La Factibilidad del consejo preventivo sobre accidentes de tráfico en atención primaria

Consultable des del TDXTítol obtingut de la portada digitalitzadaIntroducción: Los Accidentes de Tráfico (AT) son un problema de salud importante por la mortalidad, morbilidad y discapacidades que originan. Existen tres grupos de mayor riesgo: población de 15-24 años usuarios de motocicletas, población de 18-34 años ocupantes de turismos en carretera y peatones >65 años en zona urbana. En el marco de las actividades preventivas y como un elemento primordial del trabajo de los profesionales de Atención Primaria (AP) se encuentra la educación sanitaria en estilos de vida o comportamientos que afectan directamente al estado de salud. Para la prevención de los AT es importante la educación sanitaria y es responsabilidad de los profesionales sanitarios (PS) efectuar el consejo preventivo en seguridad vial. Objetivos e Hipótesis: Son Objetivos de este trabajo: 1. Determinar nivel de conocimientos y actitudes de los profesionales de la AP sobre consejo preventivo de AT relativo a: Epidemiología (datos de incidencia y/o prevalencía), lesiones más habituales producidas por los AT, utilización de medidas de seguridad activa y pasiva a recomendar en la población, consumo de bebidas alcohólicas, consumo de medicamentos y otras sustancias potencialmente peligrosas en la conducción de vehículos y enfermedades relacionadas con la capacidad de conducción. 2. Determinar la factibilidad del consejo preventivo sobre seguridad viaria desde la AP en cuanto a: Grado de responsabilidad de cada PS (médicos generales, pediatras y enfermeras), elementos facilitadores y elementos barrera. Hipótesis: 1. El nivel de conocimiento sobre la prevención de AT es insuficiente para realizar un consejo preventivo. 2. El nivel de conocimiento y la actitud sobre la seguridad vial de los profesionales de la AP es diferente en función de edad, sexo, núcleo familiar, profesión (médico o enfermera), experiencia en servicios de urgencias y experiencia personal en AT y 3. Los profesionales de AP consideran poco factible el consejo preventivo en AT por falta de tiempo. Método: Diseño: El presente trabajo se ha realizado mediante la combinación de metodología cuantitativa y cualitativa. El estudio cuantitativo es descriptivo transversal y el cualitativo mediante la tecnica de los grupos focales. El periodo de realización de ambos estudios fue de Octubre 2000 a Marzo 2001. Ambito: Centros de Atención Primaria de Barcelona ciudad. Sujetos de estudio: médicos (generales y pediatras) y personal de enfermería de AP en Barcelona ciudad. Instrumentos de medida: Encuesta autoadministrada sobre conocimientos y actitudes respecto al consejo preventivo sobre seguridad viaria y análisis de grupos focales. Variables: Según las dos herramientas de trabajo serán: edad, sexo, estado civil, número de hijos, profesión, centro de trabajo, grado de conocimiento sobre consejo preventivo, grado de responsabilidad, elementos facilitadores y elementos barrera (tiempo, incentivos, motivación y nivel de autoconfianza). Resultados: Estudio cuantitativo. Tasa de respuesta al cuestionario de 54,8% (187/341). Respondieron 74,6% mujeres y 25,4% hombres, media de edad 41,3 años (DE 8,3), rango 23-64 [IC 95%: 40,1-42,5] años. Llevaban una media de 11,6 años trabajando (DE 7,6), rango 1-43 años de práctica [IC 95%: 10,5-11,7]. Declaran haber tenido experiencia personal o familiar relacionada con algún AT el 59,9% [IC 95% 52,9-66,9]. La variable principal (puntuación del total del test) mostró una media de 11,3 (IC 95% 10,9-11,7). La puntuación total del test se relacionó de manera inversa y estadísticamente significativa con edad (r=-0,344; r2 = 0,118; p<0,001) y años de experiencia (r=-0,194; r2 = 0,038; p=0,009). La superación del test de conocimientos se relacionó con la profesión de medico (OR 3,7; IC95% 1,5-9), grupo edad hasta 45 años (OR 3,1; IC95% 1,3-7,6) y ser conductor (OR 2,9; IC95% 1,04-8,3). Estudio cualitativo. Se realizaron 4 entrevistas grupales (grupos focales), 3 segmentando según tipo de profesional sanitario y la cuarta con participación de todos los profesionales. Los AT se perciben como grave problema, pero no prioritario. Se identifica una falta significativa de coordinación de esfuerzos para reducir los AT desde diversos ámbitos. El grado de sensibilización de los PS hacia los AT es variable en función de que hayan trabajado en un servicio de urgencias, que hayan tenido experiencias directas con AT o que tengan hijos. Las principales barreras para la viabilidad de su aplicación son: falta de tiempo, formación, información sobre la efectividad de las intervenciones preventivas, falta de recursos y de motivación relacionada con el desconocimiento de la efectividad de estos consejos. Se destacan entre los elementos que podrían facilitar la aplicación de este programa: disponer de información sobre efectividad intervenciones aplicadas, manuales de ayuda, material de apoyo en consulta, sensibilización de los profesionales de AP previa al inicio de la aplicación del programa y coordinación de esfuerzos con otros ámbitos para reforzar la efectividad de este programa. Conclusiones 1. Los profesionales sanitarios de AP tienen un nivel de conocimientos intermedio, que precisa de actividades formativas. 2. Los PS consideran el consejo preventivo en AT es una actividad importante, pero no prioritaria. 3. Las principales barreras para aplicar el consejo preventivo detectadas por los profesionales de AP son: falta de tiempo, ausencia de recursos materiales (educativos y de apoyo), escasa formación y baja motivación. 