The Dimensionality, Consistency, and Structural Validity of an Instrument Used to Measure Obesogenic Attitudes in Parents from Southern Spain (The PRELSA Scale).

(1) Background: We aimed to analyze the dimensionality, internal consistency, and structural validity of the Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale), which is an instrument that was designed to measure obesogenic behaviors. (2) Methods: We carried out an observational study by means of an online survey. The PRELSA Scale consists of 13 dimensions and 60 items relating to the most common obesogenic behaviors and attitudes. Additionally, we obtained sociodemographic characteristics and concrete habits from the sample. We obtained the responses of 791 parents and caregivers of preschool children between 2 and 6 years of age in Andalusia (southern Spain). We analyzed dimensionality through an Exploratory Factor Analysis (EFA), consistency through Cronbach's Alpha, structural validity through a Confirmatory Factor Analysis (CFA), and measurement invariance with multigroup CFA models. (3) Results: The EFA showed a 14-dimensional structure with 48 items. The internal consistency was acceptable in all dimensions (Cronbach's Alpha range of 0.72 to 0.97). The structure was confirmed in the CFA with good fit indices (CFI and TLI > 0.9 and RMSEA < 0.05). We ensured that the scale had measurement invariance regarding education, income, and marital status. (4) Conclusions: The PRELSA Scale shows promising properties that have the potential to measure obesogenic behaviors in Spain, which could be the basis for future interventions associated with the prevention of childhood obesity in healthcare and educational settings.

Impact of an early 1000-day intervention for obesity prevention on adiposity and BMI at two years of age: A quasi-experimental study.

Background: The 1000-day period encompassing pregnancy and the first two years of postnatal life is critical for preventing childhood obesity. Existing interventions targeting this period have been characterised by great variability in duration, objectives, and evaluation indicators. We aimed to evaluate the impact of an intervention developed during the entire 1000-day period on body mass index and body fat percentage at two years of age. Methods: We designed a prospective, interventional, quasi-experimental study (ie, without randomisation or blinding of both groups) targeting mother-child pairs from the beginning of pregnancy up to two years of age belonging to the basic health area of Puerto Real (Cádiz). We developed and delivered an intervention from pregnancy to two years and assessed its effect. Results: The duration of breastfeeding and vitamin D supplementation increased significantly after the intervention. The intervention group showed lowed skinfolds values, a significantly lower body fat percentage, as well as a lower accumulation of factor at two years than the control group. Conclusions: The intervention has had an impact on body fat percentage at two years, potentially justified through its overall effect and the lower accumulation of early risk factors.

Biphasic Bioceramic Obtained from Byproducts of Sugar Beet Processing for Use in Bioactive Coatings and Bone Fillings.

This study focuses on developing hydroxyapatite synthesized from a CaCO3-rich byproduct of sugar beet processing called Carbocal® using a hydrothermal reactor. The purpose of this biomaterial is to enhance the osteoinductivity of implantable surfaces and serve as a bone filler, providing a sustainable and economically more affordable alternative. This research involved compositional analysis and micro- and macrostructural physicochemical characterization, complemented with bioactivity and live/dead assays. The biphasic nature of the Carbocal®-derived sample was significant within the context of the bioactivity concept previously proposed in the literature. The bioactivity of the biomaterial was demonstrated through a viability test, where the cell growth was nearly equivalent to that of the positive control. For comparison purposes, the same tests were conducted with two additional samples: hydroxyapatite obtained from CaCO3 and commercial hydroxyapatite. The resulting product of this process is biocompatible and possesses properties similar to natural hydroxyapatite. Consequently, this biomaterial shows potential as a scaffold in tissue engineering and as an adhesive filler to promote bone regeneration within the context of the circular bioeconomy in the geographical area proposed.

The Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale): Construction and Pilot Testing of a Tool to Measure Factors Associated with Childhood Obesity.

