Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study.

BACKGROUND: The World Health Organization (WHO) has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy ageing. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for decreased IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the performance of diagnostic measures (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults. METHODS: Cross-sectional analysis of the baseline of the ongoing VIMCI (Validity of an Instrument to Measure Intrinsic Capacity) cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients' visit. Agreement was assessed with the Gwet AC1 index. RESULTS: ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842. CONCLUSION: The ICOPE screening tool showed fair performance of diagnostic measures; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify decreased IC in older people with high degree of autonomy. Since low sensitivities were found, a process of external validation would be recommended to reach better discrimination. Further studies about the ICOPE Screening tool and its performance of diagnostic measures in different populations are urgently required.

Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study.

OBJECTIVE: This 12-month study in a primary healthcare network aimed to assess the effectiveness of usual smoking cessation advice compared with personalised information about the spirometry results. DESIGN: Randomised, parallel, controlled, multicentre clinical trial. SETTING: This study involved 12 primary healthcare centres (Tarragona, Spain). PARTICIPANTS: Active smokers aged 35-70 years, without known respiratory disease. Each participant received brief smoking cessation advice along with a spirometry assessment. Participants with normal results were randomised to the intervention group (IG), including detailed spirometry information at baseline and 6-month follow-up or control group (CG), which was simply informed that their spirometry values were within normal parameters. MAIN OUTCOME: Prolonged abstinence (12 months) validated by expired-CO testing. RESULTS: Spirometry was normal in 571 patients in 571 patients (45.9% male), 286 allocated to IG and 285 to CG. Baseline characteristics were comparable between the groups. Mean age was 49.8 (SD ±7.78) years and mean cumulative smoking exposure was 29.2 (±18.7) pack-years. Prolonged abstinence was 5.6% (16/286) in the IG, compared with 2.1% (6/285) in the CG (p=0.03); the cumulative abstinence curve was favourable in the IG (HR 1.98; 95% CI 1.29 to 3.04). CONCLUSIONS: In active smokers without known respiratory disease, brief advice plus detailed spirometry information doubled prolonged abstinence rates, compared with brief advice alone, in 12-month follow-up, suggesting a more effective intervention to achieve smoking cessation in primary healthcare. TRIAL REGISTRATION NUMBER: NCT01194596.

A clinical trial to evaluate the effect of the Mediterranean diet on smokers lung function.

Data on the association between lung function and some dietary patterns have been published. However, it is not yet well known if whether the Mediterranean Diet (MD) pattern can preserve or improve lung function. Our purpose is to evaluate the effect of increased MD adherence on lung function in smokers. A multicenter, parallel, cluster-randomized, controlled clinical trial is proposed. A total of 566 active smokers (>10 packs-year), aged 25-75 years will be included, without previous respiratory disease and who sign an informed consent to participate. Twenty Primary Care Centres in Tarragona (Spain) will be randomly assigned to a control or an intervention group (1:1). All participants will receive advice to quit smoking, and the intervention group, a nutritional intervention (2 years) designed to increase MD adherence by: (1) annual visit to deliver personalized nutritional education, (2) annual telephone contact to reinforce the intervention, and (3) access to an online dietary blog. We will evaluate (annually for 2 years): pulmonary function by forced spirometry and MD adherence by a 14-item questionnaire and medical tests (oxidation, inflammation and consumption biomarkers). In a statistical analysis by intention-to-treat basis, with the individual smoker as unit of analysis, pulmonary function and MD adherence in both groups will be compared; logistic regression models will be applied to analyze their associations. We hope to observe an increased MD adherence that may prevent the deterioration of lung function in smokers without previous respiratory disease. This population may benefit from a dietary intervention, together with the recommendation of smoking cessation.

Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study.

BACKGROUND: There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. DESIGN: Multicentre randomized clinical trial with an intervention and a control group. SETTING: 12 primary care centres in the province of Tarragona (Spain). SUBJECTS OF STUDY: 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. INTERVENTION: Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant), comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. MEASUREMENTS: Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. MAIN VARIABLES: Smoking cessation at 12 months. ANALYSIS: Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. EXPECTED RESULTS: Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the intervention group than in the control group. DISCUSSION: Application of a motivational intervention based on structured information about spirometry results, improved abstinence rates among smokers seen in actual clinical practice conditions in primary care. TRIAL REGISTRATION: ClinicalTrial.gov, number NCT01194596.

[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.

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

Objetivo. Determinar el grado de distorsión de la autoimagen corporal en adolescentes femeninas, y evaluar su asociación con el modelo estético-social y la adopción de medidas dietéticas. Método. Estudio observacional y transversal. Muestra aleatoria poblacional de adolescentes femeninas de entre 12 y 21 años de edad. La información fue recogida a través de 2 fuentes: mediante un cuestionario estructurado sobre datos sociodemográficos y antropométricos (deseo de parecerse a las modelos publicitarias, satisfacción con la talla de pantalón que usaban, si realizaban dietas sin supervisión, etc.) y valoración de la autopercepción de la propia imagen corporal mediante un juego de 9 imágenes de siluetas femeninas de anchura creciente. Resultados. Se analizaron 401 adolescentes con una media de edad de 17,6 años (desviación estándar = 2,6). En cuanto al peso, el 75,3% tenía normopeso, el 11% sobrepeso, el 13% obesidad y el 0,8% bajopeso. Respecto a la percepción de la imagen, el 76,8% presentaba distorsión de la autoimagen corporal y le gustaba parecerse a las modelos publicitarias (p < 0,001). El 47,7% no estaba de acuerdo con la talla de pantalón que usaba (p < 0,001). El 15,3% realizaba dieta sin supervisión (p < 0,001). Conclusiones. La mayoría de adolescentes en edades comprendidas entre 13 y 21 años no está conforme con su imagen corporal. La distorsión de la autoimagen corporal se traduce en querer parecerse más a las modelos publicitarias y a no estar satisfechas con sus tallas de pantalón. Esto las lleva a la realización de dietas sin supervisión

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 5 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