RCParvulari training: A basic life support training methodology applied to 5-year-old students: Effectiveness in a cluster-randomized clinical trail.

INTRODUCTION: Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life. METHODS: Cluster clinical trial with data collection through an ad hoc self-administered, semi-structured questionnaire. The target population encompassed the students aged 4-6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari® methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post intervention by means of the questionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups. RESULTS: A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3-12 months compared to baseline was significantly better (P < .001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the "mouth-nose-eyes" mnemonic. CONCLUSIONS: The RCParvulari® methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education.

Formación RCParvulari: una metodología de formación en soporte vital básico aplicado al alumnado de 5 años de educación infantil: Efectividad en un ensayo clínico aleatorizado por conglomerados / RCParvulari training: A basic life support training methodology applied to 5-year-old students: Effectiveness in a cluster-randomized clinical trail

Introducción: La formación en soporte vital básico en edad escolar es un tema de actualidad, ya que, con una formación adecuada, todo individuo puede ayudar a salvar una vida. Métodos: Ensayo clínico por conglomerados basado en un cuestionario ad hoc, autoadministrable y semiestructurado. La población diana fueron alumnos de entre cuatro y seis años de 49 centros educativos. Los centros se aleatorizaron en grupo intervención y control. El grupo intervención recibió la metodología RCParvulari®, consistente en una formación teórico-práctica sobre el primer anillo de la cadena de supervivencia. El grupo control solo recibió una formación teórica. Los sujetos de estudio fueron evaluados preintervención, postintervención y entre tres y 12 meses después mediante un cuestionario. Se valoró adquisición y retención a lo largo del tiempo de la información recibida, en comparación con la formación previa en ambos grupos. Resultados: Participaron un total de 1.327 escolares (79% de la población diana). El nivel de conocimientos adquiridos inmediatamente después de la formación y pasados tres a 12 meses aumentó más respecto al basal en el grupo intervención que en el grupo control con diferencias significativas (p < 0,001), tanto al reconocer y llamar al número de emergencias 112, como al recordar la mnemotecnia «boca-nariz-ojos». Conclusiones: La metodología RCParvulari® contribuyó de forma significativa a mejorar la capacidad del alumnado de quinto curso de educación infantil para reconocer una eventual emergencia médica, poner en marcha la cadena de la supervivencia alertando a un adulto y llamando al número de emergencias 112. (AU)

Introduction: Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life. Methods: Cluster clinical trial with data collection through an ad hoc self-administered, semi-structured questionnaire. The target population encompassed the students aged 4–6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari® methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post-intervention by means of the questionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups. Results: A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3–12 months compared to baseline was significantly better (P<.001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the “mouth-nose-eyes” mnemonic. Conclusions: The RCParvulari® methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education. (AU)

Evaluating the controlled reopening of nightlife during the COVID-19 pandemic: a matched cohort study in Sitges, Spain, in May 2021 (Reobrim Sitges).

OBJECTIVES: To assess the impact of relaxing the state of alarm restrictions on SARS-CoV-2 infections at 14 days among people attending reopened nightclub venues. DESIGN: Matched cohort study with a paired control group (1:5 ratio). SETTING: Five small nightclubs with indoor areas and outdoor terraces, in a nightlife-restricted area in Sitges, Spain, on 20 May 2021. Wearing masks was mandatory, drinking was allowed and social distance was not required. PARTICIPANTS: Volunteers were selected through a convenience sampling. To attend the event, participants were required to be older than 17 years, with a negative rapid antigen diagnostic test (Ag-RDT) on the same afternoon, without a positive reverse-transcription PCR (RT-PCR) or Ag-RDT and/or symptoms associated with COVID-19 in the previous 7 days, to not having knowingly been in close contact with someone infected in the previous 10 days and to not have knowingly had close contact with someone with a suspicion of COVID-19 in the previous 48 hours. A control group was paired by exact age, gender, residence municipality, socioeconomic index, previous SARS-CoV-2-confirmed infection and vaccination status, in a 1:5 ratio, from the primary care electronic health records. PRIMARY OUTCOME: Evidence of infection at electronic health records by SARS-CoV-2 at 14-day follow-up. RESULTS: Among the 391 participants (median age 37 years; 44% (n=173) women), no positive SARS-CoV-2 cases were detected at 14 days, resulting in a cumulative incidence estimation of 0 (95% CI 0 to 943) per 100 000 inhabitants. In the control group, two cases with RT-PCR test were identified, resulting in a cumulative incidence of 102.30 (12.4 to 369) per 100 000 inhabitants. CONCLUSIONS: Nightlife attendance under controlled conditions and with a requirement for a negative Ag-RDT was not associated with increased transmissibility of SARS-CoV-2 in a pandemic context of low infection rates. In such circumstances, secure opening of the nightlife sector was possible, under reduced capacity and controlled access by Ag-RDT, and environments where compliance with sanitary measures are maintainable.

Double-blind placebo-controlled randomized clinical trial to assess the efficacy of montelukast in mild to moderate respiratory symptoms of patients with long COVID: E-SPERANZA COVID Project study protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to affect the globe. After 18 months of the SARS-CoV-2 emergence, clinicians have clearly defined a subgroup of patients with lasting, disabling symptoms. While big strides have been made in understanding the acute phase of SARS-CoV-2 infection, the pathophysiology of long COVID is still largely unknown, and evidence-based, effective treatments for this condition remain unavailable. OBJECTIVES: To evaluate the efficacy of 10 mg oral montelukast every 24 h versus placebo in improving quality of life associated with mild to moderate respiratory symptoms in patients with long COVID as measured with the COPD Assessment Test (CAT) questionnaire. The secondary objectives will evaluate the effect of montelukast versus placebo on improving exercise capacity, COVID-19 symptoms (asthenia, headache, mental confusion or brain fog, ageusia, and anosmia), oxygen desaturation during exertion, functional status, and mortality. METHODS AND ANALYSIS: Phase III, randomized, double-blind clinical trial. We will include 18- to 80-year-old patients with SARS-CoV-2 infection and mild to moderate respiratory symptoms lasting more than 4 weeks. Participants will be randomly allocated in a 1:1 ratio to the intervention (experimental treatment with 10 mg/day montelukast) or the control group (placebo group), during a 28-day treatment. Follow-up will finish 56 days after the start of treatment. The primary outcome will be health-related quality of life associated with respiratory symptoms according to the COPD Assessment Test 4 weeks after starting the treatment. The following are the secondary outcomes: (a) exercise capacity and oxygen saturation (1-min sit-to-stand test); (b) Post-COVID-19 Functional Status Scale; (c) other symptoms: asthenia, headache, mental confusion (brain fog), ageusia, and anosmia (Likert scale); (d) use of healthcare resources; (e) mortality; (f) sick leave duration in days; and (g) side effects of montelukast. ETHICS AND DISSEMINATION: This study has been approved by the Clinical Research Ethics Committee of the IDIAPJGol (reference number 21/091-C). The trial results will be published in open access, peer-reviewed journals and explained in webinars to increase awareness and understanding about long COVID among primary health professionals. TRIAL REGISTRATION: ClinicalTrials.gov NCT04695704 . Registered on January 5, 2021. EudraCT number 2021-000605-24. Prospectively registered.

A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with pc-BPPV: A randomised controlled trial in primary care / Impacto de la maniobra de Epley en la discapacidad autopercibida en pacientes con vértigo posicional paroxístico benigno: un ensayo controlado aleatorio en atención primaria

Objective: The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Design: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Participants: Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix–Hallpike test (DHT) were randomised to: Interventions: Intervention (EM) group or a control (sham manoeuvre) group. Main measurements: The main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory – screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P<.001). Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusions: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale.(AU)

