Population-Based Cancer Prevention Education Intervention Through mHealth: A Randomized Controlled Trial.

Despite the high potential of mHealth-related educational interventions to reach large segments of the population, implementation and adoption of such interventions may be challenging. The objective of this study was to gather knowledge on the feasibility of a future cancer prevention education intervention based on the European Code Against Cancer (ECAC), using a population-based mHealth implementation strategy. A type-2 hybrid effectiveness-implementation study was conducted in a sample of the Spanish general population to assess adoption, fidelity, appropriateness, and acceptability of an intervention to disseminate cancer prevention messages, and willingness to consult further digital information. Participation rates, sociodemographic data, mHealth use patterns and implementation outcomes were calculated. Receiving cancer prevention messages through mHealth is acceptable, appropriate (frequency, timing, understandability and perceived usefulness) and feasible. mHealth users reported high access to the Internet through different devices, high ability and confidence to browse a website, and high willingness to receive cancer prevention messages in the phone, despite low participation rates in comparison to the initial positive response rates. Although adoption of the intervention was high, post-intervention fidelity was seriously hampered by the disruptions caused by the Covid-19 pandemic, which may have affected recall bias. In the context of the Europe's Beating Cancer Plan to increase knowledge about cancer prevention across the European Union, this study contributes to inform the design of future interventions using mHealth at large scale, to ensure a broad coverage and adoption of cancer prevention messages as those promoted by the ECAC.Trial Registration: ClinicalTrials.gov from the U.S. National Library of Medicine, NCT05992792. Registered 15 August 2023 - Retrospectively registered https://clinicaltrials.gov/study/NCT05992792?cond=Cancer&term=NCT05992792&rank=1 .

[Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care]. / Condicionantes para el abordaje del aislamiento social y la soledad de adultos mayores no institucionalizados desde atención primaria de salud.

OBJECTIVE: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness. DESIGN: Qualitative research with grounded theory, systematic analysis and narrative design of topics. LOCATION: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas. PARTICIPANTS: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness. METHOD: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews. RESULTS: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals. CONCLUSIONS: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.

Mobile application for monitoring patients under home oxygen therapy: a protocol for a randomized controlled trial.

BACKGROUND: Mobile technologies have become capable of changing the paradigm of healthcare services. A clear example is that, nowadays, these technologies are an important instrument for data collection processes, epidemiologic surveillance, health promotion and disease prevention. Therefore, technological tools should be exploited to optimize the monitoring of patients with chronic diseases, including patients who require home oxygen therapy. PURPOSE: The purpose of this study is to determine the efficacy of a mobile application in the clinical monitoring of patients under home oxygen therapy. METHODS: This is a randomized controlled trial includes subjects of 18 years or older diagnosed with Chronic Obstructive Pulmonary Disease (COPD) who are under home oxygen therapy. Subjects will be divided into two arms: the intervention group will include patients who will be monitored with a mobile application, and the control group will include patients monitored by conventional follow-up methods (periodic visits of a respiratory therapist). The following outcome variables will be considered to measure the effect of the intervention: identification of dyspnea self-management, number of acute exacerbations associated with oxygen therapy, and the occurrence of oxygen supply underuse. DISCUSSION: This study is expected to assess the efficacy of a mobile application in the follow up of patients under home oxygen therapy. It will also determine whether the monitoring of a six-month intervention by a team comprising a physician, a nurse and respiratory therapists can decrease acute exacerbations, determine the most appropriate oxygen dose, and identify the underuse of oxygen systems and supplies. TRIAL REGISTRATION: The study has been registered at ClinicalTrials.gov ( NCT04820790 ; date of registration: March 29, 2021).

Mindfulness in primary care healthcare and teaching professionals and its relationship with stress at work: a multicentric cross-sectional study.

