Description of thyroid disorders the year before conception: a population-based study.

Objective: This study aimed to monitoring the prevalence of previously identified thyroid disorders and hypothyroidism monitoring before pregnancy. Material and methods: A retrospective cross-sectional study of women whose pregnancies occurred between 2014 and 2016 was conducted, including 120,763 pregnancies in Catalonia (Spain). The presence of thyroid disorders in women was based on disease diagnostic codes and/or prescription of levothyroxine or antithyroid drugs. To evaluate the thyroid disorder diagnosis and monitoring, thyrotropin (TSH), free T4 (FT4), antiperoxidase antibody (TPOAb), and anti-TSH receptor antibody (TRAb) records were gathered and categorised according to the reference values of each laboratory. Results: The prevalence of recorded thyroid disorders before the last menstrual period was 5.09% for hypothyroidism and 0.64% for hyperthyroidism,showing a significant increase with age. A thyroid monitoring test was not performed in the year before the last menstrual period in approximately 40% of women with a known thyroid disorder. Amongst the women with hypothyroidism who underwent a TSH test, 31.75% showed an above-normal result. Amongst women previously unknown to have thyroid disorders, 3.12% had elevated TSH levels and 0.73% had low TSH levels. Conclusion: A high percentage of Catalan women with a known thyroid disorder were not properly monitored during the year before pregnancy. Amongst those monitored, more than one-third had TSH values outside the reference range. Therefore, it is important to evaluate women with thyroid disorders during pre-pregnancy visits.

Heart failure admission across glomerular filtration rate categories in a community cohort of 125,053 individuals over 60 years of age.

A reduced estimated glomerular filtration rate (eGFR) has been described as a predictor of heart failure (HF). However, the increased risk across eGFR categories has not been fully evaluated, which is especially relevant in older individuals in whom both the prevalence of HF and decreased eGFR are higher. Furthermore, this association has not been studied in Mediterranean populations, where coronary heart disease (CHD), a frequent cause of HF, has a low prevalence. We performed a retrospective cohort study using the electronic medical records from primary and hospital settings in northeastern Spain. We included 125,053 individuals ≥60 years old with the determination of creatinine and without diagnosis or previous admission due to HF. The eGFR was calculated according to the CKD-EPI formula and classified by clinical categories. The association between eGFR, as a continuous and categorical variable, and the risk of admission due to HF was assessed by Cox proportional risk analysis, considering death as a competitive risk. During a median follow-up of 38.8 months, 2,176 individuals (1.74%) were hospitalized due to HF. The unadjusted admission rates were 4.02, 13.0, 26.0, and 48.6 per 1000 person-years for eGFR > 60, 45-59, 30-44, and 15-29 ml/min/1.73 m2, respectively. The corresponding hazard ratios (95% confidence interval; reference eGFR 60-89) were 1.38 (95% CI 1.23-1.55), 2.02 (95% CI 1.76-2.32) and 3.46 (95% CI 2.78-4.31). In this Mediterranean community-based cohort of individuals ≥60 years old without previous HF, the risk of admission due to HF gradually increased with decreasing eGFR.

Carga actual de los médicos de familia; ¿una necesidad de intervención psicológica? / No disponible

Este estudio estaba dirigido a determinar en una muestra de Médicos de Atención Primaria (MAP) (a) su actual nivel de burnout, satisfacción profesional, bienestar psicológico y actitudes hacia la salud mental; (b) la influencia del burnout, satisfacción profesional y algunas variables socio-demográficas sobre el bienestar psicológico. Se desarrolló un estudio observacional-transversal con 38 MAPs. Se administraron cuestionarios para evaluar el burnout, satisfacción profesional, actitudes hacia la salud mental y una entrevista psiquiátrica para evaluar el bienestar psicológico. Algunos indicadores administrativos y de gestión sanitaria fueron también considerados. Los niveles de burnout (median= 38, IQR= 29, 54) y satisfacción laboral (median= 75.5, IQR= 73, 79) fueron moderados. Sólo el 5.26% de los MAPs informó de un alto burnout. La ansiedad, la depresión y las preocupaciones somáticas fueron los síntomas psiquiátricos predominantes. El 55.26% presentaron síntomas de moderados a extremadamente severos en al menos un síntoma psiquiátrico. Los modelos regresión logística reflejaron como el burnout desarrollaba un papel clave sobre los síntomas psiquiátricos. Los MAPs presentaron unos resultados heterogéneos en los diferentes parámetros de salud laboral analizados y altos niveles de síntomas psiquiátricos. Concluimos que existes una necesidad de proteger y mejorar la salud laboral y el bienestar psicológico de los MAPs

This study was aimed at determining in a sample of in a sample of General practitioners (GPs) (a) their current level of burnout, professional satisfaction, psychological well-being and the attitudes towards mental health; (b) the influence of burnout, professional satisfaction and some socio-demographic variables on the level of psychological well-being. A transversal observational study with 38 GPs was carried out. Self-report measures were administered to assess burnout, professional satisfaction, attitudes toward mental health and a psychiatric interview to evaluate psychological well-being. Some administrative and health care management indicators were also considered. Burnout (median= 38, IQR = 29, 54), and job satisfaction levels were moderate (median = 75.5, IQR = 73, 79). Only 5.26% of GPs reported a high burnout. Anxiety, depression and somatic concerns were the predominant psychiatric symptoms. Focusing only on these worrying cases, a 55.26% of GPs presented from moderate to extremely severe symptoms in at least one psychiatric symptom. Regression models reflected like burnout played a key role work on psychiatric symptoms. GPs presented heterogeneous (generally moderate) levels across the different work-related health parameters analyzed and high levels of psychiatric symptoms. We conclude that there's a need to protect and improve GPs' work-related health and psychological wellbeing

Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado / Heart failure in primary care: Attitudes, knowledge and self-care

OBJETIVO: Conocer actitudes, conocimientos y prácticas en autocuidado en pacientes con insuficiencia cardiaca (IC) atendidos en atención primaria, e identificar factores asociados a mayor autocuidado. DISEÑO: Estudio transversal multicéntrico. Emplazamiento: Atención primaria. PARTICIPANTES: Individuos mayores de 18 años con diagnóstico activo de IC a 1 de diciembre de 2011 en 10 centros de salud del Área Metropolitana de Barcelona. Medidas principales: Se realizó entrevista y revisión de historia clínica para obtención de datos sociodemográficos, clínicos y tests de actitudes (Self-efficacy Managing Chronic Disease Scale), conocimientos (Patient Knowledge Questionnaire), autocuidado (European Heart Failure Self-care Behaviour Scale), grado autonomía (Barthel) y cribado ansiedad-depresión (test Goldberg). Se analizaron las variables asociadas a autocuidado mediante modelo de regresión lineal múltiple de efectos mixtos jerarquizado por centros. RESULTADOS: n = 295 individuos (77,6%), edad media 75,6años (DE: 11), 56,6% mujeres, 62% sin estudios primarios. Se obtuvo una media global de autocuidado de 28,65 (DE: 8,22) puntos. Un 25% de los pacientes presentaron puntuaciones inferiores a 21 puntos. En el modelo multivariante final (n = 282; R2 condicional = 0,3382), un mayor autocuidado se relacionó con mejores conocimientos sobre la IC (coeficiente -1,37; intervalo de confianza 95%: -1,85 a -0,90) y el diagnóstico de cardiopatía isquémica (-2,41; -4,36: -0,46). CONCLUSIONES: El grado de prácticas en autocuidado es moderado. La asociación de mejor autocuidado y mayor nivel de conocimientos sobre la IC, potencialmente modificables, subraya la oportunidad de implementar estrategias para su mejora adaptadas a las características diferenciales de los pacientes con IC atendidos de atención primaria

OBJECTIVE: To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DESIGN: Cross-sectional and multicentre study. SETTING: Primary Care. PARTICIPANTS: Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. MAIN MEASUREMENTS: Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. RESULTS: A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n = 282; R2 conditional = 0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). CONCLUSION: Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care

Síndrome de obesidad-hipoventilación y factores asociados / Obesity-hypoventilation syndrome and associated factors

Fundamento y objetivos: La obesidad ocasiona alteraciones importantes de la fisiología respiratoria como el síndrome de apnea-hipoapnea del sueño (SAHS) y el síndrome de obesidad-hipoventilación (SOH), asociados ambos a elevada morbimortalidad. Además, estas entidades están claramente infradiagnosticadas y en el caso de SOH se desconoce la prevalencia en población general obesa. Los objetivos del estudio son: determinar la prevalencia del SOH en población de pacientes con obesidad mórbida y conocer la comorbilidad asociada al SOH, la clínica respiratoria y las alteraciones de la pulsioximetría. Pacientes y método: Estudio descriptivo. Se seleccionaron 136 pacientes adultos con obesidad mórbida (IMC >40). Se recogieron datos antropométricos, hábitos tóxicos, enfermedades concomitantes, registro de síntomas, datos analíticos, grado de disnea, escala de somnolencia, electrocardiograma y radiografía de tórax. También se realizó espirometría, pulsioximetría nocturna domiciliaria y gasometría arterial. Resultados: Se estudiaron 136 pacientes, con una media de edad de 60 años (DE: 12,9 años); el 73% (98) fueron mujeres. El 6,6% presentaban hipercapnia diurna indicativa de SOH. Presentaban hipertensión arterial (HTA) el 72%, dislipidemia el 44% y enfermedad cardiovascular (ECV) el 18%, sin diferencias según presentaran o no SOH. Tenían ronquidos el 83% y apneas el 46%. El 30% presentaban disnea gradoII y el 10% gradoIII. El índice de desaturaciones/hora (IDH) superior al 3% en ≥30 ocasiones estaba presente en el 28,6% de los pacientes y el porcentaje de tiempo con saturaciones de O2<90% más del 30% del tiempo lo presentaban el 23,5%, resultados peores en pacientes con SOH. Conclusiones: La prevalencia de SOH es más baja de la esperada. Destacan la elevada comorbilidad cardiovascular y frecuentes síntomas respiratorios, presenten o no SOH, así como alteraciones importantes en la pulsioximetría (AU)

Background and objectives: Obesity causes important alterations in the respiratory physiology like sleep obstructive apnoea (SOA) and obesity-hypoventilation syndrome (OHS), both associated with high morbidity and mortality. Also, these entities are clearly infradiagnosed and in the case of OHS the prevalence is unknown in the general obese population. To determine the prevalence of OHS in the population of patients with morbid obesity and to know the comorbidity related with OHS, the associated respiratory symptoms and the pulse oximetry alterations. Patients and method: Descriptive study. Selection of 136 adult patients with morbid obesity (BMI >40). Collected were, anthropometric data, toxic habits, concomitant disease, symptom data, analytic data, dyspnoea grade, sleepiness scale (Epworth Test), electrocardiogram, chest X-ray, spirometry, nocturne ambulatory pulse oximetry and arterial gasometry. Results: 136 were studied, mean age 60 years old (SD 12.9 years), 73% (98) were women; 6.6% of patients presented diurnal hypercapnia indicative of OHS; 72% presented high blood pressure, 44% dyslipidaemia, 18% presented cardiovascular disease, 83% snored and 46% had apnoea; 30% presented stageII dyspnoea and 10% stageIII. The desaturation/hour index was above 3% ≥30 of occasions in 28.6% of patients and the percentage of patients with saturations <90% more than 30% of the time was 23.5%. The results were worse in patients with OHS. Conclusions: The prevalence of OHS was lower than expected. Noteworthy was the high comorbidity of cardiovascular disease and the high frequency of respiratory symptoms associated with important alterations of pulse oximetry (AU)

[Heart failure in primary care: Attitudes, knowledge and self-care]. / Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado.