(1) Background: Childhood obesity poses a global health challenge. In the period from two to six years, the fundamental risk factors are associated with modifiable habits, related to parental attitudes. In this study, we will analyze the construction and pilot test of the PRELSA Scale, designed to be a comprehensive tool that covers the whole problem of childhood obesity, from which we can later develop a brief instrument. (2) Methods: First, we described the scale construction process. After that, we conducted a pilot test on parents to check the instrument's comprehensibility, acceptability, and feasibility. We detected items to be modified or eliminated through two criteria: the frequencies of the categories of each item and responses in the Not Understood/Confused category. Finally, we sought expert opinion through a questionnaire to ensure the content validity of the scale. (3) Results: The pilot test on parents detected 20 possible items for modification and other changes in the instrument. The experts' questionnaire showed good values on the scale's content, highlighting some feasibility problems. The final version of the scale went from 69 items to 60. (4) Conclusions: Developing scales that detect parental attitudes associated with the onset of childhood obesity may be the basis for future interventions to address this health challenge.

Social determinants of multimorbidity patterns: A systematic review.

Social determinants of multimorbidity are poorly understood in clinical practice. This review aims to characterize the different multimorbidity patterns described in the literature while identifying the social and behavioral determinants that may affect their emergence and subsequent evolution. We searched PubMed, Embase, Scopus, Web of Science, Ovid MEDLINE, CINAHL Complete, PsycINFO and Google Scholar. In total, 97 studies were chosen from the 48,044 identified. Cardiometabolic, musculoskeletal, mental, and respiratory patterns were the most prevalent. Cardiometabolic multimorbidity profiles were common among men with low socioeconomic status, while musculoskeletal, mental and complex patterns were found to be more prevalent among women. Alcohol consumption and smoking increased the risk of multimorbidity, especially in men. While the association of multimorbidity with lower socioeconomic status is evident, patterns of mild multimorbidity, mental and respiratory related to middle and high socioeconomic status are also observed. The findings of the present review point to the need for further studies addressing the impact of multimorbidity and its social determinants in population groups where this problem remains invisible (e.g., women, children, adolescents and young adults, ethnic groups, disabled population, older people living alone and/or with few social relations), as well as further work with more heterogeneous samples (i.e., not only focusing on older people) and using more robust methodologies for better classification and subsequent understanding of multimorbidity patterns. Besides, more studies focusing on the social determinants of multimorbidity and its inequalities are urgently needed in low- and middle-income countries, where this problem is currently understudied.

Interventions in the first 1000 days to prevent childhood obesity: a systematic review and quantitative content analysis.

BACKGROUND: Childhood obesity poses a global health challenge. In recent years, there has been an increase in interventions that begin in pregnancy, putting the concept of early programming and early risk factors into practice. The present study aims to update the findings regarding interventions in the first 1000 days of life. METHODS: A systematic review based on the PRISMA guidelines was carried out in PubMed, WoS, Scopus and CINAHL to obtain the articles to be analysed. We included those studies published between 2016 and 2021. Human interventions that started within the first 1000 days of life and acted on at least one programming factor were included. Once selected, coding and quantitative content analysis was carried out to obtain a profile of the interventions during the first 1000 days. RESULTS: From all screened articles, 51 unique interventions, which met the selection criteria, were included. The majority of interventions (81%) took place in high-income areas. Almost all (86%) were targeted at the general population. The majority (54%) started in the second trimester of pregnancy. A clear majority (61%) ended at the time of birth. 44% of the interventions included all pregnant women. Only 48% of these interventions were focused on improving the nutritional status of the offspring in the short term. Most interventions collected the baby's weight at birth (68%). CONCLUSIONS: It can be concluded that current interventions are not covering as many aspects as they should. Future research should be conducted more frequently in developing countries and target disadvantaged groups. These interventions should include all pregnant women, regardless of their nutritional status, aiming to cover as many programming factors as possible and extending through the first 1000 days of life, with body mass index or skinfolds as measures of effectiveness during this period.

