Oferta formativa: programa de Prescripció Social i Salut

Prescripció social; Oferta formativa; Atenció primàriaPrescripción social; Oferta formativa; Atención primariaSocial prescription; Training offer; Primary careAquesta presentació tracta de l'oferta formativa en prescripció social per als professionals d'atenció primària

Una vacuna pel virus de l'Ebola : un repte de desenvolupament i comunicació

L'Ebola es una malaltia transmissible, greu i sovint mortal. Els epidemiòlegs controlen les epidèmies d'ebola mitjançant mesures d'aïllament i seguiment de contactes. Quan el nombre de contagis és elevat una vacuna pot ser crucial en la disminució de la transmissió. La necessitat de disposar de vacunes enfront del virus de la ebola ha accelerat el desenvolupament experimental i els assajos clínics. En aquest article s'introdueix el virus de la ebola, s'exposen les fases de desenvolupament de vacunes i les peculiaritats de la comunicació en situacions d'emergència.Ebola disease is highly transmissible, serious and often deadly. Epidemiologists control Ebola epidemics by isolation measures and contact tracing. When the number of infections is high a new vaccine can be crucial in reducing transmission. The need for vaccines against Ebola virus has accelerated the experimental development and clinical trials. In this article we present Ebola virus, the phases of vaccine development and peculiarities of communication in emergency situations

Psychoactive constituents of cannabis and their clinical implications: a systematic review

Ús terapèutic del cànnabis; Drogues psicoactives; 9-THCUso terapéutico del cannabis; Drogas psicoactivas; 9-THCTherapeutic use of cannabis; Psychoactive drugs; 9-THCObjective: This systematic review aims to summarize current evidence on which naturally present cannabinoids contribute to cannabis psychoactivity, considering their reported concentrations and pharmacodynamics in humans. Design: Following PRISMA guidelines, papers published before March 2016 in Medline, Scopus-Elsevier, Scopus, ISI-Web of Knowledge and COCHRANE, and fulfilling established a-priori selection criteria have been included. Results: In 40 original papers, three naturally present cannabinoids (∆-9-Tetrahydrocannabinol, ∆-8-Tetrahydrocannabinol and Cannabinol) and one human metabolite (11-OH-THC) had clinical relevance. Of these, the metabolite produces the greatest psychoactive effects. Cannabidiol (CBD) is not psychoactive but plays a modulating role on cannabis psychoactive effects. The proportion of 9-THC in plant material is higher (up to 40%) than in other cannabinoids (up to 9%). Pharmacodynamic reports vary due to differences in methodological aspects (doses, administration route and volunteers' previous experience with cannabis). Conclusions: Findings reveal that 9-THC contributes the most to cannabis psychoactivity. Due to lower psychoactive potency and smaller proportions in plant material, other psychoactive cannabinoids have a weak influence on cannabis final effects. Current lack of standard methodology hinders homogenized research on cannabis health effects. Working on a standard cannabis unit considering 9-THC is recommended.Objetivo: Esta revisión sistemática pretende resumir la actual evidencia sobre qué cannabinoides naturalmente presentes contribuyen a la psicoactividad final del cannabis, considerando sus concentraciones registradas y su farmacodinamia en humanos. Metodología: Siguiendo las guías PRISMA, se revisaron artículos científicos publicados antes de marzo 2016 en Medline, Scopus-Elsevier, Scopus, ISI-Web of Knowledge y COCHRANE, que cumplieran unos criterios establecidos a-priori. Resultados: En 40 artículos científicos, se identificaron tres cannabinoides naturalmente presentes (∆-9-Tetrahydrocannabinol, ∆-8-Tetrahydrocannabinol y cannabinol) y un metabolito humano (11-OH-THC) con relevancia clínica. De éstos, el metabolito produce los efectos psicoactivos más potentes. El cannabidiol (CBD) no es psicoactivo, pero sí ejerce un efecto modulador sobre los efectos psicoactivos del cannabis. La concentración 9-THC en derivados cannábicos (hasta 40%) supera en gran medida la de otros cannabinoides (hasta 9%). La farmacodinamia descrita varía, dada la heterogeneidad en aspectos clave de la metodología (dosis, rutas de administración y experiencia previa con cannabis de los participantes). Conclusiones: Los resultados evidencian que el 9-THC es el cannabinoide que más contribuye al efecto psicoactivo del cannabis. Otros cannabinoides psicoactivos contribuirían mínimamente, dada su menor potencia psicoactiva y su baja concentración en los derivados cannábicos. La falta de estándares metodológicos dificulta el avance en los conocimientos sobre los efectos del cannabis en la salud. Establecer una unidad estándar de cannabis basada en 9-THC ayudaría a superar estas limitaciones.:esMinisterio de Sanidad y Consumo (PNSD 2013I082), Fundació Clínic per la Recerca Biomèdica, IDIBAPS y Generalitat de Catalunya

