ABSTRACT
OBJETIVO: Determinar si los profesionales de atención primaria (AP) conocen el Código europeo contra el cáncer (CECC) y si ello se relaciona con que practiquen sus recomendaciones. DISEÑO: Observacional descriptivo. Emplazamiento: Centros de AP españoles. PARTICIPANTES: Profesionales de AP. INTERVENCIONES: Cuestionario autoadministrado. Mediciones principales: Factores de riesgo y protectores del cáncer, pruebas de cribado y conocimiento del CECC. RESULTADOS: Respondieron 1.734 profesionales (10,5%), edad media de 48,5 años (DT: 9,2), el 71,5% mujeres. El 50,0% desconoce el CECC; los tutores (OR = 1,61), adscritos al PAPPS (OR=1,51) y que llevan más tiempo trabajando en AP (OR = 2,62) son los que más lo conocen. El 7,2% fuma y el 79,1% bebe alcohol. El 64,1% presenta normopeso y el 19% realiza actividad física. Evita exponerse al sol el 52,7% y usa protectores el 53,8%. El 85,2% nunca se ha realizado un cribado colorrectal, el 11% nunca una citología y el 12% una mamografía. Existe relación entre conocer el CECC y el tabaquismo (p < 0,001), sobrepeso/obesidad (p = 0,024), actividad física (p = 0,003), ingesta de carnes (p < 0,001), mamografía (p < 0,001), citología (p = 0,022), PSA (p = 0,045), así como el fomento de sus consejos entre los pacientes. CONCLUSIONES: El CECC es desconocido por la mitad de los profesionales de AP. La práctica de sus recomendaciones es desigual, siendo la prevalencia de tabaquismo baja, y la protección solar una conducta poco extendida. Los que lo conocen son los que más practican sus recomendaciones
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
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Attitude of Health Personnel , Attitude to Health , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Neoplasms/prevention & control , First Aid , Cross-Sectional Studies , Europe , Guidelines as Topic , Self ReportABSTRACT
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.
Subject(s)
Attitude of Health Personnel , Attitude to Health , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Neoplasms/prevention & control , Primary Health Care , Adult , Aged , Cross-Sectional Studies , Europe , Female , Guidelines as Topic , Humans , Male , Middle Aged , Self ReportABSTRACT
OBJECTIVE: To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain. METHODS: Online self-administered survey sent between May 2016 and February 2017 to 2221 primary-care physicians working across Spain. Clinicians were mostly identified through national primary-care scientific societies (20% overall response rate). RESULTS: Participants' mean age was 47.7 years, 55% were women, and 54% reported at least 20 years of primary-care practice. Among them, 47.5% considered ABPM the best diagnostic method for hypertension, 23% chose HBPM, and 7.1% chose office blood pressure. Also, 78.2% had AD available at their centers and 49.0% had ABPM, with slight urban/rural differences. HBPM was recommended in daily practice for hypertension diagnosis by 67% of participants, whereas 30% recommended ABPM. Cost to the patients was the main reason for not using HBPM (42.7%) as was lack of accessibility for not using ABPM (69.8%). Lack of specific training was also reported as an important reason in both cases. CONCLUSION: Even in the possibly best primary care scenario presented by highly motivated physicians (respondents to a voluntary anonymous survey), enormous gaps were observed between current guidelines' recommendations on ABPM and HBPM use for confirming hypertension and the modest degree of knowledge, availability, and use of these technologies.
