Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria

ObjetivoComprobar la efectividad del consejo médico antialcohólico que se da en las consultas de atención primaria.DiseñoEstudio cuasi-experimental de tipo «antes-después», abierto, multicéntrico.EmplazamientoCatorce consultas médicas de atención primaria (7 rurales y 7 urbanas) de la provincia de Córdoba (España).ParticipantesUn total de 306 pacientes de ambos sexos, captados mediante búsqueda de casos, que presentaban un consumo de alcohol ≥ 35 (varones) y 21 (mujeres) U a la semana, y/o síndrome de dependencia alcohólica (SDA) (MALTS-O ≥ 11).IntervencionesA todos se les ofreció consejo médico breve antialcohólico y se les hizo un seguimiento para valoración de su estado a los 3 meses, 1 y 2 años.Mediciones principalesLa variable de respuesta fue la suma del consumo autorreferido, más valores normales de GGT, y la confirmación del familiar. El análisis del estudio fue por «intención de tratar».ResultadosDe los 306 pacientes incluidos, en un 95,1% de los casos se trataba de varones y un 78,4% presentaba SDA. Al cabo de 2 años, el 38,89% (IC del 95%, 32,2-44,3%) había alcanzado el objetivo terapéutico: un 23,85% se encontraba en abstinencia total y el 15,0% presentaba un consumo moderado de alcohol, por debajo del límite de riesgo. El comienzo del consumo excesivo antes de los 16 años (odds ratio [OR], 3,0885), vivir en un barrio marginal (OR, 3,2103), consumir tabaco (OR, 1,7187) y un test de CAGE positivo (OR, 1,9949) se asociaron al fracaso de la intervención (p < 0,05).ConclusionesSe demuestra la alta efectividad del consejo antialcohólico impartido por el médico de familia en condiciones habituales de consulta, tanto en bebedores excesivos como en aquellos con SDA.AimTo determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers.DesignQuasi-experimental, open, multicenter before-after study.Setting14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain).Participants306 patients of both sexes, recruited with a case-finding strategy, who consumed ≥35 (men) or ≥21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O≥11).InterventionsAll patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later.Main measuresThe response variable was selfreported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis.ResultsOf the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05).ConclusionsCounseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS

Suicidality in primary care patients who present with sadness and anhedonia: a prospective European study

Background: Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia. Method: Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months. Results: 1) In patients with sadness and/or anhedonia who were not depressed at entry to the study, suicide plans (OR = 3.05; 95 % CI = 1.50–6.24; p = 0.0022) and suicide attempts (OR = 9.08; 95 % CI = 2.57–32.03; p = 0.0006) were significant predictors of developing new onset depression at 6 or 12 months. 2) In patients with sadness and/or anhedonia who met CIDI criteria for major depression at entry, suicidal ideation (OR = 2.93; 95 % CI = 1.70–5.07; p = 0.0001), suicide plans (OR = 3.70; 95 % CI = 2.08–6.57; p < 0.0001), and suicide attempts (OR = 3.33; 95 % CI = 1.47–7.54; p = 0.0040) were significant predictors of persistent depression at 6 or 12 months. Conclusions: Three questions on suicidality could help primary care professionals to assess such patients more closely without necessarily establishing whether they meet criteria for major depression.This research was funded by a grant from The European Commission, referencePREDICT-QL4-CT2002-00683. We are also grateful for part support in Europe from: the Estonian Scientific Foundation (grant number 5696); the Slovenian Ministry for Research (grant No.4369-1027); the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450) and the Spanish Network of Primary Care Research, redIAPP (ISCIII-RETICS RD06/0018) and SAMSERAP group; and the UK NHS Research and Development office for providing service support costs in the UK. We are also grateful for the support from the University of Malaga (Spain) and to Carlos García from Loyola Andalucía University (Spain)

Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The PredictA-Spain study

Background: There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months. Methods: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces. Results: The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval = 0.78–0.83) and the Hedges' g = 1.17 (95% confidence interval = 1.04–1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit. Conclusions: The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.This study was supported by the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450 and PI06/1442) and the Andalusian Council of Health (grant references: 05/403 and 06/278); as well as the Spanish Network of Primary Care Research ‘redIAPP’ (RD06/0018), the ‘Aragón group’ (RD06/0018/0020), the ‘Baleares group’ (RD07/0018/0033), and the ‘SAMSERAP group’ (RD06/0018/0039)

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health care.The research in Spain was funded by grants from the Spanish Ministry of Health (grant FIS references: PI04/1980, PI0/41771, PI04/2450, and PI06/1442), Andalusian Council of Health (grant references: 05/403, 06/278 and 08/0194), and the Spanish Ministry of Education and Science (grant reference SAF 2006/07192). The Malaga sample, as part of the predictD-International study, was also funded by a grant from The European Commission (reference QL4-CT2002-00683)

Winmedtrad utility to know the smoking addiction prevalence in a reference hospital