Objetivo: El propósito del estudio fue comparar el impacto de la ME y una maniobra simulada en Atención Primaria sobre la discapacidad autopercibida. Diseño: Ensayo clínico aleatorizado, doble ciego y controlado realizado en Atención Primaria con un seguimiento de un año. Participantes:Los pacientes ≥18 años diagnosticados de pc-BPPV según la prueba de Dix-Hallpike (DHT) fueron aleatorizados para: Intervenciones: Grupo de intervención (EM) o un grupo de control (maniobra simulada). Variables principales: Las principales variables del estudio fueron la edad, el sexo, los antecedentes de depresión y ansiedad, la presencia de nistagmo en la DHT, la discapacidad percibida por el paciente, evaluada con la versión de cribado del Inventario de discapacidad del vértigo (DHI-S). Los datos se analizaron mediante análisis Tobit mixtos bivariados y multivariados. Resultados: Se estudió a 134 pacientes: 66 en el grupo de intervención y 68 en el grupo de control. La mediana de edad fue de 52 años (rango intercuartílico [IQR], 38,25-68,00 años; desviación estandar 16,98) y el 76,12% de los pacientes eran mujeres. La DHT desencadenó nistagmo en el 40,30% de los pacientes. La media del DHI-S para la muestra general al inicio del estudio fue de 16 (IQR 8,00-22,00); 16 (RIQ, 10,5-24,0) frente a 10 (6,0-14,0) para mujeres frente a hombres (p<0,001). Los pacientes tratados con ME experimentaron una reducción media de 2,03 puntos en la puntuación DHI-S durante el período de seguimiento en comparación con los pacientes del grupo simulado. Conclusiones: El Pc-BPPV afecta a la calidad de vida de los pacientes de Atención Primaria. Una sola ME puede mejorar la autopercepción de la discapacidad en alrededor de 2 puntos en la escala DHI-S.(AU)

Responses to the Dix-Hallpike test in primary care: A comparison between subjective and objective benign paroxysmal positional vertigo / Detección de nistagmo en respuesta a la prueba de Dix-Hallpike en atención primaria: una comparación entre vértigo posicional paroxístico benigno subjetivo y objetivo

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0–10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR=3.94, p=0.021) and antihypertensive therapy (OR 3.02, p=0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p=0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV.(AU)

A los pacientes que experimentan tanto vértigo como nistagmo en la prueba de Dix-Hallpike (DHT) se les diagnostica vértigo posicional paroxístico benigno objetivo (VPPB). Esta prueba provoca solamente vértigo entre el 11 y el 48% de los pacientes a los que se les diagnostica VPPB subjetivo. La detección de nistagmo tiene importantes implicaciones diagnósticas y pronósticas. Comparar las características de los pacientes diagnosticados de VPPB objetivo y subjetivo en Atención Primaria. Estudio descriptivo transversal. Ubicación: 2 centros urbanos de Atención Primaria. Participantes: adultos (≥18 años) diagnosticados de VPPB objetivo o subjetivo entre noviembre del 2012 y enero del 2015. Resultados de la DHT (vértigo o vértigo más nistagmo; variable dependiente: nistagmo como respuesta a la DHT), edad, sexo, tiempo desde el inicio, episodios de vértigo previos, gravedad del vértigo autoinformada (escala Likert, 0-10), comorbilidades (infección viral reciente, lesión cerebral traumática, dolor de cabeza, ansiedad/depresión, hipertensión, diabetes mellitus, dislipidemia, enfermedad cardiovascular, función tiroidea alterada, osteoporosis, espondilosis cervical, cervicalgia). Se incluyó a 134 pacientes (76,1% mujeres) con una edad media de 52 años. El 59,71% presentaba VPPB subjetivo. El VPPB objetivo se asoció significativamente con hipertensión, tratamiento antihipertensivo y espondilosis cervical en el análisis bivariado y con espondilosis cervical (OR=3,94, p=0,021) y tratamiento antihipertensivo (OR=3,02, p=0,028) en el análisis multivariado. Los pacientes con VPPB subjetivo tenían más probabilidades de estar tomando benzodiacepinas (OR=0,24, p=0,023). La prevalencia de VPPB subjetivo fue superior a la esperada. La espondilosis cervical y la terapia hipertensiva se asociaron con VPPB objetivo, mientras que las benzodiacepinas se asociaron con VPPB subjetivo.(AU)

Anquiloglòssia com a causa de deshidratació hipernatrèmica neonatal / Anquiloglosia como causa de la deshidratación hipernatrémica neonatal / Ankyloglossia as a cause of neonatal hypernatremic dehydration