4. Los elementos que facilitarían el consejo preventivo en AT son: Información sobre efectividad de la intervención, material de apoyo en consultas, campañas de sensibilización y aumento de tiempo para esta función. 5. Los profesionales sanitarios creen necesario que por parte de la administración sanitaria y las sociedades científicas, se realicen actividades sensibilización entre los PS y de coordinación con otros colectivos implicados.1. Introduction: Traffic accidents (TA) are a health significant problem due to the mortality, morbility and disabilities they cause. There are three major risk groups: population between 15-24 years old motorbike users, population between 18-24 car drivers, and pedestrians in urban zone older than 65 years. In the frame of the preventive activities, and as a basic work element of Primary Health Care (PHC) Professionals, we could find the health education on lifestyles or behaviors that directly affect the Health Status. Health Education is essential and it is Health Practitioners'responsibility to give advice in road safety. 2. Objectives and hypotheses: The aims of this work are: 1. To assess the level of knowledge and attitudes of PHC Professionals about TA preventive advice relating to: epidemiology (incidence and prevalence), frequent injuries produced by TA, use of active and passive safety measures to be recommend to the general population, alcohol consumption, drugs consumption and other potentially dangerous substances for driving as well as illnesses affecting driving abilities. 2. To explore the feasibility of AP preventive advice about road safety on: responsibility of every (HP) (general practitioners, pediatricians, and nurses), facilitator elements and barrier elements. The hypotheses are as follows: 1. The level of TA prevention knowledge is not enough to make a preventive advice. 2. PHC Professionals knowledge as well as their attitude towards road safety are different depending on age, sex, familiar core, profession (doctor or nurse), experience in emergency services, and personal experience in TA. 3. PHC professionals consider the preventive advice non factible due to lack of time. 3. Method Design: this work has been done with the combination of quantitative and qualitative methodologies. The quantitative study is descri ptive transversal and the qualitative one by focal group's technique. Both studies took place from October 2000 to March 2001.Setting: Primary Attention Centers in the City of Barcelona. Study subjects: Doctors (General Practitioners and Pediatricians) and Nurses in Barcelona. Measure tools: self survey on preventive road safety advice knowledge and attitudes, and analyses of focal groups. Variables: according to working tools they would be: age, sex, civil state, number of children, profession, work center, knowledge level on preventive advice, responsibility grade, facilitator and barrier elements (time, incentives, motivation, and level of self confidence). 4. Results Quantitative study: Rate of response to the questionnaire of 54.8 % (187/341). Answered by 74.6% women and 25.4% men, average age of 41.3 years old (SD 8.3), ranging 23-64 years old (CI 95%: 40.1-42.5) years. They were taking an average of 11.6 working years (SD 7.6), ranging 1-43 years of practice [CI 95 %: 10.5-11.7]. They declare to have personal or relative experience related to some TA 59,9 % [CI 95 % 52.9-66.9]. The main variable (score of the whole test) showed an average of 11.3 (CI 95 % 10.9-11.7). The total score of the test was connected to age in an inverse and statistically significant way (r = -0.344; r2 = 0.118; p < 0.001) and years of experience (r = -0.194; r2 = 0.038; p = 0.009). The overcoming skills test were connected to the profession of the Doctor (OR 3.7; CI95 % 1.5-9), age group up to 45 years (OR 3.1; CI95 % 1.3-7.6) and being driver (OR 2.9; CI95 % 1.04-8.3). Qualitative study Four grouped interviews were carried out (focal groups), three segmenting according to type of Health Professional and the fourth one with participation of all professionals. TA are perceived as a serious problem, but not a main priority. It has been identified a significant lack of coordination of efforts to reduce the TA from diverse areas. The level of awareness of the HP towards the TA is changeable depending on having been employed with an Emergency Services dealing directly with TA or those having children on their own The main barriers for the viability of its application are: lack of time, training, information about the efficiency of the preventive actions, lack of resources and of motivation related to the ignorance of the efficiency of these advices. The highlighted elements that might ease the application of this program are as follows: to have information about efficiency applied actions, help handbooks, supporting material in surgeries, awareness of PHC professionals before the beginning of the program application, and coordination of efforts with other areas to reinforce the efficiency of this program. 5. Conclusions 1. PHC professionals have a intermediate level of knowledge, which need formative activities. 2. HP consider important the preventive advice in TA, but not as a priority activity. 3. The main barriers to apply the preventive advice detected by PA professionals are: lack of time, absence of material resources (educational and supporting), shortage of training, and low motivation. 4. The elements that would ease the preventive advice in TA are: Information on intervention efficiency, supporting material in surgeries, awareness campaigns, and increase in time for this function. 5. Health Professionals believe is necessary that the Health Authority as well as Scientific Societies are aware of the importance of activities carried out between HP and other involved groups

