Implementation of the EIRA 3 Intervention by Targeting Primary Health Care Practitioners: Effectiveness in Increasing Physical Activity.

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

Correction to: Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial.

It has been highlighted the original article (1) contained a typesetting mistake in the authorship, and that author Caterine Vicens was omitted.

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial.

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

Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations.

PURPOSE: To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present. DATA SOURCES: Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety. STUDY SELECTION: Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals. DATA EXTRACTION: Study characteristic and outcome data were abstracted by two authors and reviewed by the research team. RESULTS OF DATA SYNTHESIS: Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization. CONCLUSION: Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE.

[Program for the prevention of smoking in secondary school students]. / Programa de prevención del tabaquismo en alumnos de enseñanza secundaria.

BACKGROUND AND OBJECTIVE: School smoking prevention programs have never yielded the expected results. The aim of this study was to analyze the efficacy of an intensive smoking prevention program created by the educational community in which it was to be applied. POPULATION AND METHOD: A 3-year smoking prevention program was carried out among the students of Fuentesaúco Secondary School in Zamora, Spain. The Babilafuente Secondary School in Salamanca, Spain was the control group. The program included both prevention and treatment activities. The former were carried out in the school, in out-of-school situations, and in the community. The questionnaire of the European Smoking Prevention Framework Approach was used. RESULTS: A total of 417 students aged 12 to 17 years participated in the study. Of these, 54.4% belonged to the intervention group and 45.6% to the control group. Smokers represented 36.7% of the population. After the intervention smokers represented 40.1% of the Fuentesaúco students compared with 46.1% of the Babilafuente students, though the difference was not statistically significant. With respect to the cognitive determinants of smoking behavior, after the intervention significant differences in favor of the intervention group were only observed in the subjects' perception of the behavior of their siblings, peers, and teachers. CONCLUSIONS: The use of smoking prevention programs in schools should be reconsidered, and their evaluation should be based on educational rather than clinical criteria. Proposed changes in the program include decreasing its intensity, starting with students of an earlier age and seeking greater involvement of parents.

Programa de prevención del tabaquismo en alumnos de enseñanza secundaria / Program for the prevention of smoking in secondary school students

Introducción y objetivolos programas de prevención de tabaquismo en la escuela no han ofrecido nunca los resultados que era previsible esperar. El objetivo del presente trabajo es analizar la eficacia de un programa intensivo de prevención del tabaquismo elaborado por la propia comunidad educativa en la que se va a desarrollar. Población y métodose ha realizado un programa de intervención de tabaquismo, de 3 años de duración, dirigido a los alumnos de enseñanza secundaria del instituto de Fuentesaúco (Zamora). El instituto de Babilafuente (Salamanca) ha sido el grupo control. El programa constaba de actividades de prevención y actividades de tratamiento. Las primeras se desarrollaron en el ámbito tanto escolar como extraescolar y en la comunidad. Se utilizó el cuestionario del proyecto ESFA. Resultadosparticiparon 417 alumnos de 12-17 años, de los que el 54,4% pertenecía al grupo de intervención y el 45,6% al grupo control. Fumaba el 36,7% de los alumnos. Después de la intervención fumaba el 40,1% de los alumnos de Fuentesaúco frente al 46,1% de Babilafuente, diferencia no significativa. Con respecto a los determinantes cognitivos de la conducta fumadora, después de la intervención únicamente se observaron diferencias significativas a favor del grupo de intervención en la conducta percibida de hermanos, iguales y profesores. Conclusioneses preciso replantearse la realización de programas de prevención de tabaquismo en la escuela y su evaluación con criterios clínicos, que deben sustituirse por criterios pedagógicos. Se plantea corregir el programa disminuyendo su intensidad, comenzar a edades más tempranas e implicar más a los padres de los alumnos(AU)

Background and ObjectiveSchool smoking prevention programs have never yielded the expected results. The aim of this study was to analyze the efficacy of an intensive smoking prevention program created by the educational community in which it was to be applied. Population and MethodA 3-year smoking prevention program was carried out among the students of Fuentesaúco Secondary School in Zamora, Spain. The Babilafuente Secondary School in Salamanca, Spain was the control group. The program included both prevention and treatment activities. The former were carried out in the school, in out-of-school situations, and in the community. The questionnaire of the European Smoking Prevention Framework Approach was used. ResultsA total of 417 students aged 12 to 17 years participated in the study. Of these, 54.4% belonged to the intervention group and 45.6% to the control group. Smokers represented 36.7% of the population. After the intervention smokers represented 40.1% of the Fuentesaúco students compared with 46.1% of the Babilafuente students, though the difference was not statistically significant. With respect to the cognitive determinants of smoking behavior, after the intervention significant differences in favor of the intervention group were only observed in the subjects¿ perception of the behavior of their siblings, peers, and teachers. ConclusionsThe use of smoking prevention programs in schools should be reconsidered, and their evaluation should be based on educational rather than clinical criteria. Proposed changes in the program include decreasing its intensity, starting with students of an earlier age and seeking greater involvement of parents(AU)

Valor predictivo de la abstinencia tabáquica a los 2 meses de tratamiento / Two-month results are predictors of outcome in a smoking cesation program

FUNDAMENTO: La intervención mínima sistematizada y la terapia sustitutiva con nicotina han demostrado ser efectivas en el tratamiento del tabaquismo. El objetivo de nuestro estudio ha sido determinar si los resultados obtenidos a los 2 meses con un programa de tratamiento del tabaquismo, con ambos procedimientos, desarrollado en la asistencia habitual pueden ser considerados predictores de los resultados al año. SUJETOS Y MÉTODO: Hemos realizado un estudio longitudinal y prospectivo en el que se ha incluido a todos los fumadores (n = 357) que acudieron a una consulta de atención primaria o especializada durante un período de 6 meses. La intervención mínima fue utilizada en los fumadores con baja dependencia a la nicotina (Fagerström < 7) o que aún no se encontraban en fase de preparación. La terapia sustitutiva con nicotina se aplicó a los fumadores con alta dependencia (Fagerström 7).RESULTADOS: Un total de 32 pacientes (9 por ciento) de los 357 no acudieron a los controles establecidos y se consideraron casos perdidos. El estudio anual fue completado por 177 pacientes en el grupo de intervención mínima y 148 en el de la terapia sustitutiva. La abstinencia al año fue conseguida por el 39,2 por ciento de los sujetos del grupo de la intervención mínima y por el 36,2 por ciento de los tratados con terapia sustitutiva con nicotina. Previamente, a los 2 meses, la abstinencia observada había sido del 34 por ciento (27,4-40,7) y 52,1 por ciento (44,5-59,8), respectivamente. Los pacientes que habían conseguido la abstinencia a los dos meses del inicio del programa tenían 19 veces más probabilidades de éxito al cabo de un año (odds ratio, 19,4), presentando en el grupo de la intervención mínima una sensibilidad del 72,4 por ciento y una especificidad del 90,7 por ciento, y en el grupo de la terapia sustitutiva del 93,2 por ciento y el 71,2 por ciento, respectivamente. CONCLUSIONES: Los resultados observados a los 2 meses del inicio del programa se comportan como predictores de éxito y pueden ser de utilidad para modificar la actitud terapéutica con el fin de mejorar las tasas de abstinencia al año del inicio del programa (AU)