Dpto. Ciencias de la Salud - Osasun Zientziak Saila

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Open Access
Association of intrinsic capacity with incidence and mortality of cardiovascular disease: prospective study in UK Biobank
(Wiley, 2023) Ramírez Vélez, Robinson; Iriarte-Fernández, María; Santafé Rodrigo, Guzmán; Malanda Trigueros, Armando; Beard, John R.; García Hermoso, Antonio; Izquierdo Redín, Mikel; Ciencias de la Salud; Estadística, Informática y Matemáticas; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute for Advanced Materials and Mathematics - INAMAT2; Osasun Zientziak; Estatistika, Informatika eta Matematika; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: The World Health Organization proposed the concept of intrinsic capacity (IC; the composite of all the physical and mental capacities of the individual) as central for healthy ageing. However, little research has investigated the interaction and joint associations of IC with cardiovascular disease (CVD) incidence and CVD mortality in middle- and older-aged adults. Methods: Using data from 443 130 UK Biobank participants, we analysed seven biomarkers capturing the level of functioning of five domains of IC to calculate a total IC score (ranging from 0 [better IC] to +4 points [poor IC]). Associations between IC score and incidence of six long-term CVD conditions (hypertension, stroke/transient ischaemic attack stroke, peripheral vascular disease, atrial fibrillation/flutter, coronary artery disease and heart failure), and grouped mortality from these conditions were estimated using Cox proportional models, with a 1-year landmark analysis to triangulate the findings. Results: Over 10.6 years of follow-up, CVD morbidity grouped (n = 384 380 participants for the final analytic sample) was associated with IC scores (0 to +4): mean hazard ratio (HR) [95% confidence interval, CI] 1.11 [1.08–1.14], 1.20 [1.16–1.24], 1.29 [1.23–1.36] and 1.56 [1.45–1.59] in men (C-index = 0.68), and 1.17 [1.13–1.20], 1.30 [1.26–1.36], 1.52 [1.45–1.59] and 1.78 [1.67–1.89] in women (C-index = 0.70). In regard to mortality, our results indicated that the higher IC score (+4 points) was associated with a significant increase in subsequent CVD mortality (mean HR [95% CI]: 2.10 [1.81–2.43] in men [C-index = 0.75] and 2.29 [1.85–2.84] in women [C-index = 0.78]). Results of all sensitivity analyses by full sample, sex and age categories were largely consistent independent of major confounding factors (P < 0.001). Conclusions: IC deficit score is a powerful predictor of functional trajectories and vulnerabilities of the individual in relation to CVD incidence and premature death. Monitoring an individual's IC score may provide an early-warning system to initiate preventive efforts.
Open Access
Association of intrinsic capacity with respiratory disease mortality
(Elsevier, 2023) Ramírez Vélez, Robinson; Iriarte-Fernández, María; Santafé Rodrigo, Guzmán; Malanda Trigueros, Armando; Beard, John R.; García Hermoso, Antonio; Izquierdo Redín, Mikel; Ciencias de la Salud; Estadística, Informática y Matemáticas; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute for Advanced Materials and Mathematics - INAMAT2; Osasun Zientziak; Estatistika, Informatika eta Matematika; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren
The World Health Organization (WHO) introduced a framework for healthy aging in 2015 that emphasizes functional ability instead of absence of disease. Healthy ageing is defined as “the process of building and maintaining the functional ability that enables well-being”. This framework considers an individual’s intrinsic capacity (IC), environment, and the interaction between them to determine functional ability. In this prospective cohort study, we investigated the link between mortality and various respiratory diseases in almost half a million adults who are part of the UK Biobank. We derived an IC score using measures from 4 of the 5 domains: two for psychological capacity, two for sensory capacity, two for vitality and one for locomotor capacity. The exposure variable in the study was the number of reported factors, which was summed and categorized into IC scores of zero, one, two, three, or at least four. The outcome was respiratory disease-related mortality, which was linked to national mortality records. The follow-up period started from participants’ inclusion in the UK Biobank study (2006–2010) and ended on December 31, 2021, or the participant’s death was censored. The average follow-up was 10.6 years (IQR 10.0; 11.3). During a median follow-up period of 10.6 years, 27,251 deaths were recorded. Out of these, 7.5% (2059) were primarily attributed to respiratory disease. The results showed that a higher IC score (+4 points) was associated with a significantly increased risk of respiratory disease mortality, with HRs of 3.34 [2.64 to 4.23] for men (C-index = 0.83) and 3.87 [2.86 to 5.23] for women (C-index = 0.84), independent of major confounding factors (P < 0.001). Our study provides evidence that lower levels of the WHO’s IC construct are associated with increased risk of mortality and various adverse health outcomes. The IC construct, which is easily and inexpensively measured, holds great promise for transforming geriatric care worldwide, including in regions without established geriatric medicine.