The relationship between motivations for cannabis consumption and problematic use

Atención centrada en la persona; Cannabis; Motivación para el consumo; Consumo problemático de cánnabisPatient-centered care; Cannabis; Motivations for cannabis use; Problematic cannabis useAtenció centrada a la persona; Cannabis; Motivació per al consum; Consum problemàtic de cànnabisIntroducción. El cribado sistemático del consumo problemático de cannabis no incluye las motivaciones que llevan al consumo, aunque desde una perspectiva de atención centrada en la persona, este dato sea fundamental. El presente estudio explora las motivaciones de consumo de cannabis en adultos y su relación con el patrón de consumo y consumo problemático. Método. Consumidores adultos de cannabis (en los últimos 60 días) fueron reclutados en la provincia de Barcelona (n=468). Se pasó un cuestionario para explorar datos sociodemográficos, patrón de uso, la Cannabis Abuse Screening Test (CAST) y la motivación principal para el consumo. Los motivos de consumo se categorizaron a posteriori según la Marijuana Motives Measures (MMM). Se realizó un análisis descriptivo e inferencial para explorar la relación entre la motivación categorizada y variables sociodemográficas, patrón de consumo y puntuaciones de la CAST. Resultados. Consumir cannabis para mejorar las emociones positivas (35%), por costumbre (29%) y para afrontar emociones negativas (25%) fueron las motivaciones más frecuentes. Respecto a otras motivaciones, el “afrontamiento” se relaciona con mayor cantidad consumida (4 vs 3 porros/día, p = 0,005), mayor probabilidad de tener un consumo problemático (77% vs 64%, p = 0,05), y mayor vulnerabilidad social (desempleo 56% vs 37%, p = 0,001; y bajo nivel de estudios (14% vs 8%, p = 0,042)). Conclusiones. El afrontamiento está presente en uno de cada cuatro usuarios de cannabis, es un marcador de vulnerabilidad social y de mayor cantidad de consumo de cannabis y probabilidad de consumo problemático. Una atención centrada en la persona junto con estrategias preventivas (educación emocional y social) y clínicas (psicoterapia) pueden ser de utilidad en esta población de mayor riesgo.Introduction. Systematic screening of problematic cannabis use does not include the motivations that lead to consumption, although from a person-centered perspective this is fundamental. The present study explores the motivations for cannabis use in adults and its relationship with cannabis use patterns and problematic use. Method. Adult cannabis users (previous 60 days) were recruited in the province of Barcelona (n = 468). Information on their sociodemographic data, cannabis use pattern, Cannabis Abuse Screening Test (CAST) and the main motivation for use were collected. Motivations were categorized a posteriori according to the Marijuana Motives Measures (MMM). A descriptive and inferential analysis was carried out to link the motivations to sociodemographic variables, consumption pattern and probability of suffering problematic cannabis use (CAST). Results. Using cannabis to heighten positive feelings (35%), out of habit (29%) and to cope with negative feelings (25%) were the most frequent motivations. In comparison to other motivations, coping is related to a greater quantity of cannabis used (4 vs 3 joints per day, p = 0.005), higher probability of problematic cannabis use (77% vs 64%, p = 0.05), and greater social vulnerability (unemployment 56% vs 37%, p = 0.001; and low educational level 14% vs 8%, p = 0.042). Conclusions. Coping as a motivation for cannabis use is present in one out of four users and is a marker of social vulnerability, greater quantity of cannabis used and higher risk of problematic use. Patient-centered care together with preventive (emotional and social education) and clinical strategies (psychotherapy) can be useful for this population at higher risk

Working on a Standard Joint Unit: a pilot test

Cannabis; 9-Tetrahidrocannabinol; Unidad estándar; Estudio pilotoCannabis; 9-Tetrahydrocannabinol; Standard unit; Pilot studyCànnabis; 9-Tetrahidrocannabinol; Unitat estàndard; Estudi pilotIntroducción. Explorar el consumo de cánnabis sigue siendo complejo debido a la falta de sistemas de registro. Se evaluó la factibilidad de obtener una Unidad de Porro Estándar (UPE) que considere los principales cannabinoides con implicación clínica mediante un estudio naturalístico. Metodología. Estudio piloto con consumidores actuales de cánnabis de cuatro áreas (universidades, ocio nocturno, servicio ambulatorio de salud mental y asociaciones cannábicas) en Barcelona. Se diseñó y administró un cuestionario sobre patrones de consumo y se determinó la predisposición a donar un porro para análisis. Se utilizaron estadísticos descriptivos para analizar los datos. Resultados. Cuarenta consumidores de cannabis respondieron a la encuesta (tasa de respuesta 95%), siendo la mayoría hombres (72,5%) y jóvenes adultos (mediana de edad 24,5 años; RIQ 8,75 años) que consumen a diario o casi diariamente (70%). La marihuana es el derivado más consumido (85%), habiendo de mediana 0,25 gr de marihuana por porro. Un 67,5% de los participantes se mostraron predispuestos a donar un porro para análisis. Conclusión. La obtención de la UPE con la metodología prevista es factible. Tras el piloto el cuestionario ha sido adaptado y se ha introducido un incentivo para estimular la donación de muestras. Establecer la UPE permitirá avanzar en el conocimiento de las consecuencias del consumo de cannabis.Introduction. Assessing cannabis consumption remains complex due to no reliable registration systems. We tested the likelihood of establishing a Standard Joint Unit (SJU) which considers the main cannabinoids with implication on health through a naturalistic approach. Methodology. Pilot study with current cannabis users of four areas of Barcelona: universities, nightclubs, out-patient mental health service, and cannabis associations. We designed and administered a questionnaire on cannabis use-patterns and determined the willingness to donate a joint for analysis. Descriptive statistics were used to analyze the data. Results. Forty volunteers answered the questionnaire (response rate 95%); most of them were men (72.5%) and young adults (median age 24.5 years; IQR 8.75 years) who consume daily or nearly daily (70%). Most participants consume marihuana (85%) and roll their joints with a median of 0.25 gr of marihuana. Two out of three (67.5%) stated they were willing to donate a joint. Conclusion. Obtaining an SJU with the planned methodology has proved to be feasible. Pre-testing resulted in an improvement of the questionnaire and retribution to incentivize donations. Establishing an SJU is essential to improve our knowledge on cannabis-related outcomes.Este estudio se financió con la subvención española del Plan Nacional sobre Drogas, Ministerio de Sanidad y Consumo (PNSD 2013I082; Antoni Gual Solé)

Working on a Standard Joint Unit: A pilot test

INTRODUCTION: Assessing cannabis consumption remains complex due to no reliable registration systems. We tested the likelihood of establishing a Standard Joint Unit (SJU) which considers the main cannabinoids with implication on health through a naturalistic approach. Methodology. Pilot study with current cannabis users of four areas of Barcelona: universities, nightclubs, out-patient mental health service, and cannabis associations. We designed and administered a questionnaire on cannabis use-patterns and determined the willingness to donate a joint for analysis. Descriptive statistics were used to analyze the data. RESULTS: Forty volunteers answered the questionnaire (response rate 95%); most of them were men (72.5%) and young adults (median age 24.5 years; IQR 8.75 years) who consume daily or nearly daily (70%). Most participants consume marihuana (85%) and roll their joints with a median of 0.25 gr of marihuana. Two out of three (67.5%) stated they were willing to donate a joint. CONCLUSION: Obtaining an SJU with the planned methodology has proved to be feasible. Pre-testing resulted in an improvement of the questionnaire and retribution to incentivize donations. Establishing an SJU is essential to improve our knowledge on cannabis-related outcomes. Introducción. Explorar el consumo de cánnabis sigue siendo complejo debido a la falta de sistemas de registro. Se evaluó la factibilidad de obtener una Unidad de Porro Estándar (UPE) que considere los principales cannabinoides con implicación clínica mediante un estudio naturalístico. Metodología. Estudio piloto con consumidores actuales de cánnabis de cuatro áreas (universidades, ocio nocturno, servicio ambulatorio de salud mental y asociaciones cannábicas) en Barcelona. Se diseñó y administró un cuestionario sobre patrones de consumo y se determinó la predisposición a donar un porro para análisis. Se utilizaron estadísticos descriptivos para analizar los datos. Resultados. Cuarenta consumidores de cannabis respondieron a la encuesta (tasa de respuesta 95%), siendo la mayoría hombres (72,5%) y jóvenes adultos (mediana de edad 24,5 años; RIQ 8,75 años) que consumen a diario o casi diariamente (70%). La marihuana es el derivado más consumido (85%), habiendo de mediana 0,25 gr de marihuana por porro. Un 67,5% de los participantes se mostraron predispuestos a donar un porro para análisis. Conclusión. La obtención de la UPE con la metodología prevista es factible. Tras el piloto el cuestionario ha sido adaptado y se ha introducido un incentivo para estimular la donación de muestras. Establecer la UPE permitirá avanzar en el conocimiento de las consecuencias del consumo de cannabis

Health Impact Assessment (HIA) of a fluvial environment recovery project in a medium-sized spanish town