Subject(s)
Blood Pressure Monitoring, Ambulatory/instrumentation , Health Knowledge, Attitudes, Practice , Hypertension/physiopathology , Practice Patterns, Physicians'/statistics & numerical data , Primary Health Care/statistics & numerical data , Adult , Aged , Blood Pressure , Blood Pressure Monitoring, Ambulatory/economics , Female , Humans , Male , Middle Aged , Spain , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Elevated levels of total cholesterol and low-density lipoprotein play an important role in the development of atheromas and, therefore, in cardiovascular diseases. Cholesterol biosynthesis follows a circadian rhythm and is principally produced at night (between 12:00 am and 6:00 am). The adjustment of hypolipaemic therapy to biologic rhythms is known as chronotherapy. Chronotherapy is based on the idea that medication can have different effects depending on the hour at which it is taken. Statins are one of the most widely used drugs for the prevention of cardiovascular events. In usual clinical practice, statins are administered once per day without specifying the time when they should be taken. It is unknown whether the timing of statin administration is important for clinical outcomes. OBJECTIVES: To critically evaluate and analyse the evidence available from randomised controlled trials regarding the effects of chronotherapy on the effectiveness and safety of treating hyperlipidaemia with statins. SEARCH METHODS: We searched the CENTRAL, MEDLINE, Embase, LILACS, ProQuest Health & Medical Complete, OpenSIGLE, Web of Science Conference Proceedings, and various other resources including clinical trials registers up to November 2015. We also searched the reference lists of relevant reviews for eligible studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), enrolling people with primary or secondary hyperlipidaemia. To be included, trials must have compared any chronotherapeutic lipid-lowering regimen with statins and any other statin lipid-lowering regimen not based on chronotherapy. We considered any type and dosage of statin as eligible, as long as the control and experimental arms differed only in the timing of the administration of the same statin. Quasi-randomised studies were excluded. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. We extracted the key data from studies in relation to participants, interventions, and outcomes for safety and efficacy. We calculated odds ratios (OR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Using the GRADE approach, we assessed the quality of the evidence and we used the GRADEpro Guideline Development Tool to import data from Review Manager to create 'Summary of findings' tables. MAIN RESULTS: This review includes eight RCTs (767 participants analysed in morning and evening arms). The trials used different lipid-lowering regimens with statins (lovastatin: two trials; simvastatin: three trials; fluvastatin: two trials; pravastatin: one trial). All trials compared the effects between morning and evening statin administration. Trial length ranged from four to 14 weeks. We found a high risk of bias in the domain of selective reporting in three trials and in the domain of incomplete outcome data in one trial of the eight trials included. None of the studies included were judged to be at low risk of bias.None of the included RCTs reported data on cardiovascular mortality, cardiovascular morbidity, incidence of cardiovascular events, or deaths from any cause. Pooled results showed no evidence of a difference in total cholesterol (MD 4.33, 95% CI -1.36 to 10.01), 514 participants, five trials, mean follow-up 9 weeks, low-quality evidence), low-density lipoprotein cholesterol (LDL-C) levels (MD 4.85 mg/dL, 95% CI -0.87 to 10.57, 473 participants, five trials, mean follow-up 9 weeks, low-quality evidence), high-density lipoprotein cholesterol (HDL-C) (MD 0.54, 95% CI -1.08 to 2.17, 514 participants, five trials, mean follow-up 9 weeks, low-quality evidence) or triglycerides (MD -8.91, 95% CI -22 to 4.17, 510 participants, five trials, mean follow-up 9 weeks, low-quality evidence) between morning and evening statin administration.With regard to safety outcomes, five trials (556 participants) reported adverse events. Pooled analysis found no differences in statins adverse events between morning and evening intake (OR 0.71, 95% CI 0.44 to 1.15, 556 participants, five trials, mean follow-up 9 weeks, low-quality evidence). AUTHORS' CONCLUSIONS: Limited and low-quality evidence suggested that there were no differences between chronomodulated treatment with statins in people with hyperlipidaemia as compared to conventional treatment with statins, in terms of clinically relevant outcomes. Studies were short term and therefore did not report on our primary outcomes, cardiovascular clinical events or death. The review did not find differences in adverse events associated with statins between both regimens. Taking statins in the evening does not have an effect on the improvement of lipid levels with respect to morning administration. Further high-quality trials with longer-term follow-up are needed to confirm the results of this review.
