Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas

ObjectiveTo evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community.DesignRandomised clinical trial.SettingFamily health centre, primary care.ParticipantsIndependent elderly people living in the community.InterventionFor intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre.Main measurementsPerception of risk of falls, number of risk factors and number of falls in the study period.ResultsIn both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004).ConclusionsThe multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.     

Capacitación de población gitana en abogacía para la salud: un estudio de caso en Torreblanca,Sevilla

ObjectiveThe objective of this study is to build advocacy capacity among a group of gipsy Roma neighbours living in contexts of risk of social exclusion.MethodsA Community Based Participatory Action Research design was used, in which 4 members of the community participated in the process of collecting evidence by photo-voice, analysing it using the ReACT method and disseminating the results.ResultsA total of 96 pieces of evidence were collected and analysed for qualitative data analysis. These were categorised according to (a) the type of unhealthy conditions and (b) the area of the neighbourhood where they were located. The subsequent thematic grouping made it possible to identify the causes: (a) the abandonment of public services; (b) discrimination; and (c) the lack of Roma presence in community spaces. The consequences identified were (a) mental and physical health problems and (b) the normalisation of undignified living conditions. The plan was designed to advocate for the presence of Roma in community spaces.ConclusionsOur study highlighted the relevance of the photo-voice to transcend the biomedical perspective and develop advocacy actions based on the knowledge created by the community. Future research should look more deeply into the impact of health advocacy on reducing inequalities and consider the importance of involving researchers, public health professionals and the community in addressing it.     

Mapeo de activos comunitario para la salud en un asentamiento informal de Medellín (Colombia)

ObjectiveTo describe how the community from El Faro neighborhood identifies its community assets, uses them to face life's challenges through the capacity of collective agency; and by generating community development processes, applying the salutogenic theory that considers people as active subjects, with the capacity to conserve and generate health and well-being, through the use of their own resources called health assets.MethodsA map of community assets was made in 2018 in el Faro neighborhood, an informal settlement of Medellín, Colombia, following the phases recommended by other authors and from a qualitative, participatory approach that delves into the health situation of the community.ResultsIn this process were identified 12 individual community assets, 12 collective, 13 institutional and 10 in the environment. The main community asset among the 47 described was community participation, from the agency capacity, mainly of its leaders who participating in their own organizations encourage development, identity construction and well-being.ConclusionAsset mapping has served to identify intangible assets for the community and, in turn, this recognition has been useful in strengthening the agency's capacity for community development. This is a territory transformed by community reflection processes allowing to understand situations of exclusion and poverty, seeking to create a more livable place and developing a community capacity to solve their own problems, through solidarity and community support.     

Benzocarta: intervención mínima para la desprescripción de benzodiacepinas en pacientes con insomnio

ObjectiveTo determine whether a letter-based intervention to patients taking benzodiazepines reduces their consumption.MethodA before-after study without control group performed in primary care in May 2016. 1582 patients who took a single daily dose of benzodiazepines as hypnotic for more than 3 months were sent a personalized letter from their family doctor. The letter contained information about the risks of long-term benzodiazepine consumption and the recommendation to discontinue them with a gradual drop protocol (Benzoletter). The percentage of patients who stopped or decreased the use of benzodiazepines, and the difference in the total dose dispensed (mg equivalents of diazepam dispensed in three months) between the pre- and post-intervention period (at 6 and 12 months) were evaluated.ResultsDispensing data from 1561 patients were collected (average age: 69.3 years; 74% women). Twelve months after the intervention, 22.0% (95% confidence interval [95%CI]: 19.9-24.0) discontinued benzodiazepine consumption and 18.8% (95%CI: 16.9-20.8) reduced their consumption. A statistically significant reduction was observed in the total dose dispensed (mean difference: 89 mg; 95%CI: 72.2-105.7).ConclusionThe Benzoletter is associated with a significant decrease in the consumption of hypnotics. It is a simple and feasible intervention that allows acting on large populations, and it could even be periodically repeated. Controlled studies are required to confirm its effectiveness.     

Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas

ObjectiveTo know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season.DesignQuasi-experimental study of community intervention.SiteTwo basic health zones belonging to the Elche-Crevillente health department, Spain.ParticipantsPregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign.InterventionsTraining session for the IG prior to the 2019/20 flu campaign.Main measurementsAttitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office.ResultsThe influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n = 207) in the IG and 19.7% (n = 144) in the CG (p = 0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR = 1.09 (95% CI 1.01-1.62).ConclusionsJoint training strategies for professionals and community assets improve the results of vaccination coverage.     

Superando la dificultad de captar jóvenes. Claves para la obtención de datos cualitativos en un estudio de sexualidades

Sexuality is a central aspect of young's lives. It is a task of public health to understand how they are constructed with all their diversity, and to give satisfactory answers in the field of sexual health. The characteristics of qualitative research (flexible, open and reflective) provide the opportunity to design studies that are accepted and adapted to the realities of young people, especially in a sensitive field. The aim of this note is to provide clues for the recruitment of young people. In our case, the knowledge of key informants regarding the study population and the research context was essential, both to choose an approach and recruitment strategy and to adapt the data collection techniques. Finally, we used individual interviews and triangular groups opportunistically in waiting rooms of sexual health care services specialized in young people, where there was already a predisposition to talk about sexuality.     