Open Access
Biological sex as a tailoring variable for exercise prescription in hospitalized older adults
(Elsevier, 2024-09-27) López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Ramírez Vélez, Robinson; Zambom Ferraresi, Fabrício; Galbete Jiménez, Arkaitz; Lusa Cadore, Eduardo; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua, 2186/2014
Background. Sex-based differences in the clinical presentation and outcomes are well-established in patients hospitalized for geriatric syndromes. We aimed to investigate sex differences in response to in-hospital exercise on function, strength, cognition, and quality of life in acute care admissions. Methods. 570 patients (mean age 87 years, 298 females [52.3%]) admitted to acute care for elderly units were randomized to multicomponent exercise emphasizing progressive resistance training or usual care. Functional assessments included Short Physical Performance Battery (SPPB), grip strength, Mini-Mental State Examination (MMSE), and health-related quality of life (EQ-VAS). Results. Exercising females showed more significant SPPB improvements than males (between-group difference 1.48 points, p = 0.027), exceeding the minimal clinically significant difference. While female participants significantly increased handgrip strength and male patients improved cognition after in-hospital exercise compared to the control group (all p < 0.001), no sex differences occurred. Conclusions. Females demonstrate more excellent physical function improvements compared to male older patients. Findings highlight the importance of tailored exercise incorporating patient factors like biological sex in geriatric medicine. Trial registration. NCT04600453
Open Access
Body composition and resting energy expenditure in a group of children with achondroplasia
(Elsevier, 2024) Garde-Etayo, Laura; Trandafir, Paula Camelia; Saint-Laurent, Céline; Ugarte Martínez, María Dolores; Insausti Serrano, Ana María; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
Background: Persons with achondroplasia develop early obesity, which is a comorbidity associated with other complications. Currently, there are no validated specific predictive equations to estimate resting energy expenditure in achondroplasia. Methods: We analyzed the influence of body composition on this parameter and determined whether predictive models used for children with standard height are adjusted to achondroplasia. In this cross-sectional study, we measured anthropometric parameters in children with achondroplasia. Fat mass was obtained using the Slaughter skinfold-thickness equation and resting energy expenditure was determined with a Fitmate-Cosmed calorimeter and with predictive models validated for children with average height (Schofield, Institute of Medicine, and Tverskaya). Results: All of the equations yielded a lower mean value than resting energy expenditure with indirect calorimetry (1256±200 kcal/day [mean±SD]) but the closest was the Tverskaya equation (1017 ± 64 kcal/day), although the difference remained statistically significant. We conclude that weight and height have the greatest influence on resting energy expenditure. Conclusion: We recommend studying the relationship between body composition and energy expenditure in achondroplasia in more depth. In the absence of valid predictive models suitable for clinical use to estimate body composition and resting energy expenditure in achondroplasia, it is recommended to use the gold standard methods by taking into account certain anthropometric parameters.
Open Access
Cohort Profile: CArdiovascular Risk in patients with DIAbetes in NAvarra (CARDIANA cohort)
(BMJ, 2023) Tamayo Rodríguez, Ibai; Librero, Julián; Galbete Jiménez, Arkaitz; Cambra Contin, Koldo; Enguita Germán, Mónica; Forga, Lluís; Goñi, María José; Lecea, Óscar; Gorricho Mendívil, Javier; Olazarán Santesteban, Álvaro; Arnedo Ajona, Laura; Moreno Iribas, Conchi; Lafita, Javier; Ibáñez Beroiz, Berta; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gestión de Empresas; Enpresen Kudeaketa
Purpose The CArdiovascular Risk in patients with DIAbetes in Navarra (CARDIANA cohort) cohort was established to assess the effects of sociodemographic and clinical variables on the risk of cardiovascular events in patients with type 1 (T1D) or type 2 (T2D) diabetes, with a special focus on socioeconomic factors, and to validate and develop cardiovascular risk models for these patients. Participants The CARDIANA cohort included all patients with T1D and T2D diabetes registered in the Public Health Service of Navarra with prevalent disease on 1 January 2012. It consisted of 1067 patients with T1D (ages 2–88 years) and 33842 patients with T2D (ages 20–105 years), whose data were retrospectively extracted from the Health and Administrative System Databases. Findings to date The follow-up period for wave 1 was from 1 January 2012 to 31 December 2016. During these 5 years, 9 patients (0.8%; 95%CI (0.4% to 1.6%)) in the T1D cohort developed a cardiovascular disease event, whereas for the T2D cohort, 2602 (7.7%; 95%CI (7.4% to 8.0%)) had an event. For the T2D cohort, physical activity was associated with a reduced risk of cardiovascular events, with adjusted estimated ORs equal to 0.84 (95% CI 0.66 to 1.07) for the partially active group and 0.71 (95% CI 0.56 to 0.91) for the active group, compared with patients in the non-active group. Future plans The CARDIANA cohort is currently being used to assess the effect of sociodemographic risk factors on CV risk at 5 years and to externally validate cardiovascular predictive models. A second wave is being conducted in late 2022 and early 2023, to extend the follow-up other 5 years, from 1 January 2016 to 31 December 2021. Periodic data extractions are planned every 5 years.