BACKGROUND: Work stress is a common problem among the health personnel of the Spanish National Health System. The objective of this paper is to assess the state of mindfulness among Spanish primary care providers and to evaluate its potential relationship with work stress and basic labor and sociodemographic characteristics. METHODS: Cross-sectional, multi-centric study. Primary care nurses, teachers, teaching collaborators and residents assigned to six Spanish Family Medicine/Family and Community Care Departments were invited to participate (n = 475). A template was designed in Google Forms, including sociodemographic and work-related variables. The state of mindfulness was measured with the Five Facet Mindfulness Questionnaire (FFMQ), while work-related stress was measured using an ordinal scale ranging from 0 to 10 points. Descriptive and inferential statistical analyses were carried out, as well as bivariate and multivariate statistics. RESULTS: The mean age of participants was 40,14 ± 13.12 (range:23-65 years); 66.9% were women, 42.5% internal medicine residents, 29.3% family physicians, and 20.2% nurses. More than half (54.5%) knew about mindfulness, with 24.0% have received training on it, and 22.5% were usual practitioners. The average level of mindfulness was 127.18 ± 15.45 (range: 89-177). The average score of stress at work was 6.00 ± 2.44; 49.9% (range: 0-10). 49.9% of participants scored 7 or more on the stress at work scale. There was an inverse correlation between the levels of mindfulness (FFMQ total score) and work-related stress (Spearman's r = - 0.155, p = 0.003). Significant relationships between the mindfulness practice and the level of mindfulness (F = 29.80, p < 0.001), as well as between the mindfulness practice and the level of work-related stress (F = 9.68, p = 0.042), were also found. CONCLUSIONS: Levels of mindfulness in primary care health providers were in line with those levels observed in other groups of health professionals. Half of all of the primary care providers suffered from a high degree of stress. Although weak, inverse relationships were observed between levels of mindfulness and stress at work, with lower values of stress at work among those who practiced mindfulness. TRIAL REGISTRATION: NCT03629457 .

Health-Related Lifestyles and Cancer-Preventive Behaviors of Medical and Nursing Students and Family Medicine Residents in Relation to the European Code Against Cancer.

Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. The objective was to evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. A total of 740 participants completed the questionnaire. About 12.2% (95% CI [9.8-14.5]) were smokers, and 77.3% (95% CI [74.3-80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8-37.6]) practiced physical activity 2-3 times a week, and 12.1% (95% CI [9.8-14.5]) were overweight or obese. About 54.2% (95% CI [50.6-57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p < 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p < 0.001) in relation to the participants' academic profiles. Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high; however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test.

Awareness of the European Code Against Cancer of Family Medicine Residents and Nursing and Medicine Students in Spain.

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study. LOCATION: Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain). PARTICIPANTS: residents of FM and Medicine and Nursing undergraduate Spanish students. INTERVENTION: self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5-56.2] Nursing students, 34% [95% CI 30.3-37.6] Medicine students, and 13.6% [95% CI 11.0-16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18-52; 95% CI, 21.98-22.70). A total of 76.8% (95% CI 73.5-80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5-9.6]). Residents of FM (p < 0.001), older participants (p < 0.001), and those belonging to the Teaching Units (p = 0.002) showed a better awareness of the ECAC. Our findings reveal the unawareness on the ECAC in three out of four participants. The access to the advice described in the ECAC through the Medicine and Nursing Schools and FM Teaching Units is poor. The awareness of the ECAC of postgraduate residents is higher than that the awareness of the undergraduate students.

[Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)]. / Impacto de la formación en entrevista motivacional para médicos: diseño y evaluación de un Programa Formativo (MOTIVA).

AIM: To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. STUDY DESIGN: Multicenter, double blind and randomized clinical essay, with 2arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. LOCATION: 32 Primary Healthcare Centers. SAMPLE DESCRIPTION: 54 physicians (CG=28, EG=26). INTERVENTIONS: Training Program MOTIVA in ME with an initial presential course (16h), followed by online activities during 12months, and presential meetings (Problem BasedInterviewing with expert feedback). MAIN MEASUREMENTS: Communicative skills in MI were assessed based on video-recordings (VR) with the EVEM 2.0 scale by peer reviewers. 236 VR with standardized patients and 96 VR with real patients. RESULTS: Average results in EVEM scale (up to 56 points) at the beginning of the study were EG=21.27 (CI 95% 15.8-26.7) and CG=20.23 (CI95% 16.4-23.9) with no differences between both groups (P=.79). After the training, EG punctuation increased by 13.89 points (P<.001), average 35.16 (CI 95% 29.8-40.6). Real patients' VR in EG over a 12 month period keep their MI skills with an average of 36.9 points (CI 95% 30.3-43.6) versus CG 15.9 points (CI 95% 9.8-22.0). Once ended the MOTIVA Training Program, the EG maintains the acquired skills: final average EG=37.6 (CI 95% 33.2-41.1) versus CG=24.3 (CI95% 19.0-29.2) (P<.001). CONCLUSIONS: The MOTIVA Training Program improves Motivational Interviewing skills, significatively improving after a presential course and sequential keep-alive activities. The effectiveness of the Program has been proven in the Third and Fourth steps of Miller's Pyramid.

[Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study]. / Características clínico-epidemiológicas de la infección por el virus SARS-CoV-2 en médicos de familia: un estudio de casos y controles.

OBJECTIVE: To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies. DESING: Observational analytical case-control study. SITE: Primary care. PARTICIPANTS: 969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative). INTERVENTIONS: No. MAIN MEASUREMENTS: Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use. RESULTS: 13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4). CONCLUSIONS: Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.

Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial.

BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

BACKGROUND: Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS: An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION: PC centres of the Spanish National Health System (SNHS). PARTICIPANTS: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.

Effectiveness of a multicomponent intervention to reduce social isolation and loneliness in community-dwelling elders: A randomized clinical trial. Study protocol.

AIMS: This study aims to evaluate the effectiveness of a multicomponent intervention in non-institutionalized older people. This effectiveness will be assessed in terms of reducing social isolation and loneliness and improving Health-Related Quality of Life. BACKGROUND: The concern for social isolation and loneliness in non-institutionalized older adults has increased in recent decades. In addition, their relationship with numerous negative health outcomes is amply demonstrated. DESIGN: A mixed-method design including a cluster randomized controlled clinical trial and an exploratory qualitative study with focus groups was used. METHOD: Each study group consists of 57 subjects. The experimental group will be subjected to a multicomponent intervention comprising six domiciliary face-to-face sessions and five telephone calls that will be interspersed. Interventions will be conducted by healthcare professionals and volunteers. The control group will not be subjected to any systematized intervention. We are going to consider social isolation, loneliness, and Quality of Life as the primary outcomes. However, the factors that influence both primary outcomes and the feasibility of the intervention in clinical practice will also be assessed. DISCUSSION: Despite the negative influence of social isolation and loneliness on clinical outcomes is widely evidenced, few early detection programs are available, especially interventions at the community setting. This study will examine the effectiveness of the intervention in the Spanish community setting. At the same time, this study will identify the feasibility of this intervention in Primary Care clinical practice. IMPACT: Substantial evidence indicates the detrimental health impact of social isolation and loneliness, particularly on mental wellness. Knowing that mental disorders are associated with high economic cost, this project would have strong clinical implication to inform nursing practice on managing social isolation and loneliness. The findings may also inform primary health policy setting in Spain and the wider European countries.

[Knowledge, conduct and attitude before the European Code against Cancer by health professionals of primary care]. / Conocimiento, conducta y actitud ante el Código europeo contra el cáncer por parte de los profesionales sanitarios de atención primaria.

OBJECTIVE: To decide if Primary Care (PC) professionals know the European Code against Cancer (CECC) and if this relates to practice the recommendations with themselves and with their patients. DESIGN: descriptive, observational study. SETTING: Spanish Health Centers. PARTICIPANTS: Health professionals. INTERVENTIONS: self-administered questionnaire. MAIN MEASUREMENTS: cancer protective and risk factors, screening for colorectal, breast, cervix and prostate cancer, level of knowledge of the ECAC. RESULTS: 1734 participants (10.5%), mean age 47.4 years (SD: 8.6), 71.5% female. 50.0% do not know the CECC; tutors (OR=1.61), assigned to the PAPPS (OR=1.51) and who have been working in AP for more time (OR=2.62) are the ones who know it most. 7.2% smoke and 79.1% drink alcohol. 64.1% presented normal weight and 19% performed physical activity. They avoid exposing themselves to the sun 52.7% and use protectors 53.8%. 85.2% have never had a colorectal screening, 11% never had a cytology, and 12% had a mammogram. There is a relationship between knowing the CECC and smoking (P<.001), overweight/obesity (P=.024), physical activity (P=.003), meat intake (P<.001), mammography (P<.001), cytology (P=.022), PSA (P=.045), as well as the promotion of their advice among patients. CONCLUSIONS: The CECC is unknown by half of the AP professionals. The practice of its recommendations is uneven, with the prevalence of low smoking, and sun protection a little extended behavior. Those who know him are the ones who most practice his recommendations.