OBJECTIVE: To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DESIGN: Cross-sectional and multicentre study. SETTING: Primary Care. PARTICIPANTS: Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. MAIN MEASUREMENTS: Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. RESULTS: A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). CONCLUSION: Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care.

Obesity-hypoventilation syndrome and associated factors. / Síndrome de obesidad-hipoventilación y factores asociados.

BACKGROUND AND OBJECTIVES: Obesity causes important alterations in the respiratory physiology like sleep obstructive apnoea (SOA) and obesity-hypoventilation syndrome (OHS), both associated with high morbidity and mortality. Also, these entities are clearly infradiagnosed and in the case of OHS the prevalence is unknown in the general obese population. To determine the prevalence of OHS in the population of patients with morbid obesity and to know the comorbidity related with OHS, the associated respiratory symptoms and the pulse oximetry alterations. PATIENTS AND METHOD: Descriptive study. Selection of 136 adult patients with morbid obesity (BMI >40). Collected were, anthropometric data, toxic habits, concomitant disease, symptom data, analytic data, dyspnoea grade, sleepiness scale (Epworth Test), electrocardiogram, chest X-ray, spirometry, nocturne ambulatory pulse oximetry and arterial gasometry. RESULTS: 136 were studied, mean age 60 years old (SD 12.9 years), 73% (98) were women; 6.6% of patients presented diurnal hypercapnia indicative of OHS; 72% presented high blood pressure, 44% dyslipidaemia, 18% presented cardiovascular disease, 83% snored and 46% had apnoea; 30% presented stageII dyspnoea and 10% stageIII. The desaturation/hour index was above 3% ≥30 of occasions in 28.6% of patients and the percentage of patients with saturations <90% more than 30% of the time was 23.5%. The results were worse in patients with OHS. CONCLUSIONS: The prevalence of OHS was lower than expected. Noteworthy was the high comorbidity of cardiovascular disease and the high frequency of respiratory symptoms associated with important alterations of pulse oximetry.

Seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria / Compliance with recommendations in secondary prevention of stroke in primary care

OBJETIVO: Conocer el grado de seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria e identificar factores asociados. DISEÑO: Transversal multicéntrico. Emplazamiento: Centros de salud de atención primaria de un área metropolitana (944.280 habitantes). PARTICIPANTES: Pacientes mayores de 18 años con diagnóstico de enfermedad cerebrovascular antes de 6 meses del estudio. Mediciones principales: Extracción de historia clínica informatizada de variables demográficas, factores de riesgo y comorbilidad cardiovascular, fármacos, valores de presión arterial (PA), colesterolLDL y visitas por medicina y enfermería posteriores al episodio. Se consideró buen control: PA < 140/90mmHg, colesterolLDL < 100mg/dl, abstención tabáquica y prescripción de fármacos preventivos (antiagregantes/anticoagulantes, estatinas e IECA/ARAII o diurético) en los últimos 18 meses. RESULTADOS: Un total de 21.976 sujetos, media de edad 73,1 años (DE: 12,1), 48% mujeres, el 72,7% con accidente vascular cerebral establecido. Comorbilidad: 70,8% HTA, 55,1% dislipidemia, 30,9% DM, 14,1% fibrilación auricular, 13,5% cardiopatía isquémica, 12,5% insuficiencia renal crónica, 8,8% insuficiencia cardiaca, 6,2% arteriopatía periférica, 7,8% demencia. Sin registro de: hábito tabáquico 3,7%, PA 3,5% y colesterolLDL 6,5%. Grado de control: 75,4% abstención tabáquica, 65,7% PA < 140/90 y 41,0% colesterolLDL< 100mg/dl. Tratamiento: 86,2% antiagregantes/anticoagulantes, 61,3% estatinas y 61,8% IECA/ARAII o diurético. El registro/grado de control fue superior en el grupo de 66-79 años e inferior en el de 18-40 años. CONCLUSIONES: El seguimiento de las recomendaciones de las guías clínicas para la prevención de la enfermedad cerebrovascular en atención primaria es mejorable, especialmente en los más jóvenes. Son necesarios cambios organizativos e intervención más activa de los profesionales, así como estrategias para combatir la inercia terapéutica

OBJECTIVE: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. DESIGN: Multi-centre cross-sectional. SETTING: Health primary care centres in a metropolitan area (944,280 inhabitants). PARTICIPANTS: Patients aged 18 years and over with ischemic brain disease diagnosis prior to 6months before the study. MAIN MEASUREMENTS: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP < 140/90 mmHg, LDL-cholesterol < 100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18 months. RESULTS: A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP < 140/90 in 65.7% and LDL < 100 mg/dL in 41.0%. Treatment: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79 years aged and lower in 18-40 years aged. CONCLUSIONS: The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken

[Compliance with recommendations in secondary prevention of stroke in primary care]. / Seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria.

OBJECTIVE: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. DESIGN: Multi-centre cross-sectional. SETTING: Health primary care centres in a metropolitan area (944,280 inhabitants). PARTICIPANTS: Patients aged 18years and over with ischemic brain disease diagnosis prior to 6months before the study. MAIN MEASUREMENTS: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP <140/90 mmHg, LDL-cholesterol <100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18months. RESULTS: A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP <140/90 in 65.7% and LDL <100 mg/dL in 41.0%. TREATMENT: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79years aged and lower in 18-40years aged. CONCLUSIONS: The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken.

Evaluación de la eficacia de la aplicación de la moxibustión en presentaciones no cefálicas en gestantes asistidas en atención primaria / Evaluation of the effectiveness of the moxibustion in non-cephalic presentations in pregnant women assisted in Primary Care

OBJETIVO: Evaluar la eficacia de la moxibustión, combinada con la posición genupectoral, para versionar fetos en presentaciones no cefálicas a cefálica, durante el tercer trimestre de gestación. Como objetivos secundarios se planteó evaluar la seguridad de la técnica de moxibustión e identificar el tipo de parto, las semanas de gestación (SG) y el peso del recién nacido. MATERIAL Y MÉTODOS: Ensayo clínico aleatorizado, controlado y multicéntrico, realizado en consultas de 9 centros de atención a la salud sexual y reproductiva de la comarca del Baix Llobregat (Barcelona). La selección de gestantes se hizo tras la ecografía del tercer trimestre. Si se observaba una presentación no cefálica, se invitaba a las gestantes a participar. Tras firmar el consentimiento, se procedía a la asignación aleatoria a un grupo de intervención (GI) o a un grupo control (GC). El GI recibió 1 semana de tratamiento con moxibustión en el punto BL67 y posición genupectoral. El GC recibió tratamiento con moxibustión en un punto neutro y posición genupectoral. Las participantes recibieron las explicaciones necesarias para la aplicación de la técnica 2 veces al día durante 1 semana. RESULTADOS: Participaron 88 gestantes entre las 32 y 36 SG. Hubo 47 gestantes en el GI y 41 en el GC, con características similares al inicio del estudio. El número de sesiones aplicadas fue similar en ambos grupos, sin complicaciones. El 44,7% de los partos del GI fueron en presentación cefálica, frente al 43,9% del GC (p= 0,6). El número de partos vaginales en el GI fue de 18 (38,3%), frente a 13 (31,7%) en el GC (p= 0,3). No se observaron diferencias en las SG en el momento del parto ni en el peso de los recién nacidos. CONCLUSIONES: El uso de la moxibustión aplicada durante 7 días en el punto BL67 junto con la posición genupectoral entre las 32 y 36 SG no demostró en este estudio un aumento de las versiones de fetos en posiciones anómalas a cefálica. La técnica no presentó complicaciones

AIM: To evaluate moxibustion efficacy, combined with knee-chest position, for foetus version from no cephalic presentation to cephalic presentation during the 3rd trimester of gestation. To evaluate the security of the moxibustion technique and to identify type of delivery, weeks of gestation and the weight of the newborn. Subjects, material and methods: Multicenter, randomized, controlled trial conducted in 9 primary care centres focused on sexual and reproductive health of the Baix Llobregat (Barcelona) region. Selection was done after the 3rd trimester ultrasound scan. When a non-cephalic presentation was found, women were asked to join the study. After signing the informed consent, random allocation took place and they were divided into intervention group (IG) and control group (CG). IG received a one week treatment with moxibustion at point BL67 combined with knee-chest position. CG received moxibustion treatment at a neutral point combined with knee-chest position too. For both groups they were given the necessary explanations for a correct application twice a day during a week. RESULTS: A total 88 pregnant women between 32-36 weeks of gestation were studied, 47 pregnant mothers enrolled in IG and 41 in CG, with similar characteristics at the beginning of the study. Number of performed sessions was similar for both groups and without complications

Abordaje integrativo del insomnio en atención primaria: medidas no farmacológicas y fitoterapia frente al tratamiento convencional / An integral approach to insomnia in primary care: Non-pharmacological and phytotherapy measures compared to standard treatment

INTRODUCCIÓN: El insomnio es un trastorno del sueño que imposibilita iniciarlo o mantenerlo. En algún momento de la vida, hasta un 50% de adultos lo padecen ante situaciones estresantes. OBJETIVO: Evaluar el impacto de medidas higiénicas del sueño, técnicas de relajación y fitoterapia para abordar el insomnio, comparado con medidas habituales (tratamiento farmacológico). METODOLOGÍA: Estudio experimental, retrospectivo, sin asignación aleatorizada. Revisión de pacientes diagnosticados de insomnio (2008-2010). Los pacientes de grupo intervención (GI) recibieron abordaje integrativo (medidas higiénicas, técnicas de relajación y fitoterapia), y los del grupo control (GC), tratamiento convencional. Se compararon resultados de uso de recursos (media mensual de visitas pre y posdiagnóstico), tipo de tratamiento farmacológico prescrito y dosis total. Evaluación de la calidad del sueño a los 18-24 meses (test de Epworth). RESULTADOS: Se incluyeron 48 pacientes en GI y 47 en GC (70% mujeres, media de edad 46 años (DE: 14,3). La media mensual de visitas prediagnóstico fue 0,54(DE: 0,42) en GI y 0,53 (DE: 0,53) en GC (p = 0,88). La media posterior fue 0,36 (DE: 0,24) y 0,65(DE: 0,46), respectivamente (p < 0,0001), observándose reducción estadísticamente significativa en GI. Recibieron alguna benzodiacepina el 52,5% de los pacientes GI y el 93,6% de los del GC (p < 0,0001). En GC se prescribió más alprazolam y lorazepam, con dosis acumuladas superiores. En la evaluación posterior no presentaban insomnio el 17% de los pacientes del GI y el 5% del GC. Presentaban insomnio severo el 13% de los pacientes del GC y ninguno del GI (p < 0,0001). CONCLUSIONES: El abordaje integrativo del insomnio puede ser resolutivo, disminuyendo las visitas y los efectos secundarios y la dependencia a benzodiacepinas

INTRODUCTION: Insomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep. At some point in life, 50% of adults suffer from it, usually in stress situations. AIM: To evaluate the impact of sleep hygiene measures, relaxations techniques, and herbal medicine to deal with insomnia, compared with standard measures (drug treatment). METHODOLOGY: An experimental, retrospective, non-randomized study was conducted by means of a review of patients diagnosed with insomnia (2008-2010). Patients in the intervention group (IG) received an integrative approach (hygiene measures, relaxation techniques, and herbal medicine) and a control group (CG) with conventional treatment. A comparison was made of the resources used in the two groups (average monthly visits pre- and post-diagnosis), type of prescribed drug therapy and total dose. Sleep quality was evaluated at 18-24 months (Epworth test). RESULTS: A total of 48 patients were included in the IG and 47 in the CG (70% women, mean age 46 years (SD: 14.3). Average monthly visit pre-diagnosis was 0.54 (SD: 0.42) in the IG and 0.53 (SD: 0.53) in the CG (P = .88). Post-diagnosis it was 0.36 (SD: 0.24) and 0.65 (SD: 0.46), respectively (P < .0001), with a statistically significant reduction being observed in the IG. More than half (52.5%) of the IG patients and 93.6% in the CG had received a benzodiazepine (P < .0001). Alprazolam and lorazepam were the most prescribed in the CG and with higher cumulative dose. In the subsequent evaluation, 17% of patients in the IG and 5% in CG did not have insomnia. Severe insomnia was present in 13% of patients in the IG and none in CG (P < .0001). CONCLUSIONS: The integrative approach to insomnia may be worthwhile as it reduces resource use and side effects, as well as dependence to benzodiazepines

[An integral approach to insomnia in primary care: Non-pharmacological and phytotherapy measures compared to standard treatment]. / Abordaje integrativo del insomnio en atención primaria: medidas no farmacológicas y fitoterapia frente al tratamiento convencional.

INTRODUCTION: Insomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep. At some point in life, 50% of adults suffer from it, usually in stress situations. AIM: To evaluate the impact of sleep hygiene measures, relaxations techniques, and herbal medicine to deal with insomnia, compared with standard measures (drug treatment). METHODOLOGY: An experimental, retrospective, non-randomized study was conducted by means of a review of patients diagnosed with insomnia (2008-2010). Patients in the intervention group (IG) received an integrative approach (hygiene measures, relaxation techniques, and herbal medicine) and a control group (CG) with conventional treatment. A comparison was made of the resources used in the two groups (average monthly visits pre- and post-diagnosis), type of prescribed drug therapy and total dose. Sleep quality was evaluated at 18-24 months (Epworth test). RESULTS: A total of 48 patients were included in the IG and 47 in the CG (70% women, mean age 46 years (SD: 14.3). Average monthly visit pre-diagnosis was 0.54 (SD: 0.42) in the IG and 0.53 (SD: 0.53) in the CG (P=.88). Post-diagnosis it was 0.36 (SD: 0.24) and 0.65 (SD: 0.46), respectively (P<.0001), with a statistically significant reduction being observed in the IG. More than half (52.5%) of the IG patients and 93.6% in the CG had received a benzodiazepine (P<.0001). Alprazolam and lorazepam were the most prescribed in the CG and with higher cumulative dose. In the subsequent evaluation, 17% of patients in the IG and 5% in CG did not have insomnia. Severe insomnia was present in 13% of patients in the IG and none in CG (P<.0001). CONCLUSIONS: The integrative approach to insomnia may be worthwhile as it reduces resource use and side effects, as well as dependence to benzodiazepines.

Interferometric microscopy study of the surface roughness of Portland cement under the action of different irrigants

OBJECTIVES: Some investigations suggested common Portland cement (PC) as a substitute material for MTA for endodontic use; both MTA and PC have a similar composition. The aim of this study was to determine the surface roughness of common PC before and after the exposition to different endodontic irrigating solutions: 10% and 20% citric acid, 17% ethylenediaminetetraacetic (EDTA) and 5% sodium hypochlorite. Study design: Fifty PC samples in the form of cubes were prepared. PC was mixed with distilled water (powder/liquid ratio 3:1 by weight). The samples were immersed for one minute in 10% and 20% citric acid, 17% EDTA and 5% sodium hypochlorite. After gold coating, PC samples were examined using the New View 100 Zygo interferometric microscope. It was used to examine and register the surface roughness and the profile of two different areas of each sample. Analysis of variance (ANOVA) was carried out, and as the requirements were not met, use was made of the Kruskal-Wallis test for analysis of the results obtained, followed by contrasts using Tukey's contrast tests. RESULTS: Sodium hypochlorite at a concentration of 5% significantly reduced the surface roughness of PC, while 20% citric acid significantly increased surface roughness. The other evaluated citric acid concentration (10%) slightly increased the surface roughness of PC, though statistical significance was not reached. EDTA at a concentration of 17% failed to modify PC surface roughness. Irrigation with 5% sodium hypochlorite and 20% citric acid lowered and raised the roughness values, respectively. CONCLUSIONS: The surface texture of PC is modified as the result of treatment with different irrigating solutions commonly used in endodontics, depending on their chemical composition and concentration

