Ús i abús de les noves tecnologies de la comunicació per part dels adolescents / Adolescentes y nuevas tecnologías de la comunicación / Teenagers and new communication technologies

Objectiu: conèixer la utilització i l'actitud dels adolescents enfront les noves tecnologies de la comunicació. Mètode: estudi observacional, transversal a 539 adoles-cents que estudiaven 2n d'ESO (educació secundària obli-gatòria) en cinc instituts de Reus i dos pobles veïns. Els adolescents van respondre, el febrer del 2013, un qüestionari autoadministrat de 47 preguntes. Resultats: Televisió: el 39,1% la miren sols. La miren durant el dinar el 75,0% i durant el sopar el 80,6%. Els repetidors de curs la tenen més sovint a la seva habitació i la miren més de 3 h/dia. Telèfon mòbil: el 83,1% en tenen, el 53,1% l'utilitzen més d'1 h/dia, sobretot per a missatgeria, Internet i WhatsApp. Videojocs: el 84,2% en tenen. El 46,8% hi juguen 1-2 h/dia. Els jocs a què juguen més són de guerra i futbol. Ordinador: el 69,7% en tenen a l'habitació. Sols el 15,9% dels pares tenen control sobre el seu ús. L'utilitzen sobretot per a Facebook, navegar o xatejar. Els repetidors de curs estan una mitjana de 3 hores o més al dia connectats. El 27,8% dels enquestats han rebut propostes per quedar i el 18,8%, propostes de tipus sexual. El 49,2% diuen que la identificació del xat és fiable. Conclusions: els adolescents del nostre entorn dediquen moltes hores a les noves tecnologies de la comunicació. La majoria no tenen control parental i troben fiables les identificacions per Internet. Un nombre considerable reben proposicions per quedar, i també de tipus sexual. Els repetidors de curs són els que més tenen la televisió a l'habitació i els que dediquen més hores a veure-la i a estar connectats a Internet

Objetivo. Conocer la utilización y la actitud de los adolescentes frente a las nuevas tecnologías de la comunicación. Método. Estudio observacional, transversal a 539 adolescentes que estudiaban 2.º de ESO (educación secundaria obligatoria) en cinco institutos de Reus y dos poblaciones vecinas. Los adolescentes respondieron, en febrero de 2013, un cuestionario autoadministrado de 47 preguntas con respuestas. Resultados. Televisión: Televisión: el 39,1% la miran solos. La miran durante la comida el 75,0% y durante la cena el 80,6%. Los repetidores de curso la tienen con más frecuencia en su habitación i la miran más de 3 h/día. Teléfono móvil: Teléfono móvil: el 83,1% lo tienen. El 53,1% lo utilizan más de 1 h/día, sobre todo para mensajes, Internet y WhatsApp. Videoconsola: Videoconsola: el 84,2% la tienen. El 46,8% juegan 1-2 h/día. Los juegos con los que más juegan son de guerra y útbol. Ordenador: Ordenador: el 69,7% lo tienen en la habitación. Solo el 15,9% de los padres tienen control sobre su uso. Lo utilizan sobre todo para Facebook, navegar o chatear. Los repetidores de curso están una media de 3 horas o más al día conectados. El 27,8% de los encuestados han recibido propuestas para citas, y el 18,8% propuestas de tipo sexual. El 49,2% dicen que la identificación en los chats es fiable. Conclusiones. Los adolescentes de nuestro entorno dedican muchas horas a las tecnologías de la comunicación. La mayoría no tienen control parental y hallan fiable las identificaciones por Internet. Un número considerable reciben proposiciones para citas, y también de tipo sexual. Los repetidores de curso son los que más tienen televisión en la habitación y los que dedican más horas a verla y a estar conectados a Internet (AU)

