Effectiveness of a primary care clinical ultrasound classroom for family physicians as a formative intervention system, a quasi-experimental trial: Study protocol.

INTRODUCTION: Clinical ultrasound is a technique that increases diagnostic capacity and facilitates clinical decision making. The objective is to develop and validate an ultrasound training methodology oriented to the clinical practice of the family physician. METHODS: Quasi-experimental study, with a before/after design, a control group, and 1 year of follow-up. Twenty family physicians working in primary care health centers with a list of over 800 patients will be included, as well as a control group of family physicians with similar characteristics in terms of age, sex, and patient list. A structured training process oriented to the clinical practice of the family physician, primary care clinical ultrasound classroom (AECAP), will be carried out, and the improvement of knowledge and skills of the participants will be evaluated, as well as the improvement of the quality of care based on clinical indicators. DISCUSSION: The family physician is in a privileged situation allows increasing the performance of ultrasound in frequent clinical situations and reducing care hours. We hope that the results obtained in this study demonstrate the effectiveness of the structured training method (AECAP) and support the generalization of ultrasound in primary health care. ETHICS AND DISSEMINATION: The study was approved by the Medical Research Ethics Committee of Salamanca on December 17, 2018 (cod 2018 11 134). The trial was registered in ClinicalTrials.gov provided by the US National Library of Medicine-number: NCT04283383.

[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)

[Cardiovascular risk of hypertensive people with long-range monitoring. The effect of aging (Ciclo Risk Study)]. / Riesgo cardiovascular del paciente hipertenso con seguimiento prolongado en atención primaria. El efecto del envejecimiento (Ciclo Risk Study).

BACKGROUND: The evolution of estimated cardiovascular risk can be for evaluating the effectiveness of the different treatment interventions which are carried out on patients with regular follow-up by family physicians. This study is aimed at evaluating the effect of aging on the evolution of cardiovascular risk among hypertensive patients with long-range Primary Care monitoring. METHODS: Longitudinal, descriptive study with monitoring of 842 hypertensive patients within the 34-70 age range at two primary care centers, with a quality improvement intervention (improvement cycle) during the last year at one of these centers. The main variables were age and gender, blood pressure, lipids, smoking habit, diabetes and cardiovascular risk (CVR) (Framingham-Wilson) in the real-life situation and considering the age constant in the first case, and the risk factors in the second, plus the relative risk. RESULTS: A drop was found in the systolic and diastolic blood pressure from 11.78 mmHg (95 IC: 10.51-13.05) and 8.83 mmHg (95 CI: 8.13-9.53), respectively, and LDL Cholesterol 15.94 mg/dl (95 CI: 11.77-20.12), a rise in HDL-Cholesterol of 7.53 mg/dl (95C1: 6.39-8.66), decreased smoking habit of 31% and an increase in diabetics. The Coronary risk decreased 1.40 percent points, Coronary risk with age constant decreased 3.84 (95 CI: 3.35-4.33), having increased with constant risk factors by 3.06(95 CI: 2.82-3.29). The Relative risk dropped from 2.50 to 1.85. CONCLUSIONS: Aging may mask the effect achieved by health care in the absolute cardiovascular risk check. The relative risk could be an alternative for monitoring the follow-up.

Riesgo cardiovascular del paciente hipertenso con seguimiento prolongado en Atención Primaria. El efecto del envejecimiento (Ciclo risk study) / Cardiovascular risk of hypertensive people with long-range monitoring. The effect of aging (Ciclo risk study)