Píldoras formativas para mejorar la educación enfermera sobre programación temprana / Educational pills to improve nursing education on early programming

Introducción: La obesidad infantil ha sido declarada la epidemia del siglo XXI. La programación temprana es un elemento esencial que debe utilizarse para prevenir enfermedades no transmisibles. Las enfermeras están en una posición única para aplicar este concepto, pero no está incluido en su educación. Objetivos: El desarrollo, implementación y evaluación del uso de píldoras educativas que se ofrecen a los estudiantes de enfermería para mejorar su conocimiento sobre la programación temprana. Metodología: Se trata de una investigación cuasi-experimental. Es un estudio pre/post con seguimiento longitudinal. Para la recolección de datos, se diseñaron tres cuestionarios de desarrollo propio para medir el nivel de conocimiento, la intención de actuar y la satisfacción con la metodología. El nivel de conocimiento y la intención de actuar se midieron antes y después de la intervención para ver el efecto de la intervención. Se midió la satisfacción con la metodología y los recursos utilizados después de la intervención. La población incluida en este estudio son los estudiantes de enfermería de primer y segundo año matriculados en dos asignaturas diferentes en el curso 2019/2020. Se estima que el tamaño de la población es de 200 estudiantes. Se ha organizado el proceso en tres etapas definidas: etapa inicial, etapa de elaboración y etapa de implementación. Resultados: Se han observado diferencias significativas en todos los parámetros medidos. Conclusiones: La intervención ha mejorado el conocimiento de las futuras enfermeras sobre la programación temprana, ha aumentado la intención de actuar y los estudiantes encuentran esta metodología adecuada para su formación. (AU)

Background: Childhood obesity has been declared the epidemic of the 21st century. Early programming is an essential element that should be used to prevent non-communicable diseases. Nurses are uniquely positioned to apply this concept, but it is not included in their education. Objectives: The development, implementation and evaluation of the use of educational pills offered to nurse students to improve their knowledge of early programming. Methodology: This is quasi-experimental research. It is a pre/post study with a longitudinal follow-up. For data collection, three self-developed questionnaires were designed to measure the level of knowledge, intention to act and satisfaction with the methodology. The level of knowledge and the intention to act were measured before and after the intervention to see the intervention's effect. Satisfaction with the methodology and resources used was measured after the intervention. The population included in this study is the first-year and second-year nursing students enrolled in two different subjects in the academic year 2019/2020. The population size is estimated to be 200 students. We have organised the process into three defined stages: the initial stage, elaboration stage and implementation stage. Results: Significant differences have been observed in all the measured parameters. Conclusions: The intervention has improved the knowledge of future nurses about early programming and has increased the intention of nurses to act. Students find this methodology suiTable for their training. (AU)

Lockdown due to COVID-19 in Spanish Children Up to 6 Years: Consequences on Diet, Lifestyle, Screen Viewing, and Sleep.

Objectives: To record how the habits of children under 6 years of age in Cadiz have changed during lockdown, in order to identify those that could be a handicap for the problem of overweight and obesity. Methods: We developed a new questionnaire to analyse family living habits. The questionnaire was administered online to parents of children aged zero-six years. Eating habits, sedentary lifestyles, screen viewing, and sleep changes were evaluated. Results: Changes were found in family living habits, as shown by the results of McNemar's tests (p-value < 0.01 in all pairs except one, p-value = 0.097). A worsening of habits was also found to be more accentuated in families with low income, low educational level or small size of home. Some positive aspects associated with family meals and parental involvement were found. Conclusions: The lockdown has showed a significant break in the main routines of the children that could affect their health and may add to the worsening of the already poor childhood obesity situation. The positive aspects found can be instrumental in improving the situation in future similar situations.

Analysis of the Psychosocial Impact of the COVID-19 Pandemic on the Nursing Staff of the Intensive Care Units (ICU) in Spain.

(1) The public health emergency, caused by COVID-19, has resulted in strong physical and mental exhaustion in healthcare workers. This research has been designed with the aim to describe the psychosocial impact of the COVID-19 pandemic on nurses working in intensive care units (ICU) and identify the related risk factors. (2) This is a cross-sectional study, in which a self-administered questionnaire was designed to cover the dimensions of interest associated with psychosocial factors during the pandemic and their factor risks. (3) A total of 456 nursing professionals participated, and 88.4% were women. Most of the professionals had a temporary contract (71.3%) and person at risk close to them (88.8%). Regarding psychosocial factors, there was a worsening in most of the associated variables, especially in sleep problems, anxiety, stress, and job performance. Female nurses were more prone to anxiety. Those under 30, as well as those with temporary contracts, were more unfocused. Professionals with a person at risk in their environment felt much more worried. The degree of exposure was associated with greater fear. (4) Those nurses who were female, younger, and with a temporary employment contract were shown to be more vulnerable to the impact of the pandemic on their psychosocial health. Because of this, it is necessary to adopt effective strategies for the protection of nurses' health, focusing on the specific risk factors identified.

Early Risk Factors for Obesity in the First 1000 Days-Relationship with Body Fat and BMI at 2 Years.

(1) Background: Obesity is defined as an excessive accumulation of body fat. Several early developmental factors have been identified which are associated with an increased risk of childhood obesity and increased adiposity in childhood. The primary objective of the present study is to analyse the effect of various early risk factors on Body Mass Index (BMI) and body fat percentage at 2 years of age. (2) Methods: A prospective cohort study design was used, with the sample consisting of 109 mother-child pairs from whom data were collected between early pregnancy and 2 years old. Adiposity was determined based on skinfold measurements using the Brooks and Siri formulae. Mean comparison tests (Student's t-test and ANOVAs) and multiple linear regression models were used to analyse the relationship between early programming factors and dependent variables. (3) Results: Maternal excess weight during early pregnancy (ß = 0.203, p = 0.026), gestational smoking (ß = 0.192, p = 0.036), and accelerated weight gain in the first 2 years (ß = - 0.269, p = 0.004) were significantly associated with high body fat percentage. Pre-pregnancy BMI and accelerated weight gain in the first 2 years were associated with high BMI z-score (ß = 0.174, p = 0.047 and ß = 0.417, p = 0.000 respectively). The cumulative effect of these variables resulted in high values compared to the baseline zero-factor group, with significant differences in BMI z-score (F = 8.640, p = 0.000) and body fat percentage (F = 5.402, p = 0.002) when three factors were present. (4) Conclusions: The presence of several early risk factors related to obesity in infancy was significantly associated with higher BMI z-score and body fat percentage at 2 years of age. The presence of more than one of these variables was also associated with higher adiposity at 2 years of age. Early prevention strategies should address as many of these factors as possible.

The Effect of Play on Pain and Anxiety in Children in the Field of Nursing: A Systematic Review.

PROBLEM: The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital settings. ELIGIBILITY CRITERIA: Studies published during the period 2014-2019 including original articles in English, Spanish and Portuguese. Databases consulted: SCOPUS, MEDLINE/PubMed, WoS, and CUIDEN (Nursing database in Spanish). SAMPLE: Seventeen relevant records were selected. After critical reading using the CASPe (Critical Appraisal Skills Programme in Spanish) instrument, 7 articles were rejected and 10 were finally selected. RESULTS: Each of eight studies showed significant evidence for the role of therapeutic play in the reduction of anxiety and pain and in the overall wellbeing of paediatric patients. IMPLICATIONS: This review aimed to critically assess and synthesize the existing empirical evidence on the contributions of therapeutic play interventions for reducing anxiety, pain and improving the overall wellbeing of paediatric patients. CONCLUSIONS: Based on these findings, it may be safe to say that therapeutic play interventions are effective in reducing the negative emotional manifestations of children, decreasing preoperative anxiety and pain, improving compliance with the induction of anaesthesia and reducing anxiety and postoperative pain. There is also evidence that dramatic puppetry is an effective preoperative care and preparation strategy for reducing anxiety in children undergoing surgery.

Effectiveness of a Multifactorial Intervention in the First 1000 Days of Life to Prevent Obesity and Overweight in Childhood: Study Protocol.

(1) Background: Obesity is a global health problem, and its prevention must be a priority goal of public health, especially considering the seriousness of the problem among children. It is known that fetal and early postnatal environments may favor the appearance of obesity in later life. In recent years, the impact of the programs to prevent obesity in childhood has been scarce. The aim of this research is to evaluate the effectiveness of an intervention based on the concept of early programming. (2) Methods: Non-randomized controlled trial design. Inclusion criteria are: two-year-old infants whose gestational period begins in the 14 months following the start of the intervention, and whose mothers have made the complete follow-up of their pregnancy in the same clinical unit of the study. The intervention will be developed over all the known factors that affect early programming, during pregnancy up to 2 years of life. Data will be collected through a data collection sheet by the paediatricians. A unibivariate and multivariate analysis of the data will be carried out. (3) Ethics and dissemination: The trial does not involve any risk to participants and their offspring. Signed informed consent is obtained from all participants. Ethical approval has been obtained. (4) Results: It is expected that this study will provide evidence on the importance of the prevention of obesity from the critical period of the first 1000 days of life, being able to establish this as a standard intervention in primary care.

Glycocalyx Degradation after Pulmonary Transplantation Surgery.

PURPOSE: Ischaemia-reperfusion injury (IRI) is a main cause of morbidity after pulmonary resection surgery. The degradation of glycocalyx, a dynamic layer of macromolecules at the luminal surface of the endothelium, seems to participate in tissue dysfunction after IRI. Lidocaine has a proven anti-inflammatory activity in several tissues but its modulation of glycocalyx has not been investigated. This work aimed to investigate the potential involvement of glycocalyx in lung IRI in a lung auto-transplantation model and the possible effect of lidocaine in modulating IRI. METHODS: Three groups (sham-operated, control, and lidocaine), each consisting of 6 Large White pigs, were subjected to lung auto-transplantation. All groups received the same anaesthesia. In addition, the lidocaine group received a continuous IV administration of lidocaine (1.5 mg/kg/h). Lung tissue and plasma samples were taken before pulmonary artery clamp, before reperfusion, and 30 and 60 min post-reperfusion in order to analyse pulmonary oedema, glycocalyx components, adhesion molecules, and myeloperoxidase level. RESULTS: Ischaemia caused pulmonary oedema, which was greater after reperfusion. This effect was accompanied by decreased levels of syndecan-1 and heparan sulphate in the lung samples, together with increased levels of both glycocalyx components in the plasma samples. After reperfusion, neutrophil activation and the expression of adhesion molecules were increased. All these alterations were significantly lower or absent in the lidocaine group. CONCLUSION: Lung IRI caused glycocalyx degradation that contributed to neutrophil activation and adhesion. The administration of lidocaine was able to protect the lung from glycocalyx degradation.

Estimates of costs for modelling return on investment from smoking cessation interventions.

BACKGROUND AND AIMS: Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN: Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. SETTING AND PARTICIPANTS: Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. MEASUREMENTS: Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. FINDINGS: Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 106 (Germany); coronary heart disease between €1521 (Spain) and €3955 (Netherlands); chronic obstructive pulmonary disease between €1280 (England) and €4199 (Spain); stroke between €1829 (Hungary) and €14 880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioural support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); and €27 (Spain). CONCLUSIONS: Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across Hungary, Netherlands, Germany, Spain and England. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions.

Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD.

AIMS: To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. SETTING: Spain. PARTICIPANTS: Adult smoking population (16+ years). MEASUREMENTS: Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. FINDINGS: The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. CONCLUSIONS: According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.

OPTIMIZING USABILITY OF AN ECONOMIC DECISION SUPPORT TOOL: PROTOTYPE OF THE EQUIPT TOOL.

