Multicentric randomized clinical trial to evaluate the long-term effectiveness of a motivational intervention against smoking, based on the information obtained from spirometry in primary care: the RESET study protocol.

BACKGROUND: Spirometry is the recommended method of evaluating pulmonary function when respiratory disease is suspected in smokers. Nonetheless, no evidence exists of the usefulness of information obtained from this test as a motivational strategy for smoking cessation. The primary objective of this study is to evaluate the effectiveness of a motivational intervention based on spirometry results in achieving long-term smoking cessation. METHODS/DESIGN: We propose a multicenter randomized clinical trial in the primary care setting. STUDY SUBJECTS: We will recruit active smokers of both sexes, aged 35-70 years, with a cumulated smoking habit exceeding 10 packs/year and who consult for any reason with their primary care physician in the 20 health centers in the province of Tarragona (Spain). Patients with a history of lung disease or who have undergone exploratory measures of pulmonary function in the preceding 12 months will be excluded. All patients who agree to participate will provide signed informed consent prior to their inclusion. A total of 1000 smokers will be consecutively randomized to a control or intervention group (1:1). INTERVENTION: Participants in both groups will receive brief (5-minute) health counseling, in accordance with usual clinical practice. In a consultation lasting about 15 minutes, participants in the intervention group will also receive detailed, personalized information about the results of a spirometry test and about their lung age compared with their chronological age. Both groups will be followed up for 12 months. Main variables and analysis: The main variable will be sustained smoking abstinence at 12 months after the intervention, as confirmed by CO breath testing and urine cotinine test. Results will be analyzed based on intention to treat, using the chi-square test and logistical regression if necessary to adjust for confounding variables. DISCUSSION: We expect the rate of prolonged smoking abstinence in the intervention group will be at least 5% higher than in the control group. If this strategy proves effective, it could easily be included in the health promotion activities offered in primary care settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02153047 . Registered on 28/05/2014.

Effects of mediterranean diet on lung function in smokers: a randomised, parallel and controlled protocol.

BACKGROUND: There is evidence of an association between pulmonary function and various nutrients, although no association has been observed in our setting between the Mediterranean Diet (MD) eating pattern and improved lung function. The objective of this study is to evaluate the effect of an intervention designed to increase MD adherence on lung function in smokers with no previous respiratory disease. METHODS/DESIGN: Randomized, controlled, parallel clinical trial. SETTING: primary health care centers in Catalonia (Spain). PARTICIPANTS: Current smokers (cumulative > 10 pack-years) aged 35-70 years, with Internet access, who provide signed informed consent to participate. INTERVENTION: A nutritionist will conduct a 2-year multicomponent intervention to increase MD adherence, based on: 1) a personalized dietary-nutritional education intervention, 2) a Web 2.0 approach, the DIET Blog of nutritional information, and 3) group sessions to increase motivation to increase MD adherence and motivation to make changes in eating habits. Annually, an office visit and one group session will reinforce the nutritional intervention. The control group will follow their usual diet, with general nutritional counselling. In both groups, a 14-item questionnaire will evaluate individual MD dietary patterns and forced spirometry will assess lung function. ANALYSIS: Intention to treat. The unit of analysis will be the individual smoker. Primary outcome is lung function indicated by spirometry, FVC, FEV1 and FEV1/FVC %. Lung function parameters in both groups will be compared by adherence to the MD pattern. DISCUSSION: The DIET study could contribute data on a protective action of the MD pattern on lung function in smokers. If so, this population may benefit from a nutritional intervention, along with the fundamental recommendation to stop smoking. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02151669 . Registered 26 May 2014.

[Effect of an educational intervention on the attitudes of the nurses of primary care on depression]. / Efecto de una intervención formativa en las actitudes de las enfermeras de atención primaria ante la depresión.

