Prevalence of tobacco consumption among young physicians at a regional university hospital in southern Spain: a cross-sectional study.

Introduction The aim of the study is to analyse the prevalence of smoking among resident physicians at a regional university hospital. In addition, we examined the trends in the smoking behaviour of physicians in relation to results obtained in other studies carried out previously at this hospital, as well as those published nationally and internationally Method A cross-sectional observational study evaluating tobacco consumption in young physicians was carried out at the level of secondary healthcare in a regional university hospital in Cordoba, Spain. All the study subjects were resident physicians who underwent a mandatory preliminary occupational health examination between 2012 and 2016. There was no sampling selection as anyone who took this examination was considered to be within the target population. We calculated the proportions of smokers, former smokers and non-smokers, with 95% CIs. Univariate and multivariate analyses (binary logistic regression) were used to analyse the results (P<0.05). Results The response rate was 99.4%, with a sample size of 324 out of a possible 326 physicians. The average age was 28.6±3.7—DT—(95% CI 28.2 to 29.0), and 62.3% (202/324; 95% CI 57.3 to 67.2) were women. Smoking prevalence was 6.5% (21/324; 95% CI 3.5 to 9.3) with a further 5.2% (17/324; 95% CI 2.7 to 7.8) being ex-smokers. There were no significant differences in the prevalence of tobacco consumption according to age (P=0.266), sex (9.0% for men and 5.0% for women; P=0.128), medical specialty (P=0.651) or year of residency (P=0.975). A 52.7% decline in the number of young physician smokers was noted between 1986 and 2016 (95% CI −44.0 to −63.5), together with a 64.4% increase in non-smokers (95% CI 55.2 to 77.3). Conclusions We observed a significantly low prevalence of tobacco use among trainee physicians in the cohort, an effect of new antismoking laws, with positive role model implications for new physicians and medical students.post-print285 K

Teaching medical students to express empathy by exploring patient emotions and experiences in standardized medical encounters.

OBJECTIVES: To increase medical students’ ability to detect contextual and emotional cues and to respond empathetically to patients. METHODS: a training course in communication skills and patient-centered care with different teaching activities (didactic, reflective and interactive: workshops and encounters with simulated patients) was delivered to third-year medical students just before their clerckships. The program was evaluated by an external observer (OE) and simulated patients (SP) in 2 or 3 videotaped encounters. RESULTS: Students improved significantly from baseline to 3rd interview in all communicative skills and domains explored both in OE (32.4%) and SP (38.3%) measurement. At the end of the course students detected significantly more clues and made more empathetic expressions. CONCLUSIONS: The course seems to improve the ability of students to explore the illness experience, showing more empathy in a more genuine way. This was carried out in consultations lasting 10 minutes. PRACTICAL IMPLICATIONS: The program is effective and feasible to be applied as a regular formative activity. Further research is needed to assess whether this training program is applicable to students in more advanced educational levels and if it has any additional outcomes.pre-print432 K

Validación del Münchner Alkoholismus Test Subjektiv para el diagnóstico de alcoholismo en población adulta

