Análisis epidemiológico y etiológico del déficit de vitamina B12 y ácido fólico en atención primaria

Análisis descriptivo de los pacientes del centro de salud delicias Sur, con déficit de B12 y/o Fólico según edad, sexo, niveles, etc y análisis diagnóstico de las causas que pueden justificar el déficit: farmacología (metformina, inhibidor bomba de protones…), déficit nutricional, causa malabsortiva (gástrica o intestinal). En el 53,4% de los pacientes no se encontró la causa, mientras que la causa mayoritaria fue la farmacológica en un 34,3% y detrás de ésta se encuentran las causas gástricas con un 13,7% (gastrtitis crónica).En todos los pacientes fue un hallazgo casual en un análisis de rutina, siendo todos ellos déficits subclínicos. Todos los pacientes aumentaron los niveles con el tratamiento, aunque algunos no normalizaron sus cifras. Hallamos una posible asociación entre patología tiroidea y déficit de B12.<br /

Psychosocial interventions for supporting women to stop smoking in pregnancy

Background: Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. Objectives: To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods: In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. Selection criteria: Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. Data collection and analysis: Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. Main results: The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination. In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%). High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. Authors' conclusions: Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update

Consumo de tabaco entre los adolescentes. Valor de la intervención del personal sanitario

ObjetivosDescribir las características del consumo de tabaco entre los adolescentes atendidos en un centro de salud, conocer su opinión sobre los factores que influyen en el mismo y analizar la calidad de la intervención del personal sanitario.DiseñoEstudio descriptivo, transversal realizado en adolescentes que acuden al centro de salud.EmplazamientoAtención primaria (AP).PacientesSe seleccionó a todos los jóvenes entre 10 y 20 años que acudieron a las consultas a demanda o programadas de medicina de familia, pediatría o enfermería los martes y miércoles durante diciembre de 2000 a febrero de 2001.Resultados principalesGlobalmente fuma el 23,1% (intervalo de confianza [IC] del 95%, 14,9–33,1) de las chicas frente al 15,3% (IC del 95%, 8,4–24,7) de los chicos. Entre los no fumadores el motivo más importante para no hacerlo es la salud (94,4%). El 50% de los fumadores ha intentado dejar de fumar; de éstos el 70,5% lo ha hecho por motivos relacionados con la salud. Al 49,4% (IC del 95%, 41,8–57,1) de los incluidos en el estudio alguna vez se le ha preguntado en el centro de salud si fuma (10,1% [IC del 95%, 4,2–19,8] entre 10–13 años; 73,4% [IC del 95%, 60,9–83,7] entre 14–17, y 76,7% [IC del 95%, 61,4–88,2] entre 18–20), y al 50,6% nunca se le ha preguntado. De aquellos a los que se les ha preguntado y fuman, al 75% (IC del 95%, 55,1–89,3) se le ha indicado que lo dejen, y de éstos al 4,7% (IC del 95%, 0,1–23,8) se le ofreció ayuda para hacerlo. De los que no fuman al 28,81% (IC del 95%, 17,8–42,1) se le animó a seguir así.ConclusionesExiste una gran sensibilización tanto en no fumadores como en fumadores sobre las repercusiones del tabaco en la salud. Se observa un abordaje deficiente del tabaquismo en los jóvenes desde las consultas de un centro de salud, especialmente en la población pediátrica.ObjectivesTo describe the characteristics of tobacco consumption among adolescents seen at a health centre, find their opinions of the factors that affect consumption, and analyse the quality of the intervention of the health staff.DesignDescriptive, cross-sectional study of adolescents attending the health centre. Setting. Primary care (PC).PatientsAll the young people between 10 and 20 who attended family medicine, paediatric or nursing clinics, whether on-demand or with appointments, on Tuesdays and Wednesdays between December 2000 and February 2001.Main results23.1% of all the girls smoked (95% CI, 14.9–33.1) versus 15.3% of boys (95% CI, 8.4–24.7). Among non-smokers the main reason for not smoking was health (94.4%). 50% of smokers had tried to give up, of whom 70.5% tried for health-related reasons. 49.4% (95% CI, 41.8–57.1) of those included in the study had been asked at the health centre on some occasion whether they smoked (10.1% of these [95% CI, 4.2–19.8] were aged 10–13; 73.4% [95% CI, 60.9–83.7] 14–17; and 76.7% [CI 95%: 61.4–88.2] 18–20); and 50.6% had never been asked. Of those who were asked and did smoke, 75% (95% CI, 55.1–89.3) were advised to give up and 4.7% of these (95% CI, 0.1–23.8) were offered help to do so. 28.81% of those who did not smoke (95% CI, 17.8–42.1) were encouraged to continue not to smoke.ConclusionsBoth smokers and non-smokers are highly aware of the repercussions of tobacco on health. Tobacco dependency in young people was not tackled well enough at health centre clinics, especially by paediatricians