Effectiveness of a brief intervention for acceptance of influenza vaccine in reluctant primary care patients / Efectividad del consejo breve para la vacunación antigripal en pacientes reacios en atención primaria

Objective: To determine the effectiveness of a brief intervention in increasing influenza vaccination coverage compared with the usual advice in people who refuse it, and to record the main reasons for refusing to be vaccinated. Method: A cluster randomized clinical trial was conducted in which the study population was individuals with high risk factors who initially had refused to be vaccinated against influenza. Professionals (doctors and nurses) who voluntarily accepted to participate were assigned randomly to the intervention group (brief intervention) and the control group (usual advice). Results: 57 professionals recruited 524 people who had previously declined the influenza vaccination (271 in the control group and 253 in the intervention group). Brief intervention showed its effectiveness with an odds ratio of 2.48 (1.61-3.82; p < 0.001), in individuals aged 60 or over, both healthy or with risk factors. The most frequent reasons for rejection of vaccination were the belief that there was no risk of getting sick (53.0%) and the fear of the side effects (33.3%). (AU)

Objetivo: Determinar la efectividad del consejo breve para la vacunación antigripal frente al consejo habitual en personas que la rechazan, y conocer los principales motivos de rechazo. Método: Se realizó un ensayo clínico aleatorizado por clusters, en el que la población de estudio eran personas con factores de riesgo y que inicialmente rechazaban vacunarse. Los/las profesionales (médicos/as y enfermeros/as) que aceptaron participar se distribuyeron aleatoriamente en un grupo de intervención (consejo breve) y un grupo de control (consejo habitual). Resultados: Cincuenta y siete profesionales reclutaron 524 personas que rechazaron la vacunación (271 en el grupo control y 253 en el grupo de intervención). El consejo breve demostró su efectividad, con una odds ratio de 2,48 (1,61-3,82; p < 0.001), en las personas de 60 años o más, sanos o con factores de riesgo. Los principales motivos para no vacunarse fueron la creencia de no estar en riesgo de enfermar (53,0%) y el miedo a los efectos secundarios (33,3%). Conclusiones: El consejo breve es una herramienta efectiva para mejorar las coberturas de vacunación en personas que la rechazan inicialmente. (AU)

Consejería personalizada en salud en personas con enfermedades crónicas / Personalized health counseling for people with chronic diseases

La Consejería Personalizada en Salud es considerada una herramienta de ayuda para propiciar cambios especialmente relacionados con estilos de vida. Objetivo: Describir las bases teóricas de la consejería y su aplicación en la práctica clínica. Se identifican los objetivos, las etapas y la metodología de trabajo de la consejería. La Consejería Personalizada en Salud es una herramienta inherente al conocimiento y crecimiento personal, para tratar cambios en salud sobre todo en enfermedades de tipo crónico no transmisible. (AU)

Personalized Health Counseling is considered a helpful tool to promote changes especially related to lifestyles. Objective: Describes the theoretical bases of counseling, and its application in clinical practice. The objectives, stages, and work methodology of the counseling are identified. Personalized Health Counseling is a tool inherent to knowledge and personal growth, to treat changes in health, especially in non-communicable chronic diseases. (AU)

Self-medication consultations in community pharmacy: an exploratory study on teams' performance, client-reported outcomes and satisfaction

BACKGROUND: Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines. OBJECTIVE: The study aimed to describe CPTs' performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients' satisfaction with this service. METHODS: Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients' overall satisfaction was explored, using linear regression. RESULTS: Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the 'other medication' questioning. Most clients (93%) reported improvement after the consultation. Clients' satisfaction score was 4.70 out of 5. The variables that seem to better explain clients' overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender. CONCLUSIONS: Clients' reported outcomes were favourable, as well as satisfaction with the service. Clients' satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists' clinical role. A larger study is warranted to confirm these findings

No disponible

Health advice on alcohol consumption in pregnant women in Seville (Spain) / Consejo sanitario sobre el consumo de alcohol en embarazadas de Sevilla (España)

