Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis.

OBJECTIVE, AND MATERIAL AND METHODS: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library. SOURCE OF DATA: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform. SELECTION OF STUDIES: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed. DATA EXTRACTION: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies. Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure. RESULTS: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56-0.94. CONCLUSIONS: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease.

The Impact of Digital Health on Smoking Cessation.

BACKGROUND: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients' quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation-relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. OBJECTIVE: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. METHODS: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. RESULTS: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. CONCLUSIONS: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources.

Documento internacional de consenso sobre apnea obstructiva del sueño / International Consensus Document on Obstructive Sleep Apnea

El objetivo principal de este documento internacional de consenso sobre apnea obstructiva del sueño es proporcionar unas directrices que permitan a los profesionales sanitarios tomar las mejores decisiones en la asistencia de los pacientes adultos con esta enfermedad según un resumen crítico de la literatura más actualizada. El grupo de trabajo de expertos se ha constituido principalmente por 17 sociedades científicas y 56 especialistas con amplia representación geográfica (con la participación de 4 sociedades internacionales), además de un metodólogo experto y un documentalista del Centro Cochrane Iberoamericano. El documento consta de un manuscrito principal, con las novedades más relevantes, y una serie de manuscritos online que recogen las búsquedas bibliográficas sistemáticas de cada uno de los apartados del documento internacional de consenso. Este documento no cubre la edad pediátrica ni el manejo del paciente en ventilación mecánica crónica no invasiva (que se publicarán en sendos documentos de consenso aparte). Palabras clave: Apnea obstructiva del sueño Diagnóstico Tratamiento

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents). Keywords: Obstructive sleep apnea Diagnosis Treatment

International Consensus Document on Obstructive Sleep Apnea. / Documento internacional de consenso sobre apnea obstructiva del sueño.

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).

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

No disponible

Metabolic biomarkers in community obese children: effect of obstructive sleep apnea and its treatment.

OBJECTIVE: Obesity and obstructive sleep apnea in children have been associated with metabolic morbidities. The present study aimed to evaluate the presence of metabolic alterations among obese children recruited from the community, with and without obstructive sleep apnea syndrome (OSAS), and the impact of treatment of OSAS on metabolic profiles. METHODS: A cross-sectional, prospective, multicenter study of Spanish children aged 3-14 years with a body mass index (BMI) ≥95th percentile for age and sex were randomly selected in the first phase. Four groups emerged for follow-up: (1) no treatment; (2) dietary intervention; (3) surgical treatment of OSA; and (4) continuous positive airway pressure (CPAP) treatment of OSA. Fasting blood tests were performed at baseline (T0) and approximately one year after the intervention (T1). RESULTS: A total of 113 obese children with a mean age of 11.3 ± 2.9 years completed T0 and T1 assessments. Their mean BMI z-score at T1 was 1.34 ± 0.59, and mean Respiratory Disturbance Index was 8.6 ± 13.0 at T0 and 3.3 ± 4.0/hour total sleep time at T1. Only glucose fasting levels differed among metabolic parameters in obese children with OSAS and without OSAS at baseline (T0) (p = 0.018). There were statistically significant differences between surgically treated OSAS (p = 0.002), and CPAP-treated OSAS (p = 0.024) versus the non-OSAS group in the glucose levels between baseline (T0) and follow-up (T1) after controlling for age and change in BMI. Significant univariate associations between BMI and C-reactive protein, insulin, and homeostasis model assessment of insulin resistance emerged at both T0 and T1. CONCLUSIONS: Concurrent obesity and OSAS could promote metabolic and inflammatory alterations, and the latter appeared to be sensitive to OSAS treatment outcomes. ClinicalTrials.gov Identifier: NCT01322763.

Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study.

The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up.

Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children.

OBJECTIVE: The objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS: A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date, same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. The apnea-hypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coefficients, Bland-Altman plots, and receiver operator curves (ROCs). RESULTS: Twenty-seven boys and 23 girls, with a mean age of 5.3 ± 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defined obstructive respiratory disturbance index ≥ 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defined OSAS criterion was established as ≥ 5.6/h The latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specificity of 94.1% (95% CI, 80%-100%). CONCLUSIONS: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children.

Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study.

INTRODUCTION: Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. AIM: To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4-15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. RESULTS: 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). CONCLUSION: IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

Obstructive sleep apnea in obese community-dwelling children: the NANOS study.

INTRODUCTION: Obesity in children is assumed to serve as a major risk factor in pediatric obstructive sleep apnea syndrome (OSAS). However, the prevalence of OSAS in otherwise healthy obese children from the community is unknown. AIM: To determine the prevalence of OSAS in obese children identified and recruited from primary care centers. METHODS: A cross-sectional, prospective, multicenter study. Spanish children ages 3-14 y with a body mass index (BMI) greater than or equal to the 95th percentile for age and sex were randomly selected, and underwent medical history, snoring, and Pediatric Sleep Questionnaire (PSQ) assessments, as well as physical examination, nasopharyngoscopy, and nocturnal polysomnography (NPSG) recordings. RESULTS: Two hundred forty-eight children (54.4% males) with mean age of 10.8 ± 2.6 y were studied with a BMI of 28.0 ± 4.7 kg/m(2) corresponding to 96.8 ± 0.6 percentile when adjusted for age and sex. The mean respiratory disturbance index (RDI), obstructive RDI (ORDI), and obstructive apnea-hypopnea index (OAHI) were 5.58 ± 9.90, 5.06 ± 9.57, and 3.39 ± 8.78/h total sleep time (TST), respectively. Using ≥ 3/h TST as the cutoff for the presence of OSAS, the prevalence of OSAS ranged from 21.5% to 39.5% depending on whether OAHI, ORDI, or RDI were used. CONCLUSIONS: The prevalence of obstructive sleep apnea syndrome (OSAS) in obese children from the general population is high. Obese children should be screened for the presence of OSAS. ClinicalTrials.gov identifier: NCT01322763.

Respiratory polygraphy for follow-up of obstructive sleep apnea in children.

OBJECTIVES: (1) To evaluate the effectiveness of adenotonsillectomy for the treatment of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in children. (2) To evaluate the usefulness of respiratory polygraphy (RP) for controlling post-adenotonsillectomy effects. METHODS: The children studied were referred to the Burgos Sleep Unit (SU) with clinical suspicion of OSAHS before undergoing adenotonsillectomy. For all patients, a clinical history was taken and a general physical examination, as well as a specific ear, nose, and throat examination was done. RP before adenotonsillectomy, and seven months afterwards, was also done. OSAHS was diagnosed if the Apnea Hypopnea Index (AHI) was ≥ 4.6. RESULTS: Of the 100 children studied, 68 were male and 32 female, with an age of 4.17 ± 2.05 years. Using RP, 86 of them were diagnosed with OSAHS before undergoing adenotonsillectomy. There was a significant improvement in all clinical and polygraphic variables after adenotonsillectomy. The pre and post surgery AHI index was 11.9 ± 11.0 and 2.6 ± 1.5, respectively, with a significant mean difference (9.4 ± 10.9, p<0.01). The residual OSAHS was 11.6% (CI 95%: 4.3-19%). CONCLUSIONS: Respiratory polygraphy is a useful tool for monitoring the effectiveness of surgical treatment and the detection of residual OSAHS in children with adenotonsillar hypertrophy.

[Reliability of respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome in children]. / Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños.

OBJECTIVE: Overnight polysomnography (PSG) is the gold standard diagnostic tool for sleep apnea-hypopnea syndrome (SAHS) in children. The aim of the present study was to evaluate the usefulness of diagnostic respiratory polygraphy in children with clinically suspected SAHS referred to our sleep-disordered breathing clinic. PATIENTS AND METHODS: We studied 53 children referred with clinical suspicion of SAHS; 29 (54.7%) were boys and the mean (SD) age was 6.4 (2.9) years. After a medical history was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec) simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statistical analysis. RESULTS: SAHS was defined by an obstructive apnea-hypopnea index (OAHI) of 3 or more in overnight PSG and a respiratory disturbance index (RDI) of 3 or more in respiratory polygraphy. The rate of diagnostic agreement was 84.9%. The difference between the mean OAHI and RDI values was not significant (0.7 +/- 5.4; P=.34). The intraclass correlation coefficient between the OAHI and RDI was 89.4 (95% confidence interval, 82.4-93.7; P< .001). When receiver operating characteristic curves were calculated for the OAHI cutoff points used for the diagnosis of SAHS (> or =1, > or =3, and > or =5), the best RDI cutoff for all 3 OAHI values considered was found to be 4.6. When age strata were considered, in children 6 years or older the best RDI cutoff for the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI > or =1 and 5.85 for OAHI > or =3 and > or =5. CONCLUSIONS: Respiratory polygraphy in the sleep laboratory is a valid method for the diagnosis of SAHS in children.

Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños / Reliability of respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome in children

OBJETIVO: La polisomnografía (PSG) nocturna es la técnica diagnóstica de referencia del síndrome de apneas-hipopneas durante el sueño (SAHS) en niños. El objetivo del estudio ha sido evaluar la utilidad diagnóstica de la poligrafía respiratoria (PR) en niños con sospecha clínica de SAHS remitidos a la Unidad de Trastornos Respiratorios del Sueño. PACIENTES Y MÉTODOS: Se estudió a 53 niños remitidos por sospecha clínica de SAHS (29 varones; 54,7%), con una edad media ± desviación estándar de 6,4 ± 2,9 años. A todos ellos se les realizaron historia clínica, exploración física, PR (Edentec®) y PSG nocturna simultáneamente en el laboratorio de sueño. Se realizó el análisis estadístico para comparar ambas técnicas diagnósticas. RESULTADOS: Definiendo el diagnóstico de SAHS como la presencia de un índice de apneas-hipopneas obstructivas (IAHO) igual o mayor de 3 en la PSG y un índice de eventos respiratorios (IER) de 3 o superior en la PR, la coincidencia diagnóstica fue del 84,9%. La diferencia de medias entre el IAHO y el IER no fue significativa (0,7 ± 5,4; p = 0,34). El coeficiente de correlación intraclase entre el IAHO y el IER fue de de 89,4 (intervalo de confianza del 95%, 82,4-93,7; p < 0,001). Para el diagnóstico de SAHS se consideraron los valores de IAHO iguales o mayores de 1; iguales o mayores de 3, e iguales o mayores de 5. Se calcularon las curvas de eficacia diagnóstica para cada uno de ellos y 4,6 resultó ser el mejor IER para los 3 valores de IAHO considerados. Al analizar por estratos de edad, en niños de 6 años o más el mejor IER obtenido para los 3 valores de IAHO considerados fue 2,1. En niños menores de 6 años se obtuvieron los siguientes valores de IER: 3,35 para IAHO de 1 o superior y 5,85 para IAHO de 3 o mayor y de 5 o superior. CONCLUSIONES: La PR realizada en el laboratorio de sueño es un método válido para el diagnóstico de SAHS en niños

OBJECTIVE: Overnight polysomnography (PSG) is the gold standard diagnostic tool for sleep apnea-hypopnea syndrome (SAHS) in children. The aim of the present study was to evaluate the usefulness of diagnostic respiratory polygraphy in children with clinically suspected SAHS referred to our sleep-disordered breathing clinic. PATIENTS AND METHODS: We studied 53 children referred with clinical suspicion of SAHS; 29 (54.7%) were boys and the mean (SD) age was 6.4 (2.9) years. After a medical history was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec) simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statistical analysis. RESULTS: SAHS was defined by an obstructive apneahypopnea index (OAHI) of 3 or more in overnight PSG and a respiratory disturbance index (RDI) of 3 or more in respiratory polygraphy. The rate of diagnostic agreement was 84.9%. The difference between the mean OAHI and RDI values was not significant (0.7 ± 5.4; P=.34). The intraclass correlation coefficient between the OAHI and RDI was 89.4 (95% confidence interval, 82.4-93.7; P<.001). When receiver operating characteristic curves were calculated for the OAHI cutoff points used for the diagnosis of SAHS (³1, ³3, and ³5), the best RDI cutoff for all 3 OAHI values considered was found to be 4.6. When age strata were considered, in children 6 years or older the best RDI cutoff for the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI ³1 and 5.85 for OAHI ³3 and ³5. CONCLUSIONS: Respiratory polygraphy in the sleep laboratory is a valid method for the diagnosis of SAHS in children

Síndrome de apneas e hipopneas durante el sueño en niños / Sleep apnea-hypopnea syndrome in children

Los trastornos respiratorios del sueño, en particular el síndrome de apneas e hipopneas durante el sueño (SAHS), son frecuentes en la población infantil (su prevalencia se ha estimado en un 1-3%) y su causa más frecuente es la hipertrofia adenoamigdalar. Están infradiagnosticados y se asocian a importantes complicaciones, tales como alteraciones del crecimiento, alteraciones cognitivas e incluso, en casos graves, cor pulmonale. La polisomnografía nocturna es la técnica diagnóstica de elección para el diagnóstico del SAHS en los niños, pero en la población infantil es necesario tener en cuenta una serie de consideraciones, como la edad y el entorno adecuado. Además, los criterios diagnósticos del SAHS para adultos no son útiles. El tratamiento de elección en los niños con SAHS es la adenoamigdalectomía, que es curativa en un 70% de los casos (AU)

