Evaluación clínica y análisis coste-efectividad del envío de mensajes motivacionales como herramienta adyuvante para dejar de fumar.

171 p.El tabaquismo constituye la primera causa de morbi-mortalidad evitable a nivel mundial. Es uno de los mayores problemas de salud pública al que se ha tenido que enfrentar lahumanidad, matando hasta la mitad de sus consumidores. Son de sobra conocidas las consecuencias nefastas para la salud producidas por el tabaco que a su vez tienen grandesimplicaciones económicas. Actualmente hay diferentes maneras de abordar el tratamiento del tabaquismo, con diferentes tasas de éxito en función del tratamiento elegido, sin embargo, lasrecaídas son frecuentes y es necesario seguir explorando diferentes opciones que se puedanadaptar a las necesidades y expectativas de los pacientes.El auge de las nuevas tecnologías ha sido aprovechado para desarrollar estrategias basadas en telefonía móvil como herramientas de apoyo al profesional sanitario y al paciente para mejorar los resultados en salud. En este sentido se llevó a cabo un ensayo clínico aleatorio enfumadores motivados para iniciar un programa de deshabituación tabáquica en el que seevaluaba la efectividad de la mensajería móvil como herramienta adyuvante al consejo motivacional para dejar de fumar. Los pacientes asignados al grupo intervención (sms +consejo motivacional) alcanzaron mayores tasas de éxito que los del grupo control (sóloconsejo motivacional) (24% frente a 12% a los 6 meses). Posteriormente, se realizó un estudio coste-efectividad comparando este programa combinado (sms+ consejo motivacional) frente aconsejo motivacional únicamente, para evaluar si el coste que es necesario asumir paraimplantar este nuevo programa en la práctica clínica está justificado por una mayor gananciaen salud.Además, se ha realizado un meta-análisis sobre la efectividad de las aplicaciones móviles paradejar de fumar.Bioarab

Effectiveness of Mobile Applications to Quit Smoking: Systematic Review and Meta-Analysis

Introduction: Tobacco is the leading cause of preventable mortality. The use of mobile phones has grown exponentially, becoming a powerful tool to be used in health care. Methods: In order to assess the effectiveness of mobile phones to quit smoking, we have carried out a systematic review and meta-analysis of randomized clinical trials evaluating interventions based on mobile applications for smartphones, that were not a smaller version of the same application, against other types of therapy. To address this, a bibliographic search was carried out in MEDLINE, EMBASE and COCHRANE LIBRARY. To obtain the combined effect, the relative risk and the 95% confidence interval were used. A heterogeneity and sensitivity analysis were also conducted. Results: A total of nine studies were identified, but five were excluded. Qualitative review was performed with four selected studies, but quantitative analysis was carried out for only three, given the impossibility of calculating the RR in one of the studies. After combining the results, an RR of 0.901 (95% CI: 0.57-1.423) was calculated comparing the effectiveness of mobile applications versus others type of interventions. This measure was robust, as shown by the sensitivity analysis. Conclusions: According to the results, it cannot be concluded that apps are effective for quitting tobacco. There are very few clinical trials published evaluating the effectiveness of mobile applications compared to other alternatives. Several clinical trials are still in progress, therefore their results have not been included in the present meta-analysis

Cost-Effectiveness Analysis of Text Messaging to Support Health Advice for Smoking Cessation

Background: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. Methods: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. Results: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of euro7.4 and euro1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. Conclusions: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centresThis paper has been co-funded by the European Union through the European Regional Development Fund (ERDF) and by the European Social Fund (ESF). Call for proposals: Accion Estrategica en Salud 2017. Reference number PI17/01502

Knowledge about COVID-19 and vaccine acceptability among priority groups defined for vaccination: A cross-sectional study in Araba/Alava, Spain, before the vaccination against SARS-CoV-2

Background: The acceptability of COVID-19 vaccine varies depending on the time, place, type of vaccine and information available at the time. Knowledge of attitudes and practices towards COVID-19 among the population at high risk of developing the disease would help to tailor the strategy to improve adherence to vaccination recommendations. Aim: To analyze the willingness, knowledge and risk perception of patients and health care workers (HCW) to get the vaccines against SARS-CoV-2. Methods: Cross-sectional survey in Araba/alava province (Spain). Subjects who met the criteria for the influenza vaccination in 2019 and HCWS from the Basque Public Health Service were included. The participants answered a questionnaire on the knowledge, attitudes and practices towards COVID-19 before starting vaccination against SARS-CoV-2. The intention to vaccinate was compared using the chi-squared test. Results: 316 HCWs and 389 patients responded to the survey. Around 90% of the patients and 80% of HCW would accept vaccination in all scenarios according to the questionnaire (p < 0.001). Only 3-12% hesitated about the COVID-19 vaccines. Compared to 40-70% of patients, 60-80% of HCWs perceived a high risk of COVID-19 (p < 0.001). Statistically significant differences were found in 10 of the 17 questions regarding the mechanism of transmission and symptoms. Conclusion: HCWs had a better knowledge and risk perception of COVID-19 than the surveyed patients. They had a higher proportion of hesitancy to get COVID-19 vaccine, probably related to doubts about the effectiveness of the new vaccines and the scientific evidence.Funding for the study was provided by the Caja Vital Foundation

