Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial

Background: There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC). ethods/Design: Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis. Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial. Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation - contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage. Control group: usual care. Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of ≤ 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36. Discussion: The application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline

Passive smoking in babies: The BIBE study (Brief Intervention in babies. Effectiveness)

Background: There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth. The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS). Methods/Design: Cluster randomized field trial (control and intervention group), multicentric and open. Subject: Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia. The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care. Discussion: Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health. The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS

Un caso de piezas supernumerarias ectópicas en un individuo de la Edad del Hierro : a case of supenumerory ectopic teeth in the Iron Age

En la Necrópolis Talayótica de "S'Illot des Porros" (Mallorca, VI-II a.C.) se ha hallado un individuo que evidenciaba afloraciones de sustancia esmaltada en la bóveda palatina. Puestas a la luz, se han reconocido dos piezas dentarias supernumerarias ectópicas molariformes en las que es posible distinguir dos tipos de tejido bien individualizados: esmalte y dentina, aunque no quedan perfectamente limitados a las zonas de raíz y corona.An individual from "S'Illot des Porros" (Majorca, VI-II a. C.) has been studied. He shows three granules of enamelled substance in the vault of the palate. We have recognized two supernumerary ectopic teeth with a molariform structure. It is possible to discern the enamel from the dentine but they are not perfectly limited to the root and crown zones."S'Illot des Porros"eko (Mallorca, J.A. VI-II. m.) Nekropolis Talaiotikoan ahosabaian esmaltedun substantziazko agergune nabarmenak zituen gizabanako bat aurkitu da. Behin argitara jarriz gero, bi hortz-ale supernumerario ektopiko eta molare-formadun igerri izan dira, bertan erabat bakoiztutako bi ehun mota bereiz daitezkeelarik: esmaltea eta dentina, hauek koroa eta zain guneetara zorrotz mugatua geratzen ez badira ere

Un caso de piezas supernumerarias ectópicas en un individuo de la Edad del Hierro : a case of supenumerory ectopic teeth in the Iron Age

En la Necrópolis Talayótica de "S'Illot des Porros" (Mallorca, VI-II a.C.) se ha hallado un individuo que evidenciaba afloraciones de sustancia esmaltada en la bóveda palatina. Puestas a la luz, se han reconocido dos piezas dentarias supernumerarias ectópicas molariformes en las que es posible distinguir dos tipos de tejido bien individualizados: esmalte y dentina, aunque no quedan perfectamente limitados a las zonas de raíz y corona.An individual from "S'Illot des Porros" (Majorca, VI-II a. C.) has been studied. He shows three granules of enamelled substance in the vault of the palate. We have recognized two supernumerary ectopic teeth with a molariform structure. It is possible to discern the enamel from the dentine but they are not perfectly limited to the root and crown zones."S'Illot des Porros"eko (Mallorca, J.A. VI-II. m.) Nekropolis Talaiotikoan ahosabaian esmaltedun substantziazko agergune nabarmenak zituen gizabanako bat aurkitu da. Behin argitara jarriz gero, bi hortz-ale supernumerario ektopiko eta molare-formadun igerri izan dira, bertan erabat bakoiztutako bi ehun mota bereiz daitezkeelarik: esmaltea eta dentina, hauek koroa eta zain guneetara zorrotz mugatua geratzen ez badira ere

