Infection by Strongyloides stercoralis in immigrants with Chagas disease: evaluation of eosinophilia as screening method in primary care

Objectives: to evaluate co-infection of Strongyloides stercoralis and Trypanosoma cruzi and to assess eosinophilia as a screening test for the detection of S. stercoralis infection in patients with Chagas disease (CD). Methods: a retrospective diagnostic validation study was performed on serum samples from primary care patients diagnosed with CD in the southern Barcelona metropolitan area. All samples with eosinophilia (n = 87) and a random sample of non-eosinophilic sera (n = 180) were selected. Diagnosis of CD was based on positive serology by means of two tests: ORTHO® T. cruzi ELISA test, and BIO-FLASH® Chagas or Bioelisa CHAGAS. SCIMEDX ELISA STRONGY-96 was used to diagnose strongyloidiasis. Results: strongyloides stercoralis serology was positive in 15% of patients of whom 95% showed eosinophilia, vs. 21% of those with negative serology (P < 0.001), with differences in the mean eosinophil count (0.49 vs. 0.27 × 109 /l). Only 1.1% of patients with CD but without eosinophilia presented positive serology for S. stercoralis, whereas 44% of patients with CD and eosinophilia did (P < 0.001). Sensitivity and specificity values for eosinophilia were thus 95% and 79%, respectively. PPV was 42.5% and NPV, 98.9%. Conclusions: the prevalence of co-infection by T. cruzi and S. stercoralis is not negligible and has probably been underestimated for years in many areas, due to frequently subclinical infections. Therefore, serology seems mandatory for these patients and the use of eosinophilia as initial screening could facilitate the task, decreasing the number of analyses to be performed

Detección de nistagmo en respuesta a la prueba de Dix-Hallpike en atención primaria: una comparación entre vértigo posicional paroxístico benigno subjetivo y objetivo

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0-10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR = 3.94, p = 0.021) and antihypertensive therapy (OR 3.02, p = 0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p = 0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV

Effect of the comprehensive smoke-free law on time trends in smoking behaviour in primary healthcare patients in Spain: a longitudinal observational study

Objective: This study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall and stratified by sex. Design: Longitudinal observational study conducted between 2008 and 2013. Setting: 66 PHC teams in Catalonia, Navarre and the Balearic Islands (Spain). Participants: Population over 15 years of age assigned to PHC teams. Primary and secondary outcomes measures: Quarterly age-standardised prevalence of non-smoker, smoker and ex-smoker and incidence of new smoker, new ex-smoker and ex-smoker relapse rates were estimated with data retrieved from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardised prevalence and incidence rates. Trends were expressed as annual percentage change and average annual percent change. Results: The overall standardised smoker prevalence rate showed a significant downward trend (higher in men than women) and the overall standardised ex-smoker prevalence rate showed a significant increased trend (higher in women than men) in the three regions. Standardised smoker and ex-smoker prevalence rates were higher for men than women in all regions. With regard to overall trends of incidence rates, new smokers decreased significantly in Catalonia and Navarre and similarly in men and women, new ex-smokers decreased significantly and more in men in Catalonia and the Balearic Islands, and ex-smoker relapse increased in Catalonia (particularly in women) and decreased in Navarre. Conclusions: Trends in smoking behaviour in PHC patients remain unchanged after the implementation of comprehensive SFL. The impact of the comprehensive SFL might have been lessened by the effect of the preceding partial SFL

Effect of the comprehensive smoke-free law on time trends in smoking behaviour in primary healthcare patients in Spain : A longitudinal observational study

Altres ajuts: Funding This project has been funded by the Carlos III Health Institute through the Network for Prevention and Health Promotion in Primary Care (redIAPP, RD12/0005/0001; RD16/0007/0001), and by European Union ERDF funds.Objective This study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall and stratified by sex. Design Longitudinal observational study conducted between 2008 and 2013. Setting 66 PHC teams in Catalonia, Navarre and the Balearic Islands (Spain). Participants Population over 15 years of age assigned to PHC teams. Primary and secondary outcomes measures Quarterly age-standardised prevalence of non-smoker, smoker and ex-smoker and incidence of new smoker, new ex-smoker and ex-smoker relapse rates were estimated with data retrieved from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardised prevalence and incidence rates. Trends were expressed as annual percentage change and average annual percent change. Results The overall standardised smoker prevalence rate showed a significant downward trend (higher in men than women) and the overall standardised ex-smoker prevalence rate showed a significant increased trend (higher in women than men) in the three regions. Standardised smoker and ex-smoker prevalence rates were higher for men than women in all regions. With regard to overall trends of incidence rates, new smokers decreased significantly in Catalonia and Navarre and similarly in men and women, new ex-smokers decreased significantly and more in men in Catalonia and the Balearic Islands, and ex-smoker relapse increased in Catalonia (particularly in women) and decreased in Navarre. Conclusions Trends in smoking behaviour in PHC patients remain unchanged after the implementation of comprehensive SFL. The impact of the comprehensive SFL might have been lessened by the effect of the preceding partial SFL