OBJECTIVES: Economic decision-support tools can provide valuable information for tobacco control stakeholders, but their usability may impact the adoption of such tools. This study aims to illustrate a mixed-method usability evaluation of an economic decision-support tool for tobacco control, using the EQUIPT ROI tool prototype as a case study. METHODS: A cross-sectional mixed methods design was used, including a heuristic evaluation, a thinking aloud approach, and a questionnaire testing and exploring the usability of the Return of Investment tool. RESULTS: A total of sixty-six users evaluated the tool (thinking aloud) and completed the questionnaire. For the heuristic evaluation, four experts evaluated the interface. In total twenty-one percent of the respondents perceived good usability. A total of 118 usability problems were identified, from which twenty-six problems were categorized as most severe, indicating high priority to fix them before implementation. CONCLUSIONS: Combining user-based and expert-based evaluation methods is recommended as these were shown to identify unique usability problems. The evaluation provides input to optimize usability of a decision-support tool, and may serve as a vantage point for other developers to conduct usability evaluations to refine similar tools before wide-scale implementation. Such studies could reduce implementation gaps by optimizing usability, enhancing in turn the research impact of such interventions.

Smoking, health-related quality of life and economic evaluation.

BACKGROUND AND AIMS: The economic evaluation of tobacco control policies requires the adoption of assumptions about the impact of changes in smoking status on health-related quality of life (HRQoL). Estimates for such impacts are necessary for different populations. This paper aims to test whether smoking status has an independent effect on HRQoL over and above the effect derived from the increased likelihood of suffering a tobacco related disease, and to calculate utility values for the Spanish population. METHODS: Using data from the Spanish Encuesta Nacional de Salud of 2011-12, we estimate statistical models for HRQoL as measured by the EQ-5D-5L instrument as a function of smoking status. We include a comprehensive set of controls for biological, clinical, lifestyle and socioeconomic characteristics. RESULTS: Smoking status has an independent, statistically significant effect on HRQoL. However, the size of the effect is small. The typical smoking related diseases, such as lung cancer, are associated with a reduction in HRQoL about 5 times larger than the difference between current smokers and never smokers. CONCLUSION: Attributing substantive HRQoL gains to quitting smoking as well as accounting for the concomitant HRQoL gain derived from a smaller likelihood of contracting tobacco related diseases might lead to an overestimation of the benefits of tobacco control policies. Nonetheless, the relatively large drops in HRQoL associated with being diagnosed with diseases that might be causally linked to tobacco suggest that such diseases should not be omitted from the economic evaluations of tobacco control policies.

Coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia / Cost-benefit of medical advice for quitting smoking in the Region of Murcia

Objetivo: Realizar un análisis coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia. Diseño: Se realiza un análisis coste-utilidad del consejo médico para dejar de fumar versus la no intervención. Se utiliza un modelo de Markov para estimar los costes (en euros de 2014), bajo la perspectiva del financiador público, y los resultados en salud. Estos se medirán en años de vida ajustados por calidad (AVAC). El horizonte temporal del análisis es de 20 años, y los costes y resultados en salud se descontarán al 3%. Se realiza un análisis de sensibilidad determinístico univariante y multivariante. Emplazamiento: Región de Murcia. Participantes: Fumadores de la Región de Murcia. Intervenciones: Consejo médico breve para dejar de fumar. Mediciones principales: Años de vida ajustados por calidad (AVAC). Resultados: Con un horizonte de 5 años (2018), el ratio coste-utilidad incremental se situaría en 172.400 Euros por AVAC ganado; con un horizonte de 10 años (2023), en 30.300 Euros por AVAC ganado, y con el horizonte máximo de 20 años considerado por el modelo, en 7.260 Euros por AVAC ganado. Conclusiones: A largo plazo, el consejo breve médico es una intervención más eficiente que a corto plazo y, dependiendo del umbral coste-utilidad para España, se recomendaría su financiación pública desde el punto de vista de la eficiencia (AU)