Accidentes atendidos en un área básica de salud de girona, españa

Fundamentos: Los accidentes constituyen una patología poco estudiada en el ámbito de la Atención Primaria. Son una de las consultas más frecuentes en los servicios de urgencias y los Centros de Atención Primaria realizan la primera asistencia a la mayoría de los accidentados. Conocer la incidencia y las características clínico-epidemiológicas de los accidentes atendidos en una Área Básica de Salud puede aportar información sobre cuáles pueden ser susceptibles de actividades de prevención. Métodos: Diseño: estudio descriptivo. Emplazamiento: atención primaria. Muestra: todos los pacientes (389) que fueron atendidos por accidente en el Centro de Atención Primaria, entre octubre-98 y mayo-99. Variables: edad, sexo, lugar del accidente, tipo de lesión, localización, agentes implicados, intencionalidad, pruebas complementarias, tratamiento y derivación. Análisis estadísticos: estimación de medias, desviación estándar, estimación de proporciones e intervalos de confianza del 95%. Resultados: Incidencia: 4,1% (IC95%: 3,7-4,5%). Sexo: varones 59% (IC95%:54,2-64%) y mujeres 40,9% (IC95%: 36-45,8%). Edad: menores de 20 años, el 50,4% (IC95%:45,4-55,4%);.Actividad de mayor accidentalidad: ocio 24,4% (IC95%: 20,2-28,7%). Lugar: hogar 36,2% (IC95%: 31,5-41%). Lesión más frecuente: contusiones 39,6% (IC95%:34,7-44,4%).Localización más frecuente: extremidad superior 37,5% (IC95%: 32,7-42,3%); Agente mayoritariamente implicado: herramientas y máquinas: 15,9% (IC95%:12,3-19,6%). El 92,2% (IC95%: 89,3-94,7%) fueron casuales. Tipo de visita: el 83,3% (IC95%: 79,6-87%) fueron atendidos con carácter urgente; el 79,5% (IC95%:75,4-83,5%) recibió tratamiento con cura y/o fármacos. El 9,8% (IC95%:6,8-12,7%) requirió derivación hospitalaria, Un 13,3% (IC95%: 0-16,7%) requirió pruebas complementarias. Conclusiones: El mayor porcentaje de accidentalidad se da en población joven, por lo que se evidencia la necesidad de incorporar intervenciones de educación sanitaria para la prevención de accidentes dirigidas a dicha población

Guia per a la detecció i tractament del consum de tabac

Tabaquisme; Consum de tabac; Fumadors; TractamentTabaquismo; Consumo de tabaco; Fumadores; TratamientoSmoking; Tobacco consumption; Smoker; TreatmentAquest document aporta una revisió acurada del coneixement científic actualment disponible sobre aquest tema, i el tradueix en recomanacions per a la pràctica diària. Pel seu contingut docent, la Guia constitueix també un valuós document per facilitar l’adquisició de competències clíniques que ha de caracteritzar el desenvolupament dels professionals de l’Institut Català de la Salut. Les patologies relacionades amb el consum de tabac són un dels motius més importants en la consulta habitual en l’àmbit sanitari, en general, i en l’atenció primària, en particular. El tabaquisme és considerat actualment el primer problema de salut pública prevenible en els països desenvolupats. Es pot afirmar, sens dubte, que el tabac és la primera causa de mort prematura i de malaltia prevenible al nostre país

Guia per a la detecció i tractament del consum de tabac

Tabaquisme; Consum de tabac; Fumadors; TractamentTabaquismo; Consumo de tabaco; Fumadores; TratamientoSmoking; Tobacco consumption; Smoker; TreatmentAquest document aporta una revisió acurada del coneixement científic actualment disponible sobre aquest tema, i el tradueix en recomanacions per a la pràctica diària. Pel seu contingut docent, la Guia constitueix també un valuós document per facilitar l’adquisició de competències clíniques que ha de caracteritzar el desenvolupament dels professionals de l’Institut Català de la Salut. Les patologies relacionades amb el consum de tabac són un dels motius més importants en la consulta habitual en l’àmbit sanitari, en general, i en l’atenció primària, en particular. El tabaquisme és considerat actualment el primer problema de salut pública prevenible en els països desenvolupats. Es pot afirmar, sens dubte, que el tabac és la primera causa de mort prematura i de malaltia prevenible al nostre país

Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial

Background: There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC). Methods/Design: Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis. Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial. Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation - contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage. Control group: usual care. Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of ≤ 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36. Discussion: The application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline

Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study) : design of a cluster randomised trial

Background: There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC). ethods/Design: Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis. Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial. Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation - contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage. Control group: usual care. Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of ≤ 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36. Discussion: The application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline