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Health professionals have been one of the groups most affected by the SARS-CoV-2 virus. Currently, there is little scientific evidence on the similarities and differences between COVID-19 infection and the development of long COVID in primary care (PC) workers. Therefore, it is necessary to analyse their clinical and epidemiological profiles in depth. This study was observational and descriptive, including PC professionals who were divided into three comparison groups based on the diagnostic test for acute SARS-CoV-2 infection. The responses were analysed using descriptive and bivariate analysis to examinate the relationship between independent variables and the presence or not of long COVID. Binary logistic regression analysis was also conducted, with each symptom as the dependent variable and each group as the independent variable. The results describe the sociodemographic characteristics of these population groups, revealing that women in the health sector are the most affected by long COVID and that being in this group is associated with its development. Furthermore, individuals with long COVID exhibited the highest number of symptoms and pathologies. Certain symptoms were found to be associated with long COVID development in this population, including an altered sense of smell, pneumonia, fever, and sore throat, among others. Similarly, altered senses of smell and taste, chest tightness, and joint pain, among others, were found to be associated with acute COVID-19 infection. Additionally, patients with pre-existing overweight or obesity were more likely to experience acute COVID-19 and develop long COVID. The data obtained can be crucial for improving the detection, diagnosis, and treatment of long COVID patients, ultimately leading to an enhancement in their quality of life.

BackgroundSince the beginning of the COVID-19 pandemic, a great variability of symptoms that affect all organs and systems of the body has been identified in patients with SARS-CoV-2 infection; this symptomatology can sometimes persist over time, giving rise to the so-called long COVID or post-COVID. The aim of this study is to delve into the clinical characterization of these patients, as well as to take into account the influence of factors such as hospitalization, admission to ICU, history of pneumonia, or vaccination status on the persistence of symptoms.Material and methodsAn observational, descriptive, multicenter, and retrospective study was designed with a series of cases of people who presented long COVID, which includes univariate, bivariate, and multivariate analyses. Data were obtained from an online ad hoc questionnaire, and statistical analysis was performed using SPSS Software Version 25 (IBM-Inc., Chicago, IL, USA).ResultsHospitalization, ICU admission, history of pneumonia, and vaccination were predictive factors (positive or negative) for the following long-COVID symptoms: headache, menstrual disorders, joint pain, cough, chills, nasal congestion, back pain, abdominal pain, weight loss, eye discomfort, facial erythema, itching, tremors, dizziness, seizures, sleeping difficulty, dry eyes, palpitations, fatigue, paresthesia, dyspnea, aphonia, chest pain, high blood pressure, vomiting, memory loss, brain fog, hypothermia, low blood pressure, sputum or phlegm, lack of concentration, hair loss, and erectile dysfunction.ConclusionThis study provides evidence on the clinical characterization of patients suffering from long COVID in order to offer them the most appropriate treatments.

Background Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. Methods Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). Results Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. Discussion It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. Limitations The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. Trial registration This trial was registered in ClinicalTrials.gov (NCT03762044). Date of registration: 23 November 2018. Prospectively Registered.

Resumen: Objetivo: Analizar la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS). Material y métodos: Se realizó un estudio cualitativo de análisis de la situación para una evaluación del PAPPS en 2 fases: 1) generación de ideas y recogida de información a través de una matriz DAFO, a través de 2 tipos de criterios, internos (fortalezas y debilidades), y externos (amenazas y oportunidades); 2) priorización de las propuestas de mejora recogidas. Selección de participantes: se identificaron informadores-clave teniendo en cuenta su relación y conocimiento del programa PAPPS. Se incluyeron a todos los integrantes de los grupos de expertos del PAPPS y miembros con participación en el pasado, así como a los componentes del organismo de coordinación, incluidos los responsables autonómicos del PAPPS. Se enviaron dos invitaciones a participar en el estudio: la primera desde el 29 diciembre de 2017 al 11 febrero de 2018, y la segunda entre el 10 y el 23 de enero de 2019. La información se obtuvo a partir de un cuestionario concebido para ser autocumplimentado. Resultados y conclusiones: Respondieron el cuestionario un total de 73 sujetos. El 35% de los participantes eran miembros de los grupos de trabajo del PAPPS, siendo el grupo más numeroso, seguido de médicos de familia de otros ámbitos, con el 20,5%. El orden de priorización de las propuestas de mejora fue el siguiente: 1) unificar recomendaciones con otros grupos de trabajo de semFYC; 2) elaborar listados con «Recomendaciones No hacer» desde el punto de vista de la prevención; 3) incorporar el PAPPS en la agenda política; 4) mayor coordinación e interacción entre grupos con competencias comunes; 5) docencia en pregrado y en unidades docentes, darse a conocer también a los estudiantes de Medicina; 6) revisión, actualización y difusión a cualquier profesional de Atención Primaria. Abstract: Objective: To analyze the situation, evaluation and proposals for improvement of the Preventive Activities and Health Promotion Program (PAPPS). Material and methods: A qualitative study of situation analysis was carried out for the evaluation of the PAPPS in 2 phases: 1) Generation of ideas and collection of information through a DAFO matrix, using 2 types of criteria: internal (strengths and weaknesses), and external (threats and opportunities); 2) Prioritization of the improvement proposals collected. Selection of participants: Key informants were identified taking into account their relationship and knowledge of the PAPPS program. All members of the PAPPS, expert groups and members with past participation were included, as well as the coordinators, including the autonomous leaders of the PAPPS. Two invitations to participate in the study were sent: the first from December 29, 2017 to February 11, 2018, and the second from January 10 to 23, 2019. The information was obtained from a questionnaire designed to be self-completed. Results and conclusions: A total of 73 subjects answered the questionnaire. 35% of the participants were members of the PAPPS working groups, followed by family doctors from other areas, with 20.5%. The order of prioritization of the improvement proposals was as follows: 1) Unify recommendations with other semFYC working groups; 2) Prepare lists with “Recommendations not to do” from the point of view of prevention; 3) Incorporate PAPPS in the political agenda; 4) Greater coordination and interaction between groups with common competences; 5) Teaching in undergraduate and teaching units; 6) Review, update and dissemination of the program in Primary Care.

Resumen: Objetivo: Determinar si los profesionales de atención primaria (AP) conocen el Código europeo contra el cáncer (CECC) y si ello se relaciona con que practiquen sus recomendaciones. Diseño: Observacional descriptivo. Emplazamiento: Centros de AP españoles. Participantes: Profesionales de AP. Intervenciones: Cuestionario autoadministrado. Mediciones principales: Factores de riesgo y protectores del cáncer, pruebas de cribado y conocimiento del CECC. Resultados: Respondieron 1.734 profesionales (10,5%), edad media de 48,5 años (DT: 9,2), el 71,5% mujeres. El 50,0% desconoce el CECC; los tutores (OR = 1,61), adscritos al PAPPS (OR = 1,51) y que llevan más tiempo trabajando en AP (OR = 2,62) son los que más lo conocen. El 7,2% fuma y el 79,1% bebe alcohol. El 64,1% presenta normopeso y el 19% realiza actividad física. Evita exponerse al sol el 52,7% y usa protectores el 53,8%. El 85,2% nunca se ha realizado un cribado colorrectal, el 11% nunca una citología y el 12% una mamografía. Existe relación entre conocer el CECC y el tabaquismo (p

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses.

Resumen: Objetivo: Valorar si un programa formativo ofrecido por médicos de familia en el currículum oficial de medicina sobre principios y estrategias para ayudar a los pacientes a cambiar conductas de riesgo (APCCR) produce cambios en sus percepciones, opiniones y actitudes con relación a este tipo de intervenciones. Diseño: Estudio cuasiexperimental antes-después. Emplazamiento: Una facultad de medicina. Participantes: Todos los alumnos de 4.o curso de medicina (n = 110). Intervenciones: Formación experiencial sobre estrategias comunicativas para APCCR. Mediciones: Opiniones y percepciones evaluadas antes y después del curso mediante cuestionario ad hoc. Resultados: Tras el curso, los estudiantes (n = 103) cambiaron sus ideas sobre la motivación como factor «interno» (15, 13%) a «interno-externo» (71, 61%) (p = 0,003), reforzando sus opiniones sobre la capacidad del médico para APCCR (alta: 72, 62%; baja: 10, 12%; p = 0,008). Los alumnos se consideraron más capaces de respetar la autonomía de los pacientes cuando estos toman decisiones o siguen conductas consideradas perjudiciales (fácil: 58, 50%; difícil: 28, 24%; p = 0,001) e incrementaron su percepción sobre su capacidad para afrontar este tipo de entrevistas (83, 72% vs. 1, 1%; p

Background Mobile technologies have become capable of changing the paradigm of healthcare services. A clear example is that, nowadays, these technologies are an important instrument for data collection processes, epidemiologic surveillance, health promotion and disease prevention. Therefore, technological tools should be exploited to optimize the monitoring of patients with chronic diseases, including patients who require home oxygen therapy. Purpose: The purpose of this study is to determine the efficacy of a mobile application in the clinical monitoring of patients under home oxygen therapy. Methods This is a randomized controlled trial includes subjects of 18 years or older diagnosed with Chronic Obstructive Pulmonary Disease (COPD) who are under home oxygen therapy. Subjects will be divided into two arms: the intervention group will include patients who will be monitored with a mobile application, and the control group will include patients monitored by conventional follow-up methods (periodic visits of a respiratory therapist). The following outcome variables will be considered to measure the effect of the intervention: identification of dyspnea self-management, number of acute exacerbations associated with oxygen therapy, and the occurrence of oxygen supply underuse. Discussion This study is expected to assess the efficacy of a mobile application in the follow up of patients under home oxygen therapy. It will also determine whether the monitoring of a six-month intervention by a team comprising a physician, a nurse and respiratory therapists can decrease acute exacerbations, determine the most appropriate oxygen dose, and identify the underuse of oxygen systems and supplies. Trial registration The study has been registered at ClinicalTrials.gov (NCT04820790; date of registration: March 29, 2021)

Resumen: Objetivo: Desarrollar un programa de formación en Entrevista Motivacional (EM) para Médicos de Familia y evaluar el impacto. Diseño: Ensayo clínico multicéntrico a doble ciego y aleatorizado, con 2 ramas (experimental (GE) y control (GC)) de Médicos de Familia, con un seguimiento de 12 meses. Emplazamiento: 32 Centros de Atención Primaria. Descripción de la muestra: 54 médicos (GC = 28, GE = 26). Intervenciones: Programa de formación MOTIVA en EM con un curso presencial inicial (16 h), seguido de actividades en línea durante 12 meses y reuniones presenciales (entrevistas basadas en problemas con feedback de expertos). Medidas principales: las habilidades comunicativas en EM se evaluaron en base a videograbaciones (VG) con la escala EVEM 2.0, por parejas de revisores. Se analizaron 236 VG con pacientes estandarizados y 96 VG con pacientes reales. Resultados: Los resultados promedio en la escala EVEM (hasta 56 puntos) al inicio del estudio fueron GE = 21,27 (IC 95% 15,8-26,7) y GC = 20,23 (IC95% 16,4-23,9) sin diferencias entre ambos grupos (p = 0,79). Después del curso, la puntuación GE aumentó en 13,89 puntos (P

Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271, p = 0.042, η2 = 0.067) and self-compassion (F(2,91) = 6.046, p = 0.003, η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880, p = 0.025, η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η2 = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η2 = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η2 = 0.071—F (2.79) = 2.874; p = 0.049; η2 = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs.

