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OBJECTIVE, AND MATERIAL AND METHODS: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library. SOURCE OF DATA: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform. SELECTION OF STUDIES: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed. DATA EXTRACTION: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies. Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure. RESULTS: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56-0.94. CONCLUSIONS: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease.
Subject(s)
COVID-19 , Humans , Prognosis , Antidepressive Agents/therapeutic use , Hospitalization , Odds RatioABSTRACT
BACKGROUND: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients' quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation-relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. OBJECTIVE: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. METHODS: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. RESULTS: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. CONCLUSIONS: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources.
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Objective: The main objective is to transfer to clinical practice a new smoking cessation application (Vive sin Tabaco a) in all health centers of the public Basque Health Service. Design: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. Site: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. Intervention and main measurement: Development of Vive sin Tabaco; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected.ResultsThe percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. Conclusions: The conception of Vive sin tabaco as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.(AU)
Objetivo: El objetivo principal es transferir a la práctica clínica una herramienta corporativa para deshabituación tabáquica («Vive sin Tabaco») en la red sanitaria pública del País Vasco. Diseño: Estudio de implementación de un programa de deshabituación tabáquica previamente validado. Posteriormente se llevó a cabo un estudio retrospectivo para evaluar su efectividad en condiciones de práctica clínica. Emplazamiento: La transferencia a la práctica clínica se ha realizado en varias fases; primero se realizó un pilotaje en 4 centros de salud de Álava y, posteriormente, tras resolver todas las incidencias notificadas, se extendió al resto de centros de salud de la red sanitaria pública vasca. Intervención y principales medidas: Desarrollo de una aplicación móvil corporativa para dejar de fumar «Vive sin Tabaco», y transferencia a la práctica clínica. Todo el personal sanitario interesado recibió formación sobre el uso de la aplicación. Se elaboraron manuales de uso para pacientes y profesionales. Se recogieron las tasas de abandono del tabaco a los 12 meses. Resultados: El porcentaje de pacientes de la fase pospilotaje que dejó de fumar a los 12 meses fue del 14.1%. Conclusiones: La concepción de «Vive sin Tabaco» como herramienta corporativa para la deshabituación tabáquica, ha sido larga y ardua, y ha requerido la participación de los profesionales sanitarios y de los pacientes para conseguir una herramienta que se adapte a sus expectativas, y garantice una mayor usabilidad y satisfacción. Esta aplicación está siendo eficaz como herramienta coadyuvante del consejo sanitario.(AU)
Subject(s)
Clinical Clerkship , Tobacco Use Disorder/drug therapy , Smoking Cessation , Mobile Applications , Retrospective Studies , Primary Health CareABSTRACT
Background: The acceptability of COVID-19 vaccine varies depending on the time, place, type of vaccine and information available at the time. Knowledge of attitudes and practices towards COVID-19 among the population at high risk of developing the disease would help to tailor the strategy to improve adherence to vaccination recommendations. Aim: To analyze the willingness, knowledge and risk perception of patients and health care workers (HCW) to get the vaccines against SARS-CoV-2. Methods: Cross-sectional survey in Araba/Álava province (Spain). Subjects who met the criteria for the influenza vaccination in 2019 and HCWS from the Basque Public Health Service were included. The participants answered a questionnaire on the knowledge, attitudes and practices towards COVID-19 before starting vaccination against SARS-CoV-2. The intention to vaccinate was compared using the chi-squared test. Results: 316 HCWs and 389 patients responded to the survey. Around 90% of the patients and 80% of HCW would accept vaccination in all scenarios according to the questionnaire (p < 0.001). Only 3-12% hesitated about the COVID-19 vaccines. Compared to 40-70% of patients, 60-80% of HCWs perceived a high risk of COVID-19 (p < 0.001). Statistically significant differences were found in 10 of the 17 questions regarding the mechanism of transmission and symptoms. Conclusion: HCWs had a better knowledge and risk perception of COVID-19 than the surveyed patients. They had a higher proportion of hesitancy to get COVID-19 vaccine, probably related to doubts about the effectiveness of the new vaccines and the scientific evidence.
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OBJECTIVE: The main objective is to transfer to clinical practice a new smoking cessation application ("Vive sin Tabaco" a) in all health centers of the public Basque Health Service. DESIGN: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. SITE: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. INTERVENTION AND MAIN MEASUREMENT: Development of "Vive sin Tabaco"; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. RESULTS: The percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. CONCLUSIONS: The conception of "Vive sin tabaco" as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.
Subject(s)
Mobile Applications , Smoking Cessation , Humans , Retrospective Studies , Tobacco SmokingABSTRACT
[This corrects the article DOI: 10.18332/tpc/127770.].
