Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Background: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity =50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. Trial registration: ClinicalTrials.gov, NCT03136211. Registered 2 May 2017, “retrospectively registered”. © 2021, The Author(s)

A NEW EARLY CAMPANIAN RUDIST FAUNA FROM SAN LUIS POTOSI IN MEXICO AND ITS TAXONOMIC AND STRATIGRAPHIC SIGNIFICANCE

up to now it and Santonian and Turonian units have been mapped as the El Abra Formation in most available geological maps. Recognition of the successive carbonate platform intervals, between El Abra and Cardenas formations, improves the geological mapping and the understanding of the Mexican Gulf western margin evolution during the Late Cretaceous

Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study

Abstract Background Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. Methods A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. Results Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around ‘personal’, ‘programmatic’, and ‘transversal’ aspects. As for the personal aspects, categories regarding ‘patient history’, and ‘disposition’ were found; the programmatic aspects included categories such as ‘presentation and monitoring’, and modification of ‘cognitive’ and ‘behavioural’ habits; whereas the transversal aspects comprised the possibilities of ‘social support’ and defining categories of ‘objectives’. Conclusion The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions

Breeding system and ecological traits of the critically endangered endemic plant Limonium barceloi (Gil and Llorens) (Plumbaginaceae)

Limonium barceloi (Plumbaginaceae) is a narrow endemic seasonal halophytic plant, uniquely found in a highly degraded urban wetland in the Bay of Palma Mallorca, located in the northwest Mediterranean. It was awarded critically endangered status in 2004 and is the subject of a recovery plan administered by local government. Despite this, the last ten years have seen a dramatic decline in the population from ca. 3,000 individuals to just ca. 300; reasons for this decline are principally anthropogenic disturbance. Here we present the results of an investigation into some aspects of the reproductive biology of this species in the last remaining in situ population, in order to gain insight into its limited distribution and abundance, and to guide further development of management strategies. Findings indicate that although it provides important floral resources to a number of insect visitors, the plant is an autonomous apomictic that may also be functioning as an obligate asexual reproducer, and low genetic variation is suspected. Germinability is observed to be at ca. 70% and was positively correlated with maternal plant size characteristics. Two seed predators, the moth Goniodoma limoniella (Coleophoridae) and the ant Messor bouvieri (Myrmicinae), were discovered affecting both pre- and post-dispersal seeds. Rate of removal was high, although it is hypothesised that at this time species recruitment is not seed limited, but rather restricted by lack of suitable microsites. The results of this study are used to make recommendations for the species recovery. © 2012 Springer-Verlag.The Consortium Playa de Palma financed the project through an IMEDEA interdisciplinary study.Peer Reviewe