Effectiveness of a preschool emotional education programme administered over 3 grades: a cluster randomised controlled trial.

INTRODUCTION: Emotional education programmes are universal preventive strategies for health promotion, especially mental health. The aim of this study is to evaluate the effectiveness and implementation of '1,2,3, emoció!': a preschool-based programme designed to improve emotional competence and targeted to 3-5-year-old children in Barcelona during three academic years. STUDY DESIGN: Cluster randomised trial, using schools as clusters. METHODS: The study's population included preschoolers 3-5 years old from Barcelona. Teachers offered the programme during one or three academic years in the intervention groups. We evaluated the emotional competence of each child at the beginning and the end of the academic year with the Emotional Competence Assessment Questionnaire (30-180 scale). We studied the implementation process and analysed the outcomes with nested linear regression models. Considering sociodemographic variables and implementation outcomes, we obtained the individual differences in emotional competence at the end of the school year-segregated by sex-for intervention and comparison groups. RESULTS: 1586 children participated in the study. The emotional competence level increased significantly after one year (4.1 in boys; 5.6 in girls; P < 0.05) and after three years of intervention (5.5 in boys; 8.0 in girls; P < 0.01), compared to comparison group. The level of emotional competence was the highest for the 3-year intervention group: we obtained an average ECAQ score of 131.1 (95% CI 126.9-135.2) for boys and 141 (95% CI 137.2-144.9) for girls. We observed that an accurate implementation improved its results. CONCLUSIONS: The programme '1,2,3, emoció!' effectively increases preschool children's emotional competence, especially when the programme is rigorously implemented for three years.

Effectiveness of school-based emotional education program: a cluster-randomized controlled trial.

OBJECTIVES: The acquisition of emotional competencies through emotional education programs improves both short- and long-term health outcomes. The 1,2,3,emoció! program directed at children aged 3-5 years aims to promote health through the development of emotional competencies. This study evaluated the effectiveness of the program during its first year of implementation. STUDY DESIGN: Cluster randomized trial. METHODS: The information sources were an ad-hoc questionnaire to evaluate emotional competencies and focus group discussions with the teachers implementing the program. For the quantitative data analysis, we compared mean emotional competencies scores pre- and postintervention for the intervention group and the comparison group. We also conducted a multilevel regression with repeated measures, adjusted by sociodemographic variables and stratified by gender and school year. For the qualitative data, we performed a thematic content analysis. RESULTS: The sample consisted of 2625 children (48.4% girls and 49.2% intervention group). Emotional competencies improved in both groups after the school year (P-value < 0.001), but the increase was greater in the intervention group. The multilevel analysis showed an improvement in the final scores attributed to the intervention, especially for those in the first year of preschool [boys: 12.33 points (95% CI 5.51-19.15), girls: 9.66 points (95% CI 3.36-15.96)]. The thematic content analysis also highlighted enhanced emotional competencies in the intervention group. The final scores did not vary by sociodemographic variables. CONCLUSIONS: The 1,2,3,emoció! program had a positive effect on emotional competencies among children, with effectivity being higher among younger children.

The impact of harm reduction programs and police interventions on the number of syringes collected from public spaces. A time series analysis in Barcelona, 2004-2014.

BACKGROUND: To estimate the effect of opening two services for people who use drugs and three police interventions on the number of discarded syringes collected from public spaces in Barcelona between 2004 and 2014. METHODS: We conducted an interrupted time-series analysis of the monthly number of syringes collected from public spaces during this period. The dependent variable was the number of syringes collected per month. The main independent variables were month and five dummy variables (the opening of two facilities with safe consumption rooms, and three police interventions). To examine which interventions affected the number of syringes collected, we performed an interrupted time-series analysis using a quasi-Poisson regression model, obtaining relative risks (RR) and 95% confidence intervals (CIs). RESULTS: The number of syringes collected per month in Barcelona decreased from 13,800 in 2004 to 1655 in 2014 after several interventions. For example, following the closure of an open drug scene in District A of the city, we observed a decreasing trend in the number of syringes collected [RR=0.88 (95% CI: 0.82-0.95)], but an increasing trend in the remaining districts [RR=1.11 (95% CI: 1.05-1.17) and 1.08 (95% CI: 0.99-1.18) for districts B and C, respectively]. Following the opening of a harm reduction facility in District C, we observed an initial increase in the number collected in this district [RR=2.72 (95% CI: 1.57-4.71)] and stabilization of the trend thereafter [RR=0.97 (95% CI: 0.91-1.03)]. CONCLUSION: The overall number of discarded syringes collected from public spaces has decreased consistently in parallel with a combination of police interventions and the opening of harm reduction facilities.

