Effectiveness of a complex intervention in reducing the prevalence of smoking among adolescents: study design of a cluster-randomized controlled trial.

BACKGROUND: The likelihood of an adolescent taking up smoking may be influenced by his or her society, school and family. Thus, changes in the immediate environment may alter a young person's perception of smoking. METHODS/DESIGN: The proposed multi-center, cluster-randomized controlled trial will be stratified by the baseline prevalence of smoking in schools. Municipalities with fewer than 100,000 inhabitants will be randomly assigned to a control or intervention group. One secondary school will be randomly selected from each municipality. These schools will be randomized to two groups: the students of one will receive any existing educational course regarding smoking, while those of the other school will receive a four-year, class-based curriculum intervention (22 classroom lessons) aimed at reinforcing a smoke-free school policy and encouraging smoking cessation in parents, pupils, and teachers. The intervention will also include annual meetings with parents and efforts to empower adolescents to change the smoking-related attitudes and behaviors in their homes, classrooms and communities.We will enroll children aged 12-13 years as they enter secondary school during two consecutive school years (to obtain sufficient enrolled subjects). We will follow them for five years, until two years after they leave secondary school. All external evaluators and analysts will be blinded to school allocation.The aim of this study is to analyze the effectiveness of a complex intervention in reducing the prevalence of smoking in the third year of compulsory secondary education (ESO) and two years after secondary school, when the participants are 14-15 and 17-18 years old, respectively. DISCUSSION: Most interventions aimed at preventing smoking among adolescents yield little to no positive long-term effects. This clinical trial will analyze the effectiveness of a complex intervention aimed at reducing the incidence and prevalence of smoking in this vulnerable age group. TRIAL REGISTRATION: Current Controlled Trials: NCT01602796.

Determinants and patterns of physical activity practice among Spanish university students.

The purpose of the present study was to investigate the socio-demographic and lifestyle determinants of physical activity practice, as well as the motivations for being or not being physically active in Spanish university students. A representative sample of students from a Spanish university (n = 2,051; 42.1% males; mean age 21.9, s = 4.8 years) participated in the present cross-sectional study. A questionnaire including questions regarding lifestyle, dietary habits, parents' characteristics, and physical activity habits was administered to the students. The socio-demographic and lifestyle determinants of physical activity practice were assessed using multivariable logistic regression. 68.4% of men and 48.4% of women reported to practise physical activity in the present sample. Those who practised physical activity consumed more fruits and were less likely to be smokers compared to non-physically active students. Also, physically inactive men spent more time in front of the computer and physically inactive women spent more time in front of the TV and were more likely to be frequent alcohol consumers. Maternal educational level and maternal physical activity habits were also important determinants of physical activity practice among men and women respectively. In conclusion, physically active students tended to engage in other healthy habits in the present population, suggesting the clustering of healthy or unhealthy lifestyle factors among specific subgroups.

Perfil sintomático de los pacientes con depresión tratados en atención primaria. Un estudio epidemiológico / Symptomatic profile of depressive patients in primary care. An epidemiological study

El objetivo principal es describir la situación basal de los pacientes con depresión atendidos en atención primaria (AP) en España. Se utilizan los datos de 2 estudios observacionales, prospectivos y multicéntricos. El primero fue realizado por 882 médicos de AP sobre pacientes con síntomas depresivos y una puntuación mínima de 14 en la escala de Hamilton para la depresión de 17 ítems (HAM-D17). En el segundo estudio participaron 2.119 médicos de AP, e incluyó a pacientes deprimidos con puntuaciones mínimas de 17 en la escala HAM-D17. La muestra total se compone de 10.997 pacientes (4.300 del estudio 1 y 6.697 del estudio 2). Los síntomas depresivos más frecuentes encontrados con intensidad moderada son: insomnio medio (56,5%), impacto en el trabajo y otras actividades (53,6%), ansiedad psíquica (50,5%), estado de ánimo deprimido (45,3%), síntomas somáticos generales (69,5%) y gastrointestinales (60,6%), ansiedad somática (48,8%) y síntomas genitales (43,2%). Por el contrario, se aprecia una baja frecuencia de algunos síntomas clásicamente relacionados con cuadros más graves: ideación suicida, pérdida de peso y vivencias de culpa. Este perfil clínico podría justificar el infradiagnóstico y el manejo deficiente de la depresión en la atención médica no especializada (AU)

The primary aim of this study was to describe the baseline status of depressed patients attending primary care centers in Spain. Data from 2 observational, prospective, multicenter studies were analyzed. The first study was carried out by 882 primary care physicians in patients with depressive symptoms and a minimum score of 14 on the 17-item Hamilton Depression Rating Scale (HAM-D17). The second study was performed by 2,119 primary care physicians and included depressed patients with a minimum score of 17 on the HAM-D17. The final sample was composed of 10,997 patients (4,300 from study 1 and 6,697 from study 2). The most frequently reported depressive symptoms of moderate intensity were moderate insomnia (56.5%), impact on work and activities (53.6%), psychic anxiety (50.5%), depressed mood (45.3%), general somatic symptoms (69.5%), gastrointestinal symptoms (60.6%), somatic anxiety (48.8%), and genital symptoms (43.2%). In contrast, a low prevalence was observed of some symptoms usually associated with greater severity of the disorder: suicidal ideation, weight loss, and feelings of guilt. This clinical profile could explain the under-diagnosis and poor management of depression in non-specialized medical care (AU)

Trastorno esquizotípico de personalidad: perspectivas actuales / Schizotypal personality disorder: current perspectivas

Las corrientes actuales de investigación en torno a la esquizofrenia y los trastornos de personalidad del espectro esquizofrénico sugieren la existencia, cada vez más aceptada, de coincidencias en aspectos fenomenológicos, biológicos y genéticos entre los mencionados trastornos. En opinión de algunos autores, estos hechos deberían inducir un replanteamiento en lo referente al diagnóstico precoz, la agregación familiar, la génesis, el curso y el tratamiento de los mismos. A tal efecto, resulta de gran importancia el estudio pormenorizado del denominado trastorno esquizotípico de personalidad, tanto en lo concerniente a las características clínicas del mismo como a su etiología y las posibilidades terapéuticas y de diagnóstico precoz. Este texto pretende ser una revisión de las últimas líneas de investigación abiertas a tal efecto en la comunidad científica, incidiendo principalmente en lo tocante a la comorbilidad entre el trastorno esquizotípico de personalidad y la esquizofrenia (AU)