Ischemic heart disease and primary care: identifying gender-related differences. An observational study

Background: Gender-related differences are seen in multiple aspects of both health and illness. Ischemic heart disease (IHD) is a pathology in which diagnostic, treatment and prognostic differences are seen between sexes, especially in the acute phase and in the hospital setting. The objective of the present study is to analyze whether there are differences between men and women when examining associated cardiovascular risk factors and secondary pharmacological prevention in the primary care setting. Methods: Retrospective descriptive observational study from January to December of 2006, including 1907 patients diagnosed with ischemic heart disease in the city of Lleida, Spain. The clinical data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies with official prescriptions. Data was analyzed using bivariate descriptive statistical analysis as well as logistic regression. Results: There were no gender-related differences in screening percentages for arterial hypertension, diabetes, obesity, dyslipemia, and smoking. A greater percentage of women were hypertensive, obese and diabetic compared to men. However, men showed a tendency to achieve control targets more easily than women, with no statistically significant differences. In both sexes cardiovascular risk factors control was inadequate, between 10 and 50%. For secondary pharmaceutical prevention, the percentages of prescriptions were greater in men for anticoagulants, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, with age group variations up to 10%. When adjusting by age and specific diagnoses, differences were maintained for anticoagulants and lipid-lowering agents. Conclusion: Screening of cardiovascular risk factors was similar in men and women with IHD. Although a greater percentage of women were hypertensive, diabetic or obese, their management of risk factors tended to be worse than men. Overall, a poor control of cardiovascular risk factors was noted. Taken as a whole, more men were prescribed secondary prevention drugs, with differences varying by age group and IHD diagnosis

Feasibility Assessment of the Let’s Walk Programme (CAMINEM): Exercise Training and Health Promotion in Primary Health-Care Settings

Exercise is related to many individual health outcomes but impact evaluations of exercise programmes are seldom conducted. The purpose of the study is to evaluate the feasibility of an exercise prescription intervention in primary health-care settings (CAMINEM Programme) located in two socially disadvantaged neighbourhoods. The CAMINEM was a pragmatic-driven intervention with opportunistic recruitment. It followed the 5As framework for health promotion and also the exercise training principles. Feasibility was evaluated using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Patients with non-communicable chronic diseases participated in a 12-month home-based moderate-intensity exercise program, counselled by exercise physiologists. Participants were grouped according to their physical activity behaviour at baseline and 6-month adherence. CAMINEM reached 1.49% (n = 229) of the eligible population (N = 15,374) and included a final sample of 178. Health outcomes for adhered participants followed positive patterns. Non-adhered participants visited their practitioner more compared to adhered participants. Thirty-three practitioners (40%) referred patients. Nurses referred four times more than physicians (81% and 19% respectively). The delivery of exercise prescriptions proved to be easy to complete and record by participants as well as easy to monitor and adjust by the exercise physiologists. One out of four participants adhered during the 12-month intervention. This intervention has been feasible in primary care in Catalonia, Spain, to safely prescribe home-based exercise for several conditions.This research was funded by the Secretaria General de l’Esport and the Departament d’Innovació, Universitats i Empresa, Generalitat de Catalunya with a competitive grant for junior researchers, grant number 006780 Ordre 001

Evaluation of a family intervention programme for the treatment of overweight and obese children (Nereu Programme): a randomized clinical trial study protocol

Background: Obesity is mainly attributed to environmental factors. In developed countries, the time spent on physical activity tasks is decreasing, whereas sedentary behaviour patterns are increasing. The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multicomponent intervention (Nereu programme) and compared it to counselling intervention such as a health centre intervention programme for the management of children"s obesity. Methods/Design: The study design is a randomized controlled multicenter clinical trial using two types of interventions: Nereu and Counselling. The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention. This programme is based on a multidisciplinary intervention consisting of 4 components: physical activity sessions for children, family theoretical and practical sessions for parents, behaviour strategy sessions involving both, parents and children, and lastly, weekend extra activities for all. Counselling is offered to the family in the form of a monthly physical health and eating habits session. Participants will be recruited according the following criteria: 6 to 12 year-old-children, referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile (less than 2 hours per week of physical activity), they must live in or near the municipality of Lleida (Spain) and their healthcare paediatric unit must have previously accepted to cooperate with this study. The following variables will be evaluated: a) cardiovascular risk factors (anthropometric parameters, blood test and blood pressure), b) sedentary and physical activity behaviour and dietary intake, c) psychological aspects d) health related quality of life (HRQOL), e) cost-effectiveness of the intervention in relation to HRQOL. These variables will be then be evaluated 4 times longitudinally: at baseline, at the end of the intervention (8 months later), 6 and 12 months after the intervention. We have considered necessary to recruit 100 children and divide them in 2 groups of 50 to detect the differences between the groups. Discussion: This trial will provide new evidence for the long-term effects of childhood obesity management, as well as help to know the impact of the present intervention as a health intervention tool for healthcare centres. Trial registration: ClinicalTrials.gov, NCT01878994This research is partially funded by the Instituto de Salud Carlos III in Spain, from the Ministry of Economy and Competitiveness with the expedient number PI12/02220, the Diputació de Lleida, the Department of Health of the Generalitat de Catalunya and the City Council of Lleida “La Paeria - Ajuntament de Lleida”. This research was supported by the Institute of Physical Education of Catalonia (INEFC), University of Lleida, Spain, (VCP/3570/2010, de 29 d’octubre, DOGC NÚM. 5753 – 11.11.2010; VCP/28/2009, 14 of January, DOGC NÚM. 5302 – 22/01/1999)