Objective: To perform a cost-benefit analysis of brief medical advice to quit smoking in the Region of Murcia. Design: A cost-benefit analysis is performed on brief medical advice to quit smoking versus nonintervention. A Markov model is used to estimate the costs (Euros in 2014), under the perspective of the National Health System, and health outcomes. These are measured in quality-adjusted life years (QALY). The time horizon of the analysis is 20 years, and costs and health outcomes were discounted at 3%. A univariate and multivariate deterministic sensitivity analysis is performed. Location: Region of Murcia. Participants: Smokers in the Region of Murcia. Interventions: Brief advice to quit smoking. Key measures: Quality Adjusted Life Years (QALYs). Results: With a time horizon of 5 years (2018), the incremental cost-effectiveness ratio (ICER) would be Euros 172,400 per QALY gained; at 10 years (2023) the ICER was Euros 30,300 per QALY gained; and, for the maximum horizon considered by the model, the ICER was Euros 7,260 per QALY gained. Conclusions: Brief advice intervention is more efficient in the long-term than in the short-term and, depending on the Spanish cost-benefit threshold, public funding for this intervention would be recommended (AU)

[Cost-benefit of medical advice for quitting smoking in the Region of Murcia]. / Coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia.

OBJECTIVE: To perform a cost-benefit analysis of brief medical advice to quit smoking in the Region of Murcia. DESIGN: A cost-benefit analysis is performed on brief medical advice to quit smoking versus non-intervention. A Markov model is used to estimate the costs (€ in 2014), under the perspective of the National Health System, and health outcomes. These are measured in quality-adjusted life years (QALY). The time horizon of the analysis is 20years, and costs and health outcomes were discounted at 3%. A univariate and multivariate deterministic sensitivity analysis is performed. LOCATION: Region of Murcia. PARTICIPANTS: Smokers in the Region of Murcia. INTERVENTIONS: Brief advice to quit smoking. KEY MEASURES: Quality Adjusted Life Years (QALYs). RESULTS: With a time horizon of 5years (2018), the incremental cost-effectiveness ratio (ICER) would be €172,400 per QALY gained; at 10years (2023) the ICER was €30,300 per QALY gained; and, for the maximum horizon considered by the model, the ICER was €7,260 per QALY gained. CONCLUSIONS: Brief advice intervention is more efficient in the long-term than in the short-term and, depending on the Spanish cost-benefit threshold, public funding for this intervention would be recommended.

Similarities and differences between stakeholders' opinions on using Health Technology Assessment (HTA) information across five European countries: results from the EQUIPT survey.

BACKGROUND: The European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) project aimed to study transferability of economic evidence by co-creating the Tobacco Return On Investment (ROI) tool, previously developed in the United Kingdom, for four sample countries (Germany, Hungary, Spain and the Netherlands). The EQUIPT tool provides policymakers and stakeholders with customized information about the economic and wider returns on the investment in evidence-based tobacco control, including smoking cessation interventions. A Stakeholder Interview Survey was developed to engage with the stakeholders in early phases of the development and country adaptation of the ROI tool. The survey assessed stakeholders' information needs, awareness about underlying principles used in economic analyses, opinion about the importance, effectiveness and cost-effectiveness of tobacco control interventions, and willingness to use a Health Technology Assessment (HTA) tool such as the ROI tool. METHODS: A cross sectional study using a mixed method approach was conducted among participating stakeholders in the sample countries and the United Kingdom. The individual questionnaire contained open-ended questions as well as single choice and 7- or 3-point Likert-scale questions. The results corresponding to the priority and needs assessment and to the awareness of stakeholders about underlying principles used in economic analysis are analysed by country and stakeholder categories. RESULTS: Stakeholders considered it important that the decisions on the investments in tobacco control interventions should be supported by scientific evidence, including prevalence of smoking, cost of smoking, quality of life, mortality due to smoking, and effectiveness, cost-effectiveness and budget impact of smoking cessation interventions. The proposed ROI tool was required to provide this granularity of information. The majority of the stakeholders were aware of the general principles of economic analyses used in decision making contexts but they did not appear to have in-depth knowledge about specific technical details. Generally, stakeholders' answers showed larger variability by country than by stakeholder category. CONCLUSIONS: Stakeholders across different European countries viewed the use of HTA evidence to be an important factor in their decision-making process. Further, they considered themselves to be capable of interpreting the results from a ROI tool and were highly motivated to use it.