Efectividad de una intervención educativa breve en pacientes con insomnio en atención primaria

ObjetiveTo evaluate the effectiveness of providing an educational intervention in primary care (PC) alongside a pharmacological treatment for insomnia.DesignSingle blinded non randomised clinical trial.LocationTwo urban primary health centers in Gijón (Asturias, Spain).ParticipantsPatients who consulted for insomnia between July 2012-January 2013 and met the inclusion criteria (n = 50) were assigned systematically to the control group (CG) or intervention group (IG). All patients initiated treatment with lorazepam 1 mg in the evenings and had four weekly 15 min visits plus a follow-up visit after another month.InterventionsThe IG received training for control of stimuli, sleep hygiene and respiration and relaxation techniques in the four visits. The CG had only non invasive measures taken.MeasurementsConsidering as cured those who reached a Pittsburgh Sleep Quality Index PSQI < 6 or a 50% reduction from baseline level. It was also analyzed the change in the PSQI from baseline to final visit and to follow-up visit, and voluntary interruption of lorazepam. Analysis by Bayesian inference.ResultsTwelve out of recoveries after intervention against one out of 24 among control group. Mean change in PSQI to final visit and follow-up visit was: –4.7 (95%CrI:–5.9 to –3.5) and –6,3 (95%ICred: –7.5 to –5.1) in IG; –1.8 (95%ICred: –3 to –0.5) and –1.7 (95%ICred: –2.9 to –0.4) in CG. Interruption of lorazepan: in 4 controls (16,7%) and 9 (34,6%) in IG. Twenty nine patients in GI and 17 in GC completed the trial. Per protocol analysis showed similar results.ConclusionsThe educational intervention in PC improves sleep quality and reduces the need of treatment with benzodiacepines.     

Documento de consenso para el manejo de la esquistosomiasis en atención primaria

Human schistosomiasis is the parasitic disease with the highest morbidity and mortality worldwide after malaria. It is endemic in more than 78 tropical and subtropical countries, especially in sub-Saharan Africa, and it is estimated that 236 million people are infected. It can cause serious health complications at the genitourinary and hepatosplenic level, leading to the death of 300,000 people each year. The number of imported cases in Western countries has increased in recent years due to the arrival of a significant number of migrants from endemic regions and a growing number of travelers who have visited them. On the other hand, outbreaks of autochthonous transmission have recently been reported in Corsica (France) and Almería (Spain). For all these reasons, the European health authorities have recommended serological screening for the disease in all migrants from endemic areas who have been living in Europe for less than 5 years. Since Primary Care is usually the first point of contact for these people with the Health System, doctors must know the main aspects of the disease, and be provided with the necessary means for its diagnosis and treatment. This document has been prepared by professionals belonging to five scientific societies of Primary Care (SEMFyC, SEMG, SEMERGEN), Pediatrics (SEIP) and Tropical Medicine and International Health (SEMTSI), in order to establish clear recommendations for the diagnosis and management of schistosomiasis in Primary Care.     

Investigación y protección de datos personales en atención primaria

Research is one of the fundamental functions that have to be carried out in Primary Care. The clinical information stored in different records arising from medical care is a basic tool for this activity. The use of personal data for the purposes of research is legitimate according to our laws; however, this information must be treated confidentially at all times. Two alternatives are available for this. One is to obtain the informed consent of the patient, and the other is to dissociate the handling of the information. But in some situations, the compliance to legal demands when obtaining data for research is not easy, there being a series of obstacles which in many cases makes it impossible to carry out research. In this article, we will give guidance on how to access the information contained in records while respecting the rights of the patient and the current legislation.     

Reflexiones sobre el impacto de la crisis en la salud y la atención sanitaria de la población inmigrante. Informe SESPAS 2014

Despite the economic crisis, the immigrant population of Spain continues to be high, with 5.7 million persons (11.4%). This population, whose health needs are similar to those of the general population, is more vulnerable due to their exposure to worse social determinants (living and working conditions together with a higher risk of exclusion from social services). In this article, we analyze how the economic crisis affects or can affect the health of the immigrant population in Spain by examining distinct population-specific or institutional factors that influence the effects of the crisis and the available data. The available evidence is limited, but several effects can be identified: firstly, some social determinants, such as higher unemployment rates and worse working conditions, have deteriorated, which can be expected to lead to a worsening of health status. These consequences have already been described for mental health or have been estimated for infectious diseases. Secondly, political decisions have had a direct impact, excluding–with some exceptions–undocumented immigrants from the right to health care. Finally, the lower priority given to adapting health services to the specific characteristics of the immigrant population (most of whom are documented) together with the introduction of new barriers, has hampered or will hamper access to health care. As a result, the economic crisis can be expected to have a greater impact on the immigrant population.     

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.