Open Access
Comment on 'Effects of Vivifrail multicomponent intervention on functional capacity' by Casas-Herrero et al.-The authors reply.
(Wiley, 2024) Sánchez Sánchez, Juan Luis; Izquierdo Redín, Mikel; López Sáez de Asteasu, Mikel; Antón Rodrigo, Iván; Galbete Jiménez, Arkaitz; Álvarez Bustos, Alejandro; Casas Herrero, Álvaro; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC
In this response letter, we would like to clarify some aspects related to the methodology and inferences derived from our work entitled 'Effects of Vivifrail multicomponent intervention on functional capacity', which was aimed at investigating the effects of a home-based multicomponent individualized exercise programme (Vivifrail) on the functional capacity of frail older adults with mild cognitive impairment/dementia. Yan et al.2 raised concerns related to the amount of data missingness and methods used to handle it in our study. Although we addressed this issue as a limitation of the Discussion section of the original report, we now take the opportunity to further discuss its implications.
Open Access
Comparación de la ansiedad en el estudiante de Grado de Enfermería entre diferentes servicios de prácticas asistenciales
(Sociedad de Enfermería de Atención Primaria de Asturias, 2024) Jiménez Marcos, María Anunciación; Insausti Serrano, Ana María; Trandafir, Paula Camelia; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
Objetivo: Comparar los niveles de ansiedad en estudiantes de cuarto de enfermería en diferentes servicios clínicos de: 'Urgencias-Emergencias', 'Cuidados Intensivos', 'Oncología' y 'Atención Primaria'. Así como analizar si la edad de los estudiantes puede influir en sus niveles de ansiedad. Metodología: Estudio observacional, longitudinal y prospectivo. Participaron 85 estudiantes. Se evaluaron los niveles de ansiedad en tres momentos durante el ciclo de prácticas clínicas: al inicio, durante y al finalizar. Se utilizó el Inventario de ansiedad rasgo-estado (STAI) para medir la ansiedad en cada momento. Resultados: Se observaron diferencias estadísticamente significativas en los niveles de ansiedad entre los servicios de 'Urgencias-Emergencias' y 'Atención Primaria'. En el contexto de 'Urgencias-Emergencias', se percibió un aumento progresivo en la ansiedad estado, mientras que en 'Atención Primaria' se registró una disminución de los niveles de ansiedad rasgo a lo largo del ciclo de prácticas. Se pudo establecer una relación moderada y significativa inversa entre la edad de los estudiantes y sus niveles de ansiedad en el grupo en general. Además, esta relación también se hizo evidente en los entornos de 'Urgencias-Emergencias' y 'Atención Primaria'. Conclusiones: El estudio desvela que los niveles de ansiedad en estudiantes de enfermería varían según el contexto clínico. 'Urgencias-Emergencias' generó un aumento progresivo de la ansiedad, mientras que en 'Atención Primaria' parecía actuar como un entorno protector ante la ansiedad. La edad también desempeñó un papel importante, ya que, a nivel general y, concretamente en los contextos 'Urgencias-Emergencias' y 'Atención Primaria', los estudiantes más jóvenes reflejaron mayores niveles de ansiedad.
Open Access
Dose-response relationship between exercise duration and enhanced function and cognition in acutely hospitalized older adults: a secondary analysis of a randomized clinical Trial
(Oxford University Press, 2024-06-01) López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; Galbete Jiménez, Arkaitz; Ramírez Vélez, Robinson; Lusa Cadore, Eduardo; Abizanda, Pedro; Gómez-Pavón, Javier; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC; Gobierno de Navarra / Nafarroako Gobernua
Background and objectives: exercise may reverse functional decline in hospitalized older adults, but the optimal duration is unclear. This study examined the potential relationship between in-hospital multicomponent exercise program duration and changes in physical function, cognition, and muscle function to maximize exercise-related health benefits in acutely hospitalized older patients. Research design and methods: this secondary analysis of a multicenter randomized controlled trial examined the relationship between the duration of an in-hospital multicomponent exercise program and changes in physical function, cognition, and muscle strength in 570 acutely hospitalized older adults. Participants completed 3, 4, or 5-7 consecutive days of exercise based on the progression of their acute medical illness. The acute clinical condition of the older patients was similar across the study groups (i.e., 3/4/5-7 days) at admission. Outcomes included the Short Physical Performance Battery (SPPB) for functional capacity, Gait Velocity Test for gait speed, handgrip for muscle strength, and cognitive tests. Results: of the 570 patients included in the analysis, 298 were women (52.3%), and the mean (SD) age was 87.3 (4.8) years. Exercise groups increased SPPB scores compared with controls, with gains of 1.09 points after three days, 1.97 points after four days, and 2.02 points after 5-7 days (p < .001). The 4-day program showed the most significant benefit for functional capacity. Gait velocity increased by 0.11 m/s after 4 and 5-7 days (p = .032). Similar dose-response relationships were seen for handgrip strength and cognition, with 5-7 days showing more significant gains than three days (p < .05). Discussion and implications: multicomponent exercise programs enhance physical and cognitive function in hospitalized older adults, regardless of exercise dosage. A 4-day program significantly boosts functional capacity, although 5-7 days improves handgrip strength and cognition, highlighting the importance of exercise dosage in countering functional decline. Implementing evidence-based inpatient exercise prescriptions can help reverse muscle weakness and improve cognitive and physical function.
