Effectiveness of Physical Activity in Primary Prevention of Anxiety: Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study is supported by the Spanish Ministry of Health, Carlos III Institute of Health, and the European Regional Development Fund > (grant FIS references: PI15/00401; PI15/01021; PI15/01035) and the Andalusian Council of Health (grant reference: AP-00952016); as well as by the Prevention and Health Promotion Research Network `redIAPP' (RD12/0005 and RD16/0007).The aim of this study was to evaluate the effectiveness of physical activity in the primary prevention of anxiety. A systematic review of randomized controlled trials (RCTs) was performed. RCTs were searched in seven electronic databases. We included RCTs that assessed either the incidence of anxiety or the reduction of anxiety symptoms which excluded participants with baseline anxiety. Measurements were required to have been made using validated instruments. Objective or subjective (with validated questionnaires) verification of the performance of physical activity was required. Three reviewers carried out the search, selection, data extraction, and risk assessment of Cochrane Collaboration's tool simultaneously and independently, reaching an agreement in their discrepancies by consensus. In addition, a meta-analysis of fixed-effects model was carried out. Three RCTs met inclusion criteria, comprising 350 patients from 3 different countries. A meta-analysis was performed using five comparisons extracted from the selected studies, and the pooled standardized mean difference (SMD) was -0.18 (95% CI: -0.44; 0.07), p = 0.158. The heterogeneity was irrelevant, I-2 = 17.7% (p = 0.30). There is no evidence that anxiety can be prevented through physical activity, although the quality of evidence was very low.Instituto de Salud Carlos III Spanish Government Instituto de Salud Carlos IIIEuropean Regional Development Fund "Una manera de hacer Europa" PI15/00401 PI15/01021 PI15/01035Andalusian Council of Health AP-00952016Prevention and Health Promotion Research Network 'redIAPP' RD12/0005 RD16/000

Patients’ opinions about knowing their risk for depression and what to do about it: The PredictD-Qualitative study

Background: The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based. Methods: A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socioeconomic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities. Results: The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a ‘‘patient-centred’’ approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed. Conclusions: Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.Junta de Andalucía 2008/0195Gobierno Vasco 2008/111021Spanish Network of Primary Care Research (redIAPP) RD06/0018Salud Mental, Servicios y Atención Primaria (SAMSERAP

Complex multiple risk intervention topromote healthy behaviours in peoplebetween 45 to 75 years attended inprimary health care (EIRA study): study protocol for a hybrid trial

Background:Health promotion is a key process of current health systems. Primary Health Care (PHC) is the idealsetting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority ofthe adult population engages two or more risk behaviours, that is why a multiple intervention might be moreeffective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness andan implementation strategy of a complex multiple risk intervention to promote healthy behaviours in peoplebetween 45 to 75 years attended in PHC.Methods:This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing acomplex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. Thestudy focuses on people between 45 and 75 years who carry out two or more of the following unhealthybehaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level.The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in theroutine care of PHC practices according to the conceptual framework of the“5A’s”. It will have a maximum durationof 12 months and it will be carried out to three different levels (individual, group and community). Incremental costper quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. Theimplementation strategy is based on the“Consolidated Framework for Implementation Research”, a set of discreteimplementation strategies and an evaluation framework. Discussion:EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple riskintervention and will provide a better understanding of implementation processes of health promotioninterventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriersthat affect implementation of these interventions and to quantify the contextual factors that moderate theeffectiveness of implementation

Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial

Background In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. Aim To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Design and setting Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. Method In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. Results A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = –2.7% [95% CI = –5.1% to –0.3%]; P = 0.029). Conclusion A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety

Effectiveness of online interventions in preventing depression: a protocol for systematic review and meta-analysis of randomised controlled trials

IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing depression, little is known about its prevention through online interventions. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials assessing the effectiveness of online interventions in preventing depression in heterogeneous populations.Methods and analysisWe will conduct a systematic review and meta-analysis of randomised controlled trials that will be identified through searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Cochrane Central Register of Controlled Trials, ClinicalTrials. gov and Australia New Zealand Clinical Trials Register . We will also search the reference lists provided in relevant studies and reviews. Experts in the field will be contacted to obtain more references. Two independent reviewers will assess the eligibility criteria of all articles, extract data and determine their risk of bias (Cochrane Collaboration Tool). Baseline depression will be required to have been discarded through standardised interviews or validated self-reports with standard cut-off points. The outcomes will be the incidence of new cases of depression and/or the reduction of depressive symptoms as measured by validated instruments. Pooled standardised mean differences will be calculated using random-effect models. Heterogeneity and publication bias will be estimated. Predefined sensitivity and subgroup analyses will be performed. If heterogeneity is relevant, random-effect meta-regression will be performed

La investigación sobre la imagen de los alojamientos turísticos y las dimensiones que la componen: situación actual y retos de futuro

The present essay review or review paper is oriented to give the readers with an allpervading explanation revolving around the problem of image and its dissociation from branding or the branding process. Based on the hospitality industry (or lodging product) our approach has two significant aspects. On one hand, there is an urgent need of introducing emergent and fresh qualitative studies which complement the open answers regarding the role of knowledge in the purchasing process. On another, no less true is that each product is enrooted into a temporal matrix, in which case the evolution of the branding process seems to be a point of discussion which be brought into the foreground by the side of marketing analysts. Still further, our argument emphasizes on the crucial role of face-to-face interaction as a relational platform to position hotel-related products. This evinces that tourism and hospitality industries are leading towards an inevitable fragmentation which merits to be discussed and scrutinized.  El presente ensayo o pieza de revisión es un intento de brindar al lector una lectura holística del problema de la imagen y su disociación respecto a la marca o proceso de construcción de marca. Centrados en la industria hotelera (producto alojativo), la propuesta sugiere dos asuntos significativos. Por un lado, existe una necesidad de introducir nuevos estudios cualitativos que complementen los puntos que no tienen respuesta sobre el rol que juega el conocimiento como aspecto de intención de compra. Por el otro, cada producto se encuentra inserto en una matriz de tiempo, en cuyo caso, estudiar la evolución de la imagen a lo largo de la vida del producto se hace una cuestión de importancia para los analistas de marketing. Así mismo, el ensayo hace énfasis en la interacción microsocial (cara a cara) como forma relacional para el posicionamiento de los productos hoteleros. Ello demuestra que existe una tendencia hacia la fragmentación (segmentación) que debe ser discutida y analizada

Difusão de pesquisa científica do turismo em Portugal

Considerando la creciente importancia del turismo en Portugal y el papel protagonista que desempeña este sector en su economía, es notoria la necesidad de analizar la investigación turística que los investigadores e instituciones de este país realizan en el ámbito turístico. El presente artículo analiza la contribución realizada por aquellos investigadores afiliados a instituciones portuguesas en revistas académicas especializadas en turismo, tanto de ámbito nacional, como internacional. El análisis permite identificar aquellas instituciones y autores que han realizado un mayor esfuerzo de investigación y difusión en turismo. El artículo presenta no sólo un ranking de instituciones y autores, sino que también analiza el ámbito geográfico de la aplicación de las investigaciones, el número de coautores medio por trabajo, el número de citas, las revistas en las que publican más activamente sus trabajos y la evolución temporal (2006-2011) del resultado obtenido en la investigación turística. Finalmente, se establecen una serie de conclusiones en relación a la situación actual de la investigación en turismo en Portugal.Considerando a crescente importância do turismo em Portugal e o papel central que esse setor desempenha na economia, é evidente a necessidade de analisar os pesquisadores de turismo e instituições de pesquisa no país feito no turismo. Este artigo analisa a contribuição desses pesquisadores afiliados a instituições portuguesas em revistas acadêmicas em turismo, tanto nacional como internacionalmente. A análise identifica as instituições e autores que fizeram maiores esforços na investigação e divulgação do turismo. O trabalho apresenta não só um ranking de instituições e autores, mas também analisa o âmbito geográfico da aplicação da pesquisa, o número médio de coautores para o trabalho, o número de citações, as revistas que publicam o seu trabalho de forma mais ativa e tendências temporais (2006-2011) do resultado obtido em pesquisa em turismo. Finalmente, uma série de conclusões são tiradas sobre o estado atual da investigação no sector do turismo em Portugal.Tourism is a key industry in Portugal, representing this country an important role in the international market. Thus, there is a need to analyze the tourism research developed by authors and institutions of this country. This paper analyzes the contribution in tourism academic journals (national and international) of those researchers of Portuguese institutions. The paper allows for identifying those institutions and researchers that has shown a higher performance in researching and publishing their studies in tourism. The paper shows a ranking of institutions and authors, but also the geographic application of the studies, number of co-authors, journals where they publish, citations of their papers, etc., considering the dynamic evolution in the period 2006-2011. Finally, the paper highlights some conclusions and recommendations about the current situation of tourism research in Portugal

Measures for the assessment of stressful life events in the Spanish adult population: A systematic review

Objetivo: Este estudio pretende identificar y analizar los instrumentos de evaluación de los eventos vitales estresantes creados/adaptados para su uso con población española adulta, publicados en la literatura nacional e internacional, con especial atención en sus propiedades psicométricas y en su asociación con medidas de problemas de salud. Métodos: Se llevó a cabo una revisión sistemática de la literatura de todos los instrumentos publicados a través de los buscadores MEDLINE; ProQuest Health y Medical Complete ProQuest Psychology Journals PsycARTICLES PsycINFO Psicodoc OpenSIGLE desde la fecha de inicio hasta el 31 de enero de 2016. Dos investigadores independientes evaluaron la elegibilidad de todos los artículos, extrajeron los datos y evaluaron sus propiedades psicométricas. Resultados: Se seleccionaron 12 instrumentos que cumplían los criterios de inclusión en el estudio. Las medidas presentaron una gran heterogeneidad. La mayoría no incluían información sobre sus propiedades psicométricas o necesitaban aportar más datos, ya que eran pocas los que evaluaban su estabilidad test-retest y/o su estructura interna. Los cuestionarios creados o adaptados por González de Rivera y Morena (1983), Sandín y Chorot (1987), Fernández y Mielgo (1992), Gracia y Herrero (2004) y Motrico et al. (2013) mostraron asociaciones significativas con variables de problemas de salud. Discusión: Se requieren más estudios sobre la asociación de los instrumentos con variables de problemas de salud mental y física, lo que facilitaría su aplicación clínica. Estos resultados tienen una gran utilidad a la hora de seleccionar un instrumento de evaluación de eventos vitales estresantes en el ámbito clínico y de investigación en España

Barriers and Facilitators for the Implementation of Primary Prevention and Health Promotion Activities in Primary Care : A Synthesis through Meta-Ethnography

Evidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults. A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP. Research on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual overview provided by this synthesis resulted in the development of practical recommendations for the design of PP&HP in PC. However, the effectiveness of these recommendations needs to be demonstrated