Cigarrillos electrónicos

Dispositius electrònics; Cigarretes electròniques; Productes de tabac per escalfamentDispositivos electrónicos; Cigarrillos electrónicos; Productos de tabaco por calentamientoElectronic devices; Electronic cigarettes; Tobacco products for heatingEls dispositius electrònics (DE) són sistemes que proporcionen nicotina i altres substàncies en forma d’aerosol inhalable. Van ser introduïts en el mercat l’any 2003 sense estudis preclínics, proves toxicològiques ni assajos de seguretat a llarg termini, tal com requereixen els productes farmacèutics o els productes sanitaris, i no han estat autoritzats com a productes terapèutics. Hi ha dos tipus principals de DE: les cigarretes electròniques (CE) i els productes de tabac per escalfament (PTE). Els seus efectes sobre la salut a llarg termini són desconeguts i, per tant, no hi ha proves que els DE siguin més segurs que el tabac convencional. A curt termini, poden tenir efectes respiratoris similars als de les cigarretes convencionals. L’any 2019, es va descriure una entitat pròpia de lesions pulmonars associades al vapeig (EVALI, de l’anglès E-cigarette or Vaping Product Use-Associated Lung Injury). També s’han notificat diverses afectacions relacionades dels sistemes respiratori, cardiovascular o immunitari, entre d’altres. Els assaigs clínics publicats fins avui no han aclarit si les CE són efectives per deixar de fumar, bàsicament perquè presenten dèficits metodològics importants. Hi ha una gran evidència (OR 4,59) entre l’ús de CE i la posterior conversió d’aquestes persones en fumadors habituals. L’estratègia més efectiva per ajudar les persones fumadores es basa en el suport psicològic o conductual i la utilització de fàrmacs (teràpia substitutiva de nicotina, bupropió i vareniclina). Els professionals sanitaris haurien de desaconsellar les cigarretes electròniques.Los dispositivos electrónicos (DE) son sistemas que proporcionan nicotina y otras sustancias en forma de aerosol inhalable. Se introdujeron en el mercado el año 2003, sin estudios preclínicos, pruebas toxicológicas, ni ensayos clínicos de seguridad a largo plazo, tal como requieren los medicamentos o los productos sanitarios, y no han sido autorizados como producto terapéutico. Hay dos tipos principales de DE, los cigarrillos electrónicos (CE) y los productos de tabaco por calentamiento (PTC). Los efectos a largo plazo sobre la salud de estos productos son desconocidos y, por tanto, no se dispone de pruebas que permitan afirmar que los DE son más seguros que el tabaco convencional. A corto plazo, pueden tener efectos respiratorios similares a los de los cigarrillos convencionales. En el año 2019, se describió una entidad propia de lesiones pulmonares asociadas al vapeo (EVALI: “E-cigarette Vaping product uso Associated Lung Injury”). También se han notificado varias afectaciones en los sistemas respiratorio, cardiovascular e inmunitario entre otros. Los ensayos clínicos publicados hasta el momento no aclaran si los CE son eficaces para dejar de fumar, básicamente, a causa de que presentan déficits metodológicos importantes. Se dispone de fuerte evidencia (ORO 4,59) entre el uso de CE y la posterior conversión a fumadores habituales. La estrategia más efectiva para ayudar a las personas fumadoras se basa en el apoyo psicológico/conductual y la utilización de fármacos (Terapia sustitutiva de nicotina, bupropión y vareniclina). Los profesionales sanitarios deben desaconsejar el uso de cigarrillos electrónicos