Introducció: L’anquiloglòssia és una malformació lingualque pot causar dificultat en els moviments de la llengua ide la mandíbula dels nadons, i que provoca dolor als mugrons de la mare, una succió dèbil i una inadequada transferència de llet durant les preses al pit. Això pot ocasionaruna pèrdua de pes i un deslletament precoç si no es detecta i no es tracta. Presentem el cas de dos nadons ambanquiloglòssia i dificultats en la lactància materna que esvan complicar amb una deshidratació hipernatrèmica.Observació clínica: Ambdós nadons van patir una deshidratació hipernatrèmica sense signes d’infecció als deu diesde vida. Tots dos tenien anquiloglòssia, no tractada en elprimer cas, i no diagnosticada en el segon. L’anquiloglòssiadel segon cas es va diagnosticar posteriorment, arran de lapresentació del primer. La frenectomia feta al primer casva permetre la relactació completa, cosa que no es va aconseguir en el segon.Comentaris: Les dificultats que el tel sublingual curt potprovocar a la lactància poden ocasionar una deshidratacióhipernatrèmica greu. És important detectar l’anquiloglòssiaper poder fer un seguiment estret d’aquests nadons i tractar els casos simptomàtics. L’exploració del tel sublingualhauria de ser sistemàtica en l’exploració física inicial detots els nounats.(AU)

Introducción: La anquiloglosia es una malformación lingual quepuede causar dificultad en los movimientos de la lengua y de lamandíbula de los recién nacidos, provocando dolor en los pezonesde la madre, una succión débil y una inadecuada transferencia deleche durante las tomas al pecho. Ello puede ocasionar una pérdida de peso y un destete precoz si no se detecta y no se trata.Presentamos el caso de dos recién nacidos con anquiloglosia ydificultades en la lactancia materna que se complicaron con unadeshidratación hipernatrémica Observación clínica: Ambos sufrieron una deshidratación hipernatrémica sin signos de infección a los diez días de vida. Ambostenían anquiloglosia, sin tratar en el caso 1 y sin diagnosticar enel caso 2. La anquiloglosia del segundo caso se diagnosticó posteriormente, tras la presentación del primero. La frenectomía realizada en el primer caso permitió la relactación completa, que no selogró en el segundo.Comentarios: Las dificultades que el frenillo sublingual corto puedeprovocar en la lactancia pueden ocasionar una deshidratación hipernatrémica grave. Es importante detectar la presencia de anquiloglosia para poder realizar un seguimiento estrecho de estos recién nacidos y tratar los casos sintomáticos. La exploración delfrenillo sublingual debería de ser sistemática en la exploración física inicial de todos los neonatos.(AU)

Introduction: Ankyloglossia is a lingual malformation that may causedifficulty in tongue and mandibular movements in the newborn resulting in nipple pain in the mother, weak suction and inadequatemilk transfer during breastfeeding, which may lead to weight lossand an early cessation of breastfeeding if undetected and untreated.We report the case of two tonguetied neonates with breastfeedingdifficulties that presented with neonatal hypernatremic dehydration.Case report: Both infants experienced a hypernatremic dehydration, with no signs of infection, at 10 days of life. Both had ankyloglossia, which was untreated in case 1 and undiagnosed in case 2.The undetected ankyloglossia of case 2 was diagnosed a posterioriafter the identification of case 1. The frenotomy eventually performed in case 1 enabled complete relactation, which was not achieved in case 2.Comments: Breastfeeding difficulties caused by tonguetie maylead to severe hypernatremic dehydration. It is important to detectthe presence of ankyloglossia in all affected newborns so thatsymptomatic cases can be closely monitored and treated. Screening for ankyloglossia should be routinely performed at the initialphysical examination of all neonates.(AU)

A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with pc-BPPV: A randomised controlled trial in primary care.

Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment is the Epley manoeuvre (EM). OBJECTIVE: The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. DESIGN: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. PARTICIPANTS: Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to: INTERVENTIONS: Intervention (EM) group or a control (sham manoeuvre) group. MAIN MEASUREMENTS: The main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory - screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. RESULTS: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25-68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00-22.00); 16 [IQR, 10.5-24.0] vs 10 [6.0-14.0] for women vs men (P<.001). Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. CONCLUSIONS: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale.

Effectiveness of a brief advance directive intervention in primary care: a randomized clinical trial.