Demencia y género: una perspectiva desde la atención primaria / No disponible

Objetivo. Describir las características de las demencias en atención primaria (AP) en función del sexo de paciente y cuidador. Material y métodos. Estudio observacional transversal de 227 casos, con diagnóstico de demencia según criterios del CIE-10 (en cualquiera de sus variantes), en junio de 2009 en un centro de AP, recogiendo variables sociodemográficas, clínicas y asistenciales. Resultados. Encontramos edad mayor (83 frente a 78; p < 0,001) y escolarización menor en mujeres que en hombres (16,7 % de analfabetismo frente a 6,8 %). La enfermedad de Alzheimer fue el subtipo más frecuente, aunque con predominio mayor en mujeres (55,4 % frente a 39 %). La institucionalización (51,1 % frente a 32,2 %; p = 0,01), polifarmacia (7,6 frente a 6,1; p = 0,02) y uso de psicofármacos son mayores en mujeres, mientras que la frecuentación de AP y urgencias hospitalarias (UH) es inferior (p = 0,033). El cuidador más habitual es una mujer (64,8 %; p < 0,001). Los pacientes cuidados por hijas frecuentan menos las UH (p = 0,017) y reciben con mayor probabilidad tratamiento específico. Conclusiones. El perfil de las demencias en AP presenta diferencias entre hombres y mujeres. El paciente tipo sería una mujer, más añosa que en el caso de los hombres, menos escolarizada, con una demencia más evolucionada, más «medicalizada », más institucionalizada y menos frecuentadora. Las mujeres parecen generar menor sobrecarga asistencial directa, pero mayor impacto farmacológico y sociosanitario. El cuidador principal suele ser una mujer. Los pacientes cuidados por hijas frecuentan menos servicios hospitalarios y siguen con mayor probabilidad tratamiento específico(AU)

Objective. To describe the characteristics of dementia in primary care (AP) depending on the sex of patient and caregiver. Material and methods. Observational transversal study in a Primary Care (PC) center of 227 cases with diagnosis «dementia» ICD-10 (including all subtypes) in 2009, June, collecting socio-demographic, clinical and care-related variables. Results. We find women older (83 vs 78;p < 0.001) and with lower levels of schooling (16.7 % illiteracy vs 6.8 % men). Alzheimer’s disease was the most frequent diagnosis with higher prevalence in women (55,4 % vs 39 %). Institutionalization (51.1 % vs 32.2 %; p = 0.01), polypharmacy (7.6 vs 6.1; p = 0.02) and use of psychoactive drugs is higher in women, while PC and emergency units (EU) attendance is lower (p = 0,033). The most usual caregiver is a woman (64.8%; p < 0.001). Patients cared for by her daughters have less frequentation in EU (p = 0, 017) and follow most likely specific treatments. Conclusions. Dementia in PC presents valuable differences between men and women. The profile type would be a woman, most aged than men, with lower academic level, with a more evolved dementia, more exposed to drugs, more institutionalized and less frequenter. Women seem to generate less direct care overload, but greater pharmacological and social impact. Primary caregiver is usually a woman. Patients cared for his daughters present lower frequentation of hospital services and higher use of specific treatment(AU)

Interferometric microscopy study of the surface roughness of Portland cement under the action of different irrigants.

OBJECTIVES: Some investigations suggested common Portland cement (PC) as a substitute material for MTA for endodontic use; both MTA and PC have a similar composition. The aim of this study was to determine the surface roughness of common PC before and after the exposition to different endodontic irrigating solutions: 10% and 20% citric acid, 17% ethylenediaminetetraacetic (EDTA) and 5% sodium hypochlorite. STUDY DESIGN: Fifty PC samples in the form of cubes were prepared. PC was mixed with distilled water (powder/liquid ratio 3:1 by weight). The samples were immersed for one minute in 10% and 20% citric acid, 17% EDTA and 5% sodium hypochlorite. After gold coating, PC samples were examined using the New View 100 Zygo interferometric microscope. It was used to examine and register the surface roughness and the profile of two different areas of each sample. Analysis of variance (ANOVA) was carried out, and as the requirements were not met, use was made of the Kruskal-Wallis test for analysis of the results obtained, followed by contrasts using Tukey's contrast tests. RESULTS: Sodium hypochlorite at a concentration of 5% significantly reduced the surface roughness of PC, while 20% citric acid significantly increased surface roughness. The other evaluated citric acid concentration (10%) slightly increased the surface roughness of PC, though statistical significance was not reached. EDTA at a concentration of 17% failed to modify PC surface roughness. Irrigation with 5% sodium hypochlorite and 20% citric acid lowered and raised the roughness values, respectively. CONCLUSIONS: The surface texture of PC is modified as the result of treatment with different irrigating solutions commonly used in endodontics, depending on their chemical composition and concentration.

Insuficiencia cardíaca. Perspectiva desde atención primaria / Heart failure: a view from primary care

Objetivo: Conocer la situación de la insuficiencia cardíaca (IC) en atención primaria (AP). Diseño: Estudio transversal multicéntrico. Emplazamiento: Cuatro centros de salud y el hospital de referencia de un área urbana de Barcelona. Participantes: De una población de 35.212 habitantes mayores de 45 años, se incluyeron todos los pacientes (333) diagnosticados de IC en AP en 2006.MedicionesMediante cuestionario estandarizado se recogieron datos demográficos, clínicos y tratamiento. Resultados: Un 61,4% eran mujeres, la edad media en varones fue de 74,5 (desviación estándar [DE]: 10) y en mujeres de 79 (DE: 9,8) (p<0,0001), el 46% tenía una evolución de la enfermedad menor de 5 años. La comorbilidad en el momento del diagnóstico y al inicio del estudio fue hipertensión (65,4–73%), diabetes (33,6–40%), dislipidemia (40–53%), enfermedad coronaria (30–27%), valvulopatías (23,7–27%) y enfermedad pulmonar obstructiva crónica (20–26%). Resultados: Un 64% tenía registrado el grado funcional New York Heart Association (el 48% de clase II; el 30%, III; el 6,6%, IV). El 36% de los varones y el 20,5% de las mujeres tenían controlada la presión arterial (p=0,002). En un 75,4% constaba registro de electrocardiograma, un 57% de radiografía de tórax, un 58% en varones y un 46% en mujeres (p=0,02) de ecocardiograma. Los fármacos más prescritos fueron diuréticos (85,3%), inhibidores de la enzima de conversión de la angiotensina (43%), antagonistas de los receptores de la angiotensina (33%) y bloqueadores beta (27%). Conclusiones: Los pacientes atendidos son fundamentalmente mujeres de avanzada edad y elevada comorbilidad. Debe preocuparnos en AP el poco registro de exploraciones complementarias básicas y la poca utilización de BB (AU)