Objective. To know the use and attitude of adolescents towards new communication technologies. Method. Observational cross-sectional study with 539 adolescents studying second year of secondary education, in 5 institutes in Reus and two neighboring towns. Adolescents responded in February 2013 a self-administered questionnaire of 47 questions. Results. Television: Television: 39.1% watch it alone. 75% of the students look at it during lunch and 80.6% while having dinner. Repeating students have it more often in their room and watch it more than 3 hours/day. Mobile phone: Mobile phone: 83.1% have one and 53.1% use it more than 1 hour/day, especially for messaging, internet and whatsapp. Game console: Game console: 84.2% have one and 46.8% play 1-2hours/day. The games they play are more frequently about war or football. Computer: Computer: 69.7% have one in the room. Only 15.9% of parents have control over their use. They use it especially for Facebook, browsing or chats. Repeating students are an average of 3 or more hours a day connected. 27.8% of respondents have received proposals for dates, and 18.8% of them sexual. 49.2% say that identification is reliable in chats. Conclusions. Teenagers around us spend many hours using communication technologies. Most have no parental control and think that internet has reliable identifications. A considerable number of adolescents receive proposals for dates and a few of a sexual nature. Repeating students are those who have more TV in their room and they spend more hours to watch it and to be connected to the Internet (AU)

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

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

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

OBJETIVO: Describir las actitudes de las enfermeras hacia la depresión, usando un cuestionario estándar para evaluar cómo una intervención formativa influye o modifica estas actitudes. MÉTODOS: Estudio prospectivo basado en la aplicación del Depression Attitude Questionnaire, antes y seis meses después de participar en una jornada formativa sobre el rol de enfermería en el manejo de la depresión en atención primaria. La muestra está formada por 40 enfermeras de atención primaria de 10 centros de salud de la provincia de Tarragona. RESULTADOS: Las enfermeras se sitúan en una posición neutra en la consideración del manejo de los pacientes deprimidos como una tarea dura, o en sentirse cómodas en la planificación de cuidados, aunque existe un alto grado de aceptación de la afirmación de que el tiempo dedicado a los pacientes deprimidos es gratificante. En general, se han constatado escasas diferencias significativas en las puntuaciones medias en los diferentes ítems del Depression Attitude Questionnaire antes y seis meses después de la intervención formativa. CONCLUSIONES: Se halla, en general, una favorable predisposición hacia el abordaje de la depresión en atención primaria y hacia el papel que pueden ejercer las enfermeras. De este modo, se pueden establecer y prosperar iniciativas formativas y organizativas que puedan perfilar y estructurar más nítidamente el rol de enfermería en el diseño de planes de cuidados dirigidos al paciente deprimido en atención primaria

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

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

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

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

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

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

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

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

Cribado para el trastorno por déficit de atención/hiperactividad en pacientes adultos de atención primaria / Screening for attention deficit hyperactivity disorder in adult patients in primary care

Objetivo: Estimar la proporción de pacientes adultos de atención primaria con cribado positivo para el trastorno por déficit de atención/hiperactividad (TDAH) y estudiar sus características. Pacientes y métodos: Estudio descriptivo transversal realizado en nueve consultas de atención primaria de la provincia de Tarragona. La muestra estuvo formada por 432 pacientes consecutivos de atención primaria visitados por cualquier motivo, con edades entre 18 y 55 años. El cribado para TDAH se realizó mediante la Adult ADHD Self-Report Scale (ASRS). Se obtuvieron datos sobre impacto funcional (Sheehan Disability Inventory) y, mediante revisión de historias clínicas, datos sobre comorbilidad psiquiátrica y consumo de psicofármacos. Resultados: Se obtuvo una proporción de cribados positivos del 19,9% (IC 95% = 16,4-23,9%). Considerando la sensibilidad y especificidad de la ASRS, la estimación de la prevalencia "real" fue del 12,5% (IC 95% = 8,2-16,8%). Ninguno de estos pacientes estaba diagnosticado o tratado por TDAH. cribado positivo se asocia a disfunción laboral, social y familiar, y a mayor estrés percibido. También hay mayor comorbilidad con trastornos afectivos y consumo de sustancias, así como un uso más elevado de psicofármacos. Conclusiones: El cribado del TDAH en pacientes adultos de atención primaria da lugar a una llamativa elevada proporción de cribados positivos, lo que indica que puede haber una prevalencia relevante de pacientes con TDAH. Estos datos contrastan con la nula presencia de este diagnóstico en las historias clínicas. Es necesario profundizar en la investigación paradeterminar la utilidad del diagnóstico de TDAH y el eventual papel que debe asumir la atención primaria (AU)

