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

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

[Accidents attended in a basic health area of Girona, Spain]. / Accidentes atendidos en un área básica de salud de Girona, España.

BACKGROUND: Accidents have been largely unstudied in the area of Primary Care. They are one of the most frequent motives for consultation in the Emergency Services and the first assistance that accident victims receive is usually in primary care centres. Establishment of the incidence and clinicoepidemiological characteristics of the accidents attended in a Basic Health Area can provide important information about which of these could be susceptible to preventive actions. DESIGN: descriptive study. LOCATION: primary care: SAMPLE: all the patients attended for accidents (389) in the Primary Care Centre between October 1998 and May 1999. VARIABLES: age, sex, place of the accident, type of lesion, location of lesions, agents involved, intentionality, complementary tests, treatment and referral. STATISTICAL ANALYSIS: estimation of means, standard deviation, proportions and 95% confidence intervals. RESULTS: Incidence: 4.1% (CI95%: 3.7-4.5%). Sex: males 59% (CI95%: 54.2-64%) and females 40.9% (CI95%: 36-45.8%). Age: younger than 20 years, 50.4% (CI95%: 45.4-55.4%). Most common activity associated with accidents: leisure 24.4% (CI95%: 20.2-28.7%). PLACE: home 36.2% (C95%: 31.5-41%). Most frequent lesion: contusion 39.6% (CI95%: 34.7-44.4%). Most frequent site of lesion: arms 37.5% (CI95%: 32.7-42.3%). Most common agent involved: tools and machinery 15.9% (CI95%: 12.3-19.6%). Of these, 92.2% (CI95%: 89.3-94.7%) were accidental. Type of visit: 83.3% (CI95%: 79.6-87%) were attended as emergencies; 79.5% (CI95%: 75.4-83.5%) received treatment with dressings and/or medication. Of these, 9.8% (CI95%: 6.8-12.7%) required referral to a hospital, 13.3% (CI95%: 10-16.7%) required complementary tests. CONCLUSIONS: Most accidents occur in young people and educational campaigns to prevent accidents and directed towards this population group are clearly needed.

Accidentes atendidos en un Área Básica de Salud de Girona, España / Accidents Attended in a Basic Health Area of Girona, Spain

Fundamentos: Los accidentes constituyen una patología poco estudiada en el ámbito de la Atención Primaria. Son una de las consultas más frecuentes en los servicios de urgencias y los Centros de Atención Primaria realizan la primera asistencia a la mayoría de los accidentados. Conocer la incidencia y las características clínico-epidemiológicas de los accidentes atendidos en una Área Básica de Salud puede aportar información sobre cuáles pueden ser susceptibles de actividades de prevención. Métodos: Diseño: estudio descriptivo. Emplazamiento: atención primaria. Muestra: todos los pacientes (389) que fueron atendidos por accidente en el Centro de Atención Primaria, entre octubre-98 y mayo-99. Variables: edad, sexo, lugar del accidente, tipo de lesión, localización, agentes implicados, intencionalidad, pruebas complementarias, tratamiento y derivación. Análisis estadísticos: estimación de medias, desviación estándar, estimación de proporciones e intervalos de confianza del 95 per cent. Resultados: Incidencia: 4,1 per cent (IC95 per cent: 3,7-4,5 per cent). Sexo: varones 59 per cent (IC95 per cent:54,2-64 per cent) y mujeres 40,9 per cent (IC95 per cent: 36-45,8 per cent). Edad: menores de 20 años, el 50,4 per cent (IC95 per cent:45,4-55,4 per cent);.Actividad de mayor accidentalidad: ocio 24,4 per cent (IC95 per cent: 20,2-28,7 per cent). Lugar: hogar 36,2 per cent (IC95 per cent: 31,5-41 per cent). Lesión más frecuente: contusiones 39,6 per cent (IC95 per cent:34,7-44,4 per cent).Localización más frecuente: extremidad superior 37,5 per cent (IC95 per cent: 32,7-42,3 per cent); Agente mayoritariamente implicado: herramientas y máquinas: 15,9 per cent (IC95 per cent:12,3-19,6 per cent). El 92,2 per cent (IC95 per cent: 89,3-94,7 per cent) fueron casuales. Tipo de visita: el 83,3 per cent (IC95 per cent: 79,6-87 per cent) fueron atendidos con carácter urgente; el 79,5 per cent (IC95 per cent:75,4-83,5 per cent) recibió tratamiento con cura y/o fármacos. El 9,8 per cent (IC95 per cent:6,8-12,7 per cent) requirió derivación hospitalaria, Un 13,3 per cent (IC95 per cent: 0-16,7 per cent) requirió pruebas complementarias. Conclusiones: El mayor porcentaje de accidentalidad se da en población joven, por lo que se evidencia la necesidad de incorporar intervenciones de educación sanitaria para la prevención de accidentes dirigidas a dicha población (AU)