OBJECTIVE: To measure the effectiveness of a brief intervention aimed at increasing interest in and use of advanced directives (AD) among primary care patients. METHODS: Randomized controlled trial. In the intervention arm, patients were given brief oral information and a leaflet on AD by General Practitioners (GPs), in the control group were briefly informed about the study's purpose. Outcome variables were the proportion of patients who expressed interest in AD and those who completed one. Covariates were sex, age, education, race, Charlson comorbidity index (CCI), religion, and possession of financial will. RESULTS: Overall, 332 patients were recruited; 58 in the intervention and 36 in the control group expressed interest in AD (p = 0.033) and 18 (5.4 %) made an AD (nine in each group). Variables associated with interest were Caucasian race (odds ratio [OR], 1.88), the intervention (OR, 1.86), and CCI extreme scores (OR, 0.36). Variables associated with AD completion were primary education/no schooling (OR, 5.69) and fewer children (OR, 0.57). CONCLUSIONS: A brief oral and written intervention delivered by GP significantly increased interest in AD and achieved a completion rate of 5.4 %, without differences with the control group. PRACTICE IMPLICATIONS: AD interventions should focus on individuals already likely to be motivated.

Disability perceived by primary care patients with posterior canal benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Little is known on how posterior canal BPPV affects health-related quality of life in patients diagnosed and treated at primary care facilities or on whether patients with subjective and objective disease perceive the effects differently. This study was designed to describe how patients diagnosed with posterior canal BPPV in primary care perceive disability. METHODS: Cross-sectional descriptive study performed at two urban primary care centers. Participants were patients aged 18 years or older with suspected posterior canal BPPV recruited for baseline evaluation in a clinical trial on the effectiveness of the Epley maneuver in primary care. The recruitment period was from November 2012 to January 2015. Perceived disability was evaluated using the Dizziness Handicap Inventory - Screening version (DHI-S). Other variables collected were age and sex, a history or diagnosis of anxiety or depression, treatment with antidepressants and/or anxiolytics, and results of the Dix-Hallpike (DH) test, which was considered positive when it triggered vertigo with or without nystagmus and negative when it triggered neither. RESULTS: The DH test was positive in 134 patients, 40.30% of whom had objective BPPV (vertigo with nystagmus). The median age of the patients was 52 years (interquartile range [IQR], 39.00-68.50 years) and 76.1% were women. The median total score on the DHI-S was 16 out of 40 (IQR, 8.00-22.00). Scores were higher (greater perceived disability) in women (p < 0.001) and patients with subjective BPPV (vertigo without nystagmus) (p = 0.033). The items perceived as causing the greatest disability were feeling depressed (67.1%) and worsening of the condition on turning over in bed (88%). CONCLUSIONS: Patients diagnosed with posterior canal BPPV in primary care perceive their condition as a disability according to DHI-S scores, with higher levels of disability reported by women and patients with subjective BPPV. Feelings of depression and turning over in bed were associated with the greatest perceived difficulties. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513.

Impact of IPDE-SQ personality disorders on the healthcare and societal costs of fibromyalgia patients: a cross-sectional study.

BACKGROUND: Data is lacking on comorbid personality disorders (PD) and fibromyalgia syndrome (FMS) in terms of prevalence, and associated healthcare and societal costs. The main aim of this study was to assess the prevalence of PD in FMS patients and to analyse whether the presence of comorbid PD is related to worse functional impairment and greater healthcare (medical visits, drug consumption, and medical tests) and societal costs. METHODS: A cross-sectional study was performed using the baseline data of 216 FMS patients participating in a randomized, controlled trial carried out in three primary health care centres situated in the region of Barcelona, Spain. Measurement instruments included the International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ), the Fibromyalgia Impact Questionnaire (FIQ), the Client Service Receipt Inventory (CSRI), and a socio-demographic questionnaire. RESULTS: Most patients (65 %) had a potential PD according to the IPDE-SQ. The most prevalent PD were the avoidant (41.4 %), obsessive-compulsive (33.1 %), and borderline (27 %). We found statistically significant differences in functional impairment (FIQ scores) between FMS patients with potential PD vs non-PD (59.2 vs 51.1; p < 0.001). Multivariate regression analyses revealed that higher FIQ total scores and the presence of potential PD were related to more healthcare costs (primary and specialised care visits). CONCLUSIONS: As expected, PD are frequent comorbid conditions in patients with FMS. Our results suggest that the screening of comorbid PD in patients with FMS might be recommendable in order to detect potential frequent attenders to primary and specialised care.

