BODYFAT: a new calculator to determine the risk of being overweight validated in Spanish children between 11 and 17 years of age.

The assessment of body fat of children in primary care requires consideration of the dynamic changes in height, weight, lean mass, and fat mass during childhood growth. To achieve this, we aim to develop a predictive equation based on anthropometric values, with optimal diagnostic utility. This is a cross-sectional observational study, involving schoolgoers aged 11-17 years in the Vigo metropolitan area. Out of 10,747 individuals, 577 were randomly recruited. VARIABLES: age, sex, ethnicity/country of origin, weight, height, 8 skinfolds, 3 diameters, 7 perimeters, and 85% percentile of body fat mass as the gold standard. Generalized additive regression was selected by cross-validation and compared using receiver operating characteristic curves (ROC curves). Sensitivity, specificity, positive and negative predictive values, true positive and true negative values, false positive and false negative values, accuracy, and positive and negative likelihood ratios were calculated. Two models were identified. The optimal model includes sex, weight, height, leg perimeter, and arm perimeter, with sensitivity of 0.93 (0.83-1.00), specificity of 0.91 (0.83-0.96), accuracy of 0.91 (0.84-0.96), and area under the curve (AUC) of 0.957 (0.928-0.986). The second model includes sex, age, and body mass index, with sensitivity of 0.93 (0.81-1.00), specificity of 0.90 (0.80-0.97), accuracy of 0.90 (0.82-0.96), and an AUC of 0.944 (0.903-0.984). CONCLUSION: Two predictive models, with the 85th percentile of fat mass as the gold standard, built with basic anthropometric measures, show very high diagnostic utility parameters. Their calculation is facilitated by a complementary online calculator. WHAT IS KNOWN: • In routine clinical practice, mainly in primary care, BMI is used to determine overweight and obesity. This index has its weaknesses in the assessment of children. WHAT IS NEW: • We provide a calculator whose validated algorithm, through the determination of fat mass by impedanciometry, makes it possible to determine the risk of overweight and obesity in the community setting, through anthropometric measurements, providing a new practical, accessible and reliable model that improves the classification of overweight and obesity in children with respect to that obtained by determining BMI.

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial.

BACKGROUND: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".

Multidimensional Geriatric Assessment with MAGIC Questionnaire and Quality of Life in Elderly Primary Care Patients.

The Manageable Geriatric Assessment (MAGIC) questionnaire, recently developed by a group of European family doctors for multidimensional geriatric assessment in primary care, has not yet been evaluated in clinical practice. The objectives of this study were to translate and adapt it to Spanish and to check the association between the limitations of older adults identified by this questionnaire and their perceived health status assessed by the five-level version of the EuroQol-5D (EQ-5D-5L). First, questionnaire translation, back translation and cognitive test were applied. Then, a cross-sectional observational study was performed in two Spanish health centers Galicia, Spain. Participants were 170 people aged over 75, recruited opportunistically by consecutive case sampling. Anonymous surveys were used to collect data. The MAGIC questionnaire, the EQ-5D-5L scale, age and sex were employed. The visual analog scale of EQ-5D-5L (EQ VAS) was used as the outcome variable. Descriptive and bivariate analyses by sex and outcome variable are presented. The linear regression analysis showed an association with quality of life for daily activities, recognizing people and stress incontinence. As this is associated with quality of life, the MAGIC questionnaire may be useful in primary care and a study to investigate the impact on health with a clinical trial would be worth considering.

[Early detection of the problematic Internet use in adolescents, in pediatrics of primary care.] / Detección precoz del uso problemático de Internet en adolescentes, en pediatría de atención primaria.

OBJECTIVE: Use of the Internet has grown exponentially and adolescents are considered one of the most vulnerable groups in this new environment. Hence the problematic use of the Internet (PIU) at this stage has become a concern for a growing number of researchers. Taking into account the interest that this issue has generated at many levels, the aim of this paper is to find the prevalence of PIU among adolescents in the health area of Vigo (Spain). METHODS: Cross-sectional descriptive study. The PIU validated scale was applied to children between 10 and 16 years old, captured by systematic sampling with replacement in the primary care consultations of four health centers. A descriptive and bivariate analysis was performed. RESULTS: The questionnaire was applaid to 165 children, 51.2% men. Problematic Internet use was observed in 38.8% (95% CI: 31.7-46.4), higher in women (46.3%) than in men (31.8%), with no significant differences (p 0.07). By age groups, the positive rate on the scale reached 36.8% in the 13-14 year range and 48.6% in the 15-16 range. The item that reached the highest score was "When I am online, I feel that time flies and hours pass without me realizing it" (60.6%). CONCLUSIONS: The prevalence of UPI in children / adolescents is similar to that observed in Asian adolescents. This study is the first to apply a scale validated and adapted to the Spanish cultural context in the daily practice of Primary Care consultations. Its use would allow to identify the PIU in this context and intervene if necessary.