Fundamento La evolución del riesgo cardiovascular estimado, puede servir para valorar la efectividad de las diferentes intervenciones terapéuticas que se realizan en pacientes con seguimiento habitual en las consultas del médico de familia. El objetivo de este trabajo es comparar diferentes sistemas de evaluación del efecto de las intervenciones preventivas en la evolución del riesgo coronario en el seguimiento a largo plazo de personas hipertensas en Atención Primaria. Métodos: Estudio descriptivo longitudinal con seguimiento de 8.42 pacientes hipertensos de 34 a 70 años durante 6 años en dos centros de atención primaria, con una intervención de mejora de calidad (ciclo de mejora) en el último año en uno de ellos. El seguimiento mínimo en atención primaria previo al inicio del estudio fue de dos años. Las variables principales fueron edad y sexo, presión arterial, lípidos, tabaquismo, diabetes y riesgo cardiovascular (RCV)(Framingham-Wilson) en la situación real y considerando constante la edad en el primer supuesto y los factores de riesgo en el segundo y el riesgo relativo. Resultados: Se encontró un descenso de la presión arterial sistólica y diastólica de 11,78 mmHg (IC95%:10,51-13,05) y 8,83 mmHg (IC95%:8,13-9,53) respectivamente y LDL-Colesterol 15,94 mg/dl (IC95%:11,77-20,12), un ascenso del HDLColesterol de 7,53 mg/dl (IC95:6,39-8,66), disminución del tabaquismo del 31% y un aumento de diabéticos. El riego coronario disminuyó 1,40(IC95%:0,87-1,93) puntos porcentuales, el RCV con edad constante descendió 3,84(IC95%:3,35-4,33) y con factores de riesgo constantes incrementó 3,06(IC95%:2,82- 3,29). El Riesgo relativo descendió de 2,50 a 1,85. Conclusiones: El envejecimiento puede enmascarar el efecto logrado por la atención sanitaria en el control del riesgo cardiovascular absoluto. El riesgo relativo podría ser una alternativa para monitorizar el seguimiento (AU)

Background: The evolution of estimated cardiovascular risk can be for evaluating the effectiveness of the different treatment interventions which are carried out on patients with regular follow-up by family physicians. This study is aimed at evaluating the effect of aging on the evolution of cardiovascular risk among hypertensive patients with long-range Primary Care monitoring. Methods: Longitudinal, descriptive study with monitoring of 842 hypertensive patients within the 34-70 age range at two primary care centers, with a quality improvement intervention (improvement cycle) during the last year at one of these centers. The main variables were age and gender, blood pressure, lipids, smoking habit, diabetes and cardiovascular risk (CVR) (Framingham-Wilson) in the real-life situation and considering the age constant in the first case, and the risk factors in the second, plus the relative risk. Results: A drop was found in the systolic and diastolic blood pressure from 11.78 mmHg (95 IC: 10.51-13.05) and 8.83 mmHg (95 CI: 8.13-9.53), respectively, and LDL Cholesterol 15.94 mg/dl (95 CI: 11.77-20.12), a rise in HDL-Cholesterol of 7.53 mg/dl (95CI: 6.39-8.66), decreased smoking habit of 31% and an increase in diabetics. The Coronary risk decreased 1.40 percent points, Coronary risk with age constant decreased 3.84 (95 CI: 3.35-4.33), having increased with constant risk factors by 3.06(95 CI: 2.82-3.29). The Relative risk dropped from 2.50 to 1.85. Conclusions: Aging may mask the effect achieved by health care in the absolute cardiovascular risk check. The relative risk could be an alternative for monitoring the follow-up (AU)

[Tobacco cessation. Action-stage result as a predictor of successful long-term maintenance]. / Deshabituación tabáquica. Valor del resultado en la fase de acción sobre el resultado en la fase de consolidación.

OBJECTIVE: The paucity of long-term studies makes it difficult to evaluate the sustained abstinence over time of smokers who quit. The objective of the present study was to determine to what extent the results of tobacco cessation interventions are maintained after 5 years. PATIENTS AND METHODS: This was a longitudinal prospective study of 502 smokers. The design was quasi-experimental given that therapy was allocated according to the level of the patients' nicotine dependence: routine minimum intervention for smokers with mild addiction and those not in the preparation stage, and nicotine replacement therapy for patients with moderate-to-high dependence and/or a high level of tobacco consumption. RESULTS: Of the 267 patients followed for 5 years, 29.6% quit and were still abstinent at 1 year, and 18.0% remained abstinent after 5 years. Of those who had managed to stop smoking within 2 months of starting the intervention, 47.4% were still abstinent on follow-up at 5 years while 88.1% of those who failed to quit within 2 months were still smoking 5 years later. CONCLUSIONS: The results observed during the action stage could be of use in reorienting the treatment approach, and a planned schedule of follow-up contacts could help patients maintain the abstinence achieved in the course of the intervention.