Objective: Our aim was to find out the situation of heart failure (HF) in primary care. Design: Cross-sectional multicentre study.Setting Four primary health care centres and a hospital in an urban area of Barcelona. Participants: From a registered population of 35,212 inhabitants older than 45 years, we studied all patients (333) diagnosed with HF in 2006 in primary care. Measurements: A standardised questionnaire was used to record demographic, clinical and treatment data. Results: There were 61.4% females. Mean age was 74.5 (standard deviation [SD]: 10) for men and 79 (SD: 9.8) for women. A total of 46% of patients had HF for <5 years. The comorbidity diagnosis and at the beginning of the study were: hypertension 65.4% and 73%, diabetes 33.6% and 40%, dyslipaemia 40% and 53%, coronary disease 30% and 27%, and valvular disease 23.7% and 27%, respectively. Results: A total of 64% of patients had registered New York Heart Association functional class (48% class II, 30% III and 6.6% IV). Blood pressure was controlled in 36% men and 20.5% women (P=0.002); 75.4% had an electrocardiogram, 57% X-ray; 58% of men and 46% of women (P=0.02) had echocardiography. The most prescribed drugs were diuretics 85.3%, the least, beta blockers 27%.ConclusionsPatients with HF in primary care are elderly females with a lot of comorbidities. We must be concerned by the suboptimal use of basic investigations (electrocardiogram and X-ray) and beta blocker treatments (AU)

Violencia doméstica: preguntar para detectar / Domestic violence: a screening question

ObjetivosEvaluar si preguntas clave permiten detectar la violencia doméstica (VD) y conocer la prevalencia de ésta en atención primaria (AP) y en atención a la mujer (AM).DiseñoEstudio de intervención con asignación aleatorizada.EmplazamientoConsultas de AP y de AM (Sant Boi de Llobregat, Barcelona).ParticipantesSelección sistemática aleatorizada de mujeres en AP (se excluyó a las que se conocía que se las maltrataba) y de mujeres que acudían por primera vez al Servicio de AM. Se seleccionaron controles emparejados por edad. Se entrevistaron 400 mujeres.IntervencionesSe realizó anamnesis y un cuestionario. En el grupo control (GC) había una pregunta referente a VD, en el grupo intervención (GI) se incluían 6 preguntas clave: relación de sus padres, los de la pareja, si la pareja había sufrido maltrato, relación con su pareja, si se consentían las relaciones sexuales y si la pareja se enfadaba cuando no quería tenerlas. Ante VD se preguntaba el tipo, características y duración.ResultadosSe detectaron 101 (25,3%) casos de violencia, 58 (29,4%) en el GI y 43 (21,2%) en el GC (OR [odds ratio] = 1,55; intervalo de confianza (IC): 0,96 a 2,51; p = 0,06). En AM se detectó el 32,7 y el 17,5% (OR = 2,3; IC: 1,2 a 4,5; p = 0,007) y en AP el 25,3 y el 25,8% (OR = 0,97; IC del 95%: 0,47 a 2,02; p = 0,5), respectivamente.ResultadosLas mujeres presentaban características diferentes según la procedencia (AM frente a AP), pero similares entre el GI y el GC, excepto en cuanto a la discapacidad psíquica, que era más frecuente en el GI.ResultadosPresentaba enfermedad psiquiátrica el 23,5%, el 15% de las no maltratadas y el 44% de las maltratadas (de éstas, en el 68% la enfermedad era posterior al maltrato)...(AU)

AimsTo assess whether key questions can detect domestic violence (DV), and find out the prevalence in primary care (PC) and women's care (WC).DesignIntervention Study with random assignment.LocationPC and WC clinics (Sant Boi de Llobregat Barcelona).ParticipantsSystematic random selection of women in PC (not know if battered) and women who came for the first time to the WC service. Age-matched controls were selected. A total of 400 women were interviewed.InterventionsAnamnesis was performed and a questionnaire filled in. In the control group (CG) there was one question concerning DV, in the intervention group (IG) there were 6 key questions: relationship of their parents, partner's parents, if the partner had suffered abuse, relationship with her partner, if sexual relations were consensual or got angry if they were not. When DV was detected, asked about type, features and duration.ResultsA total of 101(25.3%) cases of violence were detected, 58(29.4%) in IG and 43(21.2%) in CG (odds ratio (OR)=1.55, confidence interval (CI): 0.96–2.51, P=0.06). WC rates were 32.7% and 17.5% (OR: 2.3, CI: 1.2–4.5, P:0.007) and PC 25.3% and 25.8% (OR: 0.97, CI: 0.47–2.02, P=0.5), respectively.ResultsDifferent characteristics were observed depending on whether they were from PC or WC, but were similar between IG and CG, except mental disability, more common in IG.Results23.5% suffered from a psychiatric disorder, 15% in non-battered and 44% in the battered, in 68% of these the disorder appeared after the abuse.ConclusionsAbuse is a Public Health problem. When women visit for the first time it is necessary to use indirect questions to make communication easier, if the woman and the professional know each other, a single question is enough to detect it(AU)

[Heart failure: a view from primary care]. / Insuficiencia cardíaca. Perspectiva desde atención primaria.