OBJECTIVE: To analyse to what extent pregnant women remembered having received health advice regarding alcohol consumption during pregnancy, what the message they perceived was and whether there is social inequality in this regard. METHOD: A cross-sectional descriptive study was performed with a sample of 426 pregnant women (in their 20th week of pregnancy) receiving care in the outpatient clinics of a university hospital in a southern Spanish city (Seville). The data were collected through face-to-face structured interviews carried out by trained health professionals. RESULTS: 43% of the interviewed women stated that they had not received any health advice in this regard. Only 43.5% of the sample remembered having received the correct message (not to consume any alcohol at all during pregnancy) from their midwife, 25% from their obstetrician and 20.3% from their general practitioner. The women with a low educational level were those who least declared having received health advice on the issue. CONCLUSION: The recommended health advice to avoid alcohol consumption during pregnancy does not effectively reach a large proportion of pregnant women. Developing institutional programmes which help healthcare professionals to carry out effective preventive activities of foetal alcohol spectrum disorder is needed

OBJETIVO: Analizar en qué medida las gestantes recuerdan haber recibido asesoramiento sanitario sobre el consumo de alcohol durante el embarazo, cuál es el mensaje percibido y si existe desigualdad social al respecto. MÉTODO: Se realizó un estudio transversal descriptivo con 426 mujeres en su semana 20 de embarazo en las consultas externas de un hospital universitario de Sevilla (España). Los datos se recopilaron mediante entrevistas estructuradas cara a cara realizadas por profesionales sanitarias entrenadas. RESULTADOS: El 43% de las entrevistadas afirmaron no haber recibido consejo sanitario alguno al respecto. Solo el 43,5% dijeron que habían recibido el mensaje correcto (no beber absolutamente nada de alcohol durante el embarazo) por parte de la matrona, el 25% por el obstetra y el 20,3% por el médico de atención primaria. Las embarazadas con menor nivel educativo fueron las que menos refirieron haber recibido asesoramiento sanitario sobre el tema. CONCLUSIÓN: El consejo sanitario adecuado (evitar todo consumo de alcohol durante el embarazo) no llega de manera efectiva a una amplia proporción de las gestantes. Es necesario desarrollar programas institucionales que posibiliten que los profesionales sanitarios puedan llevar a cabo con eficacia actividades preventivas de los trastornos del espectro alcohólico fetal

Una cosa es predicar, y otra dar trigo (cosas de la nutrición) / Actions speak louder than words (nutrition issues)

No disponible

Analysis of dispatcher-assisted cardiopulmonary resuscitation instructions to laypersons in an out-of-hospital cardiac arrest / Análisis de las instrucciones de la reanimación cardiopulmonar guiada por teléfono en paradas cardiacas extrahospitalarias atendidas por ciudadanos

Randomized simulation trial to analyze dispatcher-assisted cardiopulmonary resuscitation instructions provided from the emergency call center in an out-of-hospital heart arrest assisted by lay persons. An analysis of the telephone instructions was performed using a 14-item checklist by two external researchers. Simulations lasted nine minutes. Twenty-one volunteers were enrolled. All of them started resuscitation maneuvers. Telephone instructions were verbalized in very heterogeneous ways. Half of the indicators exceeded 90% compliance. Frequently the recommendation of push hard and fast on the patient's chest was omitted and the dispatcher tended to mark a slower compression rate. The average time from the call to the start of the resuscitation was 3 min 33 s (SD: 1 min 7 s). The telephone instructions were verbalized in a very heterogeneous way. It is necessary to standardize and provide training in how to guide a dispatcher-assisted resuscitation

Estudio de simulación para analizar el contenido de las instrucciones telefónicas de reanimación cardiopulmonar emitidas por un centro coordinador de urgencias durante la parada cardiaca extrahospitalaria asistida por ciudadanos sin entrenamiento. Cada simulación duró nueve minutos. El análisis de las instrucciones telefónicas fue realizado por dos observadores mediante una lista de comprobación de catorce indicadores. Participaron veintiún voluntarios. Todos fueron capaces de iniciar maniobras de reanimación. La mitad de los indicadores superaron el 90% de cumplimiento. Frecuentemente se omitió la necesidad de comprimir fuerte y rápido el tórax, con tendencia a marcar un ritmo de compresiones lento. El tiempo medio desde la llamada hasta el inicio de la reanimación fue de 3 min 33 s (DE: 1 min 7 s). Las instrucciones telefónicas se verbalizaron de formas muy heterogéneas. Es preciso normalizar y entrenar la forma de guiar telefónicamente una reanimación