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

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

Fundamento y objetivo: El objetivo de este análisis es conocer las características del proceso asistencial y detectar posibles problemas del funcionamiento del Código Ictus (CI) en sus 2 primeros años de implementación a partir de la incidencia poblacional de ictus en un sector territorial del Plan Director de Enfermedades Cerebrovasculares. Pacientes y método: Estudio prospectivo de cohorte constituida por personas con un primer episodio de ictus, entre 15-89 años de edad. Se realizó un análisis de los indicadores clínicos de resultados según los requerimientos del CI territorial, y de supervivencia por curvas de Kaplan-Meier y bivariante entre pacientes fallecidos y supervivientes. Resultados: Se incluyeron 380 pacientes ≤80 años, activándose el CI en el 54,3% (IC 95%: 49,0-59,3), intrahospitalariamente en el 77% de casos. El 80% de la ventana terapéutica se consume hasta la llegada al hospital. En el 13,9% (IC 95%: 9,2-19,8) se trató con fibrinólisis. La mortalidad inmediata fue del 9,9% (IC 95%: 7,5-12,5). Conclusiones: La implantación del CI es un sistema que mejoró la atención precoz del ictus en todo el territorio, pero su activación en el ámbito de atención primaria fue baja (AU)

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

Efectividad de un programa para el abordaje multidisciplinar de la depresión que potencia el rol enfermero en Atención Primaria / Effectiveness of a programme for the multidisciplinary approach to depression that boosts the nurse’s role in Primary Care

Objetivo: evaluar, en términos de efectividad clínica (días sin depresión), un modelo asistencial basado en la potenciación del rol enfermero y dirigido a mejorar el manejo de la depresión en Atención Primaria, frente al tratamiento habitual. Material y método: ensayo controlado aleatorizado. Participaron 20 centros de Atención Primaria que fueron asignados a dos grupos alternativos: un grupo de intervención y un grupo de tratamiento habitual (control). La intervención consistió en un programa multicomponente con procedimientos clínicos, educativos y organizativos que incluyen capacitación, guías clínicas, enfermeras de Atención Primaria como care managers y mejoras en la coordinación Atención Primaria-Psiquiatría. Los resultados fueron evaluados a los 0, 3, 6 y 12 meses a través de los días libres de depresión (depression free days, DFD). Para el análisis bivariante se utilizaron la prueba T de Student y la ji cuadrado. Se calcularon intervalos de confianza al 95% de seguridad. Los análisis fueron realizados por intención de tratar. Resultados: participaron 338 individuos, 189 asignados al grupo de intervención y 149 al grupo de control. La cantidad de DFD fue significativamente mayor en el grupo de intervención que en el grupo de control: entre los 0 y 12 meses, en el grupo de intervención la media fue de 204,6 DFD (desviación estándar, DE: 116,2), y en el grupo de control de 160,5 DFD (DE: 110,4), siendo la diferencia de 44,1 DFD (IC 95%: 18,1-70,1) (p = 0,001). Conclusiones: la participación del profesional de Enfermería en el manejo de la depresión en Atención Primaria en el marco de un programa multicomponente da lugar a mejores resultados clínicos en términos de días libres de depresión. Los diversos componentes del programa son simples y fácilmente disponibles, por lo que indican que podría ser recomendada su implementación. Registro internacional del estudio: ISRCTN16384353, en www.controlled.trials.com (AU)

Objective: To assess, in terms of clinical effectiveness (depression-free days), a care model based on promoting the nurse’s role and aimed at improving the management of depression in Primary Care, versus standard treatment. Material and method: Randomised controlled trial. 20 primary car e centers participated and were assigned to two alternative groups: an intervention group and a standard treatment group (control). The intervention consisted of a multicomponent programme with clinical, educational and organizational procedures that include capacity-building, clinical guidelines, Primary Car e nurses such as car e managers and improvements in Primary Care-Psychiatry coordination. Results were evaluated at 0, 3, 6 and 12 months based on depression-free days (DFD). For the bivariate analysis Student’s T test and chi square were used. 95% confidence intervals were calculated. The analyses were performed by intention to treat. Results: 338 individuals participated, 189 of which were assigned to the intervention group and 149 to the control group. The amount of DFDs was significantly higher in the intervention group than in the control group: between 0 and 12 months, the mean (standard deviation, SD) in the intervention group was 204.6 DFD, and in the control group it was 160.5 DFD (SD: 110.4), the difference being of 44.1 DFD (95% CI: 18.1-70.1) (p=0.001). Conclusions: The participation of the Nursing professional in the management of depression in Primary Care within the framework of a multicomponent programme leads to better clinical results in terms of depression-free days. The different parts of the programme are simple and easily available, which indicates that their implementation could be recommended. International registry of the study: ISRCTN16384353, at www.controlled.trials.com (AU)