Introduction: The Interdepartamental Public Health Plan of Catalonia (2014) seeks to enforce Health in All Policies (HiAP) at the regional and local levels. Within this context, the City Council of Sant Andreu de la Barca (SAB), the Metropolitan Area of Barcelona (MAB), and the Public Health Agency of Catalonia started a Health Impact Assessment (HIA) of an urbanistic redesign of the Llobregat fluvial area in SAB, the results of which are presented in this paper. Methodology: In 2018, after a HIA screening, a prospective nonquantitative HIA was conducted. Politicians, professionals, and citizens participated in identifying potential impacts. Impacts were prioritized and linked to health determinants, scientific evidence, and potentially affected social groups. Afterwards, recommendations were formulated in order to improve the health impacts of the project. Finally, indicators were selected to evaluate HIA implementation. Results: The HIA was successfully implemented with the participation of technicians and citizens of SAB. The health impacts identified were mainly related to environmental, public safety, lifestyle, socioeconomic, and political contexts. Ten recommendations were defined to minimize the potential negative health impacts of the project, with six of them directly included and only one dismissed due to incompatibility. Conclusion: A HIA was successfully carried out in the medium-sized town of Catalonia, promoting Health in all Policies at a local level and improving health impacts of an urbanistic project

A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): The study protocol

ABSTRACT Introduction: Early identification (EI) and brief interventions (BIs) for risky drinkers are effective tools in primary care. Lack of time in daily practice has been identified as one of the main barriers to implementation of BI. There is growing evidence that facilitated access by primary healthcare professionals (PHCPs) to a webbased BI can be a time-saving alternative to standard face-to-face BIs, but there is as yet no evidence about the effectiveness of this approach relative to conventional BI. The main aim of this study is to test non-inferiority of facilitation to a web-based BI for risky drinkers delivered by PHCP against face-to-face BI. Method and analysis: A randomised controlled noninferiority trial comparing both interventions will be performed in primary care health centres in Catalonia, Spain. Unselected adult patients attending participating centres will be given a leaflet inviting them to log on to a website to complete the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol screening questionnaire. Participants with positive results will be requested online to complete a trial module including consent, baseline assessment and randomisation to either face-to-face BI by the practitioner or BI via the alcohol reduction website. Follow-up assessment of risky drinking will be undertaken online at 3 months and 1 year using the full AUDIT and D5-EQD5 scale. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. Assuming reduction of 30% of risky drinkers receiving standard intervention, 1000 patients will be required to give 90% power to reject the null hypothesis. Ethics and dissemination: The protocol was approved by the Ethics Commmittee of IDIAP Jordi Gol i Gurina P14/028. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentation

Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial

Background: The present study describes the efectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). Methods: Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45–75 years who presented at least two of the following crite‑ ria were included: smoker, low adherence to the MD or insufcient level of physical activity. The intervention group (IG) had three diferent levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor’s ofce. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. Results: Three thousand sixty-two participants were included (IG=1,481, CG=1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9–17.5; p<0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the fnal visit. Moreover, the efect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p<0.001) in IG. Conclusions: A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice

Effectiveness, safety and costs of thromboembolic prevention in patients with non-valvular atrial fibrillation : phase I ESC-FA protocol study and baseline characteristics of a cohort from a primary care electronic database

Atrial fibrillation is the most common arrhythmia. Its management aims to reduce symptoms and to prevent complications through rate and rhythm control, management of concomitant cardiac diseases and prevention of related complications, mainly stroke. The main objective of Effectiveness, Safety and Costs in Atrial Fibrillation (ESC-FA) study is to analyse the drugs used for the management of the disease in real-use conditions, particularly the antithrombotic agents for stroke prevention. The aim of this work is to present the study protocol of phase I of the ESC-FA study and the baseline characteristics of newly diagnosed patients with atrial fibrillation in Catalonia, Spain. The data source is System for the Improvement of Research in Primary Care (SIDIAP) database. The population included are all patients with non-valvular atrial fibrillation diagnosis registered in the electronic health records during 2007-2012. A total of 22 585 patients with non-valvular atrial fibrillation were included in the baseline description. Their mean age was 72.8 years and 51.6% were men. The most commonly prescribed antithrombotics were vitamin K antagonists (40.1% of patients) and platelet aggregation inhibitors (32.9%); 25.3% had not been prescribed antithrombotic treatment. Age, gender, comorbidities and co-medication at baseline were similar to those reported for previous studies. The next phase in the ESC-FA study will involve assessing the effectiveness and safety of antithrombotic treatments, analysing stroke events and bleeding episodes' rates in our patients (rest of phase I), describing the current management of the disease and its costs in our setting, and assessing how the introduction of new oral anticoagulants changes the stroke prevention in non-valvular atrial fibrillation