Effectiveness of a Multi-Component Intervention for Overweight and Obese Children (Nereu Program): A Randomized Controlled Trial

Introduction: Treatment of childhood obesity is a complex challenge for primary health care professionals. Objectives: To evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake. Methods: Randomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-intervention. Results: At the end of the study period, both groups achieved a similar decrease in body mass index (BMIsd) compared to baseline. Nereu Program participants (n = 54) showed greater increases in moderate-intense physical activity (+6.27% vs. -0.61%, p<0.001) and daily fruit servings (+0.62 vs. +0.13, p<0.026), and decreased daily soft drinks consumption (-0.26 vs. -0.02, p<0.047), respectively, compared to the counselling group (n = 59). Conclusions: At the end of the 8-month intervention, participants in the Nereu Program group showed improvement in physical activity and dietary behaviours, compared to the counselling group

Promoción de la salud y prescripción de ejercicio físico desde centros de atención primaria. Justificació y diseño del Programa CAMINEM

L’activitat física regular comporta molts beneficis per a la salut, però els aspectes tècnics i organitzatius de les interven­cions centrades en la millora d’activitat física saludable són rarament difoses. L’objectiu d’aquest treball és justificar i descriure els protocols del Programa Caminem. Aquest estudi pragmàtic de prescripció d’exercici físic des de centres d’atenció primària valora la seva aplicabilitat, una intervenció més intensiva que el mer consell sobre activitat física, basat en els principis de l’entrenament esportiu i en el marc de les cinc “as”, 5As (en anglès), de promoció de la salut. L’aplicabilitat s’hi avaluarà mitjançant el marc RE-AIM, que contempla variables a nivell individual i de centre (representativitat i abast, eficàcia o efectivitat, adopció, implementació i manteniment). Pacients amb malalties cròniques no transmissibles que visitin el seu centre d’atenció primària podran participar en el programa d’exercici aeròbic d’intensitat moderada durant 12 mesos, assessorats per especialistes en exercici físic. El Caminem podria servir com a exemple d’un programa d’exercici físic amb evidència basada en la pràctica, portat a terme en un context real, a més de poder comparar els seus resultats amb altres intervencions. L’equip interdisciplinari i els protocols detallats de la intervenció són les pedres angulars que poden servir per dur a terme aquest programa en altres contexto

Promoció de la salut i prescripció d’exercici físic des de centres d’atenció primària. Justificació i disseny del Programa CAMINEM

La actividad física regular conlleva muchos beneficios para la salud, pero los aspectos técnicos y organizativos de las intervenciones centradas en la mejora de actividad física saludable son raramente difundidas. El objetivo de este trabajo es justificar y describir los protocolos del Programa Caminem (andemos). Este estudio pragmático de prescripción de ejercicio físico desde centros de atención primaria valora su aplicabilidad, una intervención más intensiva que el mero consejo sobre actividad física, basado en los principios del entrenamiento deportivo y en el marco de las cinco “as”, 5A (en inglés), de promoción de la salud. La aplicabilidad se evaluará mediante el marco RE-AIM, que contempla variables a nivel individual y de centro (representatividad y alcance, eficacia o efectividad, adopción, implementación y mantenimiento). Pacientes con enfermedades crónicas no transmisibles que visiten su centro de atención primaria podrán participar en el programa de ejercicio aeróbico de intensidad moderada durante 12 meses, asesorados por especialistas en ejercicio físico. Caminem podría servir como ejemplo de un programa de ejercicio físico con evidencia basada en la práctica, llevado a cabo en un contexto real, además de poder comparar sus resultados con otras intervenciones. El equipo interdisciplinario y los protocolos detallados de la intervención son las piedras angulares que pueden servir para llevar a cabo este programa en otros contextos