Open Access
Personal and perceived peer use and attitudes towards use of non-prescribed prescription sedatives and sleeping pills among university students in seven European countries
(Elsevier, 2018) Lehne, Gesa; Zeeb, Hajo; Pischke, Claudia R.; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Introduction: The use of non-prescribed prescription sedatives and sleeping pills (NPPSSP) among university students has been described as an important public health issue. However, the impact of perceived social norms on students' use and attitudes towards use of NPPSSP is still unclear. Our aim was to investigate whether perceptions of peer use and approval of use are associated with students' personal use and approval of NPPSSP use. Methods: Cross-sectional data from the Social Norms Intervention for the prevention of Polydrug Use (SNIPE) project containing 4482 university students from seven European countries were analyzed to investigate self-other discrepancies regarding personal use and attitudes towards NPPSSP use. Associations between personal and perceived peer use and between personal and perceived approval of use were examined using multivariable logistic regression. Results: The majority (51.0%) of students perceived their peers' NPPSSP use to be higher than their personal use. 92.6% of students perceived their peers' approval of NPPSSP use to be identical or higher than their personal approval. Students perceiving that the majority of peers had used NPPSSP at least once displayed higher odds for personal lifetime use (OR: 1.95, 95% CI: 1.49–2.55). Perceived peer approval of NPPSSP use was associated with higher odds for personal approval (OR: 5.49, 95% CI: 4.63–6.51). Conclusions: Among European university students, perceiving NPPSSP use and approval of use to be the norm was positively associated with students' personal NPPSSP use and approval of use, respectively. Interventions addressing perceived social norms may prevent or reduce NPPSSP use among university students.
Open Access
Effects of nutrition interventions on athletic performance in soccer players: a systematic review
(MDPI, 2023) Aguinaga Ontoso, Inés; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Alas Brun, Rosa María; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: More than 270 million participants and 128,893 professional players play soccer. Although UEFA recommendations for nutrition in elite football exist, implementing these guidelines among professional and semiprofessional soccer players remains suboptimal, emphasizing the need for targeted and individualized nutritional strategies to improve adherence to established recommendations. Methods: We conducted a comprehensive search in PubMed, Scopus, Web of Science, and clinical trial registers. Inclusion criteria focused on professional or semiprofessional soccer players, nutrition or diet interventions, performance improvement outcomes, and randomized clinical trial study types. We assessed quality using the Risk of Bias 2 (RoB 2) tool. We identified 16 eligible articles involving 310 participants. No nutritional interventions during the recovery period effectively improved recovery. However, several performance-based interventions showed positive effects, such as tart cherry supplementation, raw pistachio nut kernels, bicarbonate and mineral ingestion, creatine supplementation, betaine consumption, symbiotic supplements, and a high-carbohydrate diet. These interventions influenced various aspects of soccer performance, including endurance, speed, agility, strength, power, explosiveness, and anaerobic capacity. Conclusions: Specific strategies, such as solutions with bicarbonate and minerals, high carbohydrate diets, and supplements like creatine, betaine, and tart cherry, can enhance the performance of professional soccer players. These targeted nutritional interventions may help optimize performance and provide the competitive edge required in professional soccer. We did not find any dietary interventions that could enhance recovery.
Open Access
Identificación de problemas y propuestas para mejorar la atención de las urgencias extrahospitalarias en Navarra: un estudio Delphi
(Gobierno de Navarra, 2011) Pérez Ciordia, Ignacio; Brugos Larumbe, Antonio; Guillén Grima, Francisco; Fernández Martínez, C.; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Fundamento. Las urgencias extrahospitalarias de Navarra sufrieron modificaciones en la organización hace dos años, destacando la creación del servicio de urgencias rural (SUR) que coexiste geográficamente con el servicio normal de urgencias. El objetivo del estudio es conocer la opinión de expertos sobre los problemas y las recomendaciones de mejora que afectan a las urgencias extrahospitalarias. Metodología. Se realizó un estudio Delphi con la participación de 37 expertos (médicos y enfermeras). Por medio del correo electrónico se realizan 3 rondas de cuestionarios sucesivos. El último cuestionario identifica el grado de acuerdo con las ideas del grupo y se identifican los 15 problemas y recomendaciones más relevantes, seleccionando aquellas ideas que alcancen, al menos, el 50 % de acuerdo y una prioridad superior al percentil 25. Agrupamos las ideas mediante análisis de clúster jerárquico. Resultados. Se identifican 4 clúster de problemas, destacando entre ellos que «la población utiliza las urgencias para patología banal, como una consulta más» con una puntuación de 297 puntos. De las recomendaciones, con 3 clúster identificados, destaca la «necesidad de diseñar un plan estratégico de atención a las urgencias con unos recursos acorde a las necesidades» (310 puntos de prioridad) y «enviar mensajes claros a la población sobre uso correcto de urgencias» (192 puntos de prioridad). Conclusión. El método Delphi identifica problemas y áreas de mejora a través del consenso.