Effectiveness of a training intervention to improve the management of vertigo in primary care: a multicentre cluster-randomised trial, VERTAP

Background: Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. While BPPV is best treated with canalicular repositioning manoeuvres, they are not routinely performed in primary care (PC). Methods: To evaluate the effectiveness of blended training (online and face-to-face) on the diagnosis and management of vertigo to improve adherence of family doctors to clinical practice guidelines, we designed a community multicentre cluster-randomised open-label trial with an intervention (IG) and a control (GC) group of 10 primary care teams (PCT) each. Outcome variables will be ICD-10 diagnostic codes (proportion of nonspecific diagnoses such as dizziness and vertigo versus specific diagnoses such as BPPV, vestibular neuritis, and Meniere's disease); number of referrals to ENT or neurology specialists; prescription of antivertigo agents; and duration of sick leave due to vertigo. The baseline comparability of the two study groups will be analysed to ensure homogeneity. A description of all baseline variables will be performed. Student's t-test will be used to evaluate the differences between the groups. Logistic regression multivariate analysis will be performed to study the relationship between baseline variables of professionals and centres with outcome variables. Discussion: With the improvement of the diagnosis and management of vertigo by family doctors after this training, we expect an increase in the proportion of specific diagnoses, a decrease in the prescription of antivertigo agents, a decrease in referrals to ENT or neurology specialists and a reduction in the duration of sick leave due to temporary disability. The blended training will be easily expanded within primary care services, since it is mainly delivered online, with a single face-to-face session to ensure that the manoeuvres have been adequately learned

Characteristics of tobacco use among secondary school students: a cross-sectional study in a school in Valencia, Spain

IntroductionCigarette smoking is a significant public health problem, and it is essential to work actively with young people to limit the incorporation of this addiction. This study aimed to identify characteristics associated with tobacco use in adolescents in a real setting.MethodsEpidemiologic, cross-sectional study including secondary school students aged 12–17 years in the 1st, 2nd, and 3rd grades of “Joan Fuster High School” in the city of Sueca, Valencia (Spain). An anonymous, self-administered questionnaire was used to collect data on demographics, cigarette smoking history, alcohol consumption, nicotine dependence, and exposure to parental cigarette smoking.ResultsThe final sample of individuals surveyed included 306 students (50.6% females) with a median age of 13 years. The prevalence of cigarette smoking was 11.8% (13.5% in females and 9.9% in males). The mean age of cigarette smoking onset was 12.7 ± 1.6 years. Ninety-three students (30.4%) were repeaters, and 114 (37.3%) reported alcohol consumption. Significant factors associated with tobacco use were being a repeater (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.75–10.55, p = 0.002), alcohol consumption (OR 4.06, 95% CI 1.75–10.15, p = 0.002) and parental cigarette smoking (OR 3.76, 95% CI 1.52–10.74, p = 0.007).DiscussionAn operational profile of features associated with tobacco consumption was identified in the presence of parental cigarette smoking, alcohol consumption, and poor academic performance. Consideration of these factors could be useful in the operational design of cigarette smoking cessation interventions for young people in a context where there is a great need for better prevention and control of cigarette smoking

Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

BACKGROUND: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN: This study is a randomized clinical trial conducted in the primary care setting. The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. DISCUSSION: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513

Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

Background: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher's exact test will be conducted to compare categorical measures and Student's t-test or Mann-Whitney U-test will be used for intergroup comparison variables. Discussion: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients

Evaluación de la ley libre de humo española 42/2010 sobre tabaquismo, asma, y enfermedad coronaria en atención primaria de salud