The Impact of Digital Health on Smoking Cessation

Background: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients’ quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation–relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. Objective: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. Methods: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. Results: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. Conclusions: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resource

Variabilidad en Vizcaya en el registro de las actividades preventivas en la mujer

Fundamentos: Diferentes estudios han puesto de manifiesto que existe un déficit de realización de actividades preventivas en nuestro medio, sin embargo, en Vizcaya la situación todavía no se conoce. El objetivo del trabajo es determinar el porcentaje de registro en la historia clínica informatizada (Osabide) de las actividades preventivas realizadas en la mujer por los médicos/as de atención primaria, y analizar las características que condicionan las diferencias en el registro. Métodos: Estudio descriptivo transversal que incluyó a 425 mujeres con edades comprendidas entre 26 y 65 años que habían acudido a consulta en más de una ocasión y que lo hicieron nuevamente los días 28, 29 ó 30 de abril de 2010. Se recogió como variable principal el registro de prácticas anticonceptivas (grupo de 26 a 51 años), de citologías cervicales durante los últimos 5 años, y de mamografías los últimos 2 años (grupo de 52 a 65 años), y se comparó dicho registro entre médicos y médicas, entre comarcas sanitarias y entre zonas con CAM (Centro de Atención a la Mujer) y sin él, mediante el estadístico chi2. Resultados: Del total de mujeres incluidas en el estudio, en 139 (34,1%) existía registro de citología en la historia clínica. De aquéllas con edad entre 26 a 51 años, 99 (48,3%) tenían registro de prácticas anticonceptivas. 22 (10,7%) de las mujeres con edad entre 52 a 65 años tenían registro de mamografía. Conclusiones: El registro de actividades preventivas en la mujer en Osabide-Vizcaya es bajo. Se han observado diferencias en el registro según sexo del médico

Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis

Objective, and material and methods: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library. Source of data: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform. Selection of studies: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed. Data extraction: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies.Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure. Results: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56–0.94. Conclusions: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease. Resumen: Objetivo, y material y métodos: Se realizó una revisión sistemática y un metaanálisis para evaluar la eficacia de los antidepresivos en la reducción de la mala evolución de la enfermedad COVID-19 (variable compuesta que incluye muerte, hospitalización y necesidad de ventilación mecánica), y mortalidad, según las directrices para Revisiones Sistemáticas de Intervenciones publicadas por la biblioteca Cochrane. Fuente de datos: Se consultaron MEDLINE, EMBASE y la biblioteca Cochrane hasta el 25 de febrero de 2022. Se realizaron búsquedas de estudios no publicados en la plataforma clinicaltrials.gov. Selección de estudios: Se seleccionaron estudios observacionales y experimentales, enmascarados y no enmascarados, que evaluaron la muerte, la hospitalización y la necesidad de ventilación mecánica. Se realizó un segundo análisis de subgrupos con la variable mortalidad. Extracción de datos: Se realizó una evaluación completa del riesgo de sesgo que abordó temas como el sesgo de información y los factores de confusión. Se emplearon las herramientas Rob2 y Robins-I para los estudios aleatorios y no aleatorios, respectivamente. En el análisis cuantitativo, se analizó el sesgo de publicación, heterogeneidad, y se estimó la medida combinada global. La medida final se calculó como odds ratio con su correspondiente intervalo de confianza del 95%. Para ello se utilizó un modelo de efectos aleatorios debido a la heterogeneidad entre los estudios incluidos.Finalmente, se realizó un análisis de sensibilidad para evaluar la robustez de la medida final estimada. Resultados: Se consideraron 7 estudios para calcular la medida agrupada final. El efecto de la intervención (tratamiento con antidepresivos) fue OR 0,73; IC 95% 0,56-0,94. Conclusiones: El uso de antidepresivos, y especialmente de ISRS, podría ser eficaz para reducir el riesgo de mala evolución y mortalidad de la enfermedad COVID-19

Analysis of the estimation of bleeding using several proposed haematometric equations