Actividad de un servicio de medicina legal hospitalaria del siglo XXI / Activity of a 21st century hospital medico-legal department

INTRODUCCIÓN: La implantación de un Servicio de medicina legal hospitalaria, como asesor y consultor en aspectos médico-legales, éticos y deontológicos de la práctica asistencial, se ha consolidado en el Hospital Clínico de San Carlos de Madrid. Una cartera de servicios sencilla basada en la prevención de riesgos legales, ha permitido que los profesionales, la administración sanitaria y los propios pacientes confíen en él. RESULTADOS: En el período 2007-2017 se gestionaron 1.213 expedientes, aumentando de forma progresiva y destacando los años 2009 y 2017 con un 13,8 y 12,3% de la actividad total, respectivamente. Las unidades que más consultaron fueron el equipo directivo 158 (13%), el Instituto de la Mujer 144 (11,9%) y el Servicio de Atención al Paciente 116 (9,6%). DISCUSIÓN Y CONCLUSIONES: El servicio participa en múltiples comisiones y grupos de trabajo elaborando guías, documentos y protocolos, abordando conflictos, dudas normativas, deficiencias formativas, recomendando cursos de acción, e intermediando con pacientes y familiares para disminuir la incertidumbre del profesional

INTRODUCTION: A hospital legal medicine department, to advice and consult on the legal, ethical and deontological aspects of healthcare practice, has been implemented in our centre, Hospital Clínico San Carlos (Madrid Spain). A simple service portfolio based on the prevention of legal risks, has allowed professionals, health service and patients to place their trust in it. RESULTS: The number of cases over the period 2007-2017 reflects major activity, and 2009 and 2017 are highlighted with 13.8% and 12.3% of the total activity respectively. The units that consulted the most were the management team 158 (13%), the Institute for Women's Affairs 144 (11.9%) and the Patient Care Service 116 (9.6%). DISCUSSION AND CONCLUSIONS: The department participates in multiple committees and working groups preparing guidelines, documents and protocols, addressing conflicts, regulatory doubts, training deficiencies, recommending courses of action, and mediating with patients and family members to reduce professional uncertainty

Professional aspirations as indicators of responsible leadership style and corporate social responsibility. Are we training the responsible managers that business and society need? A cross-national study / Las aspiraciones profesionales como indicadores del estilo de liderazgo responsable y de la responsabilidad social corporativa. ¿Estamos formando a los directivos responsables que necesitan las empresas y la sociedad? Un estudio entre países

The relationship between responsible leadership (RL), identified from achievement expectations, and the importance attached to corporate social responsibility (CSR) was analyzed. In a survey of 1,833 business management undergraduates in six Ibero-American countries, factor analysis identified three approaches to stakeholder relations, behaviors, and professional aspirations: a relational style associated with the intention to collaborate with others; a pragmatic style geared to attaining personal and organizational objectives; and an individualist style informed by a drive for personal achievement. Regression analyses confirmed the relationship between relational and pragmatic styles and CSR geared to stakeholder well-being, protection of social and natural environments, and ethical management. Both were associated with regard to the responsibilities that ensure business survival (such as meeting customer needs), while the individualist style was aligned with hostility toward those dimensions of CSR. These findings suggest that the relational and pragmatic styles lead to more effective CSR management

Se analiza la relación entre estilos de liderazgo responsable (LR), éste último identificado a partir de las expectativas profesionales de logro, y la importancia atribuida a la responsabilidad social corporativa (RSC). Contamos con 1,833 participantes de seis países iberoamericanos que cursaban estudios universitarios relacionados con gestión empresarial. Un análisis factorial identificó un estilo de LR relacional orientado a colaborar con otras personas, un estilo pragmático asociado a logros personales y organizacionales y un estilo individualista orientado a intereses personales. Los análisis de regresión mostraron una relación positiva entre los estilos relacional prágmatico y la valoración de la RSC que busca el bienestar de la comunidad, de stakeholders internos y externos, la protección del medioambiente y el comportamiento ético, a la vez que asegura la sostenibilidad de organización, aspectos todos ellos valorados negativamente desde el estiloindividualista. Los datos sugieren que en el contexto socio-económico actual los estilos relacional y pragmático serían más efectivos para implementar la RSC

Community pharmacists' recommendations for natural products for stress in Melbourne, Australia: a simulated patient study

BACKGROUND: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. OBJECTIVE: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. METHODS: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. RESULTS: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. CONCLUSIONS: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine

No disponible

Differences between pharmacists' perception of counseling and practice in the era of prescription drug misuse

OBJECTIVE: This study was conducted to assess pharmacists' practices when counseling patients on their prescription medications, and their preferences for training. METHODS: Five focus group discussions of community pharmacists (n=45, with seven to eleven participants in each group) were conducted in a major metropolitan city in the southern United States. Participants were recruited via email using a list of community pharmacists provided by the Texas State Board of Pharmacy. All focus group discussions were structured using a moderator guide consisting of both discrete and open-ended questions. Qualitative analysis software was used to analyze the data with a thematic analysis approach. RESULTS: The participants in this study had a high self-efficacy regarding their ability to counsel on both new and opioid prescriptions. Many pharmacists experienced the same barriers to counseling and agreed on the components o counseling. However, the themes that emerged showed that the participants exhibited only a partial understanding of the components of counseling. The themes that emerged in the thematic analysis were perceived confidence and discordant counseling practices, inadequate infrastructure, lack of comprehensive counseling, inconsistent use of the Prescription Drug Monitoring Program (PDMP), and pharmacists' desired training/assistance. CONCLUSIONS: Community pharmacists are in a unique position to help combat the opioid crisis; however, there has been very little research on the pharmacist-patient interaction in this context. With policy changes, such as the PDMP mandate, going into effect across the country, it is important to capitalize on the potential community pharmacists have in ameliorating the opioid crisis in the United States

No disponible

A naturalistic observation study of medication counseling practices at retail chain pharmacies

OBJECTIVE: This study evaluated medication counseling procedures and trends at retail pharmacies in the Houston metropolitan area through a naturalistic observational study. METHODS: A blinded cross-sectional observational study was conducted at retail pharmacies in the Houston metropolitan area. Data were collected by trained observers utilizing an observational log, to record various parameters that could have an impact on the duration of patient-pharmacist interaction in a naturalistic pharmacy practice setting. Additionally, indicators of counseling such as utilization of the counseling window and performance of show-and-tell were recorded. Statistical analyses included descriptive statistics, t-tests, Pearson correlations, ANOVAs, and multiple linear regressions. RESULTS: One hundred and sixty-five interactions between patients and pharmacy staff were recorded at 45 retail pharmacies from 7 retail pharmacy chains. The counseling window was utilized in only 3 (1.81%) out of 165 observations and the show-and-tell process was observed in just 1(0.61%) interaction during this study. Mean (SD) interaction time between patient and pharmacists [159.50 (84.50)] was not statistically different (p > 0.05) from the mean interaction time between patients and pharmacy technicians [139.30 (74.19)], irrespective of type of the retail chain observed. However, it was influenced by the number of patients waiting in queue. Patient wait time significantly differed by the time of the day the interaction was observed, weekends and weekdays had significantly different wait times and patient interaction times Multiple linear regression analyses indicated that, patient interaction time, pharmacy chain type, initial contact (pharmacist/technician), and time of the day, were significantly associated with patient wait time whereas patient wait time, pharmacy chain type, number of patients in queue, and number of pharmacy technician were significantly associated with interaction time. CONCLUSIONS: Our study found that the key indicators of counseling including the use of the counseling window and the show-and-tell process were absent, suggesting lack of adequate pharmacists counseling. Further studies are needed to evaluate the validity of this conclusion and the role of pharmacy services and its value towards medication use and safety

No disponible

The provision of advice by pharmacy staff in eastern Indonesian community pharmacies

Background: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts. Results: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed

No disponible

Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the United Arab Emirates: a simulated patient study