ABSTRACT
BACKGROUND: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. METHODS: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. RESULTS: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of 7.4 and 1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. CONCLUSIONS: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.
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INTRODUCTION: Tobacco is the leading cause of preventable mortality. The use of mobile phones has grown exponentially, becoming a powerful tool to be used in health care. METHODS: In order to assess the effectiveness of mobile phones to quit smoking, we have carried out a systematic review and meta-analysis of randomized clinical trials evaluating interventions based on mobile applications for smartphones, that were not a smaller version of the same application, against other types of therapy. To address this, a bibliographic search was carried out in MEDLINE, EMBASE and COCHRANE LIBRARY. To obtain the combined effect, the relative risk and the 95% confidence interval were used. A heterogeneity and sensitivity analysis were also conducted. RESULTS: A total of nine studies were identified, but five were excluded. Qualitative review was performed with four selected studies, but quantitative analysis was carried out for only three, given the impossibility of calculating the RR in one of the studies. After combining the results, an RR of 0.901 (95% CI: 0.57-1.423) was calculated comparing the effectiveness of mobile applications versus others type of interventions. This measure was robust, as shown by the sensitivity analysis. CONCLUSIONS: According to the results, it cannot be concluded that apps are effective for quitting tobacco. There are very few clinical trials published evaluating the effectiveness of mobile applications compared to other alternatives. Several clinical trials are still in progress, therefore their results have not been included in the present meta-analysis.
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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.
Subject(s)
Health Promotion/methods , Healthy Lifestyle , Mobile Applications , Obesity/therapy , Overweight/therapy , Adult , Body Mass Index , Diet , Exercise , Female , Glycated Hemoglobin/analysis , Humans , Male , Multivariate Analysis , Obesity/blood , Overweight/blood , Spain , Weight LossABSTRACT
No disponible
Subject(s)
Humans , Diabetes Mellitus , Hyperglycemia/prevention & control , Blood Glucose Self-Monitoring/methods , Glycated Hemoglobin/analysis , Cell Phone , Telemedicine/trendsABSTRACT
BACKGROUND: The electronic health record (EHR) allows a detailed study of the primary care consultations and assessment of variability among physicians regarding the implementation of practices for prevention, detection and monitoring of chronic diseases. OBJECTIVES: To describe the variability in the detection and surveillance of chronic conditions in primary care. METHODS: Review of the medical records maintained by 1685 primary care physicians in the Basque Health Service. Estimation of age and sex standardized rates of compliance with evidence-based recommendations and the systematic component of variation (SCV). RESULTS: Compliance with screening recommendations varied from 14.2% for chronic obstructive pulmonary disease (COPD) to 37.2% for hypercholesterolaemia of the at-risk populations. Variability between Primary Care Units (PCUs) was low (SCV(5) (-95) < 0.10) for high blood pressure, hypercholesterolaemia and diabetes and high (SCV(5) (-95) ≥ 0.20) for COPD. Based on the EHR registries, recommendations were followed to in at least 50% of relevant patients according to only 10 of the 44 good care practice (GCP) criteria. For 16 of the GCP criteria, the EHR data indicated compliance to the recommendations in <25% of patients diagnosed. CONCLUSIONS: EHR data indicate that some of the preventative care practices recommended to detect chronic problems in primary care are unevenly implemented across PCUs. Notably, there is less variation in the case of conditions for which evidence-based clinical practice guidelines have been published. The level of monitoring is inadequate for all the conditions studied; particularly in those in which it is less evident that primary care is the right level of the health service to provide this care.
Subject(s)
Chronic Disease/therapy , Electronic Health Records , Guideline Adherence , Practice Patterns, Physicians' , Primary Health Care , Quality of Health Care , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , General Practice , Humans , Male , Mass Screening , Middle Aged , Young AdultABSTRACT
OBJECTIVE: To determine the intention of health professionals, doctors and nurses, concerning whether or not to be vaccinated against A/H1N1 influenza virus, and their perception of the severity of this pandemic compared with seasonal flu. MATERIAL AND METHODS: A cross-sectional study was carried out based on an questionnaire e-mailed to health professionals in public healthcare centres in Vitoria between 6 and 16 November 2009; the percentage of respondents who wanted to be vaccinated and who perceived the pandemic flu to carry a high risk of death were calculated. RESULTS: A total of 115 people completed the questionnaire of whom 61.7% (n=71) were doctors and 38.3% (n=44) were nurses. Of these, 33.3% (n=23) of doctors and 13.6% (n=6) of nurses intended to be vaccinated (p=0.019). Even among those who considered themselves to be at a high risk, 70.6% (n=48) of doctors and 31.7% (n=13) of nurses participating in the study (p=0.001) planned to have the vaccination. CONCLUSIONS: Most health professionals, and in particular nurses, had no intention to be vaccinated against A/H1N1 influenza virus at the beginning of the vaccination campaign.