OBJETIVO: El uso de Internet ha crecido exponencialmente y los adolescentes son considerados uno de los grupos más vulnerables en este nuevo contexto. De ahí que el uso problemático de Internet (UPI) en esta etapa se haya convertido en una preocupación para un número creciente de investigadores. Teniendo en cuenta el interés que este tema ha generado en muchos niveles, el objetivo de este trabajo fue conocer la prevalencia del uso problemático de Internet entre los niños/adolescentes del área sanitaria de Vigo (España). METODOS: Se realizó un estudio descriptivo transversal. Se aplicó la escala validada EUPI-a a niños entre 10 y 16 años, captados por muestreo sistemático con reposición en las consultas de atención primaria de cuatro centros de salud. Se elaboró posteriormente un análisis descriptivo y bivariante. RESULTADOS: Se entregó el cuestionario a 165 niños, de los que el 51,2% eran varones. Se objetivó un uso problemático de Internet en el 38,8% (IC 95%: 31,7-46,4), mayor en mujeres (46,3%) que en varones (31,8%), aunque no se constataron diferencias estadísticamente significativas (p=0,07). Por grupos de edad, la tasa de positivos en la escala alcanzó un 36,8% en la franja de 13-14 años y un 48,6% en la de 15-16 años. El ítem que alcanzó mayor puntuación fue "Cuando me conecto siento que el tiempo vuela y pasan las horas sin darme cuenta" (60,6%). CONCLUSIONES: La prevalencia de UPI en niños/adolescentes es similar a la observada en adolescentes asiáticos. Este estudio es el primero en aplicar una escala validada y adaptada al contexto cultural español en la práctica diaria de una consulta de atención primaria. Su utilización en este entorno permitiría identificar el UPI e intervenir si fuera preciso.

Detección precoz del uso problemático de internet en adolescentes, en pediatría de atención primaria / Early detection of the problematic internet use in adolescents, in pediatrics of primary care

OBJETIVO: El uso de Internet ha crecido exponencialmente y los adolescentes son considerados uno de los grupos más vulnerables en este nuevo contexto. De ahí que el uso problemático de Internet (UPI) en esta etapa se haya convertido en una preocupación para un número creciente de investigadores. Teniendo en cuenta el interés que este tema ha generado en muchos niveles, el objetivo de este trabajo fue conocer la prevalencia del uso problemático de Internet entre los niños/adolescentes del área sanitaria de Vigo (España). MÉTODOS: Se realizó un estudio descriptivo transversal. Se aplicó la escala validada EUPI-a a niños entre 10 y 16 años, captados por muestreo sistemático con reposición en las consultas de atención primaria de cuatro centros de salud. Se elaboró posteriormente un análisis descriptivo y bivariante. RESULTADOS: Se entregó el cuestionario a 165 niños, de los que el 51,2% eran varones. Se objetivó un uso problemático de Internet en el 38,8% (IC 95%: 31,7-46,4), mayor en mujeres (46,3%) que en varones (31,8%), aunque no se constataron diferencias estadísticamente significativas (p = 0,07). Por grupos de edad, la tasa de positivos en la escala alcanzó un 36,8% en la franja de 13-14 años y un 48,6% en la de 15-16 años. El ítem que alcanzó mayor puntuación fue "Cuando me conecto siento que el tiempo vuela y pasan las horas sin darme cuenta" (60,6%). CONCLUSIONES: La prevalencia de UPI en niños/adolescentes es similar a la observada en adolescentes asiáticos. Este estudio es el primero en aplicar una escala validada y adaptada al contexto cultural español en la práctica diaria de una consulta de atención primaria. Su utilización en este entorno permitiría identificar el UPI e intervenir si fuera preciso

OBJECTIVE: Use of the Internet has grown exponentially and adolescents are considered one of the most vulnerable groups in this new environment. Hence the problematic use of the Internet (PIU) at this stage has become a concern for a growing number of researchers. Taking into account the interest that this issue has generated at many levels, the aim of this paper is to find the prevalence of PIU among adolescents in the health area of Vigo (Spain). METHODS: Cross-sectional descriptive study. The PIU validated scale was applied to children between 10 and 16 years old, captured by systematic sampling with replacement in the primary care consultations of four health centers. A descriptive and bivariate analysis was performed. RESULTS: The questionnaire was applaid to 165 children, 51.2% men. Problematic Internet use was observed in 38.8% (95% CI: 31.7-46.4), higher in women (46.3%) than in men (31.8%), with no significant differences (p 0.07). By age groups, the positive rate on the scale reached 36.8% in the 13-14 year range and 48.6% in the 15-16 range. The item that reached the highest score was "When I am online, I feel that time flies and hours pass without me realizing it" (60.6%). CONCLUSIONS: The prevalence of UPI in children / adolescents is similar to that observed in Asian adolescents. This study is the first to apply a scale validated and adapted to the Spanish cultural context in the daily practice of Primary Care consultations. Its use would allow to identify the PIU in this context and intervene if necessary

Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial.