OBJECTIVE: Our aim was to find out the situation of heart failure (HF) in primary care. DESIGN: Cross-sectional multicentre study. SETTING: Four primary health care centres and a hospital in an urban area of Barcelona. PARTICIPANTS: From a registered population of 35,212 inhabitants older than 45 years, we studied all patients (333) diagnosed with HF in 2006 in primary care. MEASUREMENTS: A standardised questionnaire was used to record demographic, clinical and treatment data. RESULTS: There were 61.4% females. Mean age was 74.5 (standard deviation [SD]: 10) for men and 79 (SD: 9.8) for women. A total of 46% of patients had HF for <5 years. The comorbidity diagnosis and at the beginning of the study were: hypertension 65.4% and 73%, diabetes 33.6% and 40%, dyslipaemia 40% and 53%, coronary disease 30% and 27%, and valvular disease 23.7% and 27%, respectively. A total of 64% of patients had registered New York Heart Association functional class (48% class II, 30% III and 6.6% IV). Blood pressure was controlled in 36% men and 20.5% women (P=0.002); 75.4% had an electrocardiogram, 57% X-ray; 58% of men and 46% of women (P=0.02) had echocardiography. The most prescribed drugs were diuretics 85.3%, the least, beta blockers 27%. CONCLUSIONS: Patients with HF in primary care are elderly females with a lot of comorbidities. We must be concerned by the suboptimal use of basic investigations (electrocardiogram and X-ray) and beta blocker treatments.

[Domestic violence: a screening question]. / Violencia doméstica: preguntar para detectar.

AIMS: To assess whether key questions can detect domestic violence (DV), and find out the prevalence in primary care (PC) and women's care (WC). DESIGN: Intervention Study with random assignment. LOCATION: PC and WC clinics (Sant Boi de Llobregat Barcelona). PARTICIPANTS: Systematic random selection of women in PC (not know if battered) and women who came for the first time to the WC service. Age-matched controls were selected. A total of 400 women were interviewed. INTERVENTIONS: Anamnesis was performed and a questionnaire filled in. In the control group (CG) there was one question concerning DV, in the intervention group (IG) there were 6 key questions: relationship of their parents, partner's parents, if the partner had suffered abuse, relationship with her partner, if sexual relations were consensual or got angry if they were not. When DV was detected, asked about type, features and duration. RESULTS: A total of 101(25.3%) cases of violence were detected, 58(29.4%) in IG and 43(21.2%) in CG (odds ratio (OR)=1.55, confidence interval (CI): 0.96-2.51, P=0.06). WC rates were 32.7% and 17.5% (OR: 2.3, CI: 1.2-4.5, P:0.007) and PC 25.3% and 25.8% (OR: 0.97, CI: 0.47-2.02, P=0.5), respectively. Different characteristics were observed depending on whether they were from PC or WC, but were similar between IG and CG, except mental disability, more common in IG. 23.5% suffered from a psychiatric disorder, 15% in non-battered and 44% in the battered, in 68% of these the disorder appeared after the abuse. CONCLUSIONS: Abuse is a Public Health problem. When women visit for the first time it is necessary to use indirect questions to make communication easier, if the woman and the professional know each other, a single question is enough to detect it.

Evaluación del programa de Enfermería de deshabituación tabáquica / Evaluation of a Nursing program on how to quit smoking

Objetivo: conseguir que al menos un 20% de los pacientes incluidosen un programa de deshabituación tabáquica se mantuvieran sinfumar a los 3 meses.• Material y métodos: se llevó a cabo un estudio cuasiexperimentalpretest-postest de un sólo grupo. Se incluyeron a los fumadores quequerían dejar el hábito tabáquico, excluyéndose los que padecíantrastornos psiquiátricos y/o usuarios de drogas. Se siguió un programaestructurado de visitas. Los datos se recogieron mediante laentrevista con el usuario al inicio y mediante un cuestionario de satisfacciónal finalizar el estudio.• Resultados: iniciaron el programa 99 pacientes. Abandonaron elhábito tabáquico a los 3 meses, 27 (27,3%). De ellos, 17 no necesitarontratamiento farmacológico, uno utilizó bupropion, 9 caramelosde nicotina y ninguno parches de nicotina. Los intentos previos paradejar de fumar fueron 0,78 (DE:0,85) en los que consiguieron dejarlo,frente a 1,99 (DE:2,35) de los que no (p=0,009). El número mediode visitas realizadas en los que dejaron el hábito fue de 4,85(DE:1,23) y de los que no 1,88 (DE:1,53) (P<0,0001).• Conclusión: es posible dejar de fumar recibiendo una intervenciónadecuada, donde la actuación de Enfermería resulta indispensable.Cualquier logro conseguido es un éxito, debido a la alta morbimortalidadproducida por el tabaco en fumadores activos y pasivos

Objective: to make at least 20% of patients included in a programto quit smoking resist the temptation to smoke after 3 months.• Materials and methods: a pretest-posttest quasi experimentalstudy was carried one in one single group. Smokers who wished toquit the habit were included, excluding those who suffered from psychiatricdisorders and/or drug users. A staged and structuredappointment program was followed. Data was collected by personalinterview at the beginning and a satisfaction questionnaire filled in atstudy completion.• Results: ninety-nine patients started the program. Twenty-seven(27,3%) quit smoking at 3 months. Of these, 17 did not need anydrug therapy. One took bupropion and 9 nicotine candy. None requirednicotine patches. Previous attempts to quit smoking were asfollows: 0,78 (SD:0,85) succeeded and quit smoking against a 1,99(SD: 2,35) who did not succeed in the attempt. Average number ofappointments in subjects who succeeded was 4,85 (SD:1,23) and1,88 (SD:1,53) in those who did not (P<0,0001).• Conclusion: it is possible to quit smoking by receiving adequatecounseling, where the role of the nurse becomes indispensable. Anyachievement is a success, in view of the high morbimortality producedby tobacco in active and in passive smokers