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

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

Abordaje psicoeducativo de la depresión en Atención Primaria. El modelo INDI / Psychoeducational approach to depression in Primary Care

La depresión es el trastorno mental más frecuente y relevante en Atención Primaria. Sin embargo, existen dificultades en su manejo y los resultados clínicos que se obtienen no son a menudo satisfactorios. En el marco del desarrollo de un modelo multifactorial para mejorar los resultados de la depresión en Atención Primaria (el proyecto INDI) se ha diseñado un programa psicoeducativo dirigido a los pacientes deprimidos, así como a sus allegados. En el modelo INDI, la implementación de las actividades psicoeducativas recae principalmente en la enfermera de Atención Primaria. Los contenidos del programa incluyen formación sobre la propia enfermedad, especialmente orientada a combatir el estigma y los prejuicios sobre la misma, sobre el tratamiento antidepresivo y la importancia de la adherencia al mismo, sobre el automanejo de las dificultades asociadas, así como orientaciones sobre el importante papel que pueden/deben desempeñar las personas próximas al paciente deprimido (AU)

Depression is the most frequent and relevant mental disorder in Primary Care. However, there its management presents difficulties and the clinical outcomes obtained are often not satisfactory. Within the frame work of the development of a multifactor model to improve depression outcomes in Primary Care (INDI project) a psycho educational programme aimed at depressed patients, as well as their loved ones, has been designed. In the INDI model, the implementation of psycho educational activities is managed primarily by the Primary Care nurse. The programme’s contents include educating on the disease itself with a special emphasis on fighting the stigma and prejudices attached to it and providing training on antidepressant treatment and the importance of treatment adherence, on the self-management of associated difficulties, as well as offering advice on the important role that the people close to the depressed patient can/should play (AU)

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

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

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

Objetivo. Determinar la prevalencia globaldel consumo crónico de benzodiacepinasy sus análogos en atención primaria.Diseño. Estudio transversal observacional.Emplazamiento. Centros de salud del Serviciode Atención Primaria Reus-Altebrat.Participantes. Pacientes con edad superiora 15 años, en tratamiento prolongadocon benzodiacepinas o sus análogos.Mediciones. Las variables analizadas fueron laedad, el sexo, el tipo de centro de salud (ruralo urbano), la benzodiacepina o el análogoadministrados y la duración del tratamiento.Resultados. Habían utilizado unabenzodiacepina o un análogo de formaprolongada 6.885 pacientes. El 70,9% eranmujeres, el 73,4% tenía 65 años o más, y el73% estaba adscrito a un centro urbano. Laprevalencia global fue del 6,9%, mayor entrelas mujeres que entre los varones (9,7% y 4%,respectivamente), y aumentó con la edadhasta un 27,3% entre los pacientes de 75 omás años. En los resultados estratificados seobservó que el consumo crónico era superiorentre las mujeres de 75 o más años de edadadscritas a centros de salud urbanos, conuna prevalencia del 35,7%.Conclusiones. Un porcentaje elevado de lapoblación, que comprende a los pacientesmás frágiles, está siendo tratado conbenzodiacepinas o análogos, lo que no seajusta a las recomendaciones de las guíasde práctica clínica

Objective. To determine the overallprevalence of the chronic use ofbenzodiazepines and similar drugsin primary care.Design. Observational, cross-sectional study.Setting. Healthcare centres of the Reus-Altebrat Primary Care Service,Tarragona,Spain.Participants. Patients older than 15 years, onprolonged treatment with benzodiazepinesor similar drugs.Measurements. The variables studied wereage, sex, type of healthcare centre (rural orurban), benzodiazepine, or similar drugadministered and duration of treatment.Results. There were 6885 patients who wereon prolonged benzodiazepine or similardrug treatment, of which 70.9% werefemale, 73.4% were 65 years or older, and73% attended an urban centre. The overallprevalence was 6.9%, and was higher amongwomen than men (9.7% and 4%,respectively), and increased with age up to27.3% among patients of 75 years or more.The stratified results showed that chronicconsumption was higher among women75 years of age or older attached to urbanhealthcare centres, with a prevalence of35.7%.Conclusions. A high percentage of ourpopulation, which includes the most fragilepatients, use benzodiazepines or a similardrug in a way that is not consistent withthe recommendations of clinical practiceguidelines

[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.