Efecte halo de la intervenció de l’estudi predimed-plus associat als determinants socials i familiars

Objectius: Avaluar l’associació d’una intervenció sobre l’estil de vida (adherència a la DietMed i promoció d’activitat física) realitzada en participants de l’estudi PREDIMED-PLUS sobre els seus convivents (Halo-1). Avaluar la relació entre Índex de privació socioeconòmic i l’estil de vida (dieta i activitat física), en una submostra de participants de l’estudi PREDIMED-PLUS (Halo-2). Estudi Halo-1: Disseny i mètodes: Estudi transversal realitzat en una mostra de 541 cohabitants de l'estudi PREDIMED-Plus a l’any de la intervenció. Es va avaluar l'adhesió a la DietMed, l'activitat física, les mesures antropomètriques, la funció familiar i el suport social.. Mitjançant regressions lineals múltiples, es va observar que un augment de l'adherència a la DietMed del participant PREDIMED-Plus i una millor funció familiar s’associava positivament amb l'adherència de la seva parella a la DietMed. Estudi Halo-2: Disseny i mètodes: es tracta d’un estudi transversal realitzat sobre una submostra de participants de l'estudi PREDIMEDPlus a Catalunya amb l’objectiu d’avaluar la relació entre l'índex socioeconòmic compost (CSI) i l'estil de vida (dieta i activitat física) utilitzan dades a nivell basal. Es van incloure 1.512 participants (52,2% dones) d'entre 55 i 80 anys amb sobrepès/obesitat i síndrome metabòlica assignats a 137 centres d'atenció primària de Catalunya. Es van avaluar l'ISC i l'estil de vida (dieta i activitat física).El model de regressió multinomial va mostrar que un alt índex de privació estava relacionat amb un patró dietètic poc saludable i una activitat física baixa (OR 1,42 [IC del 95% 1,06–1,89]; valor de p <0,05). Conclusions: La intervenció PREDIMED-Plus va mostrar una associació positiva amb l’adhesió a la DietMed de les parelles dels participants de l’estudi. A més, aquesta associació va estar relacionada per les característiques sociofamiliars dels membres de la llar (Estudi HALO-1). Un alt índex de privació es va relacionar amb un estil de vida poc saludable en participants de l'estudi PREDIMED-Plus (Estudi Halo-2) .Objetivos: Evaluar el efecto de una intervención sobre los estilos de vida (adherencia a la dieta Mediterránea y promoción de actividad física) realizada en participantes del estudio PREDIMED-PLUS en sus convivientes (Halo-1). Evaluar la relación entre Índice de privación socioeconómico y estilo de vida (dieta y actividad física), en una submuestra de participantes en el estudio PREDIMED-PLUS (Halo-2). Estudio Halo-1: Diseño y métodos: Estudio transversal. Una muestra de 541 cohabitantes del estudio PREDIMED-Plus en el año de la intervención. Se evaluó la adhesión a la DietMed, la actividad física, las medidas antropométricas, la función familiar y el soporte social. Mediante múltiples regresiones múltiples lineales, vimos un aumento de la adhesión en la DietMed del participante PREDIMED-Plus y una mejor función familiar se asociaron positivamente con la adhesión de su pareja a la DietMed. Estudio Halo-2: Diseño y métodos: Este es un estudio transversal a partir de una submuestra de los participantes del estudio PREDIMEDPlus en Cataluña con el objetivo de evaluar la relación entre el índice socioeconómico compuesto (CSI) y el estilo de vida (dieta y actividad física) en los datos del análisis