ResumenObjetivoValidar la parte subjetiva del cuestionario MALT (Münchner Alkoholismus Test) para el diagnóstico de alcoholismo en población adulta.DiseñoEstudio descriptivo de validación de un instrumento diagnóstico.EmplazamientoDos centros de atención primaria, un centro de drogodependencias y un centro de atención a alcohólicos, ubicados en la provincia de Córdoba, España.ParticipantesSeiscientos catorce pacientes con edades de entre 18 y 80 años.Mediciones principalesMediante entrevista personal se realizaron los cuestionarios MALT, AUDIT (Alcohol Use Disorders Identification Test) y el SCAN (Schedules for clinical assessment in Neuropsychiatry). Se analizó la fiabilidad interna, la reproducibilidad, la validez criterial (patrón de referencia: criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales IV [DSM-IV]) y la validez convergente.ResultadosLa edad media de la población fue de 43 años (desviación estándar de 1,43). El 17,4% presentó síndrome de dependencia alcohólica. Los coeficientes kappa de los ítems del test oscilaban entre 0,568 y 0,969. El alfa de Cronbach del MALT completo fue de 0,919; el alfa de Cronbach del MALT subjetivo fue de 0,939, y el alfa de Cronbach del MALT objetivo fue de 0,737. El área bajo la curva de eficacia diagnóstica para el MALT-S fue de 0,946 y para el MALT completo fue de 0,953. Para un punto de corte de 4, la sensibilidad del MALT-S fue del 92,6% y la especificidad fue del 90,8%. El coeficiente de correlación del MALT-S y del AUDIT fue de 0,86 (p<0,001).ConclusionesEl MALT subjetivo es un cuestionario tan válido y fiable como el MALT completo, por lo que puede ser utilizado aisladamente para la detección y el diagnóstico de alcoholismo.AbstractObjectiveTo validate the subjective part of the MALT questionnaire (MALT-S) for the detection of alcoholism among the adult population.DesignA descriptive study on the validation of a diagnostic tool.SettingTwo primary health care centres, a centre for drug addicts and a centre for alcoholics in Cordoba (Spain).Participants614 patients, between 18 and 80 years.MeasurementsThrough personal interviews the MALT, AUDIT and SCAN questionnaires were given. The internal reliability, stability and both the criterion and convergent validity were analysed.ResultsThe mean age of the population’ was 43±1.43 (SD) years and 17.4% of them showed Alcohol Dependence Syndrome. The Kappa coefficients of the test items ranged from 0.568 to 0.969. The Cronbach alpha of the complete MALT was 0.919, of the MALT-S, 0.939 and of the MALT-O, 0.737. The area under the ROC curve of the MALT-S was 0.946 and that of the complete MALT was 0.953. For a cut-off point of four, the sensitivity of the MALT-S is 92.7% while its specificity was 90.9%. The correlation coefficient of the MALT-S and AUDIT was 0.86 (P<0.001).ConclusionsThe MALT-S questionnaire is as valid and reliable as the complete MALT; therefore, it can be used on its own for the diagnosis of alcoholism

Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study.

Objective: To assess the impact of a training program targeted to Primary Care (PC) professionals on the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. Methods: A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p<0.05). Results: PC providers’ communication skills and attitudes showed significant improvements in the variables studied (p<0.001), as well as in the clinical interview evaluation parameters. Conclusion: The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. Practice implications: Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.pre-print200 K

Conditions for Feasibility of a Multicomponent Intervention to Reduce Social Isolation and Loneliness in Noninstitutionalized Older Adults

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses

Health-related lifestyles and cancer-preventive behaviors of medical and nursing students and family medicine residents in relation to the European Code Against Cancer.

Background: Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. Objective: To evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). Methods: This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students, and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. Results: A total of 740 participants completed the questionnaire. 12.2% (95% CI [9.8–14.5]) were smokers and 77.3% (95% CI [74.3–80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8–37.6]) practiced physical activity 2–3 times a week, and 12.1% (95% CI [9.8–14.5]) were overweight or obese. 54.2% (95% CI [50.6–57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p < 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p < 0.001) in relation to the participants’ academic profiles. Conclusion: Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high, however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test.pre-print322 K

Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care.