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ObjetivosDeterminar la intención de la población general y de los profesionales sanitarios de vacunarse contra la gripe A/H1N1, así como la percepción que tienen de la gravedad de la gripe A/H1N1 en comparación con la gripe estacional.MétodosEstudio transversal mediante encuesta telefónica a una muestra de población general, a partir de la guía telefónica, y electrónica a profesionales sanitarios de los centros asistenciales públicos de Vitoria-Gasteiz, entre los días 6 y 16 de noviembre de 2009. En ambos colectivos se calcularon las frecuencias absolutas y relativas de los que se querían vacunar y de los que perciben la gripe como un riesgo alto para la vida.ResultadosContestaron al cuestionario el 33% (n=219) de las 637 personas contactadas y se obtuvieron 109 respuestas de profesionales. El 63,0% (n=138) de la población general y el 73,4% (n=80) de la población sanitaria no se vacunaría si la vacuna fuese gratis (p=0,595). En caso de pertenecer a alguno de los grupos de riesgo no se vacunaría el 14,6% (n=32) de la población ni el 40,4% (n=44) de los sanitarios (p<0,001). El porcentaje de indecisos entre la población general es del 25,6%, frente al 6,4% de los profesionales sanitarios.ConclusionesLa mayoría de la población no tiene, al inicio de la campaña de vacunación, intención de vacunarse contra la gripe A. La proporción es similar a la del colectivo de profesionales sanitarios, salvo bajo el supuesto de pertenecer a grupos de riesgo, en cuyo caso hay un importante grupo de indecisos entre la población (AU)
ObjectivesTo determine the intention of general population and health professionals to vaccinate against the H1N1 influenza A virus. To determine the perception of severity of the H1N1 influenza A in both groups compared to that of seasonal influenza.MethodsCross-sectional telephone survey performed to a sample of population (obtained randomly from the Vitoria-Gasteiz telephone directory) and cross-sectional electronically-administered survey to a sample of health professionals from public health centres in Vitoria-Gasteiz, conducted between 6th and 16th November 2009. The relative and absolute frecuency of persons willing to be vaccinated and the proportion of those considering the H1N1 influenza A as a life-threatening risk were calculated in both groups.Results219 (33%) persons out of 637 contacted telephone numbers answered the questionnaire, as well as 109 health professionals. 63.0% (n=138) of general population and 73.4% (n=80) of the professional group would not undergo vaccination, even if it was for free (p=0.595). If belonging to a high-risk group, the corresponding proportions of unwillingness were 14.6% (n=32) for general population and 40.4 (n=44) for professionals (p<0.001). The proportion of undecided persons is 25.6% (n=56) in general population, against 6.4% (n=7) among the professionals.ConclusionsAt the beginning of the vaccination campaign, the majority of population is unwilling to undergo immunization against the H1N1 influenza A virus. The proportion in general population is similar to that among the health professionals. However, when belonging to a high-risk group, there is a high proportion of undecided persons in general population (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Attitude of Health Personnel , Influenza A Virus, H1N1 Subtype , Influenza Vaccines , Patient Acceptance of Health Care , Public Opinion , Influenza, Human/prevention & control , Surveys and Questionnaires , Severity of Illness IndexABSTRACT
OBJECTIVES: To determine the intention of general population and health professionals to vaccinate against the H1N1 influenza A virus. To determine the perception of severity of the H1N1 influenza A in both groups compared to that of seasonal influenza. METHODS: Cross-sectional telephone survey performed to a sample of population (obtained randomly from the Vitoria-Gasteiz telephone directory) and cross-sectional electronically-administered survey to a sample of health professionals from public health centres in Vitoria-Gasteiz, conducted between 6th and 16th November 2009. The relative and absolute frecuency of persons willing to be vaccinated and the proportion of those considering the H1N1 influenza A as a life-threatening risk were calculated in both groups. RESULTS: 219 (33%) persons out of 637 contacted telephone numbers answered the questionnaire, as well as 109 health professionals. 63.0% (n=138) of general population and 73.4% (n=80) of the professional group would not undergo vaccination, even if it was for free (p=0.595). If belonging to a high-risk group, the corresponding proportions of unwillingness were 14.6% (n=32) for general population and 40.4 (n=44) for professionals (p<0.001). The proportion of undecided persons is 25.6% (n=56) in general population, against 6.4% (n=7) among the professionals. CONCLUSIONS: At the beginning of the vaccination campaign, the majority of population is unwilling to undergo immunization against the H1N1 influenza A virus. The proportion in general population is similar to that among the health professionals. However, when belonging to a high-risk group, there is a high proportion of undecided persons in general population.