basal. Se incluyeron 1.512 participantes (52,2% mujeres) de entre 55 y 80 años con sobrepeso/obesidad y síndrome metabólico asignados a 137 centros de atención primaria de Cataluña. Se evaluaron el ISC y el estilo de vida (dieta y actividad física). Se utilizó para analizar los datos una regresión lineal múltiple o una regresión multinomial. Se realizó un análisis de conglomerados para identificar patrones dietéticos.El modelo de regresión multinomial mostró que un alto índice de privación estaba relacionado con un patrón dietético poco saludable y actividad física baja (OR 1,42 [IC del 95% 1,06–1,89]; ( p<0, 05). Conclusiones: La intervención PREDIMED-Plus mostró una asociación positiva con la adhesión a la DietMed de las parejas de los participantes del estudio. Además, esta asociación estaba influenciada por las características sociofamiliares de los miembros del hogar (Estudio HALO-1). Un alto índice de privación estaba relacionado con un estilo de vida poco saludable en participantes del estudio PREDIMED-Plus (Estudio Halo-2).Objectives: To evaluate the effect of an intervention on lifestyles (adherence to the Mediterranean diet and promotion of physical activity) carried out in participants of the PREDIMED-PLUS study in their cohabitants (Halo-1). Assess the relationship between socioeconomic deprivation index and lifestyle (diet and physical activity) in a sub-sample of participants in the PREDIMED-PLUS study (Halo-2). Study Halo-1: Design and methods: This cross-sectional study aims to evaluate the association between the PREDIMED-Plus study lifestyle intervention and adherence to the Mediterranean diet (DietMed) and physical activity of cohabiting study participants, and to define the related social characteristics of the household members. Participants were a subsample of 541 cohabitants of the PREDIMED-Plus study. Adherence to the DietMed, physical activity, anthropometric measurements, family function, and social support were assessed. Multiple linear regressions were applied to the data. Using multiple lineal regressions, an increase in the adherence to the DietMed of the PREDIMED-Plus participant, and better family function, were positiv Study Halo-2: Design and methods: This baseline cross-sectional analysis from data acquired in a sub-sample of the PREDIMED-Plus study participants aimed to evaluate the relation between the Composite Socioeconomic Index (CSI) and lifestyle (diet and physical activity). This study involved 1512 participants (52.2% women) between 55 and 80 years with overweight/obesity and metabolic syndrome assigned to 137 primary healthcare centers in Catalonia, Spain. CSI and lifestyle (diet and physical activity) were assessed. Two a posteriori dietary patterns were identified by cluster analysis and labeled as “healthy” and “unhealthy”. In addition, the multinomial regression model showed that a high deprivation index was related to an unhealthy dietary pattern and low physical activity (OR 1.42 [95% CI 1.06–1.89]; p-value < 0.05). Conclusions: The PREDIMED-Plus intervention showed a positive association with adherence to the DietMed of the study participants’ partners. In addition, this association was influenced by the social characteristics of the household membres (Study Halo-1). A high deprivation index was related to an unhealthy lifestyle in PREDIMED-Plus study participants (Study Halo-2)

Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project (Interventions for Depression Improvement)

<p>Abstract</p> <p>Background</p> <p>Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management.</p> <p>Methods/Design</p> <p><it>Design</it>: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression.</p> <p><it>Setting</it>: 20 primary care centres in the province of Tarragona (Spain)</p> <p><it>Sample</it>: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV) and who need to initiate antidepressant treatment</p> <p><it>Intervention</it>: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface.</p> <p><it>Measurements</it>: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial). These interviews will be given at 0, 3, 6 and 12 months.</p> <p><it>Main variables</it>: Severity of the depressive symptoms, response rate and remission rate.</p> <p><it>Analysis</it>: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster.</p> <p>Discussion</p> <p>The effectiveness of caring for depression in primary care can be improved by various strategies. The most effective models involve organisational changes and a greater role of nurses. However, these models are almost exclusively from the USA, and this randomized clinical trial will determine if this approach could be effective to improve the outcomes of depression in primary care in the Spanish health care system.</p> <p>Trial registration</p> <p>ISRCTN16384353</p

Metabolic Syndrome as a Cardiovascular Disease Risk Factor: Patients Evaluated in Primary Care

To estimate the prevalence of metabolic syndrome (MS) in a population receiving attention in primary care centers (PCC) we selected a random cohort of ostensibly normal subjects from the registers of 5 basic-health area (BHA) PCC. Diagnosis of MS was with the WHO, NCEP and IDF criteria. Variables recorded were: socio-demographic data, CVD risk factors including lipids, obesity, diabetes, blood pressure and smoking habit and a glucose tolerance test outcome. Of the 720 individuals selected (age 60.3 ± 11.5 years), 431 were female, 352 hypertensive, 142 diabetic, 233 pre-diabetic, 285 obese, 209 dyslipemic and 106 smokers. CVD risk according to the Framingham and REGICOR calculation was 13.8 ± 10% and 8.8 ± 9.8%, respectively. Using the WHO, NCEP and IDF criteria, MS was diagnosed in 166, 210 and 252 subjects, respectively and the relative risk of CVD complications in MS subjects was 2.56. Logistic regression analysis indicated that the MS components (WHO set), the MS components (IDF set) and the female gender had an increased odds ratio for CVD of 3.48 (95CI%: 2.26–5.37), 2.28 (95%CI: 1.84–4.90) and 2.26 (95%CI: 1.48–3.47), respectively. We conclude that MS and concomitant CVD risk is high in ostensibly normal population attending primary care clinics, and this would necessarily impinge on resource allocation in primary care

Mejora del estreñimiento funcional con la ingesta de kiwi en una población mediterránea: Estudio piloto abierto no randomizado

Introduction: Kiwifruit consumption has shown to improve functional constipation in healthy elderly population, according to studies in New Zealand and China. The aim of this study was to evaluate the effect of kiwifruit intake on functional constipation in a Mediterranean patient population characterized by its distinctive nutritional habits.Material and Methods: An open, non-controlled and non-randomized longitudinal study was conducted in 46 patients with constipation (Rome III criteria). Patients monitored for five weeks: weeks 1 and 2 no kiwifruit and weeks 3-5 three kiwifruit per day (Green kiwifruit, Actinidia deliciosa var Hayward). Bristol Scale, volume of stools, and ease of defecation was self- reported daily. The evolution of the categorical variables was tested using the Bhapkar test; functional data methodology was used for continuous variables, and Generalized Estimating Equation (GEE) models were adjusted.Results: The percentage of patients with ≥3 stools per week increased from 82.61% (95% CI: 69–91.2) at week 1 to 97.78% (95% CI: 87.4–99.9) at week 2 of kiwifruit intake, with 76.09% (95% CI: 61.9–86.2) responding during the first week. The reporting of stable ideal stools increased from 17.39% (95% CI: 8.8–31) at week 2 to 33.33% (95% CI: 21.3–48) at week 5. According to GEE models, the number of depositions increased significantly (p-values&lt;0.001) in 0.398 daily units at week 1 the first week of intake, up to 0.593 daily units at week 5; significant improvements on facility in evacuation and volume of evacuation were found from the firstweek of intake (all p-values&lt;0.001).Conclusions: The intake of three kiwifruits per day significantly improves the quality of evacuation (number of depositions, volume, consistency and ease) in a Mediterranean patient population suffering from functional constipation.Introducción: Consumir kiwi mejora el estreñimiento funcional en la población anciana sana de Nueva Zelanda y China. Nuestro objetivo es evaluar el efecto del kiwi en la población mediterránea con estreñimiento.Material y métodos: Estudio prospectivo longitudinal no cegado no aleatorizado. 46 pacientes adultos con estreñimiento (criterios Roma-III) fueron seguidos durante cinco semanas: dos previas y tres durante la intervención (3 kiwi/día) (Green kiwifruit, Actinidia deliciosa var Hayward). Autoinforme diario del número de deposiciones, consistencia y volumen heces y facilidad de evacuación. La evolución de las variables categóricas se testó con el test Bhapkar, las variables continuas mediante metodología de análisis de datos funcionales ajustando modelos basados en las ecuaciones de estimación generalizadas (GEE).Resultados: El porcentaje de pacientes con ≥3 deposiciones/semana aumentó de 82,61% (IC 95%: 69–91,2) en la primera semana hasta 97,78% (IC 95%: 87,4–99,9) al final de semana 2 de consumo, con una respuesta del 76,09% (IC 95%: 61,9–86,2) en la primera semana. El porcentaje de heces consideradas ideales pasó de 17,39% (IC 95%: 8,8–31) en la segunda semana a 33,33% (IC 95%: 21,3–48) en la semana 5. Según los modelos GEE, el número de deposiciones aumenta significativamente (valor p&lt;0,001) en 0,398 unidades diarias en la primera semana de consumo, hasta 0,593 unidades diarias en la última semana. A partir de la primera semana se observa mejoras significativas en el volumen de las heces y en la facilidad de la defecación (valores p&lt;0,001).Conclusiones: Consumir tres kiwis al día mejora significativamente la calidad de la evacuación (número deposiciones, volumen, consistencia y facilidad evacuación), en una población mediterránea de pacientes con estreñimiento

Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the "Pas-a-Pas" community intervention trial

Intervention program; Physical activity; Cardiovascular disease risk prevention; Primary care programActivitat física; Prevenció de riscos de malalties cardiovasculars; Programa d'atenció primàriaActividad física; Prevención de riesgos de enfermedades cardiovasculares; Programa de atención primariaBACKGROUND: Physical activity is a major, modifiable, risk factor for cardiovascular disease (CVD) that contributes to the prevention and management of CVD. The aim of this study was to assess the short- and medium-term effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults. METHODS: Multicentered, randomized, controlled community intervention involving 364 patients in four primary care centers. The participants were randomly assigned to a Control Group (CG = 104) or Intervention Group (IG = 260); mean age 65.19 years; 76.8% women. The intervention consisted of 120 min/week walking (396 METs/min/week) and sociocultural gathering once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose) and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. Incidence of adverse cardiovascular events and continued adherence to the physical activity were assessed 2 years after intervention. RESULTS: At the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity (774.81 METs/min/week), a significant change during the intervention period in systolic blood pressure (-6.63 mmHg), total cholesterol (-10.12 mg/dL) and LDL-cholesterol (-9.05 mg/dL) even after adjustment for potential confounders. At 2 years after the intervention, in the IG, compared with the CG, tthe incidence of adverse cardiovascular events was significantly lower (2.5% vs. 10.5%) and the adherence to regular physical activity was higher (72.8% vs 27.2%) in IG compared to CG. CONCLUSIONS: This community-based physical activity program improved cardiovascular health in the short- as well as medium-term, and promoted regular physical activity in the medium-term in older Spanish adults. TRIALS REGISTRATION: Clinicaltrials.gov ID NCT02767739 . Trial registered on May 5th, 2016. Retrospectively registered

Evaluation of the Tobbstop Mobile App for Smoking Cessation: Cluster Randomized Controlled Clinical Trial

Mobile application; Primary public health; Tobacco smoking cessationAplicación móvil; Atención primaria de salud pública; Dejar de fumar tabacoAplicació mòbil; Salut pública primària; Cessament del consum de tabacBackground: Mobile apps provide an accessible way to test new health-related methodologies. Tobacco is still the primary preventable cause of death in industrialized countries, constituting an important public health issue. New technologies provide novel opportunities that are effective in the cessation of smoking tobacco. Objective: This paper aims to evaluate the efficacy and usage of a mobile app for assisting adult smokers to quit smoking. Methods: We conducted a cluster randomized clinical trial. We included smokers older than 18 years who were motivated to stop smoking and used a mobile phone compatible with our mobile app. We carried out follow-up visits at 15, 30, and 45 days, and at 2, 3, 6, and 12 months. Participants of the intervention group had access to the Tobbstop mobile app designed by the research team. The primary outcomes were continuous smoking abstinence at 3 and 12 months. Results: A total of 773 participants were included in the trial, of which 602 (77.9%) began the study on their D-Day. Of participants in the intervention group, 34.15% (97/284) did not use the app. The continuous abstention level was significantly larger in the intervention group participants who used the app than in those who did not use the app at both 3 months (72/187, 38.5% vs 13/97, 13.4%; P<.001) and 12 months (39/187, 20.9% vs 8/97, 8.25%; P=.01). Participants in the intervention group who used the app regularly and correctly had a higher probability of not being smokers at 12 months (OR 7.20, 95% CI 2.14-24.20; P=.001) than the participants of the CG. Conclusions: Regular use of an app for smoking cessation is effective in comparison with standard clinical practice