Electroestimulación del suelo pélvico en mujeres con incontinencia urinaria y/o síndrome de vejiga hiperactiva: una revisión sistemática / Pelvic Floor Electrostimulation in Women With Urinary Incontinence and/or Overactive Bladder Syndrome: A Systematic Review

Contexto: La electroestimulación (EE) es una de las técnicas empleadas en el tratamiento conservador de la incontinencia urinaria (IU) y/o síndrome de vejiga hiperactiva (SVH). Sin embargo, existe controversia en la literatura científica acerca de su eficacia como monoterapia. Objetivo: Evaluar la evidencia científica sobre la EE del suelo pélvico en mujeres con IU y/o SVH. Adquisición de evidencia: Se realizó una revisión sistemática de ensayos clínicos en las bases de datos PubMed, Cochrane, PEDro, Elsevier (Doyma) y EnFisPo (1980-2011). Se evaluó la calidad de los estudios y se extrajo la información de los que reunieron los criterios de inclusión establecidos. Síntesis de evidencia: Un total de 27 ensayos clínicos han sido incluidos en la revisión: 13 ensayos controlados aleatorizados, 11 ensayos aleatorizados no controlados y 3 ensayos no aleatorizados. Conclusión: La mayor parte de los ensayos clínicos concluyen que la EE es eficaz en el tratamiento de la IU y el SVH en mujeres. Sin embargo, son necesarios más estudios de buena calidad metodológica para obtener un mayor nivel de evidencia científica y conocer cuál es la modalidad, tipo y parámetros de corriente óptimas para cada tipo de IU y el SVH (AU)

Context: Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. Objective: To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. Evidence acquisition: A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. Evidence synthesis: The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. Conclusion: Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB (AU)

Pelvic floor electrostimulation in women with urinary incontinence and/or overactive bladder syndrome: a systematic review.

CONTEXT: Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. OBJECTIVE: To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. EVIDENCE ACQUISITION: A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. EVIDENCE SYNTHESIS: The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. CONCLUSION: Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB.

Socioeconomic position and type 2 diabetes mellitus in Europe 1999-2009: a panorama of inequalities.

The aim of the present review is to synthesis findings from studies on the relationship between socioeconomic position (SEP) and incidence, prevalence and mortality of type 2 diabetes mellitus (T2DM) in Europe between the years 1999 and 2009. A systematic search was carried out in the National Library of Medicine's PubMed database. The search was limited to articles published between January 1999 and December 2009, in English or Spanish. Additional requirements for inclusion were: (i) presentation of empirical results directly related with SEP and the prevalence, incidence or mortality of diabetes, (ii) dealing with T2DM, (iii) carried out in Europe, and (iv) mainly focused only on diabetes. Of the 19 articles found, twelve studied the relationship between SEP and the prevalence of T2DM, two dealt with diabetes incidence, three with mortality and two studied both inequalities in mortality and prevalence. People with more deprived SEP have greater incidence, more prevalence and higher mortality due to T2DM, although the magnitude and significance of the associations varied from one study to another. Part of these inequalities is explained by SEP differences in the prevalence of the established T2DM risk factors. SEP inequalities in T2DM tended to be greater in women than in men. There is consistent evidence that SEP inequalities in T2DM incidence, prevalence and mortality are present in Europe, especially among women. Improving accessibility of physical activity in terms of both price and availability, access to healthy food, and access to health services, will be key to achieving a reduction of SEP related diabetes inequalities in Europe.

Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century.

AIMS/HYPOTHESIS: The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women. METHODS: We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated. RESULTS: In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4). CONCLUSIONS/INTERPRETATION: In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.