Differences in Free-Living Patterns of Sedentary Behaviour between Office Employees with Diabetes and Office Employees without Diabetes: A Principal Component Analysis for Clinical Practice

Aims: To identify principal components of free-living patterns of sedentary behaviour in office employees with type 2 diabetes (T2D) compared to normal glucose metabolism (NGM) office employees, using principal component analysis (PCA). Methods: 213 office employees (n = 81 with T2D; n = 132 with NGM) wore an activPAL inclinometer 24 h a day for 7 consecutive days. Comparions of sedentary behaviour patterns between adults with T2D and NGM determined the dimensions that best characterise the sedentary behaviour patterns of office employees with T2D at work, outside work and at weekends. Results: The multivariate PCA technique identified two components that explained 60% of the variability present in the data of sedentary behaviour patterns in the population with diabetes. This was characterised by a fewer number of daily breaks and breaks in time intervals of less than 20 min both at work, outside work and at weekends. On average, adults with T2D took fewer 31 breaks/day than adults without diabetes. Conclusion: Effective interventions from clinical practice to tackle prolonged sedentary behaviour in office employees with T2D should focus on increasing the number of daily sedentary breaks.The study was funded by Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (PI17/01788), the Spanish Ministry of Science and Innovation (DEP2021-37169), grant Jose Luís Torres from redGDPS Foundation (redgdps/BJLTB/02/2022), the predoctoral research grant Isabel Fernández 2020 from the Spanish Society of Family and Community Medicine (semFYC) and another grant from the Càtedra Autonomous University of Barcelona (UAB)—Novartis for research in Family and Community Medicine. The funders had no role in the design, analysis, data interpretation or writing of the manuscript

Screening Physical Activity in Family Practice : Validity of the Spanish Version of a Brief Physical Activity Questionnaire

The use of brief screening tools to identify inactive patients is essential to improve the efficiency of primary care-based physical activity (PA) programs. However, the current employment of short PA questionnaires within the Spanish primary care pathway is unclear. This study evaluated the validity of the Spanish version of a Brief Physical Activity Assessment Tool (SBPAAT). A validation study was carried out within the EVIDENT project. A convenience sample of patients (n = 1,184; age 58.9±13.7 years; 60.5% female) completed the SBPAAT and the 7-day Physical Activity Recall (7DPAR) and, in addition, wore an accelerometer (ActiGraph GT3X) for seven consecutive days. Validity was evaluated by measuring agreement, Kappa correlation coefficients, sensitivity and specificity in achieving current PA recommendations with the 7DPAR. Pearson correlation coefficients with the number of daily minutes engaged in moderate and vigorous intensity PA according to the accelerometer were also assessed. Comparison with accelerometer counts, daily minutes engaged in sedentary, light, moderate, and vigorous intensity PA, total daily kilocalories, and total PA and leisure time expenditure (METs-hour-week) between the sufficiently and insufficiently active groups identified by SBPAAT were reported. The SBPAAT identified 41.3% sufficiently active (n = 489) and 58.7% insufficiently active (n = 695) patients; it showed moderate validity (k = 0.454, 95% CI: 0.402-0.505) and a specificity and sensitivity of 74.3% and 74.6%, respectively. Validity was fair for identifying daily minutes engaged in moderate (r = 0.215, 95% CI:0.156 to 0.272) and vigorous PA (r = 0.282, 95% CI:0.165 to 0.391). Insufficiently active patients according to the SBPAAT significantly reported fewer counts/minute (-22%), fewer minutes/day of moderate (-11.38) and vigorous PA (-2.69), spent fewer total kilocalories/day (-753), and reported a lower energy cost (METs-hour-week) of physical activities globally (-26.82) and during leisure time (-19.62). The SBPAAT is a valid tool to identify Spanish-speaking patients who are insufficiently active to achieve health benefits

Relationship between intima-media thickness of the common carotid artery and arterial stiffness in subjects with and without type 2 diabetes: a case-series report