[Analysis of the situation, evaluation and improvement proposals of the Preventive Activities and Health Promotion Program (PAPPS)]. / Análisis de la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS).

OBJECTIVE: To analyze the situation, evaluation and proposals for improvement of the Preventive Activities and Health Promotion Program (PAPPS). MATERIAL AND METHODS: A qualitative study of situation analysis was carried out for the evaluation of the PAPPS in 2 phases: 1) Generation of ideas and collection of information through a DAFO matrix, using 2 types of criteria: internal (strengths and weaknesses), and external (threats and opportunities); 2) Prioritization of the improvement proposals collected. Selection of participants: Key informants were identified taking into account their relationship and knowledge of the PAPPS program. All members of the PAPPS, expert groups and members with past participation were included, as well as the coordinators, including the autonomous leaders of the PAPPS. Two invitations to participate in the study were sent: the first from December 29, 2017 to February 11, 2018, and the second from January 10 to 23, 2019. The information was obtained from a questionnaire designed to be self-completed. RESULTS AND CONCLUSIONS: A total of 73 subjects answered the questionnaire. 35% of the participants were members of the PAPPS working groups, followed by family doctors from other areas, with 20.5%. The order of prioritization of the improvement proposals was as follows: 1) Unify recommendations with other semFYC working groups; 2) Prepare lists with "Recommendations not to do" from the point of view of prevention; 3) Incorporate PAPPS in the political agenda; 4) Greater coordination and interaction between groups with common competences; 5) Teaching in undergraduate and teaching units; 6) Review, update and dissemination of the program in Primary Care.

Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals.

BACKGROUND: The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. METHODS AND FINDINGS: A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people ≥65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA2DS2-VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in ≥65-year-olds was 1.44% (95% CI, 1.13%-1.82%) and 0.41% (95% CI, 0.31%-0.53%) for <65-year-olds. New AF detection rate increased progressively with age from 0.34% (<60 years) to 2.73% (≥85 years). Neither the choice of screening methodology or device, the geographical region, nor the screening setting influenced the detection rate of AF. Mean CHA2DS2-VASc scores (n = 1,369) increased with age from 1.1 (<60 years) to 3.9 (≥85 years); 72% of ≥65 years had ≥1 additional stroke risk factor other than age/sex. All new AF ≥75 years and 66% between 65 and 74 years had a Class-1 OAC recommendation. The NNS-Rx is 83 for ≥65 years, 926 for 60-64 years; and 1,089 for <60 years. The main limitation of this study is there are insufficient data on sociodemographic variables of the populations and possible ascertainment biases to explain the variance in the samples. CONCLUSIONS: People with screen-detected AF are at elevated calculated stroke risk: above age 65, the majority have a Class-1 OAC recommendation for stroke prevention, and >70% have ≥1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations.

Prevalence of hazardous alcohol use among Spanish primary care providers.

BACKGROUND: Alcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use. METHODS: A descriptive, cross-sectional, observational, multicenter study was performed. LOCATION: PC sites of the Spanish National Health Care System (NHS). PARTICIPANTS: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion. RESULTS: One thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56 years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR = 1.52; 95% CI: 1.22-1.90), PC physicians (OR = 1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR = 1.03; 95% CI: 1.01-1.05). CONCLUSION: Our study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting.

Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol.

BACKGROUND: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. METHODS: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). DISCUSSION: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well. TRIAL REGISTRATION: The study has been registered at ClinicalTrials.gov ( NCT03629457 ; date of registration: 13.08.2018).

