La causa més freqüent de vertigen pot ser fàcilment diagnosticada i tractada a les consultes d'atenció primària

El vertigen, definit sovint com una sensació de mareig, és un motiu de consulta freqüent a urgències dels hospitals i sobretot en les consultes d'atenció primària. No obstant això, el seu diagnòstic i tractament se sol fer en unitats especialitzades, i això fa que trigui molt de temps i en dificulti la generalització rutinària. Aquest article té com a objectiu demostrar que els metges de família poden realitzar les proves de diagnòstic i tractament del vertigen amb èxit amb un entrenament de 2 hores.El vértigo, definido a menudo como una sensación de mareo, es un motivo de consulta frecuente en urgencias de los hospitales y sobre todo en las consultas de atención primaria. Sin embargo, su diagnóstico y tratamiento se suele hacer en unidades especializadas, tardando así mucho más tiempo y dificultando su generalización rutinaria. Este artículo tiene como objetivo demostrar que los médicos de familia pueden realizar las pruebas de diagnóstico y tratamiento del vértigo con éxito con un entrenamiento de 2 horas.Vertigo, often referred to as a feeling of dizziness, is one of most frequent causes patients seek hospital emergency consultation and especially in primary healthcare centers. However, its diagnosis and treatment are usually done in specialized units, which means that it takes a long time and hinders routine generalization. This article aims to show that family doctors can successfully use Dix-Hallpike and Epley maneuvers to diagnose and treat vertigo after a 2-hour training session

Detección de nistagmo en respuesta a la prueba de Dix-Hallpike en atención primaria: una comparación entre vértigo posicional paroxístico benigno subjetivo y objetivo

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0-10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR = 3.94, p = 0.021) and antihypertensive therapy (OR 3.02, p = 0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p = 0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV

Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults : a systematic review

Altres ajuts: Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP, RD12/0005)Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design: A systematic review of randomised and non-randomised controlled trials was undertaken.Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results: Of 1147 references identified, 9 studies were selected (10 204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results

A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with pc-BPPV: A randomised controlled trial in primary care

Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment is the Epley manoeuvre (EM). Objective: The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Design: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Participants: Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix–Hallpike test (DHT) were randomised to: Interventions: Intervention (EM) group or a control (sham manoeuvre) group. Main measurements: The main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory – screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P < .001). Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusions: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale. Resumen: El vértigo posicional paroxístico benigno del canal posterior (pc-BPPV) causa deterioro físico, funcional y emocional. El tratamiento es la maniobra de Epley (ME). Objetivo: El propósito del estudio fue comparar el impacto de la ME y una maniobra simulada en Atención Primaria sobre la discapacidad autopercibida. Diseño: Ensayo clínico aleatorizado, doble ciego y controlado realizado en Atención Primaria con un seguimiento de un año. Participantes: Los pacientes ≥18 años diagnosticados de pc-BPPV según la prueba de Dix-Hallpike (DHT) fueron aleatorizados para: Intervenciones: Grupo de intervención (EM) o un grupo de control (maniobra simulada). Variables principales: Las principales variables del estudio fueron la edad, el sexo, los antecedentes de depresión y ansiedad, la presencia de nistagmo en la DHT, la discapacidad percibida por el paciente, evaluada con la versión de cribado del Inventario de discapacidad del vértigo (DHI-S). Los datos se analizaron mediante análisis Tobit mixtos bivariados y multivariados. Resultados: Se estudió a 134 pacientes: 66 en el grupo de intervención y 68 en el grupo de control. La mediana de edad fue de 52 años (rango intercuartílico [IQR], 38,25-68,00 años; desviación estandar 16,98) y el 76,12% de los pacientes eran mujeres. La DHT desencadenó nistagmo en el 40,30% de los pacientes. La media del DHI-S para la muestra general al inicio del estudio fue de 16 (IQR 8,00-22,00); 16 (RIQ, 10,5-24,0) frente a 10 (6,0-14,0) para mujeres frente a hombres (p < 0,001). Los pacientes tratados con ME experimentaron una reducción media de 2,03 puntos en la puntuación DHI-S durante el período de seguimiento en comparación con los pacientes del grupo simulado. Conclusiones: El Pc-BPPV afecta a la calidad de vida de los pacientes de Atención Primaria. Una sola ME puede mejorar la autopercepción de la discapacidad en alrededor de 2 puntos en la escala DHI-S

