Examining the influence of mental health and structural determinants of health on the stage of motivational readiness for health behaviour changes: A path analysis study.

This study explores the influence of mental health and structural determinants of health on motivational readiness for health behaviour change in 1462 Spanish primary healthcare users. Chi-square test and structural equation modelling were performed. Results showed that depression and anxiety were negatively associated with being in the action stages of motivational readiness for a healthy diet and physical activity. This association was statistically significant only for motivational readiness for a healthy diet and depression (ß=-0.076;p=0.046). Furthermore, women and workers were more likely to be in the action stages of motivational readiness for a healthy diet while older adults and adults with higher health-related quality of life were more likely to be in the action stages of motivational readiness for physical activity. The present study suggests that structural (being older, being a woman and being employed) and intermediary (suffering from depression and higher health-related quality of life) determinants of health influence motivational readiness for health behaviour changes.

La Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP): una red de referencia e impulsora de la investigación en atención primaria / The Research Network on Preventive Activities and Health Promotion (redIAPP): a reference network and promoter of primary care research

La Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), una red de referencia e impulsora de la investigación en atención primaria fue creada en 2003 gracias al programa Redes Temáticas de Investigación Cooperativa en Salud (RETICS) del Instituto de Salud Carlos III (ISCIII). Su creación ha supuesto un cambio radical en la situación de la investigación en atención primaria. A lo largo de sus 19 años (2003-2021) han participado distintos grupos de investigación y comunidades autónomas, y se han desarrollado distintas líneas de investigación con numerosos proyectos y publicaciones. A pesar de las dificultades sufridas, ha creado una experiencia de investigación colaborativa entre distintas comunidades autónomas con gran vitalidad y con importantes resultados para la atención primaria. La redIAPP, por tanto, ha sido un gran referente para la investigación en atención primaria y para la profundización de su área de conocimiento. Se sugieren varias líneas de mejora para el futuro de la investigación en atención primaria.(AU)

The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.(AU)

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis.

Introduction: The healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals' approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up. Methods: This protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC. Discussion: The analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.

[The Research Network on Preventive Activities and Health Promotion (redIAPP): a reference network and promoter of primary care research]. / La Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP): una red de referencia e impulsora de la investigación en atención primaria.

The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.

Knowledge and attitude about drug pollution in pharmacy students: A questionnaire-based cross sectional study.

INTRODUCTION: The environmental impact of drugs or pharmaceuticals is an issue of growing concern. Healthcare professionals, and pharmacists in particular, are used to managing medicines, yet aspects about drug pollution are generally neglected in schools of pharmacy worldwide. Formation in this issue is essential to tackle the problem. In this study, we aimed to find out the degree of knowledge about the problem of pharmaceuticals in the environment and the attitude about the matter of pharmacy students at the University of the Basque Country. METHODS: We conducted a pilot study (186 students) using an online questionnaire available in two languages (Basque and Spanish). The attitude scale was validated for Spanish. To improve participation, a combination of indirect and direct recruitment was applied in the final study. RESULTS: Four hundred eighty-seven students participated in the final study (response rate: 65.8%). The final questionnaire contained a total of 25 questions: 13 (knowledge), eight (attitude), and three (opinion). The results showed that knowledge can be considered relatively poor, whereas attitude was generally positive, and students considered drug pollution to be a relevant issue in general and in pharmacy practice. CONCLUSIONS: We believe there is an urgent need to include aspects about pharmaceuticals in the environment in pharmacy studies worldwide.

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial.

BACKGROUND: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".

The Relationship between Adherence to the Mediterranean Diet, Intake of Specific Foods and Depression in an Adult Population (45-75 Years) in Primary Health Care. A Cross-Sectional Descriptive Study.