Open Access
Effect of a Multicomponent Exercise Program with Virtual Reality (MEP-VR) versus standard approaches on functional and cognitive domains in hospitalised geriatric patients: study protocol for a randomized controlled trial
(Elsevier, 2025-07-01) Ferrara, Maria Cristina; Zambom Ferraresi, Fabíola; Galbete Jiménez, Arkaitz; Fernández González de la Riva, María Luisa; Izco-Cubero, Maite; García Baztán, Agurne; Capón Sáez, Amaya; Domínguez-Mendoza, Soledad ; Marín Epelde, Itxaso; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua
Antecedentes: Los modelos de atención convencionales para los adultos mayores a menudo ignoran los efectos negativos de la hospitalización y descuidan los beneficios potenciales de la tecnología. Este ensayo tiene como objetivo investigar los efectos del Programa de Ejercicio Multicomponente con Realidad Virtual (MEP-VR) sobre los resultados funcionales y cognitivos en adultos mayores hospitalizados, en comparación con el MEP solo o con los enfoques de atención habituales. Métodos: Este ensayo controlado aleatorizado de grupos paralelos de tres brazos incluirá 255 participantes de 75 años o más, con una puntuación del índice de Barthel de al menos 60, capaces de caminar y cooperar, con una estancia hospitalaria estimada de al menos cuatro días y que proporcionen consentimiento informado. Se excluirá a los pacientes con demencia grave, enfermedad terminal o inestabilidad clínica. Los participantes serán asignados aleatoriamente a un grupo de control o a uno de los dos grupos de intervención. Los grupos de intervención recibirán un programa MEP-VR o solo MEP, consistente en ejercicio aeróbico supervisado, entrenamiento de resistencia y entrenamiento del equilibrio, con o sin un componente de realidad virtual. La intervención tendrá lugar durante cuatro días consecutivos y cada sesión durará entre 30 y 40 minutos. La medida de resultado primaria serán los cambios funcionales en el momento del alta. También se evaluarán la cognición, el estado de ánimo, la calidad de vida y la usabilidad de la realidad virtual inmersiva (RVI). Discusión: Los avances tecnológicos están aumentando rápidamente con el envejecimiento de la población, creando beneficios potenciales para la integración de la tecnología en el cuidado de adultos mayores. Este estudio evalúa la implementación de RVI combinada con MEP. Si nuestra hipótesis resulta acertada, allanará el camino para modificar el sistema de hospitalización, ayudando a reducir la carga crítica para la atención sanitaria que supone la discapacidad adquirida en el hospital en la población de edad avanzada. Registro del ensayo: Este estudio fue aprobado por el Comité Ético de Investigación Clínica de Navarra el 14 de junio de 2021 (PI 2021 90). El ensayo se registró de forma retrospectiva en ClinicalTrials.gov,número de registro NCT06469554.
Open Access
Effects of an individualised exercise program in hospitalised older adults with cancer: a randomised clinical trial
(Springer, 2025-01-01) Ferrara, Maria Cristina; Zambom Ferraresi, Fabrício; Castillo, A.; Delgado, Marina; Galbete Jiménez, Arkaitz; Arrazubi, Virginia; Morilla Ruiz, Idoia; Zambom Ferraresi, Fabíola; Fernández González de la Riva, María Luisa; Vera García, Ruth; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
We aimed to examine the effects of an individualised multicomponent exercise program on functional outcomes in hospitalised older patients with cancer. Patients aged ¿ 65 were recruited upon admission to a Medical Oncology Department and randomly allocated to receive a multicomponent exercise training program twice daily for five days or standard hospital care. The primary outcome measure was the change in functional status using the Short Physical Performance Battery. This study allocated 30 patients in the Control group and 28 in the intervention group. The mean age was 74.4 years. The intervention group (n = 14) showed significant improvements vs the Control group (n = 20) in the Short Physical Performance Battery (SPPB) (between-group difference, 1.92; 95% CI = 0.80,3.07), knee extension strength (between-group difference 7.72; 95% CI = 1.83,13.8), as well as a significant reduction in fatigue (between-group difference —26.5; 95% CI = —38.6,—13.9). This individualised exercise program appears to have contributed to improving functional abilities and reducing fatigue in hospitalised older cancer patients.