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Objetivo Analizar la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS). Material y métodos Se realizó un estudio cualitativo de análisis de la situación para una evaluación del PAPPS en 2 fases: 1) generación de ideas y recogida de información a través de una matriz DAFO, a través de 2 tipos de criterios, internos (fortalezas y debilidades), y externos (amenazas y oportunidades); 2) priorización de las propuestas de mejora recogidas. Selección de participantes: se identificaron informadores-clave teniendo en cuenta su relación y conocimiento del programa PAPPS. Se incluyeron a todos los integrantes de los grupos de expertos del PAPPS y miembros con participación en el pasado, así como a los componentes del organismo de coordinación, incluidos los responsables autonómicos del PAPPS. Se enviaron dos invitaciones a participar en el estudio: la primera desde el 29 diciembre de 2017 al 11 febrero de 2018, y la segunda entre el 10 y el 23 de enero de 2019. La información se obtuvo a partir de un cuestionario concebido para ser autocumplimentado. Resultados y conclusiones Respondieron el cuestionario un total de 73 sujetos. El 35% de los participantes eran miembros de los grupos de trabajo del PAPPS, siendo el grupo más numeroso, seguido de médicos de familia de otros ámbitos, con el 20,5%. El orden de priorización de las propuestas de mejora fue el siguiente: 1) unificar recomendaciones con otros grupos de trabajo de semFYC; 2) elaborar listados con «Recomendaciones No hacer» desde el punto de vista de la prevención; 3) incorporar el PAPPS en la agenda política; 4) mayor coordinación e interacción entre grupos con competencias comunes; 5) docencia en pregrado y en unidades docentes, darse a conocer también a los estudiantes de Medicina; 6) revisión, actualización y difusión a cualquier profesional de Atención Primaria.

The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain.An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed.The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p0.001), and as age increased (p0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic.The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation.La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España.Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple).Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p0,001), y más aún conforme aumentaba la edad (p0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos.La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular.

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study.Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain).residents of FM and Medicine and Nursing undergraduate Spanish students.self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5-56.2] Nursing students, 34% [95% CI 30.3-37.6] Medicine students, and 13.6% [95% CI 11.0-16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18-52; 95% CI, 21.98-22.70). A total of 76.8% (95% CI 73.5-80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5-9.6]). Residents of FM (p 0.001), older participants (p 0.001), and those belonging to the Teaching Units (p = 0.002) showed a better awareness of the ECAC. Our findings reveal the unawareness on the ECAC in three out of four participants. The access to the advice described in the ECAC through the Medicine and Nursing Schools and FM Teaching Units is poor. The awareness of the ECAC of postgraduate residents is higher than that the awareness of the undergraduate students.

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study. Location: Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain). Participants: residents of FM and Medicine and Nursing undergraduate Spanish students. Intervention: self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5–56.2] Nursing students, 34% [95% CI 30.3–37.6] Medicine students, and 13.6% [95% CI 11.0–16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18–52; 95% CI, 21.98–22.70). A total of 76.8% (95% CI 73.5–80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5–9.6]). Residents of FM (p

Objective This study explores whether an Experiential Training Programme (ETP) in communication skills (CS) improves students' ability to identify patients clues compared to those who follow a non-experiential training throughout their medical studies. Method Intervention Group (IG): 85 4th-year medical students who received the ETP and Control Group (CG): 67 recently graduated students who did not receive it. Their immediate (written) response was requested to three expressions offered by patients containing communicative clues. The answers were grouped into 2 categories: Clue recognised and response patient-centred and the opposite. Three researchers analysed the answers. Results Responses 366 (65 from the CG and 77 from the IG): 280 did not recognise clues: 131 (62%) in IG and 149 (96%) in CG and 86 recognised them: 80 (37.9%) in IG and 6 (3.9%) in CG (p = 0.000). Some clues were more elusive than others (p = 0,003). Conclusions The students who received the ETP in CS showed greater ability to explore patients perspective taking advantage of different types of communicative clues than those who did not receive it in a non-relational context. Practice implications Further research is needed to assess whether this ability is maintained in simulated or real clinical situations. pre-print 222 KB

Resumen: Introducción: En los pacientes, asegurar una correcta técnica inhalatoria es el principal objetivo para un tratamiento efectivo. Es primordial que el personal sanitario posea los conocimientos necesarios para enseñarles. Sin embargo, los pocos estudios existentes demuestran que los sanitarios presentan conocimientos insuficientes. Objetivo: Evidenciar qué conocimientos acerca del uso de inhaladores presurizados de dosis medida (pMDI) frente a polvo seco presentan los médicos residentes de Medicina Familiar y Comunitaria y comprobar si una actividad formativa incrementa ese grado de conocimientos previo. Métodos: Estudio cuasi-experimental antes/después. Los participantes fueron residentes de Medicina Familiar y Comunitaria de la Unidad Docente de Medicina Familiar y Comunitaria de Córdoba durante noviembre y diciembre de 2015. En un primer momento, se pasó un cuestionario y se les realizó una prueba práctica. Seguidamente, se les dio una sesión formativa. Posteriormente, cumplimentaron el mismo cuestionario. Resultados: Participaron 59 residentes. La nota media en el cuestionario preactividad formativa fue 8,31 ± 2,05 (IC 95%: 7,77-8,85) y en el post fue 9,67 ± 1,19 (IC 95%: 9,24-10,09). Existían diferencias estadísticamente significativas (p = 0,001) entre los resultados obtenidos antes y después de la sesión formativa. El 5,4% obtuvo un resultado óptimo al usar inhaladores pMDI, frente al 48,6% con Spiromax. No se hallaron diferencias estadísticamente significativas al estratificar por rotación por Neumología o por año de residencia. Conclusión: Una actividad formativa en residentes de Medicina de Familia y Comunitaria tiene un efecto positivo en el conocimiento sobre inhaladores. El año de residencia y el rotatorio por Neumología no son influyentes. Abstract: Introduction: Ensuring patients use a correct inhalation technique is the main objective for effective treatment. It is of essential importance that health workers have the skills to teach these patients. However, the few existing studies show that the health workers have insufficient knowledge. Objective: To determine the knowledge of the resident physicians of Family and Community Medicine about the use of pressurised metered-dose inhalers (pMDI) against dry powder inhalers and to verify if a training activity increases this previous level of knowledge. Methods: Quasi-experimental before/after study. Participants were residents of Family and Community Medicine of the Teaching Unit of Family and Community Medicine of Cordoba during november and december 2015. At first, a questionnaire was completed, and then they were given a practical test. This was followed by a training session, and then completing the same questionnaire. Results: A total of 59 residents participated. The mean pre-questionnaire score was 8.31 ± 2.05 (95% CI: 7.77-8.85) and in the post 9.67 ± 1.19 (95% CI: 9.24-10.09). There were statistically significant differences (P = .001) between the results obtained before and after the training session. An optimal outcome was obtained in 5.4% when using pMDI inhalers, compared to 48.6% with Spiromax. No statistically significant differences were found when stratified by rotation into Chest Diseases Units or year of Residence. Conclusion: A training activity by residents of Family and Community Medicine has a positive effect on knowledge about inhalers. The year of residence and rotation into Chest Diseases Units have no influence on this knowledge. Palabras clave: Inhaladores, Residentes, Sesión formativa, Keywords: Inhalers, Medical residents, Training intervention

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165, p = 0.008, η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

Resumen: Objetivo: Valorar la aceptabilidad y la factibilidad de la búsqueda oportunista del VIH por parte de los profesionales de atención primaria. Conocer el perfil del médico que participa en este tipo de estudio. Diseño: Estudio observacional, transversal. Emplazamiento: Centros de atención primaria del Sistema Nacional de Salud. Participantes: Médicos de familia y residentes que participaron en el estudio VIH-AP para medir la aceptabilidad de la búsqueda oportunista del VIH por parte de los pacientes. Mediciones principales: Mediante encuesta autocumplimentada se determinó: edad, sexo, cualidad de docente, años de investigación, tiempo trabajando con el mismo cupo, aceptabilidad y factibilidad de la búsqueda oportunista del VIH. Resultados: Un total de 197 médicos con una media de edad de 45,2 ± 9,7 (DT) años. El 18,8% eran menores de 36 años, el 70,1% mujeres y el 62,4% docentes. El 55,8% trabajaban en localidades mayores de 100.000 habitantes y la media de años ocupando el mismo cupo fue de 6,4 ± 6,6. El 91,9% (IC 95%: 88,1-98,7) consideró la búsqueda oportunista del VIH aceptable, el 89,3% (IC 95%: 85,0-93,6), factible de realizar, mostrando el análisis multivariante relación positiva con el realizar actividad docente (OR: 2,74; IC 95%: 1,16-6,49). La aceptación de la prueba por parte de los pacientes fue del 93,1%, y esta se relacionó positivamente con el tiempo que el médico había trabajado en el mismo cupo, la cualidad de docente y los años dedicados a la investigación. Conclusiones: La búsqueda oportunista del VIH es un método aceptable y factible para los profesionales de atención primaria. Abstract: Objective: To evaluate the acceptability and feasibility of the opportunistic search of HIV according to primary care doctorsâ experience. To set up the profile of the physician involved in this study. Design: Observational, transversal study. Location: Primary Care Centers of the National Health System. Participants: General practitioners and residents who participated in VIH-AP study to measure the acceptability of HIV opportunistic search by patients. Main measurements: Self-filling survey to collect data on age, sex, teaching skills, amount of years dedicated to research, time working with the same quota of patients, acceptability and feasibility of opportunistic HIV search. Results: A total of 197 physicians with a mean age of 45.2 ± 9.7 (SD) years. 18.8% were under 36 years old, 70.1% were women and 62.4% had teaching skills. 55.8% worked in towns with a population over 100,000 inhabitants and the mean of years working with the same quota of patients was 6.4 ± 6.6. 91.9% (95% CI: 88.1-98.7) of them considered the opportunistic search of HIV acceptable and 89.3% (95% CI: 85.0-93.6), feasible to perform. The multivariate analysis showed positive relation between the acceptability/feasibility and teaching skills (OR: 2.74; 95% CI: 1.16-6.49). The acceptance of the screening by patients was 93.1% and this was positively related to how long the doctor had worked with the same quota, teaching skills and the amount of years dedicated to research. Conclusions: HIV opportunistic search is an acceptable and feasible method for primary care professionals. Palabras clave: Virus de la inmunodeficiencia humana, Detección precoz, Cribado oportunista, Aceptabilidad, Keywords: Human immunodeficiency virus, Early detection, Case finding, Patient acceptance

Resumen Fundamento y objetivo La litiasis renal es una de las enfermedades urologicas mas importantes. Parece estar relacionada con factores sociodemograficos y climaticos, estilos de vida y comorbilidad preexistente. El objetivo de este trabajo fue examinar la relacion entre variables sociodemograficas, ciertos factores de riesgo y enfermedades cronicas, y la litiasis renal. Pacientes y metodo Se realizo un estudio transversal, seleccionando a poblacion espanola de 40 a 65 anos, combinando 2 muestras aleatorias (PreLiRenA y PreLiRenE). Los datos fueron recogidos por encuestas telefonicas personales, recopilando informacion sobre variables sociodemograficas y la morbilidad percibida. Tambien se recogieron datos sobre las temperaturas medias anuales en cada region espanola. Se realizo un analisis bivariado y multivariado. Resultados Fueron encuestados 4.894 sujetos; el 51,3% eran mujeres; el 25% tenian entre 40 y 45 anos; el 36% tenian educacion primaria y el 31,4% eran de clase social baja. La prevalencia global de litiasis renal fue del 15,0% (intervalo de confianza al 95% [IC 95%] 14,5-15,5). Por medio del analisis multivariado, las variables que mostraron una fuerte relacion estadistica con la presencia de litiasis renal fueron: edad avanzada (61-65 anos, OR = 1,39; IC 95% 1,06-1,8), clase social alta (OR = 1,98; IC 95% 1,29-2,62), antecedentes familiares de litiasis renal (OR = 2,22; IC 95% 1,88-2,65), hipertension arterial (OR = 1,68; IC 95% 1,39-2,02) y sobrepeso/obesidad (OR = 1,31; IC 95% 1,12-1,54). Se observo una correlacion entre la litiasis renal y las temperaturas medias anuales en las regiones espanolas (r = 0,59; p = 0,013). Conclusiones Existe relacion entre litiasis renal y edad avanzada, pertenecer a clases sociales altas, existencia de antecedentes familiares de urolitiasis, y tener hipertension y sobrepeso/obesidad. La prevalencia de la litiasis renal es mayor en las zonas climaticas mas calidas.

Resumen Objetivo El objetivo de este estudio fue evaluar la eficacia del cribado oportunista a traves de la palpacion del pulso para la deteccion de fibrilacion auricular en sujetos asintomaticos de edad ≥ 65 anos frente a la busqueda activa de pacientes de la misma edad con sintomas y/o complicaciones y secuelas asociadas. Material y metodos Se realizo un ensayo clinico controlado aleatorizado por cluster en 48 centros de atencion primaria del Sistema Nacional de Salud espanol. Se aleatorizo a un total de 368 medicos y enfermeras. Los investigadores del grupo experimental (GE) realizaron el cribado oportunista para la fibrilacion auricular, mientras que los investigadores del grupo control (GC) realizaron una busqueda activa en pacientes sintomaticos. Se realizo un ECG en los pacientes que tenian un pulso irregular para confirmar el diagnostico de fibrilacion auricular. Resultados Un total de 5.465 pacientes con una edad media de 75,61 fueron seleccionados para el GE y 1.525 pacientes para el GC, con una edad media de 74,07 anos. El 58,6% eran mujeres, sin diferencias significativas entre los grupos. El pulso era irregular en el 4,3 y el 15% de los pacientes del GE y el GC, respectivamente (p Conclusiones La busqueda activa, a traves de la palpacion del pulso, de fibrilacion auricular en pacientes de edad ≥ 65 anos con sintomas o signos indicativos es una estrategia mas eficaz que el cribado oportunista en pacientes asintomaticos. Registro del ensayo clinico Registrado en ClinicalTrials.gov (NCT01291953; 8 de febrero de 2011).

Objective: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged ≥ 65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. -Material and methods: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the Experimental Group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the Control Group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. -Results: A total of 5,465 patients with a mean age of 75.61 were recruited for the EG, and 1,525 patients with a mean age of 74.07 were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3% and 15.0% of the patients in the EG and the CG, respectively (p

Background The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. Methods and findings A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people ≥65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA2DS2-VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in ≥65-year-olds was 1.44% (95% CI, 1.13%–1.82%) and 0.41% (95% CI, 0.31%–0.53%) for 70% have ≥1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations., Nicole Lowres and colleagues report on stroke risk in people with atrial fibrillation detected by screening., Author summary Why was this study done? Atrial fibrillation is a common heart rhythm problem that often has no symptoms, so people are unaware they have this condition. People with atrial fibrillation can have a very high stroke risk if they are not appropriately treated with anticoagulant medications, and this risk increases with age. Screening for atrial fibrillation is recommended in many guidelines, although the precise age distribution and calculated stroke risk of atrial fibrillation detected by screening is not known. Accurate age-specific data are required for cost-effectiveness analysis, to inform the most appropriate age cutoff for screening based on the age distribution of the population to be screened. What did the researchers do and find? Investigators from 19 atrial fibrillation screening studies across the world agreed to collaborate and share patient-level data, providing a combined database of 141,220 people screened and 1,539 screen-detected cases of atrial fibrillation. Our study was able to quantify the yield and stroke risk for atrial fibrillation in 5-year age brackets, showing the exact relationship of how the yield of screening and stroke risk of screen-detected atrial fibrillation increases with age. The yield of screening was not influenced by the screening method used or the recruitment setting, indicating that screening programs can be established based on available resources. To our knowledge, this is the first study to demonstrate the precise relationship of the number that need to be screened to identify one new atrial fibrillation case, or one new atrial fibrillation case in whom anticoagulant treatment is guideline recommended, in 5-year age brackets. What do these findings mean? This study demonstrates the high calculated stroke risk of screen-detected AF and the high proportion with at least one additional stroke risk factor other than age or sex. These data allow for accurate simulations of cost-effectiveness of screening, including sensitivity analyses, based on the age distribution of the population to be screened. Ultimately, these data may be used to assist development of health policy around the development of atrial fibrillation screening programs, tailored to the specific health system and resources available.

Objetivo Desarrollar un programa de formación en Entrevista Motivacional (EM) para Médicos de Familia y evaluar el impacto. Diseño Ensayo clínico multicéntrico a doble ciego y aleatorizado, con 2 ramas (experimental (GE) y control (GC)) de Médicos de Familia, con un seguimiento de 12 meses. Emplazamiento 32 Centros de Atención Primaria. Descripción de la muestra 54 médicos (GC = 28, GE = 26). Intervenciones Programa de formación MOTIVA en EM con un curso presencial inicial (16 h), seguido de actividades en línea durante 12 meses y reuniones presenciales (entrevistas basadas en problemas con feedback de expertos). Medidas principales las habilidades comunicativas en EM se evaluaron en base a videograbaciones (VG) con la escala EVEM 2.0, por parejas de revisores. Se analizaron 236 VG con pacientes estandarizados y 96 VG con pacientes reales. Resultados Los resultados promedio en la escala EVEM (hasta 56 puntos) al inicio del estudio fueron GE = 21,27 (IC 95% 15,8-26,7) y GC = 20,23 (IC95% 16,4-23,9) sin diferencias entre ambos grupos (p = 0,79). Después del curso, la puntuación GE aumentó en 13,89 puntos (P

This study aims to evaluate the effectiveness of a multicomponent intervention in non-institutionalized older people. This effectiveness will be assessed in terms of reducing social isolation and loneliness and improving Health-Related Quality of Life.The concern for social isolation and loneliness in non-institutionalized older adults has increased in recent decades. In addition, their relationship with numerous negative health outcomes is amply demonstrated.A mixed-method design including a cluster randomized controlled clinical trial and an exploratory qualitative study with focus groups was used.Each study group consists of 57 subjects. The experimental group will be subjected to a multicomponent intervention comprising six domiciliary face-to-face sessions and five telephone calls that will be interspersed. Interventions will be conducted by healthcare professionals and volunteers. The control group will not be subjected to any systematized intervention. We are going to consider social isolation, loneliness, and Quality of Life as the primary outcomes. However, the factors that influence both primary outcomes and the feasibility of the intervention in clinical practice will also be assessed.Despite the negative influence of social isolation and loneliness on clinical outcomes is widely evidenced, few early detection programs are available, especially interventions at the community setting. This study will examine the effectiveness of the intervention in the Spanish community setting. At the same time, this study will identify the feasibility of this intervention in Primary Care clinical practice.Substantial evidence indicates the detrimental health impact of social isolation and loneliness, particularly on mental wellness. Knowing that mental disorders are associated with high economic cost, this project would have strong clinical implication to inform nursing practice on managing social isolation and loneliness. The findings may also inform primary health policy setting in Spain and the wider European countries.目的: 本研究旨在评估对不是住在福利院的老年人进行多因素干预的有效性。将从减少社会孤立和孤独感以及提高与健康相关的生活质量的角度对有效性进行评估。 背景: 近几十年来,对不是住在福利院的老年人被社会孤立和孤独感的担忧有所增加。此外,它们也被充分证明与许多负面健康结果有关。 设计: 采用包括分组随机对照临床试验和针对重点人群的探索性定性研究在内的混合方法设计。 方法: 每个研究小组由57名试验对象组成。实验小组将接受多因素干预,包括六次面对面的家庭谈话,并插入五次电话谈话。干预将由专业医疗人员以及志愿者进行。对照组将不接受任何系统化干预。我们将把社会孤立、孤独感以及生活质量视为主要结果,但还会评估影响主要结果的因素和临床实践干预的可行性。 讨论: 尽管社会孤立和孤独感对临床结果的负面影响已被广泛证实,却很少有可用的早期探测项目,尤其是在社区中的干预措施。本研究将考察干预措施在西班牙人居住社区中的有效性。与此同时,本研究将确定此干预措施在初级保健临床实践中的可行性。 影响: 大量证据表明,被社会孤立以及孤独感对健康有害,尤其是对精神健康。由于精神障碍与高经济成本相关,本研究课题在为护理实践提供管理社会孤立及孤独感上有着极大的临床意义。调查结果还可能为西班牙乃至更多的欧洲国家基本卫生政策的制定提供参考。.

AimTo estimate the prevalence of alcohol consumption and analyse the drinking patterns among primary healthcare (PHC) providers.DesignObservational, cross-sectional, descriptive study.SettingPHC centres in the Spanish National Health System (SNHS).ParticipantsDoctors and nurses who completed an online questionnaire which explored their alcohol intake, using the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol assessment tool. The study population was recruited by random sampling stratified by regions of the SNHS PHC centres.Primary and secondary outcome measuresFrequency of alcohol consumption, number of alcohol drinks on a typical day, frequency of more than six standard drinks (SDs) intake.ResultsA total of 1760 PHC providers completed the questionnaire. The frequency of alcohol consumption was: abstention (12%, 95% CI 10.4% to 13.5%); one or less SDs/month (26%, 95% CI 23.8% to 27.9%); 2–4 SDs/month (32.2%, 95% CI 29.7% to 34.1%); 2–3 SDs/week (17.9%, 95% CI 16.0% to 19.6%); four or more SDs/week (11.9%, 95% CI 10.3% to 13.3%). The number of drinks on a typical day was: none (45.6%, 95% CI 42.9% to 47.6%); 1–2 drinks (47.3%, 95% CI 23.8% to 27.9%); 3–4 drinks (6.5%, 95% CI 5.3% to 7.6%). The percentage of hazardous drinking, according to AUDIT-C criteria, was 32% (95% CI 26.7 to 37.3), with a greater frequency of intake in older professionals (pConclusionsOur study discloses the most up-to-date portrait of current alcohol consumption among Spanish PHC providers, showing a higher prevalence of alcohol intake, compared with the general population. Preventive strategies should be implemented to improve the awareness and training of PHC professionals towards alcohol consumption.

Background: Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. Objective: 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). Methods: 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. Results: A total of 740 participants completed the questionnaire. 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. 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. Conclusion: 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. pre-print 322 KB

ResumenObjetivoValorar la aceptabilidad de la prueba del virus de la inmunodeficiencia humana (VIH) mediante búsqueda oportunista.DiseñoEstudio observacional, transversal.EmplazamientoCentros de atención primaria (CAP) del Sistema Nacional de Salud.ParticipantesPacientes de 18 a 65años a los que hubiese que realizar una analítica y que nunca antes se hubiesen realizado la prueba del VIH.Mediciones principalesEdad, sexo, pareja estable, nivel de instrucción, consumo de tabaco/alcohol, motivo de la analítica, aceptabilidad de la prueba del VIH, motivo por el que no acepta o por el que no se le ha realizado antes. Se realizó un análisis estadístico descriptivo, bivariante y multivariante (regresión logística).ResultadosDoscientos ocho médicos de 150 CAP captaron 3.314 pacientes. La aceptabilidad del test del VIH fue del 93,1% (IC95%: 92,2-93,9). De estos, el 56,9% no se la habían realizado antes por no considerarse en riesgo, y el 34,8% por no habérsela ofertado su médico. Del 6,9% que rechazaron la serología, el 73,9% alegaron no considerarse en riesgo. Mediante análisis de regresión logística las variables que mostraron relación con la aceptabilidad de la prueba positivamente fueron: la edad (grupo de 26 a 35años; OR=1,79; IC95%:1,10-2,91) y ser no fumador (OR=1,39; IC95%: 1,01-1,93). Los residentes en poblaciones entre 10.000 y 50.000 habitantes (OR=0,57; IC95%: 0,40-0,80) fueron los que en menor grado aceptaron la prueba. La prevalencia de VIH detectada fue del 0,24%.ConclusionesLa prueba serológica del VIH tiene una alta aceptación entre los usuarios que acuden para hacerse un análisis de sangre a los CAP. La búsqueda oportunista es coste-efectiva.AbstractObjectiveTo assess the acceptability of opportunistic search for human immunodeficiency virus (HIV).DesignCross-sectional, observational study.LocationPrimary Care Centres (PCC) of the Spanish National Health Care System.Participantspatients aged 18 to 65 years who had never been tested for HIV, and were having a blood test for other reasons.Recorded variablesage, gender, stable partner, educational level, tobacco/alcohol use, reason for blood testing, acceptability of taking the HIV test, reasons for refusing to take the HIV test, and reasons for not having taken an HIV test previously. A descriptive, bivariate, multivariate (logistic regression) statistical analysis was performed.ResultsA total of 208 general practitioners (GPs) from 150 health care centres recruited 3,314 patients. Most (93.1%) of patients agreed to take the HIV test (95%CI: 92.2-93.9). Of these patients, 56.9% reported never having had an HIV test before because they considered not to be at risk of infection, whereas 34.8% reported never having been tested for HIV because their doctor had never offered it to them. Of the 6.9% who refused to take the HIV test, 73.9% considered that they were not at risk. According to the logistic regression analysis, acceptability was positively associated to age (higher among between 26 and 35 year olds, OR=1.79; 95%CI: 1.10-2.91) and non-smokers (OR=1.39; 95%CI: 1.01-1.93). Those living in towns with between 10,000 and 50,000 inhabitants showed less acceptance to the test (OR=0.57; 95%CI: 0.40-0.80). The HIV prevalence detected was 0.24%ConclusionsAcceptability of HIV testing is very high among patients having a blood test in primary care settings in Spain. Opportunistic search is cost-effective.

Resumen Fundamento y objetivo La urolitiasis constituye una afeccion frecuente, cuya prevalencia se ha incrementado a nivel mundial. En Andalucia (Espana) el estudio PreLiRenA mostro una elevada prevalencia (16,4%; intervalo de confianza al 95% [IC 95%] 14,8-17,8) en poblacion de 40 a 65 anos, lo cual nos hizo cuestionarnos cual seria la situacion a nivel nacional. El objetivo fue estimar la prevalencia de urolitiasis en la poblacion espanola de entre 40 y 65 anos. Pacientes y metodo Estudio observacional, transversal, mediante muestreo estratificado segun las regiones del pais, sexo y edad. Se realizaron un total de 2.444 entrevistas telefonicas mediante un cuestionario que incluia variables sociodemograficas y clinicas. Se realizo una estadistica descriptiva y bivariada, calculando las ratios de prevalencia (RP) con IC 95%. Resultados De los 2.444 sujetos entrevistados, el 51,2% (n = 1.251) eran mujeres. La prevalencia de urolitiasis fue del 14,6% (IC 95% 13,1-15,9), y la incidencia, del 2,9% (IC 95% 2,2-3,6). Se observaron diferencias significativas respecto a la edad, con una mayor prevalencia en pacientes de 46-50 anos (RP 1,58; IC 95% 1,12-2,21; p Conclusiones Se observa una elevada prevalencia de urolitiasis entre la poblacion espanola de 40 a 65 anos, sobre todo entre los sujetos de clase social superior y mediana edad, asi como una alta tasa de recurrencia.

Background: Obstructive sleep apnea (OSA) is a chronic illness that increases in prevalence with age. Treatment includes continuous positive airway pressure (CPAP) devices. Studies about the use of CPAP in the elderly are scarce. The main objective of this study is to determine whether CPAP contributes to improvement in health-related quality of life (HRQL) in elderly patients with OSA. Method: This was a prospective, pre-/postintervention assessment of a cohort of patients ≥65 years of age with OSA diagnosis by polysomnography who were being treated with CPAP and were physically independent and had good cognitive status. We determined HRQL before and after 3 months of CPAP treatment using the Short Form-36 Health Survey (SF-36, a 36-item, patient-reported survey) and Sleep Apnea Quality of Life Index (SAQLI). The effect of CPAP on daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Results: Of the 103 participants with a mean age of 71.5 ± 4.19 years, 66% were male. After 3 months of therapy, the mean CPAP usage was 6.3 ± 1.41 hr/day. The effectiveness of CPAP in controlling the OSA was demonstrated (mean difference pre- and posttherapy: 34.30 ± 18.52 events/hr, p < .001). Postintervention, the categories of the SF-36 improved meaningfully ( p < .001). Moreover, all categories of SAQLI improved ( p < .001) with the exception of “symptoms” ( p = .073). ESS scores also improved significantly (difference = 5.2 ± 4.47, p < .001) postintervention. Conclusion: Therapy with CPAP in elderly patients with OSA helps improve their HRQL and reduces daytime sleepiness.