Background: We examined the relationship between the intima-media thickness of the common carotid artery (CCA-IMT) and arterial stiffness, assessed by pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI) and the augmentation index (AIx) in subjects with and without type 2 diabetes. Methods: A case-series study was made in 366 patients (105 diabetics and 261-non-diabetics). Ambulatory blood pressure monitoring was performed on a day of standard activity with the SpaceLabs 90207 system. AASI was calculated as "1-slope" from the within-person regression of diastolic-on-systolic ambulatory blood pressure readings. PWV and AIx were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of CCA-IMT. Results: PWV, AASI and CCA-IMT were found to be greater in diabetic patients, while no differences in AIx were observed between the two groups. CCA-IMT was independently correlated to the three measures of arterial stiffness in both groups. We found an increase in CCA-IMT of 0.40, 0.24 and 0.36 mm in diabetics, and of 0.48, 0.17 and 0.55 mm in non-diabetics for each unit increase in AASI, AIx and PWV. The variability of CCA-IMT was explained mainly by AASI, AIx and gender in diabetic patients, and by age, gender, AASI and PWV in non-diabetic patients. Conclusions: CCA-IMT showed a positive correlation to PWV, AASI and AIx in subjects with and without type 2 diabetes. However, when adjusting for age, gender and heart rate, the association to PWV was lost in diabetic patients, in the same way as the association to Alx in non-diabetic patients. The present study demonstrates that the three measures taken to assess arterial stiffness in clinical practice are not interchangeable, nor do they behave equally in all subjects

Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review

Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design: A systematic review of randomised and non-randomised controlled trials was undertaken. Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results: Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results

Risk levels for suffering a traffic injury in primary health care. The LESIONAT* project

Background: Literature shows that not only are traffic injuries due to accidents, but that there is also a correlation between different chronic conditions, the consumption of certain types of drugs, the intake of psychoactive substances and the self perception of risk (Health Belief Model) and the impact/incidence of traffic accidents. There are few studies on these aspects in primary health care. The objectives of our study are: Main aim: To outline the distribution of risk factors associated with Road Traffic Injuries (RTI) in a driving population assigned to a group of primary health care centres in Barcelona province. Secondly, we aim to study the distribution of diverse risk factors related to the possibility of suffering an RTI according to age, sex and population groups, to assess the relationship between these same risk factors and self risk perception for suffering an RTI, and to outline the association between the number of risk factors and the history of reported collisions. Methods/Design: Design: Cross-sectional, multicentre study. Setting: 25 urban health care centres. Study population: Randomly selected sample of Spanish/Catalan speakers age 16 or above with a medical register in any of the 25 participating primary health care centres. N = 1540. Unit of study: Basic unit of care, consisting of a general practitioner and a nurse, both of whom caring for the same population (1,500 to 2,000 people per unit). Instruments of measurement: Data collection will be performed using a survey carried out by health professionals, who will use the clinical registers and the information reported by the patient during the visit to collect the baseline data: illnesses, medication intake, alcohol and psychoactive consumption, and self perception of risk. Discussion: We expect to obtain a risk profile of the subjects in relation to RTI in the primary health care field, and to create a group for a prospective follow-up. Trial Registration: Clinical Trials.gov Identifier: NCT00778440. </p

Effectiveness of an intensive E-mail based intervention in smoking cessation (TABATIC study) : study protocol for a randomized controlled trial

Background: Intensive interventions on smoking cessation increase abstinence rates. However, few electronic mail (E-mail) based intensive interventions have been tested in smokers and none in primary care (PC) setting. The aim of the present study is to evaluate the effectiveness of an intensive E-mail based intervention in smokers attending PC services. Methods/design: Randomized Controlled Multicentric Trial. Study population: 1060 smokers aged between 18-70 years from Catalonia, Salamanca and Aragón (Spain) who have and check regularly an E-mail account. Patients will be randomly assigned to control or intervention group. Intervention: Six phase intensive intervention with two face to face interviews and four automatically created and personal E-mail patients tracking, if needed other E-mail contacts will be made. Control group will receive a brief advice on smoking cessation. Outcome measures: Will be measured at 6 and 12 months after intervention: self reported continuous abstinence (confirmed by cooximetry), point prevalence abstinence, tobacco consumption, evolution of stage according to Prochaska and DiClemente's Stages of Change Model, length of visit, costs for the patient to access Primary Care Center. Statistical analysis: Descriptive and logistic and Poisson regression analysis under the intention to treat basis using SPSS v.17. Discussion: The proposed intervention is an E-mail based intensive intervention in smokers attending primary care. Positive results could be useful to demonstrate a higher percentage of short and long-term abstinence among smokers attended in PC in Spain who regularly use E-mail. Furthermore, this intervention could be helpful in all health services to help smokers to quit. Trial Registration: Clinical Trials.gov Identifier: NCT01494246