Open Access
Effects of game-based interventions on functional capacity in acutely hospitalised older adults: results of an open-label non-randomised clinical trial
(Oxford University Press, 2022-01-23) Cuevas Lara, César; López Sáez de Asteasu, Mikel; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Zambom Ferraresi, Fabíola; Antoñanzas Valencia, Cristina; Galbete Jiménez, Arkaitz; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua
Background: Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. Objective: To assess the effect of gamified interventions on functional capacity in hospitalised older adults. Methods: A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n = 21), a technology-based gamification group (TGG) (n = 23) or a control group (CG) (n = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. Results: Seventy patients (mean age 86.01 ± 4.27 years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15–2.80 points) and 2.69 points (95%CI, 1.32–4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70–9.76 points) in the Barthel Index and 2.03 kg (95%CI, 0.33–3.72 kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (β = 1.30; 95%CI, 0.45–2.14; indirect effect 0.864; 95%CI, 0.09–1.90) significantly mediated the TGG effect on the SPPB score. Conclusions: The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults.
Open Access
Effects of immersive virtual reality stimulation and/or multicomponent physical exercise on cognitive and functional performance in hospitalized older patients with severe functional dependency: study protocol for a randomized clinical trial
(BioMed Central (BMC), 2024-11-08) Casa Marín, Antón de la; Zambom Ferraresi, Fabíola; Ferrara, Maria Cristina; Ollo Martínez, Iranzu; Galbete Jiménez, Arkaitz; González Glaría, Belén; Moral Cuesta, Débora; Marín Epelde, Itxaso; Chenhuichen, Chenhui; Lorente-Escudero, Marta; Molero-de-Ávila, Ródrigo; García Baztán, Agurne; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background Hospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index <60 points). Methods This clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥75, Barthel Index <60, able to collaborate, expected length of stay ≥5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days. The ME group will undergo aerobic and strength exercise for progressive training of the upper and lower limbs. The IVR + ME group will do both cognitive and physical intervention. The primary outcomes will be cognitive and physical measures at discharge. Mood, quality of life, isometric strength, and acceptance of IVR will be also assessed. Discussion This project has the potential to enhance physical and psychological well-being of patients with severe functional dependency hospitalized for acute conditions, using technology. Virtual reality is expected to be favourably perceived by hospitalized older adults. This intervention represents a novelty in the geriatric patients¿ care, comprising IVR and/or ME dispensed within the patient¿s room, and including patients who are commonly excluded from research clinical trials.
Open Access
Effects of time-restricted eating and resistance training on skeletal muscle tissue quantity, quality and function in postmenopausal women with overweight or obesity: a study protocol
(Elsevier, 2024-12-30) Alfaro-Magallanes, Víctor Manuel; Medrano Echeverría, María; Echarte Medina, Jon; Osés Recalde, Maddi; Izquierdo Rodríguez, Claudia; Concepción Álvarez, Mara de la Caridad; Galbete Jiménez, Arkaitz; Idoate, Fernando; Zugasti Murillo, Ana; Petrina Jáuregui, María Estrella; Goñi Gironés, María Elena; Ribelles, María Jesús; Amasene, María; Arenaza Etxeberría, Lide; Tejada Garrido, Clara Isabel; Elejalde, E.; Azcárate Jiménez, Unai Xabier; Ruiz Sarrias, Oskitz; Sayar-Beristain, Onintza; García-Ramos, Amador; Martínez Labari, Cristina; Armendáriz Brugos, Cristina; Villanueva Larre, Arantxa; Ruiz, Jonatan R.; Cabeza Laguna, Rafael; Labayen Goñi, Idoia; Ciencias de la Salud; Osasun Zientziak; Institute of Smart Cities - ISC; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio Ingeniaritza; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Background & aims: time-restricted eating (TRE) shows promise for weight loss and improving menopauserelated body composition and cardiometabolic health, but its effects on skeletal muscle tissue (SMT) in postmenopausal women are unknown. This study investigates the effects of three weight loss interventions over 12 weeks on SMT quantity, quality, function, and cardiometabolic health in postmenopausal women with overweight/obesity, with effects persistence evaluated at a 12-month follow-up. Methods and results: in this randomized controlled trial, 78 postmenopausal women (50–65 years; BMI 25–40 kg/m2; sedentary lifestyle; eating window ≥12 h/day; no severe metabolic impairments) will be recruited. Participants will be randomly assigned to one of three groups for 12 weeks: TRE, TRE + resistance training, or CR + resistance training. The TRE groups will reduce their eating window to 8 h and receive nutritional advice to adhere to a Mediterranean diet. The CR group will follow a personalized hypocaloric diet (− 500 kcal/day). Resistance training groups will perform supervised resistance training 3 times/week. Primary Outcome: Change in SMT quantity measured by MRI at baseline and after 12 weeks. Secondary Outcomes: intermuscular adipose tissue (IMAT), strength, power, body weight and composition, and cardiometabolic risk factors. Conclusion: this study will illustrate the effects of TRE and TRE combined with resistance exercise compared with the currently recommended obesity-lifestyle treatment on SMT quantity, quality, function, and cardiometabolic markers. The results will offer insights into dietary strategies to combat obesity and metabolic diseases without increasing sarcopenia risk in postmenopausal women, a sparsely studied and particularly affected population.