Open Access
The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
(MDPI, 2025-06-23) Yoseph, Amanuel; Mussie, Lakew; Belayineh, Mehretu; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Mutwiri, George Kiremu; Ciencias de la Salud; Osasun Zientziak
Background/Objectives: Anemia and undernutrition are severe public health concerns in Ethiopia. These are the two most common nutritional disorders in pregnant women and frequently coexist. However, to our knowledge, there is little evidence of the coexistence of anemia and undernutrition among pregnant women. Therefore, this study aimed to examine the prevalence of coexisting anemia and undernutrition (CAU) and associated factors among pregnant women. Methods: A community-based cross-sectional study was conducted from 1 to 25 June 2024, on 515 pregnant women in the Hawela Lida district of Sidama, Ethiopia. We utilized a multi-stage sampling method to choose eligible study participants. A pre-tested and structured questionnaire was used to collect data via the online Open Data Kit mobile tool. We controlled the effect of confounders and clustering by using a multi-level mixed-effect modified Poisson regression analysis model. Results: The prevalence of CAU among pregnant women was 25.4% (95% CI: 21.9–28.9). The prevalence of CAU was associated with household food insecurity (adjusted prevalence ratio [APR]: 2.17; 95% CI: 1.43–3.28), training on model family (APR: 0.66; 95% CI: 0.45–0.96), inadequate dietary diversity (APR: 1.51; 95% CI: 1.18–1.95), and having poor knowledge of nutrition (APR: 1.55; 95% CI: 1.06–2.26) at individual levels. Low community-level women’s autonomy (APR: 6.19; 95% CI: 3.42–11.22) and community-level road accessibility (APR: 0.65; 95% CI: 0.43–0.98) were the identified determinants of CAU at the community level. Conclusions: One in four pregnant women had CAU in the study area. Household food insecurity, inadequate dietary diversity, and poor nutrition knowledge were associated with an increased likelihood of CAU, while participation in model family training and improved road accessibility were associated with reduced CAU. We have also indicated that low community-level women’s autonomy significantly increased the risk of CAU. Therefore, inter-sectorial collaboration should be required to comprehensively address CAU’s determinants at different levels. Additionally, any CAU prevention and intervention programs should provide model family training explicitly targeting women with poor nutritional knowledge and low autonomy in healthcare decision-making.
Open Access
Trends in hospital morbidity from Alzheimer's disease in the European Union, 2000-2014
(SAGE, 2018) Niu, Hao; Álvarez Álvarez, Ismael; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: Alzheimer’s disease (AD) has become a concerning public health issue. We aimed to analyse the trends of hospital morbidity from AD in the European Union (EU) in the period 2000-2014. Methods: Data from hospital discharges of men and women over 50 years old hospitalised from AD in the EU were extracted from Eurostat database. We tested for secular trends computing the annual percent change, and identifying significant changes in the linear slope of the trend. Results: Hospital morbidity from AD showed a 0.8% (95% confidence intervals -2.2, 0.6) slight declining trend in the EU. In men and women, we recorded a -0.5% and -1.0% decrease in hospital morbidity rates, respectively. Several countries showed changing trends during the study period. Conclusion: AD hospital morbidity has slightly declined in the entire EU in the past years. Eastern European countries showed steadily increasing trends, whereas in western and Mediterranean countries rates decreased or levelled off.
Open Access
Evaluating the efficacy of ChatGPT in navigating the spanish medical residency entrance examination (MIR): promising horizons for AI in clinical medicine
(MDPI, 2023) Guillén Grima, Francisco; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Alas Brun, Rosa María; Onambele, Luc; Ortega-Leon, Wilfrido; Montejo, Rocío; Aguinaga Ontoso, Enrique; Barach, Paul; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model’s overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. Material and methods: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4’s new image analysis capability. Results: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as “error requiring intervention to sustain life” and “error resulting in death”, had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model’s high success rate is commendable, understanding the error severity is critical, especially when considering AI’s potential role in real-world medical practice and its implications for patient safety.
