Good practices for the prevention of alcohol harmful use amongst the elderly in Europe, the VINTAGE project

Consum d'alcohol; Prevenció; Persones gransConsumo de alcohol; Prevención; Personas mayoresAlcohol drinking; Prevention; AgedIntroduction: There is a lack of information about initiatives aimed at preventing the harm-ful effects of alcohol amongst the elderly. Objectives: One of the objectives of the VINTAGE study was to collect the initiatives carried out in Europe and review the published grey literature about this topic. Methods: Email-based survey addressed to researchers, professionals and policymakers, and internet search of grey literature. Results: Three hundred nine contacts were finally made, and 21 of the 36 collected initiatives were considered as useful in preventing the harmful use of alco-hol amongst the elderly. Out of the about 2900 references identified 96 were classified as relevant. Conclusions: Despite a growing interest, alcohol use in the elderly is not yet perceived as a major issue for prevention.The VINTAGE project Good Health into Older Age is a project funded by the Executive Agency for Health and consumers, under the European commission Second Programme of community Action in the Field of Health 2008-2013 (Grant Agreement no. 20081203

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

Alcohol screening; Brief intervention; Referral to electronic brief adviceDetección de alcohol; Intervención breve; Remisión a asesoramiento breve electrónicoDetecció d'alcoholèmia; Intervenció breu; Derivació a assessorament breu electrònicObjectives: The objective of the present study was toexplore whether the possibility of offering facilitatedaccess to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increasedthe proportion of consulting adults who were screenedand given brief advice. Design: The study was a 12-week implementationstudy. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands,Poland and Sweden) were asked to screen adults whoattended the PHCU for risky drinking. Setting: A total of 120 primary healthcare centresfrom 5 jurisdictions in Europe. Participants: 746 individual providers (generalpractitioners, nurses or other professionals)participated in the study. Primary outcome: Change in the proportion ofpatients screened and referred to eBI comparing abaseline 4-week preimplementation period with a12-week implementation period. Results: The possibility of referring patients to the eBIwas not found to be associated with any increase in theproportion of patients screened. However, it wasassociated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole(p<0.05), mainly driven by a significant increase in briefintervention rates in England from 87% to 96%(p<0.01). The study indicated that staff displayed a lowlevel of engagement in this new technology. Staffcontinued to offer face-to-face advice to a largerproportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among thereferred patients; on average, 18% of the patientslogged on to the website with a mean log-on rate acrossthe different countries between 0.58% and 36.95%. Conclusions: Referral to eBI takes nearly as muchtime as brief oral advice and might require moreintroduction and training before staff are comfortablewith referring to eBIThe research leading to these results or outcomes has receivedfunding from the European Union’s Seventh Framework Programme forResearch, Technological Development and Demonstration under grantagreement no. 259268—Optimizing Delivery of Health Care Interventions(ODHIN)

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial

Brief interventions; Risky drinking; Primary healthcareIntervenciones breves; Bebedores de riesgo; Atención primariaIntervencions breus; Bevedors de risc; Atenció primàriaBackground: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners’ attitudes, their actual behaviour and care improvement strategies to enhance implementation science.The research leading to these results or outcomes has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 259268 – Optimizing delivery of healthcare intervention (ODHIN)

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study

Detecció d'alcoholèmia; Intervenció breu; Actitud del personal sanitariDetección de alcoholemia; Intervención breve; Actitud del personal sanitarioAlcoholism detection; Brief intervention; Attitude of Health PersonnelAims: To determine the relation between existing levels of alcohol screening and brief interventionrates infive European jurisdictions and role security and therapeutic commitment by the participat-ing primary healthcare professionals. Methods: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psy-chologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities aspart of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Pro-blems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screeningrate in a multilevel logistic regression analysis adjusted for occupation of the provider, number ofeligible patients and the random effects of jurisdictions and primary health care units (PHCU). Nosignificant relationship was found between role security and brief intervention rate nor betweentherapeutic commitment and screening rate/brief intervention rate. The proportion of patientsscreened varied across jurisdictions between 2 and 10%. Conclusion: Thefindings show that the studied factors (role security and therapeutic commitment)are not of great importance for alcohol screening and BI rates. Given the fact that screening and briefintervention implementation rate has not changed much in the last decade in spite of increased pol-icy emphasis, training initiatives and more research being published, this raises a question aboutwhat else is needed to enhance implementation.Radboud university medical centre received co-funding from The NetherlandsOrganization for Health Research and Development (ZonMW, Prevention Pro-gramme), under Grant Agreement n° 200310017—ODHIN—Optimizing de-livery of healthcare interventions in the Netherlands, according to Art.II.17 ofthe FP7 EC Grant Agreement. Pomeranian Medical University in Szczecin re-ceived co-funding regarding presented research from the Polish sciencefinancialresources in the years 2012–2014 allocated to conduct the international co-funded project ODHIN

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

Detecció d'alcoholèmia; Intervenció breu; Atenció electrònicaDetección de alcoholemia; Intervención breve; Atención electrónicaAlcoholism detection; Brief intervention; Electronic attentionIntroduction: 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 web-based 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 non-inferiority 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 presentations.This work has been funded by project PI042924 integrated in theNational R+D+I and funded by the Carlos III Health Institute-Deputy GeneralAssessment and the European Regional Development Fund (ERDF)

The contribution of HIV point-of-care tests in early HIV diagnosis: community-based HIV testing monitoring in Catalonia, 1995 to 2018

Infeccions per VIH; Serveis de salut; DiagnòsticInfecciones por VIH; Servicios de salud; DiagnósticoVIH infections; Health services; DiagnosisBackground: Community-based HIV testing services combined with the use of point-of-care tests (POCT) have the potential to improve early diagnosis through increasing availability, accessibility and uptake of HIV testing. Aim: To describe community-based HIV testing activity in Catalonia, Spain, from 1995 to 2018, and to evaluate the impact of HIV POCT on the HIV continuum of care.Methods: A community-based network of voluntary counselling and testing services in Catalonia, Spain has been collecting systematic data on activity, process and results since 1995. A descriptive analysis was performed on pooled data, describing the data in terms of people tested and reactive screening test results. Results: Between 1995 and 2018, 125,876 HIV tests were performed (2.1% reactive). Since the introduction of HIV POCT in 2007, a large increase in the number of tests performed was observed, reaching 14,537 tests alone in 2018 (1.3% reactive). Men who have sex with men (MSM), as a proportion of all people tested, has increased greatly over time reaching 74.7% in 2018. The highest percentage of reactive tests was found in people who inject drugs followed by MSM. The contribution of community-based HIV testing to the overall total notified cases in the Catalonia HIV registry has gradually increased, reaching 37.9% in 2018, and 70% of all MSM cases. In 2018, the percentage of individuals with a reactive screening test who were linked to care was 89.0%. Conclusion: Our study reinforces the important role that community-based HIV POCT has on the diagnosis of HIV in key populations

Més de 20 anys de cribratge del VIH de base comunitària a Catalunya

Cribatge; VIH; Serveis de base comunitàriaCribado; VIH; Servicios de base comunitariaScreening; HIV; Community-based servicesDescriure l’activitat de cribratge del VIH en els serveis de base comunitària que participen a la xarxa DEVO entre 1995 i 2018 per tal d’avaluar la contribució del cribratge del VIH de base comunitària al continu d’atenció al VIH

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt