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1.
Artigo em Inglês | MEDLINE | ID: mdl-34639836

RESUMO

The World Health Organization (WHO) estimated that physical inactivity (PI) is responsible for 20 to 30% of all non-communicable diseases. We aimed to analyze the effectiveness of a multiple health behavior change (MHBC) intervention to increase physical activity (PA) in patients 45 to 75 years old who had at least 2 of 3 unhealthy behaviors (tobacco use, reduced fruit and vegetable consumption, and insufficient PA). The MHBC intervention is based on the Transtheoretical Model and the conceptual framework of the "5 A's" and includes an individually tailored intervention, group sessions, and the use of community resources. We included 3062 participants, 1481 in the intervention group and 1581 in the control group. After 12 months, there were no differences in PA intensity measured by metabolic_equivalent_of_task_minutes/week (adjusted mean difference: 284.093, 95% CI: -298.24, 866.42) nor in the proportion of participants who increased PA levels to moderate or high (OR: 1.02, 95% CI: 0.85, 1.23; p = 0.822), and no differences in blood pressure, weight loss, or waist circumference. We found an increased proportion of patients in the intervention group who followed the WHO recommendations for PA (OR: 1.29; 95% CI: 1.04, 1.60; p = 0.02). We concluded that the intervention did not lead to a significant increase in PA.

2.
R Soc Open Sci ; 8(9): 210537, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34540251

RESUMO

Virtual reality applications depend on multiple factors, for example, quality of rendering, responsiveness, and interfaces. In order to evaluate the relative contributions of different factors to quality of experience, post-exposure questionnaires are typically used. Questionnaires are problematic as the questions can frame how participants think about their experience and cannot easily take account of non-additivity among the various factors. Traditional experimental design can incorporate non-additivity but with a large factorial design table beyond two factors. Here, we extend a previous method by introducing a reinforcement learning (RL) agent that proposes possible changes to factor levels during the exposure and requires the participant to either accept these or not. Eventually, the RL converges on a policy where no further proposed changes are accepted. An experiment was carried out with 20 participants where four binary factors were considered. A consistent configuration of factors emerged where participants preferred to use a teleportation technique for navigation (compared to walking-in-place), a full-body representation (rather than hands only), the responsiveness of virtual human characters (compared to being ignored) and realistic compared to cartoon rendering. We propose this new method to evaluate participant choices and discuss various extensions.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34360136

RESUMO

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach's alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86-0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1-95.1%) and specificity was 76.7% (CI 95%, 73.3-79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.


Assuntos
Lista de Checagem , Depressão , Estudos Transversais , Depressão/diagnóstico , Humanos , Atenção Primária à Saúde , Psicometria , Reprodutibilidade dos Testes , Espanha , Inquéritos e Questionários
4.
Nutrients ; 13(8)2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34444884

RESUMO

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.


Assuntos
Depressão/dietoterapia , Dieta Saudável/estatística & dados numéricos , Dieta Mediterrânea/psicologia , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Estudos Transversais , Depressão/psicologia , Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia
5.
J Adv Nurs ; 77(6): 2898-2907, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33675247

RESUMO

AIM: To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain. DESIGN: We will carry out a two-week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention. METHODS: The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID-19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire-primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. DISCUSSION: Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context. IMPACT: Despite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. CLINICAL TRIAL REGISTRATION: NCT04393818 (ClinicalTrials.gov identifier). APPROVED FUNDING: May 2020.


Assuntos
COVID-19 , Pessoal de Saúde , Humanos , Saúde Mental , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Espanha , Resultado do Tratamento
6.
J Infect ; 82(3): 391-398, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33592253

RESUMO

OBJECTIVES: We aimed to evaluate the accuracy of the Panbio™ Ag-RDT at primary health care (PHC) centers and test sites in symptomatic patients and close contacts, using the Reverse-Transcription Polymerase Chain Reaction (RT-PCR) test as the gold standard. METHODS: The study was conducted in four PHC centers and two test sites in Mallorca, Spain. Consecutive patients older than 18 years, attending the sites for RT-PCR testing were included. Two nasopharyngeal samples were collected, one for RT-PCR and the other was processed on-site using the Panbio™ rapid antigen test kit for SARS-CoV-2. The sensitivity and specificity were calculated using RT-PCR as the reference, and the predictive values using the pretest probability results for each analyzed group. FINDINGS: A total of 1369 participants were included; mean age 42.5 ±â€¯14.9 years and 54.3% women. The overall prevalence was 10.2%. Most participants (70.6%) presented within 5 days of the onset of symptoms. The overall sensitivity was of 71.4% (95% CI: 63.1%, 78.7%), the specificity of 99.8% (95% CI: 99.4%, 99.9%), the positive predictive value of 98.0% (95% CI: 93.0%, 99.7%) and a negative predictive value of 96.8% (95% CI: 95.7%, 97.7%). The sensitivity was higher in symptomatic patients, in those arriving within 5 days since symptom onset and in those with high viral load. INTERPRETATION: Ag-RDT had relatively good performance characteristics in suspected symptomatic patients within five days since the onset of symptoms. However, our data do not support the sole use of Panbio™ Ag-RDT in asymptomatic individuals. FUNDING: None.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Sensibilidade e Especificidade , Espanha
7.
BMC Res Notes ; 13(1): 376, 2020 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-32771042

RESUMO

OBJECTIVE: To compare the presence of comorbidities and self-perceived health and social support between long-term cancer survivors and people without a history of cancer from a clinical trial examining the effects of a multiple risk behavior intervention. RESULTS: Of the 4259 people studied, 190 (4.46%) were cancer survivors. They had a mean ± SD age of 62.8 ± 7 years vs. 58.7 ± 8 years (P < 0.01) for non-cancer people and were more likely to be on long-term sick leave (11.9 vs. 3.5%, P < 0.001). No differences were observed for smoking, adherence to the Mediterranean diet, physical activity, obesity, or social support. Cancer survivors were more likely to have worse self-perceived health (OR 1.82; 95% CI 1.02-2.75), more comorbidities (OR 1.68; 95% CI 1.18-2.39), COPD (OR 2.17; 95% CI 1.25-3.78), and depression (OR 1.65; 95% CI 1.06-2.57). Older age and worse self-perceived health were independent predictors of survivorship in the adjusted analysis.


Assuntos
Sobreviventes de Câncer , Neoplasias , Idoso , Estudos Transversais , Hábitos , Nível de Saúde , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Qualidade de Vida , Apoio Social , Sobreviventes
8.
Br J Gen Pract ; 70(suppl 1)2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32554688

RESUMO

BACKGROUND: Primary care is the ideal setting for promotion and prevention intervention. Multiple risk behaviour interventions present several advantages over single-risk lifestyle interventions. Multiple risk behaviour interventions could be easily implemented in primary care to prevent non-communicable disease and depression. AIM: To test the effectiveness of a multiple risk behaviour intervention to promote Mediterranean diet, physical activity, and/or smoking cessation in people attending Spanish primary health care with incidence of depression and symptoms of depression. METHOD: This was a secondary analysis of the EIRA study that aims to test the effectiveness of a multiple risk behaviour intervention to promote healthy lifestyles. Twenty-six primary care centres were randomised to receive multiple risk behaviour intervention or usual care. The multiple risk behaviour intervention included individual sessions, group sessions, communitarian activities, and SMS reception. Participants were followed for 10-14 months. The primary outcomes of this study were incidence of depression and reductions of depressive symptoms. RESULTS: Three thousand and sixty-seven participants were included. Females accounted for 45.13% and 93.88% were Spanish. Age varied between 45 and 75 years old. The effectiveness of the intervention will be calculated using the Patient Health Questionnaire (PHQ-9) and the Composite International Diagnostic Interview ( CIDI) depression section. Linear and logistic regression will be used to create predictive models. CONCLUSION: Primary care is the most accessible service in the health system for patients. Hence primary care is the ideal setting for health education, promotion, and prevention interventions. This study will provide high-quality evidence about the effectiveness of multiple risk behaviour interventions over depression prevention.

9.
Fam Pract ; 37(6): 821-827, 2020 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-32424409

RESUMO

BACKGROUND: Patient feedback interventions are receiving increasing attention given their potential to improve health care provision. However, primary health care (PHC) professionals' acceptability and perceived utility of this type of interventions remain largely unexplored. OBJECTIVES: The aim of this study was to explore PHC professionals' perceptions, opinions and suggestions about a patient feedback intervention currently being designed to improve patient safety in Spanish PHC centres. METHODS: We conducted an exploratory qualitative study with 43 PHC professionals. Information was obtained from three semi-structured interviews and four focus groups. All data were audio-recorded, transcribed and analyzed using content analysis by three analysts. RESULTS: The patient feedback intervention was acceptable to health care professionals, who perceived it as a useful strategy to improve health care processes and activate patients. A number of factors potentially limiting the acceptability and perceived utility of the intervention were identified (low patient safety culture, low patient-centred care orientation and limited credibility of patient feedback data). Recommendations for designing and implementing the proposed intervention in the Spanish PHC centres were identified in relation to the following areas: 'collection and analysis of feedback data'; 'feedback display'; 'feedback delivery' and; 'implementation of safety improvement initiatives'. CONCLUSIONS: Although the proposed intervention was generally perceived as useful and acceptable, our study identified a number of tensions about the practical aspects of using the patient-reported data and the credibility of the data and what actions would arise from its use. The intervention has been adapted to address these tensions before its formal evaluation in a randomized clinical trial.

10.
BMJ Open ; 9(12): e031367, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874872

RESUMO

INTRODUCTION: Despite the enormous potential for adverse events in primary healthcare (PHC), the knowledge about how to improve patient safety in this context is still sparse. We describe the methods for the development and evaluation of an intervention targeted at PHC professionals to improve patient safety in Spanish PHC centres. METHODS AND ANALYSIS: The intervention will consist in using the patient reported experiences and outcomes of safety in primary care (PREOS-PC) survey to gather patient-reported experiences and outcomes concerning the safety of the healthcare patients receive in their PHC centres, and feed that information back to the PHC professionals to help them identify opportunities for safer healthcare provision. The study will involve three stages. Stage 1 (developing the intervention) will involve: (i) qualitative study with 40 PHC providers to optimise the acceptability and perceived utility of the proposed intervention; (ii) Spanish translation, cross-cultural adaptation and validation of the PREOS-PC survey; (iii) developing the intervention components; and (iv) developing an online tool to electronically administrate PREOS-PC and automatically generate feedback reports to PHC centres. Stage 2 (piloting the intervention) will involve a 3-month feasibility (one group pre-post) study in 10 PHC centres (500 patients, 260 providers). Stage 3 (evaluating the intervention) will involve: (i) a 12-month, two-arm, two-level cluster randomised controlled trial (1248 PHC professionals within 48 PHC centres; with randomisation at the centre level in a 1:1 ratio) to evaluate the impact of the intervention on patient safety culture (primary outcome), patient-reported safety experiences and outcomes (using the PREOS-PC survey), and avoidable hospitalisations; (ii) qualitative study with 20 PHC providers to evaluate the acceptability and perceived utility of the intervention and identify implementation barriers. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of the Balearic Islands (CEI IB: 3686/18) with the 1964 Helsinki Declaration and its later amendments. The results will be disseminated in peer-reviewed publications and national and international conferences. TRIAL REGISTRATION NUMBER: NCT03837912; pre-results.


Assuntos
Segurança do Paciente/normas , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Retroalimentação , Humanos , Medidas de Resultados Relatados pelo Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha , Inquéritos e Questionários
11.
PLoS One ; 14(6): e0217335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166976

RESUMO

BACKGROUND: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). Previous trials have reported that gabapentin can relieve chronic neuropathic pain, but its effect on prevention of PHN is unclear. OBJECTIVE: To assess the efficacy of a 5-week course of gabapentin on acute herpetic pain and on the prevention of PHN at 12 weeks in patients with acute HZ. METHODS: This was a randomized, double blind, placebo-controlled trial conducted in 17 primary care health centers in Mallorca, Spain. All patients were older than 50 years, presented with HZ within 72 h of rash onset, and had moderate-severe pain (≥4 on a 10-point visual analogue scale [VAS]). Ninety-eight patients were randomized to receive gabapentin or placebo. All patients received valaciclovir for 7 days and analgesia if needed. The treatment period was 5 weeks, followed by 7 weeks of follow-up. Gabapentin was initiated at 300 mg/day and gradually titrated to a maximum of 1800 mg/day. The main outcome measure was pain at 12 weeks. RESULTS: Seventy-five patients completed the study, 33 in the gabapentin group and 42 in the control group. A total of 18.2% of patients in the gabapentin group and 9.5% in the control group reported pain at 12 weeks (p = 0.144). Four patients in the gabapentin group (12.1%), but no patients in the placebo group, reported pain of 4 or more on a 10-point VAS. Patients taking gabapentin reported worse health-related quality of life and poorer sleep quality. Three patients discontinued the trial due to adverse effects from gabapentin. CONCLUSION: Addition of gabapentin to the usual treatment of HZ within 72 h of rash onset provided no significant relief from acute herpetic pain or prevention of PHN. TRIAL REGISTRATION: ISRCTN Registry identifier: ISRCTN79871784.


Assuntos
Gabapentina/administração & dosagem , Herpes Zoster/tratamento farmacológico , Neuralgia Pós-Herpética/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Gabapentina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sono/efeitos dos fármacos , Espanha
12.
BMC Geriatr ; 19(1): 101, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971215

RESUMO

BACKGROUND: Previous observational studies and clinical trials have shown that cholinesterase inhibitors (with or without memantine) provide benefit for patients with mild-to-moderate Alzheimer's disease. However, the impact of treatment continuation after progression to severe disease is unknown. The main aim of this study is to evaluate the effect and safety of continuing treatment with ChEIs (with or without memantine) for patients with severe dementia. METHODS: This randomized, pragmatic, open-label clinical trial with blinded evaluators will evaluate the efficacy of continuing drug treatment in patients with advanced dementia. A total of 302 community-dwelling patients with severe dementia, Alzheimer's disease, with or without a coexisting diagnosis of vascular dementia, and a score of 10 or less on the Mini-Mental State Examination who received previous treatment with a cholinesterase inhibitor (with or without memantine) for at least 3 months, will be randomized to continue or discontinue drug treatment. Follow-up will be 12 months or until the primary endpoint is achieved. The primary endpoint is entry into institutional care and progression of disability, defined as a loss of 2 of 4 basic functions, or 6 of 11 instrumental functions, according to the Bristol Activities of Daily Living Scale at 12 months. The secondary outcomes are patient changes in functional and cognitive state, quality of life, and caregiver burden. DISCUSSION: We expect that the results of our study will allow to identify if there is clinical relevant impact for patients and caregivers between maintaining or halting pharmacological treatment. TRIAL REGISTRATION: The study was prospectively registered in the REec (2017-000042-22) on May 11 2017 and ID ISRCTN12134230 on February 25 2019.


Assuntos
Demência/tratamento farmacológico , Demência/psicologia , Índice de Gravidade de Doença , Suspensão de Tratamento/tendências , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Inibidores da Colinesterase/uso terapêutico , Demência/diagnóstico , Feminino , Humanos , Masculino , Memantina , Qualidade de Vida/psicologia , Método Simples-Cego , Resultado do Tratamento
13.
BMJ Open ; 9(3): e020120, 2019 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-30833307

RESUMO

OBJECTIVE: This study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall and stratified by sex. DESIGN: Longitudinal observational study conducted between 2008 and 2013. SETTING: 66 PHC teams in Catalonia, Navarre and the Balearic Islands (Spain). PARTICIPANTS: Population over 15 years of age assigned to PHC teams. PRIMARY AND SECONDARY OUTCOMES MEASURES: Quarterly age-standardised prevalence of non-smoker, smoker and ex-smoker and incidence of new smoker, new ex-smoker and ex-smoker relapse rates were estimated with data retrieved from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardised prevalence and incidence rates. Trends were expressed as annual percentage change and average annual percent change. RESULTS: The overall standardised smoker prevalence rate showed a significant downward trend (higher in men than women) and the overall standardised ex-smoker prevalence rate showed a significant increased trend (higher in women than men) in the three regions. Standardised smoker and ex-smoker prevalence rates were higher for men than women in all regions. With regard to overall trends of incidence rates, new smokers decreased significantly in Catalonia and Navarre and similarly in men and women, new ex-smokers decreased significantly and more in men in Catalonia and the Balearic Islands, and ex-smoker relapse increased in Catalonia (particularly in women) and decreased in Navarre. CONCLUSIONS: Trends in smoking behaviour in PHC patients remain unchanged after the implementation of comprehensive SFL. The impact of the comprehensive SFL might have been lessened by the effect of the preceding partial SFL.


Assuntos
Atenção Primária à Saúde , Política Antifumo/legislação & jurisprudência , Fumantes , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar , Adulto , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Fumantes/psicologia , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Fumar/tendências , Espanha/epidemiologia
15.
BMC Public Health ; 18(1): 874, 2018 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-30005705

RESUMO

BACKGROUND: Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. METHODS: This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the "5A's". It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the "Consolidated Framework for Implementation Research", a set of discrete implementation strategies and an evaluation framework. DISCUSSION: EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 .Retrospectively registered on May 2, 2017.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Atenção Primária à Saúde , Idoso , Análise Custo-Benefício , Feminino , Promoção da Saúde/economia , Comportamentos de Risco à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Espanha , Inquéritos e Questionários
16.
Prev Med ; 114: 88-94, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29940292

RESUMO

Tobacco smoking is a major preventable cause of death, and a significant public health problem worldwide. Most smokers begin in adolescence, age at which they are more susceptible to nicotine addiction. The prevalence of smoking in adolescence is considerable. Therefore, it would be convenient to incorporate smoking prevention programs in the school environment. It is necessary to provide evidence of its effectiveness. The primary objective of the study was to evaluate the effectiveness of a teacher-delivered school-based intervention on the initiation of smoking in adolescents (ITACA smoking prevention education program). A multi-center cluster randomized trial was designed. Twenty-two secondary schools from Spain were enrolled in 2 successive cohorts, from 2010 to 2011. The intervention consisted in the application of the ITACA smoking prevention education program. A 4-year cognitive-behavioral intervention that is based on the social-influences model and is integrated into schools' regular curricular activities. A total of 1055 students were surveyed before the intervention (age: 12-13 years-old), and at the third year of the intervention (age: 14-15 years-old) of a 4-year education program. The outcome measures were daily and weekly use of cigarettes, and initiation of smoking. There was no evidence that the intervention impacted the incidence of regular smoking (OR = 1.08; 95% CI: 0.50-2.33) or the initiation of smoking (OR = 1.09; 95% CI: 0.56-1.72). This trial provides evidence supporting the non-effectiveness of a complex educational smoking prevention program at 3 years after the intervention. TRIAL REGISTRATION NUMBER: Current Controlled Trials: NCT01602796.


Assuntos
Currículo , Promoção da Saúde/métodos , Prevenção do Hábito de Fumar/métodos , Fumar/epidemiologia , Estudantes/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Masculino , Prevalência , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , Espanha/epidemiologia , Inquéritos e Questionários
17.
Eur J Public Health ; 28(3): 553-559, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29401282

RESUMO

Background: To examine the impact of comprehensive smoke-free legislation (SFL) (Law 42/2010) on the incidence and prevalence of adult asthma and coronary disease in primary health care (PHC) patients from three Spanish regions, overall and stratified by sex. Methods: Longitudinal observational study conducted between 2007 and 2013 in the population over 15 years of age assigned to 66 PHC teams in Catalonia, Navarre and the Balearic Islands. Crude rates and age-standardized (truncated: asthma ≥ 16 years and coronary disease ≥ 35 years) incidence and prevalence rates using the direct method based on the European Standard Population were estimated based on data from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardized incidence and prevalence rates. Trends were expressed as annual percentage change and average annual percent change (AAPC). Results: The standardized asthma incidence rate showed a non-significant downward trend and the standardized prevalence rates rose significantly in the three regions. Standardized coronary disease incidence and prevalence rates were considerably higher for men than for women in all regions. The standardized coronary disease incidence rates in Catalonia (AAPC: -8.00%, 95% CI: -10.46; -5.47) and Navarre (AAPC: -3.66%, 95% CI: -4.95;-2.35) showed a significant downward trend from 2007 to 2013, overall and by sex. The standardized coronary disease prevalence trend rate increased significantly in the whole period in Catalonia and the Balearic Islands, although a non-significant downward trend was observed from 2010 in Catalonia. Conclusion: No changes in the trends of adult asthma and coronary disease in PHC Spanish patients were detected after the introduction of comprehensive SFL.


Assuntos
Asma/epidemiologia , Doença das Coronárias/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Política Antifumo , Fumar/legislação & jurisprudência , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia , Adulto Jovem
18.
BMJ Open ; 7(10): e015934, 2017 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-28993380

RESUMO

OBJECTIVE: Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN: Two case-control studies. SETTING: Performed in primary care of five Spanish regions. SUBJECTS: In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES: Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS: The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS: Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Promoção da Saúde/métodos , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Estudos de Casos e Controles , Comportamento Cooperativo , Feminino , Humanos , Masculino , Programas Nacionais de Saúde/estatística & dados numéricos , Papel Profissional , Classe Social , Espanha , Inquéritos e Questionários
19.
BMC Palliat Care ; 17(1): 4, 2017 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-28693520

RESUMO

BACKGROUND: The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. According to the World Health Organization (WHO), patients with advanced cancer and other terminal diseases benefit from early identification and proactive PC. We will evaluate the effectiveness of an intervention in which a PC leader is established in the primary health care center, and assess the effect of this intervention on the early identification of patients in need of PC, the efficient use of health care services, and direct health care costs. METHODS: Design: A two-arm cluster randomized clinical trial of 30 Primary Health Care Centers (PHCC) in Mallorca (Spain), in which each center was randomized to an intervention arm or a usual care arm. We expect that the number of patients identified as suitable for PC (including non-oncological PC) is at least 5% greater in the intervention arm. SAMPLE SIZE: A total of 4640 deceased patients. Outcomes will be assessed by a blinded external review of the electronic records. INTERVENTIONS: General practitioners (GPs) and nurse leaders in PC for each PHCC will be appointed. These leaders will help promote PC training of colleagues, improve symptom management and psychological support of patients, and evaluate the complexity of individual cases so that these cases receive assistance from PC home-based teams. MEASUREMENTS: Early identification (>90 days before death), evaluation of case complexity, level of case complexity (with referral to a home-based PC team), use and cost of hospital and primary care services, and quality of life during the last month of life (≥2 emergency room visits, ≥2 hospital admissions, ≥14 days of hospitalization). DISCUSION: PC leaders in primary care teams will improve the early identification of patients eligible for PC. This initiative could improve the quality of end-of-life care and utilization of hospital resources. TRIAL REGISTRATION: ISRCTN Registry identifier: ISRCTN92479122 . Retrospectively registered on 28 February 2017.


Assuntos
Liderança , Cuidados Paliativos , Atenção Primária à Saúde/métodos , Análise por Conglomerados , Clínicos Gerais/psicologia , Humanos , Enfermeiras e Enfermeiros/psicologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente/tendências , Desenvolvimento de Programas/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha , Inquéritos e Questionários , Recursos Humanos
20.
Trials ; 18(1): 24, 2017 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-28088231

RESUMO

BACKGROUND: Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition. METHODS/DESIGN: Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions). DISCUSSION: Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons. TRIAL REGISTRATION: ISRCTN Registry identifier: ISRCTN79871784 . Registered on 2 May 2013.


Assuntos
Aciclovir/análogos & derivados , Aminas/uso terapêutico , Analgésicos/uso terapêutico , Antivirais/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Herpes Zoster/tratamento farmacológico , Neuralgia Pós-Herpética/prevenção & controle , Valina/análogos & derivados , Ácido gama-Aminobutírico/uso terapêutico , Aciclovir/efeitos adversos , Aciclovir/uso terapêutico , Aminas/efeitos adversos , Analgésicos/efeitos adversos , Antivirais/efeitos adversos , Protocolos Clínicos , Ácidos Cicloexanocarboxílicos/efeitos adversos , Método Duplo-Cego , Feminino , Gabapentina , Herpes Zoster/diagnóstico , Herpes Zoster/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/diagnóstico , Neuralgia Pós-Herpética/fisiopatologia , Neuralgia Pós-Herpética/virologia , Medição da Dor , Qualidade de Vida , Projetos de Pesquisa , Sono , Espanha , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Valaciclovir , Valina/efeitos adversos , Valina/uso terapêutico , Ácido gama-Aminobutírico/efeitos adversos
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