Originales[ES] Introducción: La creación de lugares de trabajo sin humo sigue siendo la medida de mayor implantación frente al tabaquismo. WinMedtra es la aplicación informática corporativa del Servicio Andaluz de Salud para la Vigilancia de la Salud.Objetivo: Aprovechando dicha aplicación, planteamos mostrar su utilidad para calcular la prevalencia de tabaquismo en un Hospital de referencia. Material y método: Estudio observacional a partir de los exámenes de salud realizados en 2013 (n=1672). Se extrajeron los datos relativos al consumo de tabaco de WinMedtra realizándose una estadística descriptiva e inferencial (prueba «t» de Student, análisis de varianza simple y Ji-Cuadrado). Resultados: La aplicación informática nos ha permitido obtener datos del hábito tabáquico en la población laboral estudiada. La prevalencia de sujetos fumadores activos fue de un 22,8% (IC95%:20,79%-24,81%) y el 19,8% eran ex fumadores, por lo que el 77,2% no fumaba en el periodo del estudio (IC95%: 75,19%-79,21%). El consumo acumulado fue mayor en el grupo de los hombres que en el de las mujeres (21,08 ± 16,31 versus 15,38±13,28 paquetes-año) (t: 3,61, p<0,001). Se obtuvieron diferencias significativas (p<0,001) al comparar la edad media de los no fumadores con respecto a la de los fumadores, (48,33± 9,82 versus 50,55 ± 7,62 años) y a la de exfumadores (48,33 ± 9,82 versus 50,65 ± 8,32 años). En relación a la categoría laboral, el mayor porcentaje de «No fumadores» pertenecía al personal residente en formación (87%) seguido del grupo de jefaturas (75%); siendo los auxiliares administrativos (34,7%) y el los supervisores (33,3%) quienes presentaban un mayor porcentaje de consumo tabáquico (Ji-cuadrado=131,23, p<0,001). Conclusiones: La aplicación informática puede ser útil para tener un conocimiento epidemiológico más exacto de la magnitud de conductas adictivas como el tabaquismo en centros de trabajo, obteniéndose en nuestro estudio una prevalencia de tabaquismo activo inferior a la del entorno. [EN] Introduction: creating smoke-free workplaces still remains the most implemented action concerning tobacco smoking. WinMedtra is the Andalusian Health Service corporate software for the medical surveillance. AIM: by using this application, we intend to show its utility in calculating the smoking prevalence in a reference hospital. Material and Methods: an observational study was performed based on health examinations conducted in 2013 (n = 1672). After extracting data related with the tobacco consumption from WinMedtra, a descriptive and inferential statistics (student, simple anova and Chi-square statistical tests) were performed. We calculated arithmetic means and standard deviations for quantitative variables; and absolute and relative frequencies for qualitative variables. Confidence intervals up to 95% were calculated for the main estimates.Results: the application allowed us to obtain smoking habits data in the interviewed working population. The smoking prevalence active subjects were 22.8% (95% CI: 20.79%-24.81%); 19.8% were former smokers so 77.2% did not smoke during the period study (95% CI: 75.19% -79.21%). The accumulated smoking intake was higher in the group of men than in that of women (21.08 ± 16.31 versus 15.38 ± 13.28 packs/year) (t: 3.61, p<0.001). Significant differences (p <0.001) were obtained by comparing the average age of nonsmokers and that of smokers, (48.33 ± 9.82 versus 50.55 ± 7.62 years) and former smokers (48.33 ± 9.82 versus 50.65 ± 8.32 years). Regarding occupational status, the highest «Non Smokers» percentage belonged to the resident workers (87%) followed by the chief group (75%). The group of administrative assistants (34.7%) and the supervisors (33.3%) had the highest «Smokers» percentage (Chi-square = 131.23, p<0.001). Conclusions: the software application may be useful to have an accurate epidemiological knowledge about the magnitude of addictive behavior like smoking in workplaces. We have obtained a lower smoking prevalence compared to the area in our study.N

Consumo de alcohol entre los escolares de una zona básica de salud de Córdoba

FUNDAMENTO: Determinar el consumo de alcohol entre los escolares y conocer los factores que se encuentran asociados a dicho consumo. MÉTODOS: Estudio transversal, por encuesta de salud a 548 escolares de 6º y 8º de Enseñanza General Básica de los colegios de una Zona Básica de Salud de Córdoba, con un promedio de edad de 12,4 años (límites:10-15 años). Se recogieron datos sobre el consumo de alcohol por parte del escolar y de su entorno y sobre otras variables de los estilos de vida del escolar. RESULTADOS: El 43,7% (Intervalo de Confianza al 95% -IC 95%-: 39,4-47,9) ha probado el alcohol. Un 3,8% (IC 95%2,5-5,9) bebe regularmente, mientras que el 26,8% (IC 95%23,2-30,8) lo hace esporádicamente. Mediante análisis de regresión logística encontramos relación entre el consumo de alcohol y una mayor edad (Odds Ratio -OR-: 0,83; IC 95%0,70-0,98), ser varón (OR: 1,78; IC 95%1,16-2,73), el consumo de alcohol en los hermanos mayores (OR: 2,25; IC 95%1,35-3,75), la ingesta de medicamentos para el nerviosismo (OR: 5,33; IC 95%: 1,26-22,5), peor rendimiento escolar (OR: 1,002; IC 95%1,0-1,005), el consumo de tabaco (OR: 4,55; IC 95%2,4-8,61) y sentimiento de soledad (OR: 1,41; IC 95%1,01-1,97). CONCLUSIONES: aunque el número de escolares que acceden a probar el alcohol es bajo en comparación con otras zonas, la prevalencia de bebedores actuales es muy similar. La influencia de los hermanos mayores parece ser importante para el inicio en el consumo. El perfil del escolar bebedor de alcohol se caracteriza por ser varón, consumir tabaco, y por presentar sentimiento de soledad