosp 2015 Oct 1;32(4):1595-602. Epub 2015 Oct 1.

University of Extremadura, Spain..

Introduction: diabetes is a metabolic disease that can lead a reduction in health-related quality of life. The EQ-5D is a generic preference-based health-related quality of life questionnaire widely used in patients with diabetes.

Objective: the aim of the current manuscript is to provide normative values of EQ-5D-5L for Spanish people suffering from diabetes.

Methods: data from the Spanish Health Survey (2011/2012) was utilized. A total of 1 857 people suffering from diabetes participated in the survey. EQ-5D-5L scores were defined by sex, region (including the 17 Autonomous regions and 2 Autonomous cities of Spain), and 8 age groups.

Results: mean EQ-5D-5L utility index for the whole sample was 0.742. It was better for men (0.826) than for women (0.673). Similar results were observed in the VAS. The ceiling effect was much higher for men (44.83%) than for women (24.41%).

Conclusions: the current study provides EQ-5D-5L normative and representative data for Spanish people suffering from diabetes.
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http://dx.doi.org/10.3305/nh.2015.32.4.9605DOI Listing
October 2015

Using a dry electrode EEG device during balance tasks in healthy young-adult males: Test-retest reliability analysis.

Somatosens Mot Res 2015 15;32(4):219-26. Epub 2015 Sep 15.

a University of Extremadura , Cáceres , Spain .

Background: The analysis of brain activity during balance is an important topic in different fields of science. Given that all measurements involve an error that is caused by different agents, like the instrument, the researcher, or the natural human variability, a test-retest reliability evaluation of the electroencephalographic assessment is a needed starting point. However, there is a lack of information about the reliability of electroencephalographic measurements, especially in a new wireless device with dry electrodes.

Objective: The current study aims to analyze the reliability of electroencephalographic measurements from a wireless device using dry electrodes during two different balance tests.

Method: Seventeen healthy male volunteers performed two different static balance tasks on a Biodex Balance Platform: (a) with two feet on the platform and (b) with one foot on the platform. Electroencephalographic data was recorded using Enobio (Neuroelectrics). The mean power spectrum of the alpha band of the central and frontal channels was calculated. Relative and absolute indices of reliability were also calculated.

Results: In general terms, the intraclass correlation coefficient (ICC) values of all the assessed channels can be classified as excellent (>0.90). The percentage standard error of measurement oscillated from 0.54% to 1.02% and the percentage smallest real difference ranged from 1.50% to 2.82%.

Conclusion: Electroencephalographic assessment through an Enobio device during balance tasks has an excellent reliability. However, its utility was not demonstrated because responsiveness was not assessed.
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http://dx.doi.org/10.3109/08990220.2015.1074566DOI Listing
August 2016

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Lancet 2015 Dec 11;386(10010):2287-323. Epub 2015 Sep 11.

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.

Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S0140-6736(15)00128-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685753PMC
December 2015

Effects of Whole-Body Vibration Therapy in Patients with Fibromyalgia: A Systematic Literature Review.

Evid Based Complement Alternat Med 2015 17;2015:719082. Epub 2015 Aug 17.

Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain.

Objective. To review the literature on the effects of whole-body vibration therapy in patients with fibromyalgia. Design. Systematic literature review. Patients. Patients with fibromyalgia. Methods. An electronic search of the literature in four medical databases was performed to identify studies on whole-body vibration therapy that were published up to the 15th of January 2015. Results. Eight articles satisfied the inclusion and exclusion criteria and were analysed. According to the Dutch CBO guidelines, all selected trials had a B level of evidence. The main outcomes that were measured were balance, fatigue, disability index, health-related quality of life, and pain. Whole-body vibration appeared to improve the outcomes, especially balance and disability index. Conclusion. Whole-body vibration could be an adequate treatment for fibromyalgia as a main therapy or added to a physical exercise programme as it could improve balance, disability index, health-related quality of life, fatigue, and pain. However, this conclusion must be treated with caution because the paucity of trials and the marked differences between existing trials in terms of protocol, intervention, and measurement tools hampered the comparison of the trials.
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http://dx.doi.org/10.1155/2015/719082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553315PMC
September 2015

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

Lancet 2015 Nov 28;386(10009):2145-91. Epub 2015 Aug 28.

Background: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

Methods: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

Findings: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

Interpretation: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S0140-6736(15)61340-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673910PMC
November 2015

Reliability of Spirometric Tests during the Different Menstrual Cycle Phases in Healthy Women.

Iran J Public Health 2014 Jul;43(7):1009-10

2. Dept. of Physiology, Sport Science Faculty, University of Extremadura, , Spain.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401045PMC
July 2014
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