BACKGROUND: The relationship between the quality of the diet and the adherence to the Mediterranean diet with the presence of persistent or recurrent depressive symptoms have been described. The objective of this study is to analyze the relationship between adherence to the Mediterranean diet and the intake of specific foods in primary care patients aged 45 to 75, having subclinical or major depression. The study also specifically analyzes this relationship in individuals suffering from chronic diseases. METHODS: A cross-sectional descriptive study was conducted. 3062 subjects met the inclusion criteria from the EIRA study. Sociodemographic variables, clinical morbidity, depression symptomatology (PHQ-9) and adherence to Mediterranean diet (MEDAS) were collected. RESULTS: Being female, younger, with a higher BMI, consuming more than 1 serving of red meat a day and drinking more than one carbonated or sugary drink daily, not consuming 3 servings of nuts a week and not eating 2 vegetables cooked in olive oil a week are predictors of having higher depressive symptomatology. CONCLUSIONS: Assessing the type of diet of patients presenting depressive symptoms and promoting adherence to a healthy diet is important, especially in patients with chronic diseases. However, depression is a very complex issue and the relationship between nutrition and depression must be further examined.

Using a smartphone app in changing cardiovascular risk factors: A randomized controlled trial (EVIDENT II study).

BACKGROUND AND OBJECTIVE: The last few years have seen the appearance many mobile applications aimed at improving health, but studies analyzing their effectiveness on cardiovascular risk factors (CVRFs) are few and far between. Our aim was to assess the effect on CVRFs such as hypertension, dyslipidemia, diabetes and global CVR, of adding the use of a smartphone app to an intervention consisting of standard counseling on physical activity and the Mediterranean diet. METHOD: This is a multicenter, randomized and controlled clinical trial. From January 2014 and September 2016, a total of 833 subjects selected by random sampling from six health centers participated. Of these, 415 were assigned to the counseling + app group (IG) and 418 to the counseling only group (CG). The IG additionally received training in the use of a mobile application. The main outcome was the change in CVRFs and estimated CVR at 3 and 12 months in the IG compared to the CG. RESULTS: No significant changes were observed at 3 or 12 months in terms of CVR. Nevertheless, an effect between groups was observed in favor of the CG at 12 months in some CVRFS: SBP, DBP, total cholesterol and triglycerides: 2.02 mmHg (95%CI: 0.43-3.61), 1.21 mmHg (95%CI: 0.20-2.24), 5.24 mg/dl (95%CI: 1.22-9.26) and 7.24 mg/dl (95%CI: 0.53-14.32). CONCLUSION: Adding an intervention with the use of an app for three months to standard counseling on diet and physical activity, does not provide additional benefits for improving CVRFs or the estimated CVR in the long term. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02016014.

Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial.

AIM: The purpose of this study was to assess the efficacy of the Spanish Diabetes Self-Management Program (SDSMP) versus usual care in adults with type 2 diabetes mellitus (T2DM) residing in a Spanish region. METHODS: A two-year follow-up randomised controlled trial. The intervention consisted of 6 weekly structured peer-to-peer workshops. The primary outcome was change in HbA1c levels. Secondary outcomes included other clinical measures, quality of life, self-efficacy, life-style changes, medication and use of healthcare services. Mixed effect models were fitted. RESULTS: n=297 patients were recruited in each study arm. Baseline HbA1c levels were comparable in both groups with an overall mean 7.1 (SD=1.2). The intervention did not significantly modify HbA1c, or other cardiovascular variables. Significant improvements were seen in self-efficacy, and in particularly its disease control component. Certain differences were also observed in the use of healthcare resources and medication consumption. High workshop participation and satisfaction rates were achieved. CONCLUSION: HbA1c reductions are difficult to obtain in adequately controlled patients. On the other hand, raising awareness on one's disease can increase disease control self-efficacy. This finding, accompanied by reduced medication consumption and healthcare use rates, highlights that usual care would be benefited by incorporating certain SDSMP aspects. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01642394.

A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country.

Purpose. The purpose of this study was to assess the feasibility of the Spanish Diabetes Self-Management Program (SDSMP) in the primary care setting of the Basque Health Service and offer initial estimations of the randomized controlled trial (RCT) effects. Methods. Ten health centers (HCs) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012. Recruitment was performed via invitation letters, health professionals, and the local media. Each intervention group consisted of 8-15 people. The ability of each HC in forming up to 2 groups, participants' compliance with the course, and coordination and data collection issues were evaluated. Glycated haemoglobin (HbA1c) was the main outcome variable. Secondary outcomes were cardiovascular risk factors, drugs consumption, medical visits, quality of life, self-efficacy, physical exercise, and diet. Results. Two HCs did not organize a course. A total of 173 patients initiated the program, 2 dropped out without baseline data, and 90% completed it. No pre-post HbA1c differences existed. Certain improvements were observed in blood pressure control, self-efficacy, physical activity, and some dietary habits. Conclusion. The SDSMP is feasible in our setting. Our experience can be of interest when planning and conducting this program in similar health settings. The trial is registered with ClinicalTrials.gov identifier NCT01642394.

