El manejo de los episodios de diarrea atendidos en Atención Primaria / Management of diarrhea episodes attended in Primary Care

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Effectiveness of randomized controlled trial of a mobile app to promote healthy lifestyle in obese and overweight patients.

BACKGROUND: Health advice is useful for establishing behavioural changes, but such changes tend not to last. It would therefore be good to identify mechanisms for reinforcing advice and one option is the use of information and communication technologies. Given the limited evidence on the effectiveness of such technologies, we decided to conduct a clinical trial to assess the efficacy of a mobile application (app) for supporting the provision health advice for weight loss. METHODS: A randomized clinical trial with 110 obese and overweight patients from the Basque public health care network (Araba). Patients were randomly allocated to the control (health advice) or intervention (health advice + app) groups. Primary (weight) and secondary (blood cholesterol level, blood pressure, haemoglobin A1c (HbA1c) and adherence to dietary and exercise recommendations) outcome variables were assessed at 1, 3 and 6 months after the end of the intervention. RESULTS: There were no significant differences in weight (0.357 kg; P = 0.7), blood cholesterol (2.6 mg/dl; P = 0.617), blood pressure (2.3 mmHg; P = 0.369) or adherence to recommendations on diet (84.6% in control and 92.9% the intervention group, P = 0.413) or physical activity (56% in controls and 75% the intervention group, P = 0.145). On the other hand, there were significant differences in HbA1c in favour of the control group (-0.095%; %; P = 0.046). DISCUSSION: The use of AKTIDIET® to support health advice for weight loss cannot be recommended. More high quality studies are needed, and patients should be involved in the design of apps to increase their efficacy and usability. CLINICAL TRIAL REGISTRATION: NCT02308176.

Effectiveness of Text Messaging as an Adjuvant to Health Advice in Smoking Cessation Programs in Primary Care. A Randomized Clinical Trial.

INTRODUCTION: Smoking remains a major risk factor for chronic diseases. Health advice is considered one of the most cost-effective interventions; however, changes produced by counseling tend not to persist over time, it is necessary to implement enforcement mechanisms. METHODS: Randomized clinical trial to evaluate the effectiveness of a combined program that includes health advice and text messaging to mobile phone (SMSalud®). Patients were randomized to one of two interventions: health advice (control group) or health advice and text messaging (intervention group). We included 320 smoker patients who met the inclusion criteria: being motivated, aged over 18 years, having a mobile phone, being able to read and send messages. Patients were excluded if they had a history of mental or behavioral disorders, or depression. The primary endpoint was the percentage of patients who had stopped smoking by 6 months and confirmed by CO breath test. RESULTS: By 6 months after the start of the program, 24.4% (39/160) of patients in the intervention group and 11.9% (19/160) of controls had stopped smoking (OR: 2.3; 95% CI: 1.3-4.3, p = .007). Patients with no dependence or mild dependence were more likely to stop (28.3%, 36/127 vs. 11.4%, 22/193; OR: 3.0, 95% CI: 1.7-5.5, p < .001). The rate of continuous abstinence at 12 months was 16.3% (26/160) in intervention group patients and 5.6% (9/160) in controls (OR: 3.2; 95% CI: 1.3-5.9).]. CONCLUSIONS: The combined program is effective for smoking cessation. Patients with less tobacco dependence have a higher probability of success. IMPLICATIONS: Health advice is effective for promoting changes in lifestyle but these changes do not persist over time, so we have to use strengthening mechanisms, as e-health, and specifically, mobile phone based interventions. SMSalud® is an innovate program that includes text messaging and health advice, and it's effective for smoking cessation. The only feature that seems to affect the probability of smoking cessation is the degree of tobacco dependence.