Open Access
Epidemiology of severe trauma in Navarra for 10 years: out-of-hospital/ in-hospital deaths and survivors
(BMC, 2023) Arbizu Fernández, Eider; Echarri Sucunza, Alfredo; Galbete Jiménez, Arkaitz; Fortún Moral, Mariano ; Belzunegui Otano, Tomás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background Major trauma is a leading cause of death. Due to the difficulties to keep a registry of these cases, few studies include all subjects, because they exclude out-of-hospital deaths. The purpose of this work was to compare the epidemiological profiles of out-of-hospital deaths, in-hospital deaths, and survivors over a 10-year period (2010– 2019) of patients who had been treated by Navarre´s Health Service (Spain). Methods Retrospective longitudinal cohort study using data of patients injured by an external physical force of any intentionality and with a New Injury Severity Score above 15. Hangings, drownings, burns, and chokings were excluded. Intergroup differences of demographic and clinical variables were analysed using the Kruskal Wallis test, chi-squared test, or Fisher´s exact test. Results Data from 2,610 patients were analysed; 624 died out-of-hospital, 439 in-hospital, and 1,547 survived. Trauma incidences remained moderately stable over the 10-year period analysed, with a slight decrease in out-of-hospital deaths and a slight increase in in-hospital deaths. Patients of the out-of-hospital deaths group were younger (50.9 years) in comparison to in-hospital deaths and survivors. Death victims were predominantly male in all study groups. Intergroup differences regarding prior comorbidities and predominant type of injury were observed. Conclusions There are significant differences among the three study groups. More than half of the deaths occur out-of-hospital and the causative mechanisms differ in each of them. Thus, when designing strategies, preventive measures were considered for each group on a case-by-case basis.
Open Access
Estudio del patrón lesional de los traumas graves en Navarra (2010-2019)
(Gobierno de Navarra, 2024-06-26) Arbizu Fernández, Eider; Galbete Jiménez, Arkaitz; Belzunegui Otano, Tomás; Fortún Moral, Mariano; Echarri Sucunza, Alfredo; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute of Smart Cities - ISC
Fundamento. El objetivo de este estudio es describir los traumas graves (TG) en Navarra y analizar sus diferencias por mortalidad, sexo y mecanismo lesional. Material y métodos. Estudio transversal de TG (gravedad ≥3) registrados en Navarra desde 2010 a 2019. Se analizó el tipo de TG, su intencionalidad, mecanismo y región anatómica afectada. Se calculó el riesgo (OR) de TG según distintas variables. Resultados. Se incluyeron 2.609 pacientes con TG, con media de edad 54,7 años (0-101) y 70,9% varones. Predominaron los TG contusos (94,7%) y accidentales (84%) causados por caí-das (46,5%) y accidentes de coche (18,4%). Las mujeres sufrieron más caídas y atropellos y los hombres más accidentes de moto, bicicleta, arma blanca/de fuego y contusiones. La mayoría de TG se registraron en cabeza y tórax. Las lesiones en cabeza fueron significativamente más frecuentes en fallecidos y en mujeres, y las lesiones en tórax en personas fallecidas in situ y en hombres. Las causas más frecuentes de TG en cabeza fueron caídas de baja altura y armas de fuego y, en tórax, los accidentes de coche y las caídas de altura. El riesgo de TG disminuyó con la edad y se multiplicó por 2-3 en pacientes fallecidos. Conclusión. Se han identificado diferencias por sexo en intencionalidad, tipo de traumatismo y mecanismo del TG. Globalmente, las lesiones en cabeza y tórax son más letales, y las abdominales y de extremidades/anillo pélvico se observaron en muertes tempranas, sugiriendo una afectación tan extensa y grave que dificulta su tratamiento y manejo.