Relationship between physical activity and plasma fibrinogen concentrations in adults without chronic diseases.

OBJECTIVE: To analyze the relationship between regular physical activity, as assessed by accelerometer and 7-day physical activity recall (PAR), and plasma fibrinogen concentrations. METHODS: A cross-sectional study in a previously established cohort of healthy subjects was performed. This study analyzed 1284 subjects who were included in the EVIDENT study (mean age 55.0±13.6 years; 60.90% women). Fibrinogen concentrations were measured in blood plasma. Physical activity was assessed with a 7-day PAR (metabolic equivalents (METs)/hour/week) and GT3X ActiGraph accelerometer (counts/minute) for 7 days. RESULTS: Physical exercise, which was evaluated with both an accelerometer (Median: 237.28 counts/minute) and 7-day PAR (Median: 8 METs/hour/week). Physical activity was negatively correlated with plasma fibrinogen concentrations, which was evaluated by counts/min (r = -0.100; p<0.001) and METs/hour/week (r = -0.162; p<0.001). In a multiple linear regression analysis, fibrinogen concentrations of the subjects who performed more physical activity (third tertile of count/minute and METs/hour/week) respect to subjects who performed less (first tertile), maintained statistical significance after adjustments for age and others confounders (ß = -0.03; p = 0.046 and ß = -0.06; p<0.001, respectively). CONCLUSIONS: Physical activity, as assessed by accelerometer and 7-day PAR, was negatively associated with plasma fibrinogen concentrations. This relation is maintained in subjects who performed more exercise even after adjusting for age and other confounders.

Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country.

BACKGROUND: Type 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) has proven to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Health Service - Osakidetza (Spain). METHOD/DESIGN: This is a randomised clinical trial in which patients diagnosed with DM2, 18-79 years of age, from four health regions within the Basque Health Service will be randomised into two groups: an intervention group, who will follow the SDSMP, and a control group, who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region. The intervention consists of 2,5 hour-group sessions once a week for six weeks. The sessions cover target setting and problem solving techniques, promotion of physical exercise, basic knowledge of nutrition, proper use of medication, effective communication with relatives and health professionals, and basic knowledge about DM2 and its complications. This content is complemented by educational material: books, leaflets and CDs. The primary outcome measure will be the change in glycated haemoglobin (HbA1c), and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables, cardiovascular risk, quality of life, self-efficacy, number of consultations and drug prescriptions. The results will be analysed 6, 12 and 24 months after the intervention. DISCUSSION: If the intervention were to be effective, the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01642394.

Effect on cardiovascular risk of an intervention by family physicians to promote physical exercise among sedentary individuals.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of a program promoting physical activity (PEPAF) implemented by family physicians on cardiovascular risk reduction. METHODS: The cluster randomized clinical trial involved 56 family physicians randomly allocated to an intervention group (n=29) and a control group (n=27). Of the patients recruited, only those aged 30-74 years (1915 PEPAF and 1783 control) were included in the analysis. The intervention involved giving general advice about the benefits of physical activity to all patients and prescribed advice to a subgroup of patients (30%) who agreed to an additional consultation. Outcome measures included risk factors and cardiovascular risk assessed using the Framingham-D'Agostino scale. RESULTS: A significant decrease from baseline in systolic and diastolic blood pressure and pulse pressure was observed after 12 months in both groups (control group: -2.93 mmHg, -1.81 mmHg and -1.15 mmHg, respectively; PEPAF group: -3.35 mmHg, -1.4 mmHg, and -1.94 mmHg, respectively). The high-density lipoprotein cholesterol level increased (control group: +1.73 mg/dl; PEPAF group: +2.67 mg/dl), while the atherogenic index decreased (by 0.12 and 0.16 in the two groups, respectively), all from baseline (P< .05). Cardiovascular risk decreased by 0.68 (95% confidence interval [CI], 0.13-1.25) in the control group and 0.79 (95%CI, 0.22-1.35) in the PEPAF group. There was no significant difference in the improvement at 12 months between the groups. CONCLUSIONS: Patients' participation in the project was effective in improving control of risk factors and decreasing cardiovascular risk. No significant difference in outcome was observed between the control group and the group participating in the program promoting physical activity.