Riesgo de depresión en personas de 75 años o más, valoración geriátrica integral y factores de vulnerabilidad asociados en Atención Primaria / Risk of depression in 75 years or older persons, comprehensive geriatric assessment and associated factors in primary care: cross sectional study

OBJETIVOS: Conocer la prevalencia de riesgo de depresión, características principales y factores de vulnerabilidad geriátrica asociados. DISEÑO: Subestudio derivado de un estudio sobre valoración geriátrica integral. Emplazamiento: Centro de Atención Primaria. PARTICIPANTES: Para una prevalencia estimada del 14% se precisaba muestra de 288 pacientes. De 3854 se seleccionaron 290 personas ≥ 75 años. Excluidos: terminales, quimioterapia, cirugía reciente, desplazados, retraso mental/enfermedad psiquiátrica grave y régimen de atención domiciliaria. Mediciones: Variable de resultado: riesgo de depresión (≥ 2 puntos en subescala de depresión de Goldberg). Variables dependientes: sociodemográficas y cinco áreas de estudio de la valoración geriátrica integral: médica -comorbilidad, polifarmacia, caídas e ingresos-, funcional -Test Up&Go, índices de Lawton-Brody y Barthel-, nutricional -Mini Nutritional Assessment (MNA)-, mental-afectiva -cuestionario Pfeiffer y escalas Goldberg- y social. Análisis descriptivo y regresión logística. RESULTADOS: Realizadas 290 entrevistas, con 102 (35,1%) hombres y edad media de 79,41 años (DE : 3,2). Prevalencia del riesgo de depresión: 37,2%, siendo 26,5% en hombres y 43,1% en mujeres (p = 0,005). Observamos asociación de riesgo de depresión con: hipertensión arterial (OR: 3,87 IC 95%: 1,61-9,34), cáncer (OR: 4,12 IC 95%: 1,58-10,76), falta de actividad de ocio (OR: 2,75 IC 95%: 1,33-5,67), subir en la escala de ansiedad (OR: 1,87 IC 95%: 1,57-2,22) y bajar en MNA (OR: 0,78 IC 95%: 0,68-0,9). CONCLUSIONES: La prevalencia del riesgo de depresión es mayor a lo esperado, pero se requiere confirmación con test diagnóstico. Apreciamos nuevas asociaciones del riesgo de depresión con variables de comorbilidad (hipertensión arterial y cáncer); corroboramos otras conocidas (viudedad y falta de apoyo social). Los factores asociados con el riesgo de depresión, deberían incluirse en futuros estudios sobre depresión geriátrica

OBJECTIVES: To determine the prevalence of the risk of depression, major defining characteristics and factors associated with. DESIGN: Sub-study of comprehensive geriatric assessment cross-study. SETTING: Primary health center. PARTICIPANTS: For an estimated 14% prevalence we need a sample of 288 people. From 3854, 290 people ≥ 75 years were selected. Excluding terminals, chemotherapy, recent surgery, temporary residence, mental retardation, serious psychiatric illness, or under home care. Measurement: Outcome: risk of depression (≥ 2 points on the Goldberg depression subscale. Dependent variables: Sociodemographic and five study areas of the Comprehensive Geriatric Assessment: medical -comorbidity, polypharmacy, falls and hospital admissions-, functional -Up&Go Test, Lawton-Brody and Barthel Index-, nutritional -Mini Nutritional Assessment (MNA)-, mental-affective -Pfeiffer Questionnaire and Goldberg scale-, and social. Descriptive analysis and logistic regression. RESULTS: We obtained 290 interviews, with 102 (35.1%) male and mean age of 79.4 years (SD: 3.2). The prevalence of the risk of depression was 37.2%, 26.5% in men and 43.1% in women (p = 0.005). Association of risk of depression is observed with arterial hypertension (OR : 3.87 95% CI : 1.61-9.34), cancer (OR : 4.12 95%, CI : 1.58-10.76), lack of leisure activity (OR : 2.75 95%, CI : 1.33-5.67), increase of anxiety scale (OR : 1.87 95%, CI : 1.57-2.22) and decrease in MNA (OR : 0.78 95%, CI : 0.68-0.9). CONCLUSIONS: The prevalence of risk of depression is higher than expected, although overestimated until being confirmed with a diagnostic test. We appreciate new associations of comorbidity variables with risk of depression and corroborate other known. The studied factors that were associated with the risk of depression should be included in future studies of geriatric depression

Criterios a considerar en la elección de especialidad y Unidad Docente del futuro residente de Atención Primaria / Criteria for consideration in the choice of specialty and future resident Teaching Unit Primary Care

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[Risk of depression in 75 years or older persons, comprehensive geriatric assessment and associated factors in primary care: cross sectional study]. / Riesgo de depresión en personas de 75 años o más, valoración geriátrica integral y factores de vulnerabilidad asociados en Atención Primaria.