Open Access
Identificación y manejo de situaciones emocionales vividas por los estudiantes de enfermería durante las prácticas clínicas
(Universidad de Murcia Servicio de Publicaciones, 2024) Jiménez Marcos, María Anunciación; Insausti Serrano, Ana María; Zubeldia Etxeberria, Josune; Berasain Erro, Itziar; Trandafir, Paula Camelia; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Ciencias de la Salud; Osasun Zientziak
Introducción: La Enfermería es una profesión en la que se viven situaciones emocionales muy complejas y difíciles, por lo que adquiere especial importancia el saber gestionar de forma adecuada las emociones para poder evitar estados de estrés crónico. Objetivo: Identificar las situaciones emocionales que experimentan los estudiantes de enfermería durante su experiencia clínica y la relación de ésta con las habilidades de la profesión enfermera, así como su gestión emocional. Método: Estudio de diseño mixto cualitativo/cuantitativo. La parte cualitativa se basa en el estudio de las situaciones emocionales percibidas por el alumnado en las prácticas clínicas, recabado a través de una pregunta abierta sobre situaciones que le habrían generado une emoción intensa. La cuantitativa, por su parte, se centra en la IEP (Inteligencia Emocional Percibida) del alumnado medido por cuestionario Trait Meta-Mood Scale (TMMS-24). Resultados: En la primera parte se identifican dos categorías principales: Las habilidades y la falta de habilidades, entre las cuales, la categoría más identificada es la de las “habilidades”, siendo la subcategoría más representativa la de “empatía”, seguida del “autoconocimiento”. En ambas, la situación emocional primordialmente identificada es la muerte. En la segunda parte, se examinan los resultados y se infiere una asociación entre la dimensión Comprensión de la IEP y las habilidades de la profesión enfermera. Conclusión: La muerte está muy presente en las emociones del alumnado de prácticas clínicas siendo la empatía, la habilidad más presente. La comprensión emocional puede ayudar a estimular la empatía y promover el autoconocimiento.
Open Access
The impact of loneliness and social isolation on the benefits of an exercise program with hospitalised older adults
(Elsevier, 2024-06-03) Martínez Velilla, Nicolás; López Sáez de Asteasu, Mikel; Zambom Ferraresi, Fabrício; Galbete Jiménez, Arkaitz; Marín Epelde, Itxaso; Ferrara, Maria Cristina; Yanguas-Lezáun, José Javier; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika
Objectives: this study aimed to assess the prevalence and impact of loneliness (De Jong Gierveld scale) and isolation (Lubben scale) on the effects of a hospital-based exercise programme. Design: secondary analysis of a randomised clinical trial. Setting: Acute Geriatric Unit of a tertiary hospital in Spain. Participants: 103 hospitalised older adults. Intervention: individualised multicomponent exercise program (20-minute sessions twice a day for 3 consecutive days). Results: among the 103 randomised patients included in the analysis (both arms included), 58.3% were male, and their mean age was 87.3 (4.5) years. According to the Lubben scale, 15.8% of patients were at risk of isolation, while 62.7% were in a situation of severe or moderate loneliness according to the De Jong Gierveld scale. In the non-isolated group, training showed a substantial positive impact on Geriatric Depression Scale (B = -1.25, 95% CI = -0.24 to -0.27). In the isolated group, all outcomes improved, but only the Quality of Life showed significant changes (B = 35, 95% CI = 4.96-35.8). The SPPB test (B = 1.62, 95% CI = 0.19-3.04) and Quality of Life, (B = 17.1, 95% CI = 1.84-32.3) showed a significant improvement in the non-loneliness exercise group while no differences were found in the loneliness group. Conclusion: despite the high prevalence of loneliness and social isolation, individualised exercise programs provide significant benefits to hospitalised patients, especially in quality of life.
Open Access
Police as first reponders improve out-of-hospital cardiac arrest survival
(BMC, 2023) Jean Louis, Clint; Cildoz Esquíroz, Marta; Echarri Sucunza, Alfredo; Beaumont, Carlos; Mallor Giménez, Fermín; Greif, Robert; Baigorri Iguzquiaguirre, Miguel; Reyero Díez, Diego; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: Police forces are abundant circulating and might arrive before the emergency services to Out-of-Hospital-Cardiac-Arrest victims. If properly trained, they can provide basic life support and early defibrillation within minutes, probably increasing the survival of the victims. We evaluated the impact of local police as first responders on the survival rates of out-of-hospital cardiac arrest victims in Navarra, Spain, over 7 years. Methods: A retrospective analysis of an ongoing Out-of-Hospital Cardiac registry to compare the characteristics and survival of Out-of-Hospital-Cardiac-Arrest victims attended to in first place by local police, other first responders, and emergency ambulance services between 2014 and 2020. Results: Of 628 cases, 73.7% were men (aged 68.9 ± 15.8), and 26.3% were women (aged 65,0 ± 14,7 years, p < 0.01). Overall survival of patients attended to by police in the first place was 17.8%, other first responders 17.4% and emergency services 13.5% with no significant differences (p > 0.1). Time to initiating cardiopulmonary resuscitation is significant for survival. When police arrived first and started CPR before the emergency services, they arrived at a mean of 5.4 ± 3 min earlier (SD = 3.10). This early police intervention showed an increase in the probability of survival by 10.1%. Conclusions: The privileged location and the sole amount of personnel of local police forces trained in life support and their fast delivery of defibrillators as first responders can improve the survival of out-of-hospital cardiac arrest victims.