Efecto en el riesgo cardiovascular de una intervención para la promoción del ejercicio físico en sujetos sedentarios por el médico de familia / Effect on cardiovascular risk of an intervention by family physicians to promote physical exercise among sedentary individuals

Introducción y objetivos. Evaluar el efecto de un programa de promoción de la actividad física (PEPAF) realizado por médicos de familia en la disminución del riesgo cardiovascular. Métodos. Ensayo clínico por conglomerados en el que se asignó aleatoriamente a 56 médicos de familia a un grupo de intervención (n = 29) y un grupo de control (n = 27). Entre los pacientes reclutados, se analizó a los que estaban entre 30 y 74 años (1.915 PEPAF y 1.783 controles). Intervención: consejo sobre los beneficios de la actividad física a todos los pacientes y prescripción a un subgrupo que aceptó una consulta adicional (30%). Medidas: factores de riesgo y riesgo cardiovascular con la escala Framingham-D’Agostino. Resultados. A los 12 meses se observó un descenso significativo de las presiones arteriales sistólica y diastólica y la presión de pulso en los dos grupos (controles, 2,93, 1,81 y 1,15 mmHg; PEPAF, 3,35, 1,4 y 1,94 mmHg) respecto a la evaluación basal. Hubo incremento del colesterol de las lipoproteínas de alta densidad (controles, 1,73 mg/dl; PEPAF, 2,67 mg/dl) y descenso del índice aterogénico (controles, 0,12; PEPAF, 0,16) respecto al basal (p < 0,05). El riesgo cardiovascular disminuyó en el grupo control 0,68 (intervalo de confianza [IC] del 95%, 0,13-1,25) y en el PEPAF, 0,79 (IC del 95%, 0,22-1,35). No se observaron diferencias significativas en la mejoría a los 12 meses entre el grupo PEPAF y el de controles. Conclusiones. La inclusión de pacientes en el proyecto fue eficaz para mejorar el control de los factores de riesgo y reducir el riesgo cardiovascular; no se observaron diferencias entre el grupo de control y el que recibió promoción de la actividad física (AU)

Introduction and objectives. To evaluate the effect of a program promoting physical activity (PEPAF) implemented by family physicians on cardiovascular risk reduction. Methods. The cluster randomized clinical trial involved 56 family physicians randomly allocated to an intervention group (n=29) and a control group (n=27). Of the patients recruited, only those aged 30-74 years (1915 PEPAF and 1783 control) were included in the analysis. The intervention involved giving general advice about the benefits of physical activity to all patients and prescribed advice to a subgroup of patients (30%) who agreed to an additional consultation. Outcome measures included risk factors and cardiovascular risk assessed using the Framingham-D’Agostino scale. Results. A significant decrease from baseline in systolic and diastolic blood pressure and pulse pressure was observed after 12 months in both groups (control group: –2.93 mmHg, –1.81 mmHg and –1.15 mmHg, respectively; PEPAF group: –3.35 mmHg, –1.4 mmHg, and –1.94 mmHg, respectively). The high-density lipoprotein cholesterol level increased (control group: +1.73 mg/dl; PEPAF group: +2.67 mg/dl), while the atherogenic index decreased (by 0.12 and 0.16 in the two groups, respectively), all from baseline (P<.05). Cardiovascular risk decreased by 0.68 (95% confidence interval [CI], 0.13-1.25) in the control group and 0.79 (95%CI, 0.22-1.35) in the PEPAF group. There was no significant difference in the improvement at 12 months between the groups. Conclusions. Patients’ participation in the project was effective in improving control of risk factors and decreasing cardiovascular risk. No significant difference in outcome was observed between the control group and the group participating in the program promoting physical activity (AU)