OBJECTIVE: To describe nurse attitudes toward depression, using a standardized questionnaire and to evaluate how a training workshop can modify or influence these attitudes. METHODS: A prospective study based on the application of the Depression Attitude Questionnaire, before and six months after, participating in a training day on the nursing role in the management of depression in Primary Care. The sample consisted of 40 Primary Care nurses from 10 health centers in the province of Tarragona. RESULTS: Nurses are in a neutral position when considering the management of depressed patients as a difficult task, or to feel comfortable in this task, but there is a high degree of acceptance of the claim that the time spent caring for depressed patients is rewarding. In general, there was little significant difference in the mean scores for the different items of the Depression Attitude Questionnaire, before and six months, after the training intervention. CONCLUSIONS: The attitude towards the management of depression in Primary Care and to the role that nurses can play in this task is generally favorable. Fruitful training and organizational initiatives can be established in order to define and structure the nursing role in the management of depression in Primary Care.

[Screening for attention deficit hyperactivity disorder in adult patients in primary care]. / Cribado para el trastorno por deficit de atencion/hiperactividad en pacientes adultos de atencion primaria.

AIMS. To estimate the proportion of adult patients in primary care with a positive screening test for attention deficit hyper-activity disorder (ADHD) and to analyse their characteristics. PATIENTS AND METHODS. A cross-sectional descriptive study was performed in nine primary care clinics in the province of Tarragona. The sample consisted of 432 consecutive patients in primary care who visited for any reason, with ages ranging from 18 to 55 years. Screening for ADHD was carried out by means of the Adult ADHD Self-Report Scale (ASRS). Data about functional impact (Sheehan Disability Inventory) were obtained and a review of the patient records provided data concerning psychiatric comorbidity and the consumption of psychopharmaceuticals. RESULTS. The percentage of positive results in the screening tests was 19.9% (95% CI = 16.4-23.9%). Taking into account the sensitivity and specificity of the ASRS, the 'real' prevalence was estimated to be 12.5% (95% CI = 8.2-16.8%). None of these patients were diagnosed or treated for ADHD. Positive screening tests are associated with occupational, social and familial dysfunction, and greater perceived stress. There is also a higher level of comorbidity with affective disorders and substance abuse, as well as greater use of psychopharmaceuticals. CONCLUSIONS. Screening for ADHD in adult patients in primary care gives rise to a notably high proportion of positive screening test results, which suggests that there could be a significant prevalence of patients with ADHD. These data contrast with the absence of this diagnosis in the patient records. Further research is needed to determine the usefulness of the diagnosis of ADHD and the possible role that must be played by primary care.

TITLE: Cribado para el trastorno por deficit de atencion/hiperactividad en pacientes adultos de atencion primaria.Objetivo. Estimar la proporcion de pacientes adultos de atencion primaria con cribado positivo para el trastorno por deficit de atencion/hiperactividad (TDAH) y estudiar sus caracteristicas. Pacientes y metodos. Estudio descriptivo transversal realizado en nueve consultas de atencion primaria de la provincia de Tarragona. La muestra estuvo formada por 432 pacientes consecutivos de atencion primaria visitados por cualquier motivo, con edades entre 18 y 55 anos. El cribado para TDAH se realizo mediante la Adult ADHD Self-Report Scale (ASRS). Se obtuvieron datos sobre impacto funcional (Sheehan Disability Inventory) y, mediante revision de historias clinicas, datos sobre comorbilidad psiquiatrica y consumo de psicofarmacos. Resultados. Se obtuvo una proporcion de cribados positivos del 19,9% (IC 95% = 16,4-23,9%). Considerando la sensibilidad y especificidad de la ASRS, la estimacion de la prevalencia 'real' fue del 12,5% (IC 95% = 8,2-16,8%). Ninguno de estos pacientes estaba diagnosticado o tratado por TDAH. El cribado positivo se asocia a disfuncion laboral, social y familiar, y a mayor estres percibido. Tambien hay mayor comorbilidad con trastornos afectivos y consumo de sustancias, asi como un uso mas elevado de psicofarmacos. Conclusiones. El cribado del TDAH en pacientes adultos de atencion primaria da lugar a una llamativa elevada proporcion de cribados positivos, lo que indica que puede haber una prevalencia relevante de pacientes con TDAH. Estos datos contrastan con la nula presencia de este diagnostico en las historias clinicas. Es necesario profundizar en la investigacion para determinar la utilidad del diagnostico de TDAH y el eventual papel que debe asumir la atencion primaria.

[The stroke care system in Terres de l'Ebre, Spain, after the implementation of the Stroke Code model: Ebrictus Study]. / La atención sanitaria del ictus en el área Terres de l'Ebre desde la implantación del Código Ictus: Estudio Ebrictus.

BACKGROUND AND OBJECTIVE: We aimed to know the characteristics of the urgent stroke assistance system, the Stroke Code (SC) model, 2 years after its implementation through testing the specific impact on several result indicators on individuals with a first stroke. PATIENTS AND METHOD: Prospective study of a cohort who suffered a first stroke episode, 15 to 89-year-old. Several clinical indicators were selected to evaluate results according to the SC and an analysis survival for Kaplan-Meier's curves was made as well as a bivariate analysis between dead and surviving patients. Data were collected by a community based registry. RESULTS: A total of 380 patients ≤80-year-aged were enrolled and the SC was activated in 54.3% (CI95%: 49,0-59.3), 77% at the hospital. An 80% of the therapeutic window was wasted before arrival to hospital. In 13.9% (CI95%: 9,2-19,8) thrombolysis was used. The immediate mortality was 9.9% (CI95%: 7.5-12.5). CONCLUSIONS: The implantation of the SC is a system that improved the welfare chain of stroke in the whole territory, but its activation in the area of primary care was low.

[Increased benzodiazepine use in elderly women attending urban primary health care centers]. / Elevado consumo de benzodiacepinas en mujeres ancianas asignadas a centros de salud urbanos de atención primaria.

OBJECTIVE: To determine the overall prevalence of the chronic use of benzodiazepines and similar drugs in primary care. DESIGN: Observational, cross-sectional study. SETTING: Healthcare centres of the Reus-Altebrat Primary Care Service, Tarragona, Spain. PARTICIPANTS: Patients older than 15 years, on prolonged treatment with benzodiazepines or similar drugs. MEASUREMENTS: The variables studied were age, sex, type of healthcare centre (rural or urban), benzodiazepine, or similar drug administered and duration of treatment. RESULTS. There were 6885 patients who were on prolonged benzodiazepine or similar drug treatment, of which 70.9% were female, 73.4% were 65 years or older, and 73% attended an urban centre. The overall prevalence was 6.9%, and was higher among women than men (9.7% and 4%, respectively), and increased with age up to 27.3% among patients of 75 years or more. The stratified results showed that chronic consumption was higher among women 75 years of age or older attached to urban healthcare centres, with a prevalence of 35.7%. CONCLUSIONS: A high percentage of our population, which includes the most fragile patients, use benzodiazepines or a similar drug in a way that is not consistent with the recommendations of clinical practice guidelines.

[Assessment of self-perceived body image in female adolescents aged 12-21 years in the city of Reus (Spain)]. / Valoración de la propia imagen corporal en adolescentes femeninas de 12 a 21 años de la ciudad de Reus.

OBJECTIVE: To assess the degree of body image distortion in female adolescents and evaluate its association with the social esthetic model and the adoption of dietary measures. METHOD: We performed a cross sectional, observational study in a random sample of female adolescents aged 12 to 21 years old. Information was gathered via two different sources. A structured questionnaire including sociodemographic and anthropometric items was administered to determine adolescents' desire to resemble advertising models, their satisfaction with trouser size, and whether they would follow an unsupervised diet, etc. A game consisting of 9 images of female shapes of increasing size was used to evaluate self-perceived body image. The subjects chose the shape they believed most closely resembled their own. RESULTS: A sample of 401 subjects with a mean age of 17.6 (standard deviation = 2.6) years was evaluated. Seventy-five percent had normal weight, 11% were overweight, 13% were obese, and 0.8% were underweight. A total of 76.8% of the subjects had distorted body image and wished to look like advertising models (p < 0.001), 47.7% were dissatisfied with their trouser size (p < 0.001), and 15.3% were following special diets without supervision (p < 0.001). CONCLUSIONS: The majority of adolescents aged between 13 and 21 years old were dissatisfied with their body image. A distorted body image translates into wanting to resemble advertising models and dissatisfaction with trouser size, which in turn leads to following unsupervised diets.