BACKGROUND: Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. METHODS: Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants' demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. RESULTS: Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (- 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39-3.35), and by 13.75 (2.41-354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. CONCLUSION: A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. TRIAL REGISTRATION: It was retrospectively registered with ( ISRCTN41911128 , 31/12/2010).

[Prevalence of BreastFeeding in a Galician Health Area, Spain]. / Prevalencia de lactancia materna en el Área Sanitaria de Vigo, Galicia.

OBJECTIVE: The quantitative evaluation of actions to promote breastfeeding, with standardized material and method, is essential to understand their impact and allow international comparison. The aim was to know the prevalence of breastfeeding in Galician Health Area. METHODS: A cross-sectional descriptive study through interviews, following methodology and questionnaire designed by the Baby-Friendly Initiative. The infant´s mother/caregiver were asked about feeding to calculate the five indicators proposed (exclusive breastfeeding under 15 days, exclusive breastfeeding under six months, continued breastfeeding at one year and two years, introduction of solid, semi-solid or soft foods). A random sample of 431 infants aged between 0 and 2 years of the participating centers, between 2013 and 2014, has been selected. Descriptive and bivariate analyses have been performed. RESULTS: In the sample, 50.00% (95% CI 39.3 to 60.7) of infants fewer than 15 days were exclusively receiving breastfeeding. At 6 months, the prevalence was 50.28% (95% CI 43.0 to 57.6). Breastfeeding at 12 to 15 months was 34.62% (95% CI 22.0 to 49.1). At two years, it was 26.67% (95% CI 17.1 to 38.1), with significant differences between rural and urban areas. Between 6 and 8 months, all infants have breastfeeding combined with other foods. CONCLUSIONS: In our environment the starting rate and average duration are lower than desirable.

OBJETIVO: La evaluación cuantitativa de las actuaciones para promover la lactancia materna, con material y método estandarizados, es imprescindible para conocer su impacto y permitir la comparación internacional. El objetivo fue conocer la prevalencia de la lactancia materna en un Área Sanitaria de Galicia. METODOS: Estudio observacional mediante entrevista, siguiendo metodología y cuestionario diseñados por la Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia. Se preguntó a la madre/cuidador principal del lactante sobre la alimentación recibida por él/ella para calcular los 5 indicadores propuestos (lactancia materna exclusiva en menores de 15 días, lactancia materna exclusiva en menores de 6 meses, lactancia materna entre 12 y 15 meses y a los dos años, combinación con otros alimentos a los 6-7 meses). Se seleccionó una muestra aleatoria de 431 lactantes entre 0 y 2 años de los centros participantes, entre 2013 y 2014. Se realizó un análisis descriptivo y bivariante. RESULTADOS: Se observó que el 50,00% (IC 95%: 39,3-60,7) de lactantes menores de 15 días recibieron lactancia materna en exclusiva. A los 6 meses, la prevalencia fue del 50,28% (IC 95%: 43,0-57,6). La lactancia materna en lactantes de 12 a 15 meses era del 34,62% (IC 95%: 22,0-49,1). A los dos años era 26,67% (IC 95% 17,1-38,1), con diferencias significativas entre ámbito rural y urbano. Entre 6 y 8 meses la totalidad combinaban lactancia con otros alimentos. CONCLUSIONES: En nuestro entorno se observa una tasa de inicio y una duración media menor de lo deseable.

Prevalencia de lactancia materna en el Área sanitaria de Vigo, Galicia / Prevalence of breastfeeding in a Galician Health Area, Spain

Fundamentos: La evaluación cuantitativa de las actuaciones para promover la lactancia materna, con material y método estandarizados, es imprescindible para conocer su impacto y permitir la comparación internacional. El objetivo fue conocer la prevalencia de la lactancia materna en un Área Sanitaria de Galicia. Métodos: Estudio observacional mediante entrevista, siguiendo metodología y cuestionario diseñados por la Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia. Se preguntó a la madre/cuidador principal del lactante sobre la alimentación recibida por él/ella para calcular los 5 indicadores propuestos (lactancia materna exclusiva en menores de 15 días, lactancia materna exclusiva en menores de 6 meses, lactancia materna entre 12 y 15 meses y a los dos años, combinación con otros alimentos a los 6-7 meses). Se seleccionó una muestra aleatoria de 431 lactantes entre 0 y 2 años de los centros participantes, entre 2013 y 2014. Se realizó un análisis descriptivo y bivariante. Resultados: Se observó que el 50,00% (IC 95%: 39,3-60,7) de lactantes menores de 15 días recibieron lactancia materna en exclusiva. A los 6 meses, la prevalencia fue del 50,28% (IC 95%: 43,0-57,6). La lactancia materna en lactantes de 12 a 15 meses era del 34,62% (IC 95%: 22,0-49,1). A los dos años era 26,67% (IC 95% 17,1-38,1), con diferencias significativas entre ámbito rural y urbano. Entre 6 y 8 meses la totalidad combinaban lactancia con otros alimentos. Conclusiones: En nuestro entorno se observa una tasa de inicio y una duración media menor de lo deseable (AU)

Background: The quantitative evaluation of actions to promote breastfeeding, with standardized material and method, is essential to understand their impact and allow international comparison. The aim was to know the prevalence of breastfeeding in Galician Health Area. Methods: A cross-sectional descriptive study through interviews, following methodology and questionnaire designed by the Baby-Friendly Initiative. The infant´s mother/caregiver were asked about feeding to calculate the five indicators proposed (exclusive breastfeeding under 15 days, exclusive breastfeeding under six months, continued breastfeeding at one year and two years, introduction of solid, semi-solid or soft foods). A random sample of 431 infants aged between 0 and 2 years of the participating centers, between 2013 and 2014, has been selected. Descriptive and bivariate analyses have been performed. Results: In the sample, 50.00% (95% CI 39.3 to 60.7) of infants fewer than 15 days were exclusively receiving breastfeeding. At 6 months, the prevalence was 50.28% (95% CI 43.0 to 57.6). Breastfeeding at 12 to 15 months was 34.62% (95% CI 22.0 to 49.1). At two years, it was 26.67% (95% CI 17.1 to 38.1), with significant differences between rural and urban areas. Between 6 and 8 months, all infants have breastfeeding combined with other foods. Conclusions: In our environment the starting rate and average duration are lower than desirable (AU)

Adverse events analysis as an educational tool to improve patient safety culture in primary care: a randomized trial.

BACKGROUND: Patient safety is a leading item on the policy agenda of both major international health organizations and advanced countries generally. The quantitative description of the phenomena has given rise to intense concern with the issue in institutions and organizations, leading to a number of initiatives and research projects and the promotion of patient safety culture, with training becoming a priority both in Spain and internationally. To date, most studies have been conducted in a hospital setting, even though primary care is the type most commonly used by the public, in our experience. Our study aims to achieve the following:--Assess the registry of adverse events as an education tool to improve patient safety culture in the Family and Community Teaching Units of Galicia.--Find and analyze educational tools to improve patient safety culture in primary care.--Evaluate the applicability of the Hospital Survey on Patient Safety Culture by the Agency for Healthcare Research and Quality, Spanish version, in the context of primary health care. DESIGN: Experimental unifactorial study of two groups, control and intervention. STUDY POPULATION: Tutors and residents in Family and Community Medicine in last year of studies in Galicia, Spain. SAMPLE: From the population universe through voluntary participation. Twenty-seven tutor-resident units in each group required, randomly assigned. INTERVENTION: Residents and their respective tutor (tutor-resident pair) in teaching units on Family and Community Medicine from throughout Galicia will be invited to participate. Tutor-resident pair that agrees to participate will be sent the Hospital Survey on Patient Safety Culture. Then, tutor-resident pair will be assigned to each group--either intervention or control--through simple random sampling. The intervention group will receive specific training to record the adverse effects found in patients under their care, with subsequent feedback, after receiving instruction on the process. No action will be taken in the control group. After the intervention has ended, the survey will once again be provided to all participants. OUTCOME MEASURES: Change in safety culture as measured by Hospital Survey on Patient Safety CultureCONSORT Extension for Non-Pharmacologic Treatments 2008 was applied. DISCUSSION: The most significant limitations on the project are related to selecting a tool to measure the safety environment, the training calendar of residents in Family and Community Medicine in last year of studies and the no-answer bias inherent to research conducted through self-administered surveys.The development and application of a safety culture in the health sector, specifically in primary care, is as yet limited. Thus, identifying the strengths and weaknesses in the safety environment may assist in designing strategies for improvement in the primary care health centers of our region. TRIAL REGISTRATION: ISRCTN: ISRCTN41911128.