Resumen Objetivo Evaluar la efectividad de actividades formativas dirigidas a sanitarios de atención primaria sobre el manejo de pacientes con problemas de consumo de alcohol. Diseño Revisión sistemática cualitativa de ensayos clínicos controlados aleatorizados. Fuentes de datos Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database–ETOH y FAMILY RESOURCES DATABASE. La búsqueda se realizó en junio de 2017. Selección de estudios Muestra final n = 3. Se incluyeron: ensayos clínicos controlados aleatorizados, indexados hasta el 30 de mayo de 2017, con objetivo evaluar la efectividad de actividades formativas orientadas a profesionales de atención primaria en el abordaje de pacientes con problemas de consumo de alcohol. Extracción de datos Las medidas fueron expresadas en términos de efectividad de la aplicación de la actividad formativa: nivel de implementación global, cribado de consumo de alcohol, intervención de pacientes con consumo de riesgo y nivel de apoyo requerido. Resultados Tres ensayos clínicos controlados aleatorizados, publicados desde 1999 a 2004, fueron incluidos. Tanto el cribado, como las técnicas de intervención breve, experimentaron un incremento de su aplicación en los tres estudios, tras el desarrollo de los programas formativos. Se consiguieron resultados significativos en términos de efectividad en 2 de los 3 ensayos seleccionados, tanto en la detección de consumidores de riesgo, como en la intervención breve. Conclusión El desarrollo de programas formativos en el abordaje de pacientes con problemas de consumo de alcohol constituye una estrategia efectiva para los profesionales de atención primaria, permitiendo la implementación del cribado poblacional y de técnicas de intervención breve.

OBJECTIVE To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain. METHODS Online self-administered survey sent between May 2016 and February 2017 to 2221 primary-care physicians working across Spain. Clinicians were mostly identified through national primary-care scientific societies (20% overall response rate). RESULTS Participants' mean age was 47.7 years, 55% were women, and 54% reported at least 20 years of primary-care practice. Among them, 47.5% considered ABPM the best diagnostic method for hypertension, 23% chose HBPM, and 7.1% chose office blood pressure. Also, 78.2% had AD available at their centers and 49.0% had ABPM, with slight urban/rural differences. HBPM was recommended in daily practice for hypertension diagnosis by 67% of participants, whereas 30% recommended ABPM. Cost to the patients was the main reason for not using HBPM (42.7%) as was lack of accessibility for not using ABPM (69.8%). Lack of specific training was also reported as an important reason in both cases. CONCLUSION Even in the possibly best primary care scenario presented by highly motivated physicians (respondents to a voluntary anonymous survey), enormous gaps were observed between current guidelines' recommendations on ABPM and HBPM use for confirming hypertension and the modest degree of knowledge, availability, and use of these technologies.

IntroductionThe aim of the study is to analyse the prevalence of smoking among resident physicians at a regional university hospital. In addition, we examined the trends in the smoking behaviour of physicians in relation to results obtained in other studies carried out previously at this hospital, as well as those published nationally and internationallyMethodA cross-sectional observational study evaluating tobacco consumption in young physicians was carried out at the level of secondary healthcare in a regional university hospital in Cordoba, Spain. All the study subjects were resident physicians who underwent a mandatory preliminary occupational health examination between 2012 and 2016. There was no sampling selection as anyone who took this examination was considered to be within the target population. We calculated the proportions of smokers, former smokers and non-smokers, with 95% CIs. Univariate and multivariate analyses (binary logistic regression) were used to analyse the results (PResultsThe response rate was 99.4%, with a sample size of 324 out of a possible 326 physicians. The average age was 28.6±3.7—DT—(95% CI 28.2 to 29.0), and 62.3% (202/324; 95% CI 57.3 to 67.2) were women. Smoking prevalence was 6.5% (21/324; 95% CI 3.5 to 9.3) with a further 5.2% (17/324; 95% CI 2.7 to 7.8) being ex-smokers. There were no significant differences in the prevalence of tobacco consumption according to age (P=0.266), sex (9.0% for men and 5.0% for women; P=0.128), medical specialty (P=0.651) or year of residency (P=0.975). A 52.7% decline in the number of young physician smokers was noted between 1986 and 2016 (95% CI −44.0 to −63.5), together with a 64.4% increase in non-smokers (95% CI 55.2 to 77.3).ConclusionsWe observed a significantly low prevalence of tobacco use among trainee physicians in the cohort, an effect of new antismoking laws, with positive role model implications for new physicians and medical students.

OBJECTIVES: To increase medical students’ ability to detect contextual and emotional cues and to respond empathetically to patients. METHODS: a training course in communication skills and patient-centered care with different teaching activities (didactic, reflective and interactive: workshops and encounters with simulated patients) was delivered to third-year medical students just before their clerckships. The program was evaluated by an external observer (OE) and simulated patients (SP) in 2 or 3 videotaped encounters. RESULTS: Students improved significantly from baseline to 3rd interview in all communicative skills and domains explored both in OE (32.4%) and SP (38.3%) measurement. At the end of the course students detected significantly more clues and made more empathetic expressions. CONCLUSIONS: The course seems to improve the ability of students to explore the illness experience, showing more empathy in a more genuine way. This was carried out in consultations lasting 10 minutes. PRACTICAL IMPLICATIONS: The program is effective and feasible to be applied as a regular formative activity. Further research is needed to assess whether this training program is applicable to students in more advanced educational levels and if it has any additional outcomes. pre-print 432 KB