Open Access
Relevance of sex, age and gait kinematics when predicting fall-risk and mortality in older adults
(Elsevier, 2020) Porta Cuéllar, Sonia; Martínez Ramírez, Alicia; Millor Muruzábal, Nora; Gómez Fernández, Marisol; Izquierdo Redín, Mikel; Ingeniería Eléctrica, Electrónica y de Comunicación; Estadística, Informática y Matemáticas; Ciencias de la Salud; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren; Estatistika, Informatika eta Matematika; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, 87/10
Approximately one-third of elderly people fall each year with severe consequences, including death. The aim of this study was to identify the most relevant features to be considered to maximize the accuracy of a logistic regression model designed for prediction of fall/mortality risk among older people. This study included 261 adults, aged over 65 years. Men and women were analyzed separately because sex stratification was revealed as being essential for our purposes of feature ranking and selection. Participants completed a 3-m walk test at their own gait velocity. An inertial sensor attached to their lumbar spine was used to record acceleration data in the three spatial directions. Signal processing techniques allowed the extraction of 21 features representative of gait kinematics, to be used as predictors to train and test the model. Age and gait speed data were also considered as predictors. A set of 23 features was considered. These features demonstrate to be more or less relevant depending on the sex of the cohort under analysis and the classification label (risk of falls and mortality). In each case, the minimum size subset of relevant features is provided to show the maximum accuracy prediction capability. Gait speed has been largely used as the single feature for the prediction fall risk among older adults. Nevertheless, prediction accuracy can be substantially improved, reaching 70% in some cases, if the task of training and testing the model takes into account some other features, namely, sex, age and gait kinematic parameters. Therefore we recommend considering sex, age and step regularity to predict fall-risk.
Open Access
Sex-dependent effect of socioeconomic status on cardiovascular event risk in a population-based cohort of patients with type 2 diabetes
(Oxford University Press, 2024) Enguita Germán, Mónica; Tamayo Rodríguez, Ibai; Librero, Julián; Ballesteros-Domínguez, Asier; Oscoz-Villanueva, Ignacio; Galbete Jiménez, Arkaitz; Arnedo Ajona, Laura; Cambra Contin, Koldo; Gorricho Mendívil, Javier; Moreno Iribas, Conchi; Millán-Ortuondo, Eduardo; Ibáñez Beroiz, Berta; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Ciencias de la Salud; Osasun Zientziak; Gestión de Empresas; Enpresen Kudeaketa
Background: Socioeconomic status (SES) factors often result in profound health inequalities among populations, and their impact may differ between sexes. The aim of this study was to estimate and compare the effect of socioeconomic status indicators on incident cardiovascular disease (CVD)-related events among males and females with type 2 diabetes (T2D). Methods: A population-based cohort from a southern European region including 24,650 patients with T2D was followed for five years. The sex-specific associations between SES indicators and the first occurring CVD event were modeled using multivariate Fine-Gray competing risk models. Coronary Heart Disease (CHD) and stroke were considered secondary outcomes. Results: Patients without a formal education had a significantly higher risk of CVD than those with a high school or university education, with adjusted hazard ratios (HRs) equal to 1.24 (95%CI: 1.09-1.41) for males and 1.50 (95%CI: 1.09-2.06) for females. Patients with <18 000euro income had also higher CVD risk than those with >= 18 000euro, with HRs equal to 1.44 (95%CI: 1.29-1.59) for males and 1.42 (95%CI: 1.26-1.60) for females. Being immigrant showed a HR equal to 0.81 (95%CI: 0.66-0.99) for males and 1.13 (95%CI: 0.68-1.87) for females. Similar results were observed for stroke, but differed for CHD when income is used, which had higher effect in females. Conclusion: Socioeconomic inequalities in CVD outcomes are present among T2D patients, and their magnitude for educational attainment is sex-dependent, being higher in females, suggesting the need to consider them when designing tailored primary prevention and management strategies.