Background: Hormonal contraceptive pills have evolved as a common form of contraception worldwide. Pharmacists play a vital role in providing safe and effective access to these medicines. In many developing countries such as the United Arab Emirates (UAE), these medicines are available to the general public without the presentation of a prescription which requires the pharmacist to shoulder responsibility by assessing and educating patients to assure their appropriate use. Objectives: To evaluate community pharmacists' current practice of dispensing and counseling on hormonal contraceptives. Methods: Simulated patient methodology was used in this study. A single simulated patient visited community pharmacies requesting an oral contraceptive as per a preplanned scenario. Information from the visits were recorded on a data collection form including: pharmacist assessing patient eligibility to take hormonal contraceptives, selecting the appropriate oral contraceptive, providing complete counseling on how to use the pill, adherence, missed dose handlings and side effects of the medication. The Pharmacist was prompted by the simulated patient to provide the information if they did not provide spontaneous counseling. The quality of pharmacists' counseling was rated and consequently coded as complete, incomplete or poor. Results: A total of 201 community pharmacies were visited. More than 92% of the pharmacists did not ask the simulated patient any question to assess their eligibility to use contraceptives. Twenty three pharmacists (11.4%) selected the proper product. One hundred seventeen (58.2%) of the pharmacists provided spontaneous counseling on how to use the pill, 17 of them had their counsel rated as complete, but none of the pharmacists provided spontaneous counseling regarding adherence or side effects of the medications. On prompting, 10 pharmacists (12%) provided complete counseling regarding how to use oral contraceptives, 14 pharmacists (7.0%) provided complete counseling on adherence and missing dose handling and five pharmacists (2.5%) provided complete counseling about expected side effects. Conclusions: Pharmacists' practice regarding hormonal contraceptive dispensing and counseling was suboptimal in this study. Areas needing intervention were related to pharmacist assessment of eligibility for oral contraceptive use, choice of optimal oral contraceptive for patient-specific co-morbidities and provision of adequate counseling regarding proper use, adherence and missed dose handlings

No disponible

La matrona como guía para la aplicación del método madre canguro. A propósito de un caso / The midwife as a guide for the application of the Kangaroo mother care method. A case report

Se presenta un caso clínico en el que tras un parto prematuro de una gestante de 33+5 semanas de gestación, la recién nacida es ingresada en el servicio de neonatos por bajo peso, prematuridad y tiraje a pesar de un Apgar 8/9/10 y un peso de 1.300 g en el nacimiento. El equipo de matronas que atendió a la mujer desde su llegada realiza una valoración según las necesidades de Virginia Henderson. Se identifican como diagnósticos enfermeros de la madre baja autoestima y conocimientos deficientes y para la recién nacida se identifica termorregulación ineficaz. Se realiza un plan de cuidados basado en gran medida en el método madre canguro, que se inicia en el Servicio de Neonatos, adaptándose a las necesidades y los cuidados que la prematura requiere. El método logra que los padres afronten la situación de una mejor forma y también permite mantener adecuadamente las constantes vitales de la prematura

We present a clinical case of a premature birth from a mother of 33+5 weeks gestation where the newborn was admitted to the neonatal unit due to her low weight, chest retraction and prematurity, despite an Apgar score of 8/9/10 and birth weight of 1.300 g. The team of midwives that attended the woman from her arrival performed an assessment according to Virginia Henderson's Needs. Nursing diagnoses for the mother of Situational low self- esteem and Deficient Knowledge were established, and of Ineffective thermoregulation for the newborn infant. The care plan was based in great measure on the Kangaroo-mother care method which was started in the neonatal unit, and adapted to the needs and care required by the newborn infant. The method enabled the parents to cope with the situation in a better way and the vital signs of the infant to be maintained

Use of the levonorgestrel-releasing intrauterine device in Spain / Uso del dispositivo intrauterino liberador de levonorgestrel (DIU-LNG) en España

