RESUMO
Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that "moderate" consumption is beneficial to health. The most recent evidence indicates that "moderate" consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.
Assuntos
Alcoolismo , Intervenção em Crise , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/diagnóstico , Humanos , Programas de Rastreamento/métodos , Motivação , EspanhaRESUMO
We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.
Assuntos
Promoção da Saúde , Estilo de Vida , Criança , Humanos , Medicina Comunitária , Estilo de Vida Saudável , Exercício FísicoRESUMO
Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. The objective was to evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. A total of 740 participants completed the questionnaire. About 12.2% (95% CI [9.8-14.5]) were smokers, and 77.3% (95% CI [74.3-80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8-37.6]) practiced physical activity 2-3 times a week, and 12.1% (95% CI [9.8-14.5]) were overweight or obese. About 54.2% (95% CI [50.6-57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p < 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p < 0.001) in relation to the participants' academic profiles. Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high; however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test.
Assuntos
Neoplasias da Próstata , Estudantes de Enfermagem , Estudos Transversais , Detecção Precoce de Câncer , Medicina de Família e Comunidade , Estilo de Vida Saudável , Humanos , Masculino , Antígeno Prostático Específico , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS: An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION: PC centres of the Spanish National Health System (SNHS). PARTICIPANTS: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.
Assuntos
Consumo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Pessoal de Saúde/educação , Atenção Primária à Saúde , Adulto , Aconselhamento , Estudos Transversais , Feminino , Promoção da Saúde , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Médicos de Família/educação , Espanha , Inquéritos e QuestionáriosRESUMO
Primary and secondary health determinants explain a large part of the morbidity and mortality observed in primary care. The recommendations of the Program of Preventive Activities and Health Promotion (PAPPS) of the semFyC are presented, for the promotion of a healthy lifestyle through intervention methodology and preventive actions in tobacco consumption, alcohol consumption, healthy eating, physical activity in free time and prevention of traffic accidents and child restraint systems. The most common clinical prevention guidelines are outlined. The recommendations are updated, new aspects are pointed out, such as the definition of low-risk alcohol consumption, and the bibliography is updated. For the main recommendations, specific tables are included that show the quality of the evidence and the strength of the recommendation.
Assuntos
Promoção da Saúde , Estilo de Vida , Criança , Exercício Físico , Estilo de Vida Saudável , Humanos , Atenção Primária à SaúdeRESUMO
BACKGROUND: Alcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use. METHODS: A descriptive, cross-sectional, observational, multicenter study was performed. LOCATION: PC sites of the Spanish National Health Care System (NHS). PARTICIPANTS: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion. RESULTS: One thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56 years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR = 1.52; 95% CI: 1.22-1.90), PC physicians (OR = 1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR = 1.03; 95% CI: 1.01-1.05). CONCLUSION: Our study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Espanha/epidemiologiaRESUMO
INTRODUCTION: Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. METHODS: A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months post-intervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. RESULTS: A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the self-reported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0-2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8). CONCLUSIONS: The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.
Assuntos
Promoção da Saúde/métodos , Estilo de Vida Saudável , Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Exercício Físico , Comportamentos de Risco à Saúde , Humanos , Obesidade/prevenção & controle , Fumar/efeitos adversos , Prevenção do Hábito de FumarRESUMO
OBJECTIVE: Toxic oil syndrome is a multisystemic disease that arose in 1981 due to the ingestion of contaminated rapeseed oil. Previous studies have found a higher prevalence of cardiovascular risk factors in these patients. The aim of this study was to analyze the differences in the prevalence of chronic diseases among a population affected by Toxic oil syndrome compared with a reference population in the Community of Madrid. METHODS: Cross-sectional observational study of patients with a registry diagnosed with Toxic oil syndrome in the primary care medical record and a reference sample without Toxic oil syndrome matched by age group and sex. Sociodemographic variables, cardiovascular risk factors, cardiovascular and cerebrovascular disease, anxiety, depression, asthma, chronic obstructive pulmonary disease, and low back pain, and multimorbidity (≥2 chronic diseases) were assesed. Descriptive and multivariate analysis was performed to study the association between morbidity and Toxic oil syndrome. RESULTS: 3,527 patients (1,394 Toxic oil syndrome) were included with a mean age of 66 (SD14) years, 71% women. Patients with a diagnosis of SAT were more likely to present multimorbidity (OR 1.36; 95%CI: 1.10-1.45), diabetes (OR 1.55; 95%CI: 1.29-1.86), complicated hypertension (OR 1.77; IC95%: 1.31-2.39), heart attack (OR 2.23; 95%CI: 1.47-3.38), depression (OR 1.39; 95%CI: 1.17-1.66) and asthma (OR 1.56; 95%CI: 1.23-1.97). The prevalence of anxiety was lower in TOS (OR 0.35; 95% CI: 0.18-0.69) as well as low back pain (OR 0.77; 95%CI: 0.65-0.91). CONCLUSIONS: Patients with toxic oil syndrome have a higher frequency of chronic diseases and mutimorbidity compared to the general population of the same sex and age.
OBJETIVO: El síndrome del aceite tóxico es una enfermedad multisistémica que surgió en 1981 debido a la ingesta de aceite de colza contaminado. Estudios previos han encontrado en estos pacientes una mayor prevalencia de factores de riesgo cardiovascular. El objetivo de este estudio fue analizar las posibles diferencias en prevalencia de morbilidad crónica entre una población afectada por síndrome de aceite tóxico comparada con una población de referencia en la Comunidad de Madrid. METODOS: Estudio observacional transversal de pacientes diagnosticados de síndrome del aceite tóxico en la historia clínica de atención primaria y una muestra de referencia sin síndrome del aceite tóxico apareados por grupo de edad y sexo. Se recogieron variables sociodemográficas, factores de riesgo cardiovascular, enfermedad cardiovascular y cerebrovascular, ansiedad, depresión, asma, enfermedad pulmonar obstructiva crónica, lumbalgia y multimorbilidad (≥2 enfermedades crónicas). Se realizó análisis descriptivo y multivariante para estudiar la asociación entre morbilidad y síndrome del aceite tóxico. RESULTADOS: Se incluyeron 3.527 pacientes (1.394 SAT) con una edad media de 66 (14) años, el 71% mujeres. Los pacientes con diagnóstico de síndrome del aceite tóxico tuvieron mayor probabilidad de presentar multimorbilidad (OR 1,36; IC95%: 1,10-1,45), diabetes (OR 1,55; IC95%: 1,29-1,86), hipertensión arterial complicada (OR 1,77; IC95%: 1,31-2,39), infarto (OR 2,23; IC95%: 1,47-3,38), depresión (OR 1,39; IC95%: 1,17-1,66) y asma (OR 1,56; IC95%: 1,23-1,97). La prevalencia de ansiedad fue menor (OR 0,35; IC95%: 0,18-0,69) así como de lumbalgia (OR 0,77; IC95%: 0,65-0,91). CONCLUSIONES: Los pacientes con síndrome de aceite tóxico presentan una mayor frecuencia de enfermedades crónicas y mutimorbilidad comparado con población general del mismo sexo y edad.
Assuntos
Doença Crônica/epidemiologia , Multimorbidade , Óleo de Brassica napus/toxicidade , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , SíndromeRESUMO
Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.
El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno.
Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas , Consumo Excessivo de Bebidas Alcoólicas/complicações , Humanos , Espanha/epidemiologia , Terminologia como AssuntoRESUMO
The Consensus on Health Assistance for Smoking Cessation in Spain, is a document reviewing the treatment evidence, as well as policy needs in relation to smoking cessation in Spain. It has been developed by technical representatives of public health administrations, at a national and autonomous level, together with representatives of the scientific societies and professional bodies which are members of the Spanish coalition on smoking prevention National Committee on Tobacco Prevention (CNPT). After approval of a new national tobacco control law 28/2005, several tobacco control policies are being developed, especially by the autonomous governments, including treatment policies. Within this framework, and as part of the requirements of the law, all parties have considered the need to review effectiveness, experimentally validated tobacco dependence treatments and practices. An initial draft written by an expert committee was presented to all parties and discussed at three meetings over a period of a year and a half. The initial draft did review primary and secondary scientific literature from 1987 to 2007 on efficacy and effectiveness of different smoking cessation interventions, including: medical advice and brief smoking cessation interventions; pharmacological aids for treating nicotine dependence; behavioral interventions; specialized intensive treatment; community interventions; and treatment for groups with special needs. Considering the available evidence; current treatment needs; policy gaps; and the criteria of risk, accessibility, efficiency, sustainability and equity; the consensus document recommends the minimal requirements which should be taken into account when developing a policy on smoking cessation in Spain.