[Effectiveness of training programs on alcohol consumption in the Primary Care setting: Systematic review]. / Efectividad de programas formativos orientados al consumo de alcohol en atención primaria: revisión sistemática.

OBJECTIVE: To evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems. DESIGN: A systematic review of randomised controlled trials. DATA SOURCES: Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017. STUDY SELECTION: The final sample was n=3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included. DATA EXTRACTION: The main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required. RESULTS: Three Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention. CONCLUSION: The development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques.

[Acceptability and feasibility among primary care doctors of the opportunistic search for HIV in Health Care centers in Spain]. / Aceptabilidad y factibilidad entre los médicos de atención primaria de la búsqueda oportunista de VIH en los centros de salud de España.

OBJECTIVE: To evaluate the acceptability and feasibility of the opportunistic search of HIV according to primary care doctors' experience. To set up the profile of the physician involved in this study. DESIGN: Observational, transversal study. LOCATION: Primary Care Centers of the National Health System. PARTICIPANTS: General practitioners and residents who participated in VIH-AP study to measure the acceptability of HIV opportunistic search by patients. MAIN MEASUREMENTS: Self-filling survey to collect data on age, sex, teaching skills, amount of years dedicated to research, time working with the same quota of patients, acceptability and feasibility of opportunistic HIV search. RESULTS: A total of 197 physicians with a mean age of 45.2±9.7 (SD) years. 18.8% were under 36years old, 70.1% were women and 62.4% had teaching skills. 55.8% worked in towns with a population over 100,000 inhabitants and the mean of years working with the same quota of patients was 6.4±6.6. 91.9% (95%CI: 88.1-98.7) of them considered the opportunistic search of HIV acceptable and 89.3% (95%CI: 85.0-93.6), feasible to perform. The multivariate analysis showed positive relation between the acceptability/feasibility and teaching skills (OR: 2.74; 95%CI: 1.16-6.49). The acceptance of the screening by patients was 93.1% and this was positively related to how long the doctor had worked with the same quota, teaching skills and the amount of years dedicated to research. CONCLUSIONS: HIV opportunistic search is an acceptable and feasible method for primary care professionals.

[Acceptability of the opportunistic search for human immunodeficiency virus infection by serology in patients recruited in Primary Care Centres in Spain]. / Aceptabilidad de la búsqueda oportunista de la infección por el virus de la inmunodeficiencia humana mediante serología en pacientes captados en centros de atención primaria de España: estudio VIH-AP.

OBJECTIVE: To assess the acceptability of opportunistic search for human immunodeficiency virus (HIV). DESIGN: Cross-sectional, observational study. LOCATION: Primary Care Centres (PCC) of the Spanish National Health Care System. PARTICIPANTS: patients aged 18 to 65 years who had never been tested for HIV, and were having a blood test for other reasons. RECORDED VARIABLES: age, gender, stable partner, educational level, tobacco/alcohol use, reason for blood testing, acceptability of taking the HIV test, reasons for refusing to take the HIV test, and reasons for not having taken an HIV test previously. A descriptive, bivariate, multivariate (logistic regression) statistical analysis was performed. RESULTS: A total of 208 general practitioners (GPs) from 150 health care centres recruited 3,314 patients. Most (93.1%) of patients agreed to take the HIV test (95%CI: 92.2-93.9). Of these patients, 56.9% reported never having had an HIV test before because they considered not to be at risk of infection, whereas 34.8% reported never having been tested for HIV because their doctor had never offered it to them. Of the 6.9% who refused to take the HIV test, 73.9% considered that they were not at risk. According to the logistic regression analysis, acceptability was positively associated to age (higher among between 26 and 35 year olds, OR=1.79; 95%CI: 1.10-2.91) and non-smokers (OR=1.39; 95%CI: 1.01-1.93). Those living in towns with between 10,000 and 50,000 inhabitants showed less acceptance to the test (OR=0.57; 95%CI: 0.40-0.80). The HIV prevalence detected was 0.24% CONCLUSIONS: Acceptability of HIV testing is very high among patients having a blood test in primary care settings in Spain. Opportunistic search is cost-effective.