Open Access
Influencia de las características urbanísticas ambientales en el nivel de actividad física de la población de 18 a 65 años del área metropolitana de Pamplona
(Ministerio de Sanidad, Consumo y Bienestar Social, 2016) Orzanco Garralda, María Rosario; Guillén Grima, Francisco; Sáinz Suberviola, María Lourdes; Redín Areta, María Dolores; Rosa Eduardo, Rosanna de la; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Fundamentos: Un entorno adecuado puede favorecer la práctica de la actividad física, siendo una opción fácil para la población. El objetivo fue determinar la influencia de la percepción de los factores urbanísticos ambientales en el nivel de actividad física de las personas adultas. Métodos: Estudio transversal basado en el International Physical Activity and the Environment Network. Las personas participantes fueron seleccionadas de forma aleatoria y estratificada de la población de las zonas básicas de salud del Área Metropolitana de Pamplona entre las que tenían edad de 18 a 65 años. Se utilizó un cuestionario autoadministrado que incluyó la versión completa de la escala Neighborhood Environment Walkability Scale para valorar la percepción de los factores urbanísticos ambientales y la versión larga del International Physical Activity Questionnaire para recoger datos de actividad física. Se calculó la chi2 y se realizó un análisis multivariable mediante regresión logística no condicional Resultados: Participaron 905 sujetos (54,70% mujeres). Tener sendas de paseo próximas al domicilio o lugar de trabajo se relacionó con practicar actividad física moderada OR: 3,86 (IC 95% 1,70-8,74)] y actividad física total (suma de actividad física vigorosa, moderada y caminar) OR: 2,61 (IC 95% 1,24-5,45)]. La presencia en el barrio de lugares a los que podían ir caminando se asoció con dedicar más tiempo a caminar [OR: 1,26 (IC 95% 1,01-1,58)] y disponer cerca del domicilio o lugar de trabajo de espacios deportivos se asoció conpracticar más actividad física vigorosa [OR: 1,46 (IC 95% 1,01 - 2,12). Conclusiones: Existe asociación directa entre las personas que se declaran más activas y los factores urbanísticos ambientales, como sendas de paseo o instalaciones deportivas.
Open Access
The impact of COVID-19 on DTP3 vaccination coverage in Europe (2012-2023)
(MDPI, 2025-12-24) Aguinaga Ontoso, Inés; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Alas Brun, Rosa María; Guillén-Aguinaga, Miriam; Onambele, Luc; Aguinaga Ontoso, Enrique; Rayón Valpuesta, Esperanza; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: The COVID-19 pandemic disrupted routine child immunization efforts, threatening to reverse progress in controlling vaccine-preventable diseases. Materials and Methods: We analyzed the impact of COVID-19 on DTP3 vaccination in Europe by comparing trends before and after the pandemic using time series data from 2000 to 2023. Employing joinpoint regression, chi-square tests, and segmented regression analysis, we assessed DTP3 vaccination trends and coverage changes. Results: The findings revealed significant regional disparities across Europe. Statistical models indicated reductions in DTP3 coverage in countries such as Ireland, Sweden, and Switzerland, whereas Ukraine and San Marino showed improvements. Conclusions: There are variations in the effect of COVID-19 on DTP3 coverage rates, indicating the need for targeted public health strategies to address vaccine hesitancy, logistical barriers, and systemic inequities.
Open Access
Alimentación materna y desarrollo de alergias en menores de 6 y 7 años
(Universidad del Norte (Colombia), 2018) Cervantes de la Torre, Karol; Guillén Grima, Francisco; Aguinaga Ontoso, Inés; Mendoza Mendoza, Adel; Iglesias Acosta, Jesús; Ciencias de la Salud; Osasun Zientziak
Objetivo: Determinar la prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la nutrición materna. Materiales y métodos: Estudio transversal descriptivo de prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la alimentación de la madre se recolecto la información a través del cuestionario del International Study of Asthma and Allergies in Childhood el cual es empleado para describir el comportamiento epidemiológico de las enfermedades como asma, rinitis y eccema en niños y jóvenes, este fue resuelto por los padres de los menores previa firma y entrega del consentimiento informado, el cuestionario arrojo una confiabilidad del 0,78 en el alfa de cronbach, a las categorías de interés de este estudio se les hizo análisis de proporción, el contraste de hipótesis se realizó mediante diferencia de proporciones con intervalo de confianza en un nivel del 95%, y cálculo de error aceptado. Resultados: Teniendo en cuenta los resultados sobre el consumo de alimentos de la madre en etapa de gestación y la presencia de síntomas de alergia en los menores se concluye que: Valor-P= 0,0 Valor-Zα/2= -34,6241 No se acepta la H0 para un α/2= 0,025, se encontró en el estudio que aunque las madres refirieron haber consumido mayormente alimentos saludables, sus hijos presentaron síntomas de enfermedades alérgicas, asociados a asma, rinitis y eccema. Conclusiones: No existe un consenso sobre si la dieta materna influye positivamente en la disminución de alergias en los neonatos, se sugiere continuar con las recomendaciones de los expertos en lo referente a una nutrición balanceada que culmine en un óptimo estado de salud de la gestante y el feto.
Open Access
International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries
(BioMed Central, 2015) Bourdeaudhuij, Ilse de; Dyck, Delfien Van; Salvo, Deborah; Davey, Rachel; Reis, Rodrigo S.; Schofield, Grant; Sarmiento, Olga L.; Mitas, Josef; Christiansen, Lars Breum; MacFarlane, Duncan; Sugiyama, Takemi; Aguinaga Ontoso, Inés; Owen, Neville; Conway, Terry L.; Sallis, James F.; Cerin, Ester; Ciencias de la Salud; Osasun Zientziak
Background: Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries. Methods: A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18–66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries. Results: Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI. Conclusions: Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity