Conditions for Feasibility of a Multicomponent Intervention to Reduce Social Isolation and Loneliness in Noninstitutionalized Older Adults

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses

Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care.

Objective: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. Methods: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). Interventions: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an “advice approach”. Three follow-up visits were completed, at 15 days and at 3 and 6[0] months. Medication adherence in both groups was compared (p<0.05). Results: Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). Conclusion: A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. Practice Implications: MI is a patient-centered approach that can be used to improve medication adherence in primary care.pre-print152 K

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

Background: Health professionals’ training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider’s knowledge and skills addressing alcoholrelated problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. Methods: An observational, descriptive, cross-sectional, multicenter study was performed. Location: PC centres of the Spanish National Health System (SNHS). Participants: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS’s PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. Results: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5–71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4–31.7) reported having received basic training, and 3% (95% CI: 2.3–4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). Conclusion: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.post-print565 K

Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: a cluster-controlled clinical trial.

Objective: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged ≥ 65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. -Material and methods: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the Experimental Group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the Control Group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. -Results: A total of 5,465 patients with a mean age of 75.61 were recruited for the EG, and 1,525 patients with a mean age of 74.07 were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3% and 15.0% of the patients in the EG and the CG, respectively (p<0.001). A total of 165 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95%CI: 0.18-0.45). -Conclusions: Case finding for atrial fibrilation in patients aged ≥ 65 years with symptoms or signs suggestive of atrial fibrilation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients.pre-print325 K

Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care

[ES] Objetivo: Identificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad. Diseño: Investigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos. Emplazamiento: Desarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales. Participantes: Se identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad. Método: Muestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas. Resultados: a) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales. Conclusiones: La intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad. [EN] Objective: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness. Design: Qualitative research with grounded theory, systematic analysis and narrative design of topics. Location: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas. Participants: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness. Method: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews. Results: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals. Conclusions: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.El presente trabajo ha sido financiado por la Consejería de Salud y Familias de la Junta de Andalucía (AP-0079-2016) y por la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), gracias a la beca «Francesc Borrell», 2018.S

Prevalence of hazardous alcohol use among Spanish primary care providers

BackgroundAlcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use.MethodsA descriptive, cross-sectional, observational, multicenter study was performed. Location: PC sites of the Spanish National Health Care System (NHS). Participants: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion.ResultsOne thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR=1.52; 95% CI: 1.22-1.90), PC physicians (OR=1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR=1.03; 95% CI: 1.01-1.05).ConclusionOur study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting

Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol.

Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers.post-print290 K

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Peligrosidad por movimientos de ladera en itinerarios turísticos de alta frecuentación en el Alto Genil, Güéjar Sierra (Granada): Parque Nacional y Natural de Sierra Nevada

Congreso Internacional de las Montañas (1º. 2018. Sierra Nevada, Granada). - Texto en español, con resumen y palabras claves en español e inglés.El Instituto Geológico y Minero de España, en el marco del Convenio de Colaboración establecido con la Diputación Provincial de Granada ha realizado un estudio de peligrosidad por movimientos de ladera y avenidas e inundaciones en el municipio de Güéjar Sierra. En dicho trabajo se prestó una cierta importancia a la observación específica de la peligrosidad en espacios de alta frecuentación turística. En esta comunicación se parte de dicho trabajo y se profundiza en el análisis de los cinco senderos de mayor frecuentación en el municipio: La Vereda de la Estrella, Loma Papeles-Los Lavaderos de la Reina, la Ruta del Tranvía de la Sierra y los trayectos de las grandes rutas del Transnevada y Sulayr en el municipio de Güéjar Sierra. = The Instituto Geológico y Minero de España (Spanish Geological Institute) (IGME), within the framework of the Collaboration Agreement established by the Provincial Council of Granada, has conducted a study of geological hazards due to hillside movement and floods in the municipality of Güéjar Sierra. The work places significant importance on studying specific dangers in areas of high tourist density. This paper is derived from said work and is concentrated on analyzing five frequented trails within the municipality of Güéjar Sierra: the Vereda de la Estrella; Loma Papeles-Los Lavaderos de la Reina; the route of the Tranvía de la Sierra; and the Transnevada and Sulayr grand routes.NUBIA Consultores, EspañaInstituto Geológico y Minero de España, Españ