La prevención de las caídas de las personas mayores y sus familiares: una síntesis cualitativa

ObjectiveTo analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providersMethodQualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis.ResultsCare providing, and kinship relationships mediated family care providers’ interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions.ConclusionsTaking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.     

Diseño y validación de un cuestionario sobre las actitudes ante la prevención y promoción de la salud en atención primaria (CAPPAP)

ObjectiveTo develop and validate a questionnaire to measure attitudes towards prevention and health promotion.DesignCross-sectional study for the validation of a questionnaire.LocationPrimary Health Care (autonomous community of Andalusia, Spain).Participants282 professionals (nurses and doctors) belonging to the Public Health System.Main measurementsContent validation by experts, ceiling effects and floor effects, correlation between items, internal consistency, stability and exploratory factor analysis.ResultsThe 56 items of the tool (CAPPAP) obtained, including those from the review of other tools and the contributions of the experts, were grouped into 5 dimensions. The percentage of expert agreement was over 70% on all items, and a high concordance between prevention and promotion item was obtained, thus, duplicates were removed leaving a final tool with 44 items. The internal consistency, measured by Cronbach's alpha, was 0.888. The test retest indicated concordance from substantial to almost perfect. Exploratory factor analysis identified five factors that accounted for 48.92% of the variance.ConclusionsCAPPAP is a tool that is quick and easy to administer, that is well accepted by professionals, and that has acceptable psychometric results, both globally and at the level of each dimension.     

El cambio de paradigma en la prevención de ictus en la fibrilación auricular. Retos y oportunidades emergentes para el médico de familia

Atrial fibrillation (AF), is the most prevalent sustained arrhythmia in general population, affecting up to 10% in patients of advanced age. AF doubles overall mortality and increases up to 5–6 times the risk of stroke, which have the characteristic of being particularly harmfull. The basis of treatment on AF are the rhythm or rate control and the prevention of thromboembolism. For the latter purpose the treatments that have been most effective are oral acticoagulants. For decades and until just a few years ago, the only oral drugs available for this purpose have been the anti-vitamin K, mainly represented in our country by acenocoumarol and lesser extent by warfarin. These drugs have been shown to reduce strokes and mortality compared to placebo and with antiplatelet drugs, so have been and continue to be the standard treatment and the comparator for all antithrombotic drugs in patients with AF. The variability in the therapeutic response, their food and drugs interactions and their narrow therapeutic window that entail the need to frequently monitoring, has led to look for new drugs that, at least maintaining their advantages, where able to avoid some of the drawbacks.Currently we have a number of new drugs that meet these premises, although they have the disadvantage of a higher direct cost. The arrival of these new oral anticoagulants (NOAC) make necessary to know them well, reach a consensus for a correct use and to make changes in the clinical management of these patients when they are used.In this article we review the indications and way of use of the different options (classics and news) of antithrombotic therapy in patients with AF, the situation of anticoagulated patients in our country, the characteristics of the NOAC, its recommendations for use and the challenges to that are subjected family physicians regarding these changes.     

Efectividad de las intervenciones educativas para la prevención del embarazo en la adolescencia

ObjectiveTo assess the effectiveness of the interventions to prevent a pregnancy in adolescence.DesignSystematic review.Data sourcesThe following databases were consulted: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS, and IME, in order to identify interventions aimed at preventing a pregnancy in adolescence.Study selectionA total of 24 primary investigations, in which an educational program to prevent a pregnancy in the adolescence was evaluated, were selected. The quality of the selected studies was assessed according to the CASPe scale.ResultsEducational programs for the modification of the teenage pregnancy rate show inconclusive results, as there are 2 studies that find a reduction, and 2 that find that there are no significant changes. For secondary outcomes, it was found that educational programs are effective for increasing the knowledge level about sexuality and contraceptive methods and changing attitudes about the risk of a teenage pregnancy or the use of contraceptive methods. There are no statistically significant differences between the studies with a positive and negative outcome (P > .05) for any of the results analysed in this review.ConclusionThere is no a single intervention modality that is the most effective for prevention of a teenage pregnancy. More research is needed with a longitudinal approach that assess not only intermediate results, but also a modification in the pregnancy rate.     

Fiabilidad de la retinografía para la detección de retinopatía hipertensiva en Atención Primaria

ObjectiveHigh blood pressure is one of the most prevalent diseases in general adult population. Its importance lies in the complications it causes in target organs such as kidney, heart, brain and eye. The aim of this work is to evaluate the agreement in the evaluation and interpretation of retinographies of hypertensive patients by family doctors and ophthalmologists.Material and methodsThis is a multicentric cross-sectional study in which 976 hypertensive patients from 50 to 70 years old were involved. They were participants of the «Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study» (ISSYS project) carried out in primary care centers of Barcelona and who agreed to undergo retinography. Six family physicians and 2 ophthalmologists evaluated the presence of retinal lesions through the Keith-Wagener-Barker criteria.ResultsThe inter/intra-observer Kappa concordance of the evaluations was analyzed. The evaluation of the retinographies under the usual conditions of clinical practice obtained a high subjective component with slight and fair intra-observer concordance values in the Keith-Wagener-Barker criteria. Only the assessment of the microaneurysms showed a moderate concordance and the ratio artery/vein was the worst concordant.ConclusionsThe evaluation of the retinographies in habitual conditions of clinical practice has a high subjective component that is reflected in slight and fair inter-intraobserver concordance values. The use of objective reading systems in the assessment of retinography in hypertensive patients would be useful.