A meta-analysis of smokefree legislation effects on respiratory diseases

Introduction Aim: To synthesize the available evidence in scientific papers of smokefree legislations (SFL) effects on respiratory diseases (such as asthma, chronic obstructive pulmonary disease [COPD]) and lung infections (pneumoniae, bronchitis) among all populations (adults, children or general population). Methods Systematic review and meta-analysis were carried out. PRISMA guidelines were followed. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. The inclusion criteria were: 1)Original scientific studies concerning SFL, 2) With data before and after its implementation and 3) assessment of the impact of SFL on respiratory diseases. A meta-analysis was performed using the Review Manager (RevMan, version 5.3). The effect of SFL was estimated by risk ratios (RR) and risk difference (RD). Pooled effect measures were computed applying the inverse-variance method in a random-effect model. Heterogeneity was quantified with the I2 statistic. Subgroup and sensitivity analysis were performed. Results 17 studies reported effects on asthma, 9 on COPD and 4 on lung infections admissions. All the meta-analysis concerned comprehensive SFL settings. Six studies were included in a meta-analysis for asthma admissions in general population, 5 in children and 7 in adults. There was a significant decrease of 13% after SFL in general population (RR 0.87; 95%CI 0.81, 0.93; I2 78%) and of 15% both in children (95%CI 0.79, 0.91; I2 87%) and adults (95%CI 0.73, 0.99; I2 65%). In contrast, the 6 studies for COPD admissions showed a non significant decrease of 20% after SFL (95%CI 0.63, 1.00; I2 96%). For lung infections admissions, only 2 studies showed a non significant decrease of 14% after SFL (95%CI 0.67, 1.10; I2 55%). Conclusions SFL appears to decrease rates of admissions for asthma in all populations in comprehensive settings but not for COPD or lung infections. Funding This work was supported by the Instituto de Salud Carlos III (Institute of Health Carlos III, ISCiii) of the Ministry of Economy and Competitiveness (Spain) through the Network for Prevention and Health Promotion in Primary Care (redIAPP, RD12/0005/0001; RD16/0007/0001), co-financed with European Union ERDF funds

Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults : a systematic review

Altres ajuts: Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP, RD12/0005)Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design: A systematic review of randomised and non-randomised controlled trials was undertaken.Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results: Of 1147 references identified, 9 studies were selected (10 204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results

Disability perceived by primary care patients with posterior canal benign paroxysmal positional vertigo

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Little is known on how posterior canal BPPV affects health-related quality of life in patients diagnosed and treated at primary care facilities or on whether patients with subjective and objective disease perceive the effects differently. This study was designed to describe how patients diagnosed with posterior canal BPPV in primary care perceive disability. Methods: Cross-sectional descriptive study performed at two urban primary care centers. Participants were patients aged 18 years or older with suspected posterior canal BPPV recruited for baseline evaluation in a clinical trial on the effectiveness of the Epley maneuver in primary care. The recruitment period was from November 2012 to January 2015. Perceived disability was evaluated using the Dizziness Handicap Inventory - Screening version (DHI-S). Other variables collected were age and sex, a history or diagnosis of anxiety or depression, treatment with antidepressants and/or anxiolytics, and results of the Dix-Hallpike (DH) test, which was considered positive when it triggered vertigo with or without nystagmus and negative when it triggered neither. Results: The DH test was positive in 134 patients, 40.30% of whom had objective BPPV (vertigo with nystagmus). The median age of the patients was 52 years (interquartile range [IQR], 39.00-68.50 years) and 76.1% were women. The median total score on the DHI-S was 16 out of 40 (IQR, 8.00-22.00). Scores were higher (greater perceived disability) in women (p < 0.001) and patients with subjective BPPV (vertigo without nystagmus) (p = 0.033). The items perceived as causing the greatest disability were feeling depressed (67.1%) and worsening of the condition on turning over in bed (88%). Conclusions: Patients diagnosed with posterior canal BPPV in primary care perceive their condition as a disability according to DHI-S scores, with higher levels of disability reported by women and patients with subjective BPPV. Feelings of depression and turning over in bed were associated with the greatest perceived difficulties. Trial registration: ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT0196951

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

<div><p>Aims</p><p>The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations.</p><p>Materials and methods</p><p>Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment.</p><p>Results</p><p>A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1–36%) than for asthma (5–31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies.</p><p>Conclusions</p><p>Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma.</p></div

Summary of studies on the impact of smoke-free legislation on symptomatology.

<p>Summary of studies on the impact of smoke-free legislation on symptomatology.</p