Deshabituación tabáquica. Valor del resultado en la fase de acción sobre el resultado en la fase de consolidación / Tobacco cessation: action-stage result as a predictor of successful long-term maintenance

Objetivo: La escasez de estudios a largo plazo dificulta la valoración de la abstinencia mantenida en el tiempo de los fumadores que consiguen dejar de fumar. El objetivo de nuestro estudio ha sido determinar en qué medida los resultados obtenidos tras la intervención para dejar de fumar se consolidan en el tiempo, al cabo de 5 años. Pacientes y métodos: Se ha realizado un estudio longitudinal y prospectivo sobre 502 fumadores, cuasi experimental, al considerar el grado de dependencia nicotínica como criterio para la asignación del tratamiento: intervención mínima sistematizada en los fumadores con dependencia baja o que aún no se encontraban en fase de preparación, y tratamiento sustitutivo con nicotina en aquéllos con dependencia moderada-alta y/o alto consumo de cigarrillos. Resultados: De los 267 pacientes que completaron el seguimiento a los 5 años, el 29,6% dejó de fumar y se mantuvo abstinente al año de seguimiento, y el 18,0% a los 5 años. De los que consiguieron dejar de fumar a los 2 meses de la intervención el 47,4% consolidó su abstinencia al cabo de los 5 años de seguimiento, y de los que no lo consiguieron seguía fumando el 88,1%. Conclusiones: Los resultados observados en la fase de acción pueden considerarse un elemento de ayuda para reorientar la actitud terapéutica, y quizá el planteamiento de controles programados en el tiempo ayude a consolidar la abstinencia tabáquica conseguida durante la intervención

Objective: The paucity of long-term studies makes it difficult to evaluate the sustained abstinence over time of smokers who quit. The objective of the present study was to determine to what extent the results of tobacco cessation interventions are maintained after 5 years. Patients and methods: This was a longitudinal prospective study of 502 smokers. The design was quasi-experimental given that therapy was allocated according to the level of the patients' nicotine dependence: routine minimum intervention for smokers with mild addiction and those not in the preparation stage, and nicotine replacement therapy for patients with moderate-to-high dependence and/or a high level of tobacco consumption. Results: Of the 267 patients followed for 5 years, 29.6% quit and were still abstinent at 1 year, and 18.0% remained abstinent after 5 years. Of those who had managed to stop smoking within 2 months of starting the intervention, 47.4% were still abstinent on follow-up at 5 years while 88.1% of those who failed to quit within 2 months were still smoking 5 years later. Conclusions: The results observed during the action stage could be of use in reorienting the treatment approach, and a planned schedule of follow-up contacts could help patients maintain the abstinence achieved in the course of the intervention

[Continuous and momentous tobacco abstinence with pharmacologic therapy in clinical practice]. / Abstinencia puntual y continuada con el tratamiento farmacológico del tabaquismo en la práctica clínica.

BACKGROUND AND OBJECTIVE: The objective of the study was to evaluate the effectiveness of the pharmacological treatment of tobacco dependence according to the criteria established by SEPAR. PATIENTS AND METHOD: Longitudinal, prospective and multicentre study. We included smokers aged more than 18 years who attended 5 smokers clinics and received nicotine replacement therapy (NRT), bupropion or both. The punctual and continuous abstinence was studied at the 15, 30, 60, 90 and 180 days with each one of the proposed treatments. Effective results were defined as the intention to treat. RESULTS: There were 904 smokers, 476 males and 428 females, mean age 42.51 (10.09). Of the 904 individuals who started the treatment, 820, 776, 687, 719 and 679 were present at the follow-up sessions at 15, 30, 60, 90 and 180 days, respectively. The punctual global abstinence at 15 and 180 days was 65.6% and 43.1%, while the continuous one was 57.4% and 38.8% at two and six months, respectively. Significant differences were not observed with regard to the punctual or continuous abstinence among patients treated with NRT, bupropion or both. CONCLUSIONS: The pharmacological treatment of tobacco dependence used individually according to the recommendations of the clinical guidelines allows to obtain good results with regard to the momentous and continuous abstinence. The effectiveness of the different first line treatments is similar in all the phases of the therapeutic process.

[Results of the first program to reduce the prevalence of smoking in the staff of Salamanca Council, Spain]. / Resultados del primer programa para la reducción del tabaquismo en los trabajadores del Ayuntamiento de Salamanca, España.

BACKGROUND: Smoking is the most important risk factor for public health and one of the factors with the greatest economic repercussions for society. The aim of the present work is to publish the results of a programme to reduce smoking in the working environment. METHODS: A programme was designed in two stages. The first consisted of carrying out a survey to establish the prevalence of smoking and the attitudes towards smoking of staff working for Salamanca district Council. The second stage consisted of a specialized treatment programme for all the workers who wanted to try to give up smoking. RESULTS: A total of 384 workers answered the questionnaire. Of these, 135 (35.1%) were smokers of whom 80.5% (n = 113) wanted to give up smoking and to receive medical help to do so. A total of 73 workers started the programme. After one year of treatment, 41% of the workers who had started the programme had dropped out. An average of 2.9 of every 3 workers found the programme satisfactory. CONCLUSIONS: The prevalence of smoking in Salamanca District Council is similar to that described in the National Health Survey, 1997. Programmes to treat smoking in the working environment are useful to reduce the prevalence of smoking and are welcomed by the workers. Reducing the prevalence of smoking is the first step towards achieving smoke-free institutions.

Resultados del Primer Programa para la Reducción del Tabaquismo en los trabajadores del Ayuntamiento de Salamanca, España / Results of First Programme to Reduce the Prevalence of Smoking in the Staff of Salamanca Council, Spain

Fundamento: El tabaquismo es el principal factor de riesgo en salud pública y una de las causas que ocasionan una mayor carga económica para la sociedad. El presente trabajo tiene por objeto conocer los resultados de un programa de deshabituación tabáquica en el medio laboral. Métodos: Se diseñó un programa con dos fases. La primera consistió en la realización de una encuesta para conocer la prevalencia y actitudes respecto al tabaco de los trabajadores del Ayuntamiento de Salamanca. La segunda en un programa de tratamiento especializado destinado a todos los trabajadores que deseasen dejar de fumar. Resultados: Respondieron a la encuesta 384 trabajadores, de los cuales 135 (35,1 per cent) eran fumadores. El 80,5 per cent de estos (n = 113) deseaban dejar el tabaco y recibir ayuda médica para lograrlo. Iniciaron el programa de tratamiento 73 trabajadores. Al año de tratamiento se observó una tasa de abandono del tabaco del 41 per cent de los trabajadores que lo iniciaron. El nivel de satisfacción de los trabajadores con el programa fue de una media de 2,9 sobre 3.Conclusiones: La prevalencia de tabaquismo entre los trabajadores del Ayuntamiento de Salamanca es similar a la descrita en la Encuesta Nacional de Salud de 1997. El programa de tratamiento del tabaquismo logró un porcentaje de abstinencia al año de más del 40 per cent. Los programas de tratamiento del tabaquismo en el medio laboral son útiles para reducir la prevalencia del tabaquismo y bien valorados por los trabajadores. Reducir la prevalencia del tabaquismo es el primer paso para la consecución de instituciones libres de humo (AU)

Background: Smoking is the most important risk factor for public health and one of the factors with the greatest economic repercussions for society. The aim of the present work is to publish the results of a programme to reduce smoking in the working environment. Methods: A programme was designed in two stages. The first consisted of carrying out a survey to establish the prevalence of smoking and the attitudes towards smoking of staff working for Salamanca district Council. The second stage consisted of a specialized treatment programme for all the workers who wanted to try to give up smoking. Results: A total of 384 workers answered the questionnaire. Of these, 135 (35.1%) were smokers of whom 80.5% (n = 113) wanted to give up smoking and to receive medical help to do so. A total of 73 workers started the programme. After one year of treatment, 41% of the workers who had started the programme had dropped out. An average of 2.9 of every 3 workers found the programme satisfactory. Conclusions: The prevalence of smoking in Salamanca District Council is similar to that described in the National Health Survey, 1997. Programmes to treat smoking in the working environment are useful to reduce the prevalence of smoking and are welcomed by the workers. Reducing the prevalence of smoking is the first step towards achieving smoke-free institutions (AU)