Objective: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. Methods: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). Interventions: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an “advice approach”. Three follow-up visits were completed, at 15 days and at 3 and 6[0] months. Medication adherence in both groups was compared (p<0.05). Results: Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). Conclusion: A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. Practice Implications: MI is a patient-centered approach that can be used to improve medication adherence in primary care.pre-print152 K

Prevalence of hazardous alcohol use among Spanish primary care providers

BackgroundAlcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use.MethodsA descriptive, cross-sectional, observational, multicenter study was performed. Location: PC sites of the Spanish National Health Care System (NHS). Participants: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion.ResultsOne thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR=1.52; 95% CI: 1.22-1.90), PC physicians (OR=1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR=1.03; 95% CI: 1.01-1.05).ConclusionOur study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

Background: Health professionals’ training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider’s knowledge and skills addressing alcoholrelated problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. Methods: An observational, descriptive, cross-sectional, multicenter study was performed. Location: PC centres of the Spanish National Health System (SNHS). Participants: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS’s PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. Results: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5–71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4–31.7) reported having received basic training, and 3% (95% CI: 2.3–4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). Conclusion: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.post-print565 K

Acceptability and feasibility among primary care doctors of the opportunistic search for HIV in Health Care centers in Spain

Objective To evaluate the acceptability and feasibility of the opportunistic search of HIV according to primary care doctors’ experience. To set up the profile of the physician involved in this study. Design Observational, transversal study. Location Primary Care Centers of the National Health System. Participants General practitioners and residents who participated in VIH-AP study to measure the acceptability of HIV opportunistic search by patients. Main measurements Self-filling survey to collect data on age, sex, teaching skills, amount of years dedicated to research, time working with the same quota of patients, acceptability and feasibility of opportunistic HIV search. Results A total of 197 physicians with a mean age of 45.2 ± 9.7 (SD) years. 18.8% were under 36 years old, 70.1% were women and 62.4% had teaching skills. 55.8% worked in towns with a population over 100,000 inhabitants and the mean of years working with the same quota of patients was 6.4 ± 6.6. 91.9% (95% CI: 88.1-98.7) of them considered the opportunistic search of HIV acceptable and 89.3% (95% CI: 85.0-93.6), feasible to perform. The multivariate analysis showed positive relation between the acceptability/feasibility and teaching skills (OR: 2.74; 95% CI: 1.16-6.49). The acceptance of the screening by patients was 93.1% and this was positively related to how long the doctor had worked with the same quota, teaching skills and the amount of years dedicated to research. Conclusions HIV opportunistic search is an acceptable and feasible method for primary care professionals.Objetivo Valorar la aceptabilidad y la factibilidad de la búsqueda oportunista del VIH por parte de los profesionales de atención primaria. Conocer el perfil del médico que participa en este tipo de estudio. Diseño Estudio observacional, transversal. Emplazamiento Centros de atención primaria del Sistema Nacional de Salud. Participantes Médicos de familia y residentes que participaron en el estudio VIH-AP para medir la aceptabilidad de la búsqueda oportunista del VIH por parte de los pacientes. Mediciones principales Mediante encuesta autocumplimentada se determinó: edad, sexo, cualidad de docente, años de investigación, tiempo trabajando con el mismo cupo, aceptabilidad y factibilidad de la búsqueda oportunista del VIH. Resultados Un total de 197 médicos con una media de edad de 45,2 ± 9,7 (DT) años. El 18,8% eran menores de 36 años, el 70,1% mujeres y el 62,4% docentes. El 55,8% trabajaban en localidades mayores de 100.000 habitantes y la media de años ocupando el mismo cupo fue de 6,4 ± 6,6. El 91,9% (IC 95%: 88,1-98,7) consideró la búsqueda oportunista del VIH aceptable, el 89,3% (IC 95%: 85,0-93,6), factible de realizar, mostrando el análisis multivariante relación positiva con el realizar actividad docente (OR: 2,74; IC 95%: 1,16-6,49). La aceptación de la prueba por parte de los pacientes fue del 93,1%, y esta se relacionó positivamente con el tiempo que el médico había trabajado en el mismo cupo, la cualidad de docente y los años dedicados a la investigación. Conclusiones La búsqueda oportunista del VIH es un método aceptable y factible para los profesionales de atención primaria.semFYC (ayudas «Isabel Fernández» a tesis doctorales, 2014)SAMFYC (proyectos de tesis doctorales «Isabel Fernández», 2014, Ref.118/14