En 2011, se aplicó en España una ley integral libre de humo (Ley 42/2010) que prohibía completamente fumar en espacios cerrados. El primer objetivo de la tesis fue analizar el impacto de esta ley en la prevalencia e incidencia del tabaquismo en personas adultas atendidas en Atención Primaria de Salud (APS). El segundo objetivo fue sintetizar la evidencia disponible en los artículos científicos de los efectos de la legislación libre de humo sobre los trastornos respiratorios y sensoriales en toda la población. Y el tercer objetivo fue evaluar la tendencia en la incidencia y prevalencia de asma y enfermedad coronaria aguda en APS en el contexto de la Ley integral en España. Para evaluar el impacto de la Ley integral española en hábito tabáquico, asma y enfermedad coronaria en APS se diseñaron dos estudios observacionales longitudinales en Cataluña, Navarra e Islas Baleares. La fuente de información en estos dos estudios fue la historia clínica informatizada de APS. Se calcularon las prevalencias de personas fumadoras y ex fumadoras; incidencias de nuevas personas fumadoras, nuevas ex fumadoras y recaída de ex fumadoras del 2008 al 2013 (en Baleares, del 2010 al 2013); además de las prevalencias e incidencias de asma y de enfermedad coronaria del 2007 al 2013 (en Baleares, del 2010 al 2013). Para revisar el impacto de las leyes libres de humo en la literatura se realizó una revisión sistemática desde 1995 hasta 2015 y meta-análisis. Se escogieron estudios originales con datos antes y después de ley libre de humo e impacto en trastornos respiratorios o sensoriales. Se halló una disminución significativa en la tendencia de las tasas de prevalencia de personas fumadoras, mayor en hombres, y un aumento en la tendencia de la prevalencia de personas ex fumadoras en las tres regiones estudiadas, mayormente en las mujeres. Respecto a la incidencia, la tendencia de las tasas de nuevas personas fumadoras disminuyó en Cataluña y Navarra, pero también disminuyó la tendencia de los nuevas personas ex fumadoras en Cataluña y las Islas Baleares, especialmente en hombres. Las tendencias de las tasas de incidencia de recaída de personas exfumadoras mostraron datos contradictorios entre regiones. La introducción de la Ley 42/2010 no modificó significativamente las tendencias de incidencia y prevalencia del hábito tabáquico tras tres años de su implantación. En la revisión sistemática y meta-análisis realizados se observaron efectos beneficiosos de las leyes libres de humo en los trabajadores tanto con leyes integrales como parciales con respecto a la sintomatología respiratoria y sensorial. También se halló una disminución significativa de los ingresos hospitalarios por asma en población adulta e infantil. Hubo una mayoría de estudios que reportaron disminuciones en los ingresos por enfermedad pulmonar obstructiva crónica en la revisión narrativa pero sin significación en el meta-análisis. Respecto a otras enfermedades pulmonares, mortalidad respiratoria y parámetros espirométricos, los resultados fueron heterogéneos. En el ámbito de la APS y en las tres regiones estudiadas, la tendencia de prevalencia de asma aumentó significativamente del 2007 al 2013, en menor medida durante el período 2009-13 en Cataluña y Navarra, y mayormente en hombres en todas las regiones. En cambio, las tendencias de las tasas de incidencia de asma no obtuvieron resultados significativos. Las tasas de incidencia de la enfermedad coronaria mostraron una tendencia descendente significativa en Cataluña y Navarra. Por el contrario, la tendencia de las tasas de prevalencia aumentó significativamente en Cataluña de 2007 a 2010 en global y en los hombres y también en las Islas Baleares durante todo el período de estudio. La introducción de la Ley 42/2010 tampoco modificó significativamente las tendencias de incidencia y prevalencia de asma y de enfermedad coronaria.In 2011, a comprehensive smoke-free law was applied in Spain (Law 42/2010) that completely prohibited smoking in enclosed areas. The first objective of the thesis was to analyze the impact of this law on the prevalence and incidence of smoking in adults attended in Primary Health Care (PHC). The second objective was to synthesize the evidence available in scientific articles about the effects of smoke-free legislation on respiratory and sensory disorders in all populations. And the third objective was to evaluate the trend in the incidence and prevalence of asthma and acute coronary disease in PHC in the context of the Comprehensive Law in Spain. To evaluate the impact of the Spanish comprehensive law on smoking, asthma and coronary disease in PHC, two longitudinal observational studies were designed in Catalonia, Navarre and the Balearic Islands. The source of information in these two studies was the computerized clinical history of PHC. The prevalences of smokers and ex-smokers were calculated; incidents of new smokers, new ex-smokers and relapse of ex-smokers from 2008 to 2013 (in the Balearic Islands, from 2010 to 2013); in addition to the prevalence and incidences of asthma and coronary heart disease from 2007 to 2013 (in the Balearic Islands, from 2010 to 2013). To review the impact of smoke-free laws in the literature, a systematic review was carried out from 1995 to 2015 and meta-analysis. Original studies with data before and after smoke-free law and impact on respiratory or sensory disorders were chosen. We found a significant decrease in the trend of the prevalence rates of smokers, higher in men, and an increase in the trend of the prevalence of ex-smokers in the three regions, mainly in women. Regarding the incidence, the trend of the rates of new smokers decreased in Catalonia and Navarre, but the trend of new ex-smokers in Catalonia and the Balearic Islands, especially in men, also decreased. The trends of relapse incidence rates of ex-smokers showed contradictory data between regions. The introduction of Law 42/2010 did not significantly modify the trends of incidence and prevalence of smoking after three years of its implementation. In the systematic review and meta-analyzes performed, beneficial effects of smoke-free laws were observed in workers with both integral and partial laws regarding respiratory and sensory symptoms. We also found a significant decrease in hospital admissions for asthma in the adult and child population. There was a majority of studies that reported decreases in the income from chronic obstructive pulmonary disease in the narrative review but without significance in the meta-analysis. Regarding other pulmonary diseases, respiratory mortality and spirometric parameters, the results were heterogeneous. In the area of PHC and in the three studied regions, the prevalence of asthma increased significantly from 2007 to 2013, to a lesser extent during the 2009-13 period in Catalonia and Navarre, and mainly in men in all regions. In contrast, trends in asthma incidence rates did not yield significant results. The incidence rates of coronary disease showed a significant downward trend in Catalonia and Navarra. On the contrary, the trend of prevalence rates increased significantly in Catalonia from 2007 to 2010 overall and in men and also in the Balearic Islands throughout the study period. The introduction of Law 42/2010 also did not significantly modify the incidence and prevalence trends of asthma and coronary heart disease