Sleep disordered breathing in children, especially sleep apnea-hypopnea syndrome (SAHS), is common, affecting 1-3% of the pediatric population. The most frequent cause is adenotonsillar hypertrophy. This disease is under-diagnosed and leads to important complications such as growth alterations, cognitive impairment and even, in severe cases, to cor pulmonale. Nocturnal polysomnography (PSG) is the technique of choice for diagnosing SAHS in children; however, in this population a series of considerations should be taken into account such as the age of the population to be studied and a suitable environment. The diagnostic criteria for SAHS in adults are not useful in children. The treatment of choice in children with SAHS is denotonsillectomy, which is curative in 70% (AU)

[Protocol to evaluate the effectiveness of a consciousness-raising and training intervention for primary care professionals, in order to improve detection of domestic violence (ISFVIDAP)]. / Protocolo para la evaluación de la efectividad de una intervención sensibilizadora y formativa en profesionales de atención primaria para la mejora de la detección de la violencia doméstica (ISFVIDAP).

OBJECTIVE: To evaluate the effectiveness of an intervention aimed at primary care physicians and nurses to improve the detection of domestic violence. DESIGN: Community intervention study with control, randomized in clusters, pragmatic, open, and with parallel groups. SETTING: Primary care centres in Spain. POPULATION: Primary care physicians and nurses from the entire country who agree to participate in the study. UNIT OF ANALYSIS: The basic care team (BCT) of doctor and nurse looking after a list is the unit of analysis for evaluating the number of cases detected; and their clinical records are the units of analysis for evaluating recorded cases (suspicion and/or confirmation of mistreatment). SAMPLE SIZE: Sixty eight BCT in each group (136 in the 2 groups) and 1700 clinical records per group (25 per BCT). Altogether, they will cover some 130,000 women of 14 and over. INTERVENTION: A short training programme with homogeneous training contents, aimed at raising the awareness of health professionals and teaching them how to identify risk factors, situations of special vulnerability and alarm signals. The programme also aims to provide health professionals with tools to make the clinical interview easier, when they suspect mistreatment and how to tackle a case once it is detected. MEASUREMENTS: The main measurement will be the mean variation between intervention and control groups in the number of cases of domestic violence detected during the study, through specific recording and mean variation between the initial and final variations in each group. ANALYSIS: A weighted student's t test or, if covariates need to be adjusted, a regression analysis will be used for comparison. All analyses will be based on intention to treat.

Protocolo para la evaluación de la efectividad de una intervención sensibilizadora y formativa en profesionales de atención primaria para la mejora de la detección de la violencia doméstica (ISFVIDAP)

Objetivo. Evaluar la efectividad de una intevención dirigida a médicos y enfermeras de atención primaria, orientada a mejorar la detección de la violencia doméstica. Diseño. Estudio de intervención comunitaria, controlado, aleatorizado en conglomerados, pragmático, abierto y de grupos paralelos. Emplazamientos. Centros de atención primaria de diferentes comunidades autónomas, coordinados a través de la Red de Investigación en Actividades Preventivas y de Promoción de la Salud realizadas en Atención Primaria (red IAPP). Sujetos. Médicos y enfermeras de atención primaria de todo el país que acepten participar en el estudio hasta completar la muestra prevista. Unidad de análisis. Unidad básica asistencial de atención primaria (UBA), formada por un médico y una enfermera que atienden un cupo, mediante registro específico para la evaluación de los casos detectados y mediante auditoría de historias clínicas para los casos registrados (sospecha y/o confirmación de maltrato). Tamaño de la muestra. En total, 136 UBA: 68 Uba experimentales y 68 UBA control, formadas por un médico de familia y una enfermera que atienden un cupo. Se incluyen 1.700 historias clínicas por grupo (25 por UBA) que en conjunto atienden a unas 130.000 mujeres ≥ 14 años. Intervención. Programa de formación breve con contenidos formativos homogéneos y estadarizados, dirigidos a sensibilizar al profesional, enseñar a identificar factores de riesgo y vulnerabilidad, signos y señales de alerta, proporcionar elementos facilitadores de la entrevista clínica ante sospecha de una situación de maltrato y a enseñar el abordaje del problema una vez detectado. Mediciones. La principal medida de resultado será la variación promedio en el número de casos de violencia detectados a lo largo del estudio entre el grupo de intervención y el grupo control, mediante registro específico y variación promdeio de los casos registrados en la historia clínica (a través de una auditoría) entre la evaluación final y la inicial de cada grupo. Análisis La comparación se realizará mediante una prueba de la t de Student ponderara o, en caso de ser necesario para ajustar covariables, un análisis de regresión. Todos los análisis se realizarán por intención de tratar.(AU)