OBJECTIVES: To determine the prevalence of the risk of depression, major defining characteristics and factors associated with. DESIGN: Sub-study of comprehensive geriatric assessment cross-study. SETTING: Primary health center. PARTICIPANTS: For an estimated 14% prevalence we need a sample of 288 people. From 3854, 290 people ≥75 years were selected. Excluding terminals, chemotherapy, recent surgery, temporary residence, mental retardation, serious psychiatric illness, or under home care. OUTCOME: risk of depression (≥2 points on the Goldberg depression subscale. DEPENDENT VARIABLES: Sociodemographic and five study areas of the Comprehensive Geriatric Assessment: medical -comorbidity, polypharmacy, falls and hospital admissions-, functional -Up&Go Test, Lawton-Brody and Barthel Index-, nutritional -Mini Nutritional Assessment (MNA)-, mental-affective -Pfeiffer Questionnaire and Goldberg scale-, and social. Descriptive analysis and logistic regression. RESULTS: We obtained 290 interviews, with 102 (35.1%) male and mean age of 79.4 years (SD:3.2). The prevalence of the risk of depression was 37.2%, 26.5% in men and 43.1% in women (p=0.005). Association of risk of depression is observed with arterial hypertension (OR:3.87 95% CI:1.61-9.34), cancer (OR:4.12 95%, CI:1.58-10.76), lack of leisure activity (OR:2.75 95%, CI:1.33-5.67), increase of anxiety scale (OR:1.87 95%, CI:1.57-2.22) and decrease in MNA (OR:0.78 95%, CI:0.68-0.9). CONCLUSIONS: The prevalence of risk of depression is higher than expected, although overestimated until being confirmed with a diagnostic test. We appreciate new associations of comorbidity variables with risk of depression and corroborate other known. The studied factors that were associated with the risk of depression should be included in future studies of geriatric depression.

Effectiveness of a brief primary care intervention to reduce passive smoking in babies: a cluster randomised clinical trial.

BACKGROUND: Tobacco smoke pollution (TSP) has major negative effects on infant health. Our objectives were to determine the effectiveness of a brief primary care intervention directed at parents who smoke in reducing babies' TSP exposure, and to establish variables related to greater exposure. METHOD: A multicentre, open, cluster-randomised clinical trial in Catalonia. The 83 participating primary health paediatric teams of the Catalan Health Service recruited 1101 babies whose parents were smokers. The intervention group (IG) received a brief TSP intervention; the control group (CG) received the usual care. Outcomes were measured by parents' reported strategies to avoid TSP exposure. Baseline clinical data and characteristics of each baby's TSP exposure were collected, along with infant hair samples and parents' tobacco use and related attitudes/behaviours. At 3-month and 6-month follow-up, behavioural changes to avoid TSP exposure were recorded; the association between reported parental behaviours and nicotine concentration in infant hair samples was tested in a random sample of 253 babies at baseline and 6 months. RESULTS: During follow-up, TSP-avoidance strategies improved more in the IG than in the CG: 35.4% and 26.9% ( p=0.006) at home, and 62.2% and 53.1% in cars (p=0.008). Logistic regression showed adjusted ORs for appropriate measures in the IG versus CG of 1.59 (95% CI 1.21 to 2.09) at home and 1.30 (95% CI 0.97 to 1.75) in cars. Hair samples showed that 78.7% of the babies tested were exposed. Reduced nicotine concentration was associated with improved implementation of effective strategies reported by parents at home (p=0.029) and in cars (p=0.014). CONCLUSIONS: The intervention produced behavioural changes to avoid TSP exposure in babies. The proportion of babies with nicotine (>=1ng/mg) in hair samples at baseline is a concern. TRIAL REGISTRATION NUMBER: Clinical Trials.gov Identifier: NCT00788996.

Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial.

BACKGROUND: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. DISCUSSION: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513.

Prevalencia de pacientes con alta complejidad y/o alta dependencia para la gestión de casos en atención primaria / Prevalence of patients with high complexity and/or high dependency for case management in primary care

Objetivo. Identificar el porcentaje de personas adultas con alta complejidad y/o alta dependencia en población ≥ 18 años tributaria del modelo de gestión de casos. Método. Estudio descriptivo, observacional, transversal. Ámbito comunitario. Muestreo aleatorio simple. Tamaño muestral: 551 individuos (tasa de reposición por pérdidas del 40%). Variables dependientes: Alta complejidad ≥ 4criterios: edad, comorbilidad, polifarmacia, proceso terminal, ingresos hospitalarios, visitas a urgencias, caídas, dependencia funcional, deterioro cognitivo, vivir solo. Alta dependencia (Barthel ≤ 30 y/o Pfeiffer ≥ 8). Análisis: descriptivo, variables y factores asociados. IC 95%. Índice de Kappa para estudiar la correlación entre variables. Resultados. Participaron 327. X edad=49años (DE=18) y 179 (54,7%) mujeres. Presentaban alta complejidad 6 personas (1,8%, IC 95%: 0,38-3,29), 4 (67%) mujeres, 5; (83%) > 75 años, y 1 < 65 años. X edad=79,5 (DE=12,6). Presentaban alta dependencia 5 mujeres (1,5%, IC 95%: 0,49-3,53), 4 mujeres (80%) > 75 años y 1 < 65 años. X edad=82 años (DE 14,8). Presentaban alta complejidad y/o alta dependencia 7 personas (2,14%, IC 95%: 0,86-4,3), 5 mujeres (71,4%); 6 > 75 años y 1 < 65 años. X edad=81,3 años (DE=12,4). Prevalencia en > 65 años (8,3%) y en < 65 (0,6%) (p=0,001). El índice de correlación de Kappa entre las variables de alta complejidad y alta dependencia fue del 0,723. Discusión. El porcentaje de pacientes que presentan alta complejidad y/o alta dependencia sobre población general es relevante, aunque inferior al esperado. En la planificación de futuros programas de gestión de casos habrá que considerar, además de las personas con alta complejidad, las personas con alta dependencia y las menores de 65 años (AU)

Objective. To identify the percentage of the population over 18 years with high complexity or high dependency using the case management model. Method. Observational, cross-sectional, descriptive study. Community level. Simple random sampling. Sample size calculation: 551 individuals were needed, with a rate of replacement for losing participation of 40%. Variables: High complexity ≥ 4 of following criteria: age, comorbidity, high drug consumption, terminal disease, hospital admissions, visits to Emergency Departments, falls, functional dependency, mental deterioration, to live alone or with family with capacity for limited support; High dependency (Barthel ≤ 30 and/or Pfeiffer ≥ 8; social-demographic variables; health services use; chronic diseases; specific treatments and caregiver data. Analysis: Descriptive for all variables and associated factors (95% CI). Correlation between variables was studied using the Kappa index. Results. A total of 327 patients were studied, with a mean age of 49 years (SD=18), of whom 179 (54.7%) were women. Six individuals had high complexity (1.8%, 95% CI: 0.38%-3.29%), 4 women (67%), 5>75 years old (83%) and 1<65 years old, mean age=79.5 years (SD=12.6). Five women presented high dependency (1.5%, 95% CI: 0.49-3.53), 4>75 years old (80%) and 1<65 years old, mean age= 82 years (SD=14.8). Seven individuals in total presented high complexity and/or high dependency criteria (2.14%, 95% CI: 0.86-4.3), 5 women (71.4%); 6>75 years old and 1<65 years old, mean age=81.3 years (SD=12.4). Prevalence > 65 years (8.3%) and < 65 (0.6%) (P=.001). Correlation Kappa Index between high complexity and high dependency variables was 0.723. Discussion. The percentage of patients who had high complexity or high dependency compared to the general population is significant, although lower than expected. In the planning of future programs for case management those persons who have high dependency and aged less than 65 years should also be taken into account along with those who have high complexity (AU)