Purpose Among various methods for estimating blood loss, the gravimetric method is the most accurate; however, its use in routine practice is complicated. Although several equations have been proposed for this purpose, there is no consensus on the most suitable. Methods A cross-sectional study was conducted in seven secondary and tertiary hospitals between March and July 2018 including all patients undergoing total hip arthroplasty or hip prosthesis replacement under general or regional anaesthesia. We compared blood loss estimates obtained using the gravimetric method (weighing gauzes and pads and measuring volumes of blood collected by suction during surgery) and using three different equations, two of which considered intravenous fluids (CRYS 3.5 and 1.5) and a third which did not (the traditional equation). Additionally, intraclass correlation coefficients (ICCs) and Bland-Altman plots were used. Results The mean blood loss estimated using the gravimetric method was 513.7 +/- 421.7 mL, while estimates calculated using the CRYS 3.5, CRYS 1.5 and traditional equations were 737.2 +/- 627.4, 420.8 +/- 636.2 and 603.4 +/- 386.3 mL, respectively. Comparing these results, we found low levels of agreement (based on ICCs), except when using the traditional equation (ICC: 0.517). The limits of agreement comparing external blood loss with the estimates from the equations ranged from - 1655.6 to 1459.2 in the case of the CRYS 1.5 equation to - 839.6 to 1008.4 in the case of the traditional equation. Conclusions For use in clinical practice, haematological index-based equations, regardless of whether they consider fluids administered, do not show sufficiently strong correlations with gravimetric estimates of intraoperative blood loss

Podcasts como ferramenta para aprender sobre Direito

La proliferación de nuevas formas de transmisión del conocimiento, así como de su difusión constituye una oportunidad que la enseñanza del Derecho no puede dejar pasar. La elaboración de podcast o podcasting con fines educativos o de aplicación a la docencia ha sido ya objeto de utilización en el contexto anglosajón y, en un nivel mucho menor, en el contexto español. Como ya alude Piñero-Otero, T. en su investigación “La utilización de los podcasts en la universidad española: entre la institución y la enseñanza”, la incorporación de los podcasts como herramienta docente en las universidades españolas fue tardía respecto a otras universidades, como las norteamericanas. Y, no sólo eso, sino que su aplicación en la práctica es escasa. Los podcasts muestran relevantes potencialidades para la formación universitaria y, en específico, para la formación en Derecho. El formato de fragmentos o episodios de audio que desarrollan conocimiento, online, público, gratuito y accesible en cualquier momento se evidencia pertinente para captar el interés del estudiantado. Evidencia que queda patente en los estudios que ya han aplicado esta herramienta. El presente proyecto busca fomentar la extensión de este instrumento en el entorno universitario como recurso formativo complementario y de apoyo a la clase magistral y práctica establecida en la regulación de las enseñanzas superiores. Tal y como se ha apuntado en numerosas ocasiones por docentes que ya han aplicado los podcasts en la educación, se trata de una fuente más que, en ningún caso, se propone como sustitutoria de las clases ordinarias. Ello supondría el desencadenamiento de efectos negativos como una insuficiencia de formación, falta de intercambio de pensamiento y debate y riesgo de asistencia y participación en el aula, entre otros. Respecto de este último aspecto, estudios como el de Parson, V., Reddy, P., Wood, J. y Senior, C. (2009), “Educating and iPod generation: undergraduate attitudes, experiences and understanding of vodcast and podcast use”, reflejan que los estudiantes consideran como un aspecto muy positivo el hecho de que los podcasts permitan aprender y revisar el contenido de la asignatura; aspecto que quedaría desvirtuado si la docencia tradicional quedará completamente subsumida al empleo del podcast.El objetivo del Proyecto de Innovación Docente es ofrecer una herramienta para el aprendizaje del Derecho, basada en la digitalización mediante podcast, que permita a los estudiantes disponer de contenidos jurídicos para su proceso formativo.The aim of the Teaching Innovation Project is to offer a tool for learning law, based on digitalisation through podcasts, which allows students to have access to legal content for their learning process.L'obiettivo del Progetto di Innovazione Didattica è quello di offrire uno strumento per l'apprendimento del diritto, basato sulla digitalizzazione attraverso i podcast, che permetta agli studenti di avere accesso a contenuti giuridici per il loro processo di formazione.O objetivo do Projeto de Inovação Didática é oferecer uma ferramenta de aprendizagem do direito, baseada na digitalização através de podcasts, que permita aos estudantes ter acesso a conteúdos jurídicos para o seu processo de formação.Depto. de Derecho del Trabajo y Seguridad SocialFac. de DerechoFALSEsubmitte