Objective: To assess sociodemographic characteristics and the reasons for choosing the 52-mg levonorgestrel-releasing intrauterine device (LNG-IUD) for birth control among Spanish women. Material and methods: Observational, cross-sectional, multicenter, nationwide study women of reproductive age (18-49 years) attending a gynecological clinic to request long-acting reversible contraception (LARC). Results: The study population comprised 1612 women with a mean age of 38.6±5.7 years. Most women (91.7%) were primi/multiparous (1.9±0.7 children/woman), and 78.9% no longer wished to become pregnant. Women had no experience of LARC methods. The gynecologist was the main source of information (67.1%). The main reasons for choosing LARC were contraceptive efficacy (94.0%), long duration of action (62.5%), ease of use (61.3%), and safety (59.9%). Conclusions: Women who choose the LNG-IUD are mainly older than 38 years and primi/multiparous, with no previous experience in the use of LARC. They particularly appreciate contraceptive efficacy, long duration of action, ease of use, and safety

Objetivo: determinar las características sociodemográficas y los motivos de elección del dispositivo intrauterino liberador de levonorgestrel 52mg (DIU-LNG) como método anticonceptivo entre mujeres españolas. Material y métodos: estudio observacional, transversal, multicéntrico y nacional, en mujeres en edad reproductiva (18-49 años) que acudían a consulta ginecológica solicitando anticoncepción de larga duración (LARC). Resultados: la edad media de las mujeres del estudio fue de 38,6±5,7 años, primi/multiparas (91,7%) (1,9±0,7 hijos/mujer), con deseo genésico finalizado (78,9%), sin experiencia en los métodos LARC y el ginecólogo fue la principal fuente de información (67,1%). Los principales motivos de elección fueron la eficacia anticonceptiva (94,0%), larga duración (62,5%), comodidad de uso (61,3%) y seguridad (59,9%). Conclusiones: las mujeres que eligen el DIU-LNG son principalmente mayores de 38 años y primi/multíparas, sin experiencia previa en el uso de los LARC. Valoran principalmente la eficacia anticonceptiva, larga duración, comodidad y seguridad

La directiva ya está aquí. ¿Estamos preparados? / The directive is now here. Are we ready?

No disponible

Centrality measures to identify key stakeholders in Family Violence Councils / Las medidas de centralidad en la identificación de las partes interesadas en los Consejos de Violencia Familiar

The Family Violence Councils (FVC) are collaborative settings that bring together various organizations involved in the systems response to family violence. Social network analysis (SNA) is a technique that allows one to assess the connections between members (e.g., agencies) within a particular bounded network () and is well-suited to the study of councils. Centrality measures in SNA indicate which members in the network are central and prominent players in the setting, and therefore might be critical to engage in change efforts. The current study applied three centrality measures in five councils to identify consistent patterns regarding which organizations tend to be most central in the exchange of information among agencies responding to family violence. Further, the study examined whether and which type of centrality was related to the degree to which a given organization's policy and practices were influenced by council efforts. The study found domestic violence programs were significantly more likely to emerge as central in these settings. The study also found a relationship between an organization's centrality and perceived shifts in its policy and practices. However, only one type of centrality measure, namely closeness centrality, emerged as significantly predicting outcomes of interest when all three were examined simultaneously. The implications of these findings for research and practice will be discussed

Los Consejos de Violencia Familiar (Family Violence Councils, FVC) son espacios de colaboración que reúnen a diversas organizaciones que participan en el sistema de respuesta a la violencia familiar. El análisis de redes sociales (ARS) es una técnica que permite evaluar las conexiones entre los miembros de una red concreta (por ejemplo, agencias de servicios) () y es muy adecuada para el estudio de los consejos. Las medidas de centralidad en ARS indican qué miembros de la red son centrales y prominentes en un contexto determinado, y por tanto puede ser fundamental implicarlos en los esfuerzos de cambio. En este estudio aplicamos tres medidas de centralidad en cinco consejos, para identificar patrones consistentes en el intercambio de información entre las entidades que intervienen contra la violencia familiar. Además, con esta investigación examinamos si la centralidad se relaciona con el grado en que las políticas y las prácticas de una organización determinada fueron influenciadas por los esfuerzos del consejo. Los programas de violencia doméstica eran con mayor probabilidad centrales en los contextos analizados. También encontramos una relación entre la centralidad de la organización y los cambios percibidos en su política y sus prácticas. Sin embargo, sólo un tipo de medida de centralidad, concretamente la cercanía (closeness), predijo los resultados de interés cuando se tuvieron en cuenta las tres simultáneamente. Se discuten las implicaciones de estos hallazgos para la investigación y la práctica

The effectiveness of intervention programs in the prevention and control of obesity in infants: a systematic review / Efectividad de programas de intervención en la prevención y en el control del exceso de peso infantil: revisión sistemática

Objective: This study aims to conduct a literature review to evaluate the effectiveness of intervention programs in the prevention and control of obesity in children and to map the locations where the studies were carried out. Methods: A systematic review using the PubMed / MEDLINE and LILACS databases to trace the published literature on intervention programs for prevention and control of obesity in the period of January 2004 to October 2013. The initial search was conducted using the terms 'body mass index', 'Intervention' and 'children' or 'adolescent' and only articles published in English, Spanish or Portuguese were selected. Results: We found that interventions based only on advice had modest results in identifying changes in the anthropometric indicators of children and adolescents over time, although they appear to be effective in promoting positive changes in the eating habits of this population. Among the studies identified, 77.8% were conducted in high-income countries, 22.2% in middle to high income countries and no intervention studies were found in middle to low income countries. Conclusion: Intervention programs based only on counseling are effective in promoting changes in dietary patterns, but show poor results in the changes of anthropometric parameters of children and adolescents (AU)

Objetivo: Este trabajo pretende realizar una revisión de literatura para evaluar la efectividad de programas de intervención en la prevención y en el control del exceso de peso infantil y hacer el mapeamiento de los sitios donde los estudios fueron hechos. Métodos: Estudio de revisión sistemática utilizando las bases de datos de PUBMED/MEDLINE y LILACS para rastrear la literatura publicada sobre programas de intervenciones para prevención y control de exceso de peso entre el período de enero de 2004 a octubre de 2013. La búsqueda inicial fue realizada utilizando los términos 'body mass index' and 'Intervention' and 'children' or 'adolescent' y fueron seleccionados apenas los artículos publicados en Inglés, español y portugués. Resultados: se observó que intervenciones pautadas unicamente en el aconsejamiento presentaron resultados modestos para identificar alteraciones en los indicadores antropométricos de niños y adolescentes a lo largo del tiempo, aunque parezcan ser efectivos para realizar cambios positivos en los hábitos alimentares de esa población. Entre los estudios identificados, 77.8% fueron realizados en países con renta alta, 22.2% en los países con renta media-alta y no hay estudios de intervención en países con renta media-baja y baja. Conclusión: Los programas de intervenciones basados solamente en el aconsejamiento son efectivos para promover cambios en la calidad alimentar, pero presentan insignificantes resultados en la alteración de los parámetros antropométricos de niños y adolescentes (AU)

Características y actitudes del tabaquismo en médicos de la Argentina en relación a la especialidad / Smoking characteristics and attitudes in physicians in Argentine in regards to the specialty

Objetivos. Analizar la epidemiología del tabaquismo en médicos de Argentina y la actitud que estos toman frente a sus pacientes fumadores, en relación con la especialidad ejercida. Métodos y pacientes. Estudio transversal, analítico-observacional. Se evaluaron médicos de ambos géneros, clasificándolos en categorías según la especialidad: cardiólogos, neumólogos, psiquiatras, clínicos (resto de las especialidades clínicas), tocoginecólogos y cirujanos (otras especialidades quirúrgicas). Se analizaron las características del consumo, la capacitación y el consejo médico en relación a la especialidad. Resultados. Se incluyeron 6.150 médicos, 63% varones, edad 41,5 ± 10 años, fumadores 29,7%, 28% comenzaron a fumar antes de los 15 años, consumo promedio 14 cigarrillos/día, 30% fumaban al despertar, y otro tanto tenían capacitación en tabaquismo. Los psiquiatras mostraron mayor prevalencia (40,8%), el mayor consumo (16 ± 9,7/día) y la mayor proporción de fumadores en la primera hora del despertar (42,9%) o en el hospital (54,8%). Dichas características se observaron menos frecuentemente en las otras especialidades. Los cardiólogos y neumólogos mostraron un mayor entrenamiento y fueron los que más frecuentemente brindaban consejo de cesación tabáquica (>90%). Conclusión. En este estudio, la prevalencia de tabaquismo en médicos fue elevada. Las características del consumo de cigarrillos, el grado de entrenamiento y la frecuencia de brindar el consejo de cesación tabáquica mostraron diferencias según la especialidad analizada (AU)

Objective. To analyze the epidemiology of smoking in Argentinian physicians and their attitude towards their patients who smoke, in relation to medical specialty. Methods and patients. A cross-sectional, observational-analytical study was performed. Physicians of both sexes were evaluated, classifying them into categories by specialty: cardiologists, pneumonologists, psychiatrists, clinical (other clinical specialties), gynecologists and surgeons (other surgical specialties). Characteristics of cigarette consumption, medical training and advice to quit smoking among physicians by specialty were analyzed. Results. 6,150 physicians were included (male 63%, mean age 41.5 ± 10 years, smokers 29.7%). 28% of the doctors started smoking before age 15, and the average consumption was 14 cigarettes/day. Thirty percent of the physicians smoke at the time of awakening. Other thirty percent had training in tobacco. Psychiatrists showed the higher prevalence of smoking (40.8%), daily consumption of cigarettes (16 ± 9.7) and proportion of smokers that smoked at the first hour of awakening (42.9%) or in the hospital (54.8%). These characteristics were observed less frequently in other specialties. Cardiologists and pneumonologists showed further training and were the most frequently provided advice to quit smoking (>90%). Conclusion. The prevalence of smoking was high in this study. The characteristics of smoking consumption, the degree of medical training and the frequency that physicians gave advice to quit smoking, showed differences according to specialty (AU)

Presente y futuro de la evaluación del semen con finalidad reproductiva en un centro de reproducción asistida / Present and future of semen evaluation with reproductive purpose in an assisted reproduction center

El objetivo de las personas infértiles al acudir a un centro de reproducción asistida, es el de lograr tener descendencia sana, con los menores costes médicos, biológicos, emocionales y económicos posibles. Una de las piedras angulares para lograr este objetivo, sin duda es la correcta evaluación de la capacidad reproductiva del varón. El análisis del semen en los centros de reproducción asistida, para evaluar al varón con las intenciones arriba descritas tiene una función múltiple, incluyendo la valoración de su potencial fértil, la ayuda en la elección del procedimiento de reproducción asistida a acometer más conveniente, la revelación de la necesidad de pruebas adicionales que permitan conocer las causas de la infertilidad y/o los riesgos del uso de estas muestras, y finalmente, aunque no muy ampliamente diseminado, orientar hacia las técnicas de selección espermática a emplear en los tratamientos. Todo esto en conjunto podría resumirse en que gracias al resultado del análisis del semen, podría llevarse a cabo un adecuado consejo reproductivo desde el punto de vista del varón. Con esta revisión narrativa, la intención del autor es describir el uso recomendado actual del análisis básico del semen, describiendo tanto las ventajas como las limitaciones que presenta, las claves para su interpretación, y las nuevas técnicas complementarias que se están desarrollando con la intención de mejorar la capacidad diagnóstica de las muestras de semen, así como para permitir desarrollar estrategias terapéuticas y de selección espermática que contribuyan a la mejora de los resultados clínicos en reproducción asistida (AU)

Infertile patients attending an assisted reproduction Center aim to have healthy offspring, with the lowest possible medical, biological, emotional, and economic costs. One of the cornerstones to achieve this objective is certainly the correct evaluation of the reproductive ability of the male. The semen analysis in the assisted reproduction centers in order to assess the male with the intentions described above is multi-functional, including the valuation of its fertile potential, helping in the choice of the most convenient procedure of reproduction to undertake, the revelation of the need for additional tests that allow to know the causes of infertility or the risks of the use of these samples, and finally, although not very widely disseminated, to orient towards the sperm selection techniques to be used in the treatments. All of this together could be summarized in the need for the semen analysis to enable reproductive advice from the point of view of the male.With this narrative review, the author's intention is to describe the preferred current usage of the basic analysis of semen, describing both the advantages and the limitations presented, the keys to its interpretation, and new complementary techniques that are being developed with the aim of improving the diagnostic tests about the capability of the semen samples,as well as to allow development of therapeutic and sperm selection strategies that can contribute to the improvement of clinical outcomes in assisted reproduction (AU)