Protocolo para la evaluación de la efectividad de una intervención sensibilizadora y formativa en profesionales de atención primaria para la mejora de la detección de la violencia doméstica (ISFVIDAP) / Protocol to evaluate the effectiveness of a consciousness-raising and training intervention for primary care professionals, in order to improve detection of domestic violence (ISFVIDAP)

Objetivo. Evaluar la efectividad de una intervención dirigida a médicos y enfermeras de atención primaria, orientada a mejorar la detección de la violencia doméstica. Diseño. Estudio de intervención comunitaria, controlado, aleatorizado en conglomerados, pragmático, abierto y de grupos paralelos. Emplazamiento. Centros de atención primaria, de diferentes comunidades autónomas, coordinados a través de la Red de Investigación en Actividades Preventivas y de Promoción de la Salud realizadas en Atención Primaria (redIAPP). Sujetos. Médicos y enfermeras de atención primaria de todo el país que acepten participar en el estudio hasta completar la muestra prevista. Unidad de análisis. Unidad básica asistencial de atención primaria (UBA), formada por un médico y una enfermera que atienden un cupo, mediante registro específico para la evaluación de los casos detectados y mediante auditoría de historias clínicas para los casos registrados (sospecha y/o confirmación de maltrato). Tamaño de la muestra. En total, 136 UBA: 68 UBA experimentales y 68 UBA control, formadas por un médico de familia y una enfermera que atienden un cupo. Se incluyen 1.700 historias clínicas por grupo (25 por UBA) que en conjunto atienden a unas 130.000 mujeres >= 14 años. Intervención. Programa de formación breve con contenidos formativos homogéneos y estandarizados, dirigidos a sensibilizar al profesional, enseñarle a identificar factores de riesgo y vulnerabilidad, signos y señales de alerta, proporcionar elementos facilitadores de la entrevista clínica ante sospecha de una situación de maltrato y a enseñar el abordaje del problema una vez detectado. Mediciones. La principal medida de resultado será la variación promedio en el número de casos de violencia detectados a lo largo del estudio entre el grupo de intervención y el grupo control, mediante registro específico y variación promedio de los casos registrados en la historia clínica (a través de una auditoría) entre la evaluación final y la inicial para cada grupo. Análisis. La comparación se realizará mediante una prueba de la t de Student ponderada o, en caso de ser necesario para ajustar covariables, un análisis de regresión. Todos los análisis se realizarán por intención de tratar

Objective. To evaluate the effectiveness of an intervention aimed at primary care physicians and nurses to improve the detection of domestic violence. Design. Community intervention study with control, randomized in clusters, pragmatic, open, and with parallel groups. Setting. Primary care centres in Spain. Population. Primary care physicians and nurses from the entire country who agree to participate in the study. Unit of analysis. The basic care team (BCT) of doctor and nurse looking after a list is the unit of analysis for evaluating the number of cases detected; and their clinical records are the units of analysis for evaluating recorded cases (suspicion and/or confirmation of mistreatment). Sample size. Sixty eight BCT in each group (136 in the 2 groups) and 1700 clinical records per group (25 per BCT). Altogether, they will cover some 130 000 women of 14 and over. Intervention. A short training programme with homogeneous training contents, aimed at raising the awareness of health professionals and teaching them how to identify risk factors, situations of special vulnerability and alarm signals. The programme also aims to provide health professionals with tools to make the clinical interview easier, when they suspect mistreatment and how to tackle a case once it is detected. Measurements. The main measurement will be the mean variation between intervention and control groups in the number of cases of domestic violence detected during the study, through specific recording and mean variation between the initial and final variations in each group. Analysis. A weighted student's t test or, if covariates need to be adjusted, a regression analysis will be used for comparison. All analyses will be based on intention to treat