Search

Resumen: Objetivo: Analizar la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS). Material y métodos: Se realizó un estudio cualitativo de análisis de la situación para una evaluación del PAPPS en 2 fases: 1) generación de ideas y recogida de información a través de una matriz DAFO, a través de 2 tipos de criterios, internos (fortalezas y debilidades), y externos (amenazas y oportunidades); 2) priorización de las propuestas de mejora recogidas. Selección de participantes: se identificaron informadores-clave teniendo en cuenta su relación y conocimiento del programa PAPPS. Se incluyeron a todos los integrantes de los grupos de expertos del PAPPS y miembros con participación en el pasado, así como a los componentes del organismo de coordinación, incluidos los responsables autonómicos del PAPPS. Se enviaron dos invitaciones a participar en el estudio: la primera desde el 29 diciembre de 2017 al 11 febrero de 2018, y la segunda entre el 10 y el 23 de enero de 2019. La información se obtuvo a partir de un cuestionario concebido para ser autocumplimentado. Resultados y conclusiones: Respondieron el cuestionario un total de 73 sujetos. El 35% de los participantes eran miembros de los grupos de trabajo del PAPPS, siendo el grupo más numeroso, seguido de médicos de familia de otros ámbitos, con el 20,5%. El orden de priorización de las propuestas de mejora fue el siguiente: 1) unificar recomendaciones con otros grupos de trabajo de semFYC; 2) elaborar listados con «Recomendaciones No hacer» desde el punto de vista de la prevención; 3) incorporar el PAPPS en la agenda política; 4) mayor coordinación e interacción entre grupos con competencias comunes; 5) docencia en pregrado y en unidades docentes, darse a conocer también a los estudiantes de Medicina; 6) revisión, actualización y difusión a cualquier profesional de Atención Primaria. Abstract: Objective: To analyze the situation, evaluation and proposals for improvement of the Preventive Activities and Health Promotion Program (PAPPS). Material and methods: A qualitative study of situation analysis was carried out for the evaluation of the PAPPS in 2 phases: 1) Generation of ideas and collection of information through a DAFO matrix, using 2 types of criteria: internal (strengths and weaknesses), and external (threats and opportunities); 2) Prioritization of the improvement proposals collected. Selection of participants: Key informants were identified taking into account their relationship and knowledge of the PAPPS program. All members of the PAPPS, expert groups and members with past participation were included, as well as the coordinators, including the autonomous leaders of the PAPPS. Two invitations to participate in the study were sent: the first from December 29, 2017 to February 11, 2018, and the second from January 10 to 23, 2019. The information was obtained from a questionnaire designed to be self-completed. Results and conclusions: A total of 73 subjects answered the questionnaire. 35% of the participants were members of the PAPPS working groups, followed by family doctors from other areas, with 20.5%. The order of prioritization of the improvement proposals was as follows: 1) Unify recommendations with other semFYC working groups; 2) Prepare lists with “Recommendations not to do” from the point of view of prevention; 3) Incorporate PAPPS in the political agenda; 4) Greater coordination and interaction between groups with common competences; 5) Teaching in undergraduate and teaching units; 6) Review, update and dissemination of the program in Primary Care.

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that "moderate" consumption is beneficial to health. The most recent evidence indicates that "moderate" consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno.

Toxic oil syndrome is a multisystemic disease that arose in 1981 due to the ingestion of contaminated rapeseed oil. Previous studies have found a higher prevalence of cardiovascular risk factors in these patients. The aim of this study was to analyze the differences in the prevalence of chronic diseases among a population affected by Toxic oil syndrome compared with a reference population in the Community of Madrid.Cross-sectional observational study of patients with a registry diagnosed with Toxic oil syndrome in the primary care medical record and a reference sample without Toxic oil syndrome matched by age group and sex. Sociodemographic variables, cardiovascular risk factors, cardiovascular and cerebrovascular disease, anxiety, depression, asthma, chronic obstructive pulmonary disease, and low back pain, and multimorbidity (≥2 chronic diseases) were assesed. Descriptive and multivariate analysis was performed to study the association between morbidity and Toxic oil syndrome.3,527 patients (1,394 Toxic oil syndrome) were included with a mean age of 66 (SD14) years, 71% women. Patients with a diagnosis of SAT were more likely to present multimorbidity (OR 1.36; 95%CI: 1.10-1.45), diabetes (OR 1.55; 95%CI: 1.29-1.86), complicated hypertension (OR 1.77; IC95%: 1.31-2.39), heart attack (OR 2.23; 95%CI: 1.47-3.38), depression (OR 1.39; 95%CI: 1.17-1.66) and asthma (OR 1.56; 95%CI: 1.23-1.97). The prevalence of anxiety was lower in TOS (OR 0.35; 95% CI: 0.18-0.69) as well as low back pain (OR 0.77; 95%CI: 0.65-0.91).Patients with toxic oil syndrome have a higher frequency of chronic diseases and mutimorbidity compared to the general population of the same sex and age.El síndrome del aceite tóxico es una enfermedad multisistémica que surgió en 1981 debido a la ingesta de aceite de colza contaminado. Estudios previos han encontrado en estos pacientes una mayor prevalencia de factores de riesgo cardiovascular. El objetivo de este estudio fue analizar las posibles diferencias en prevalencia de morbilidad crónica entre una población afectada por síndrome de aceite tóxico comparada con una población de referencia en la Comunidad de Madrid.Estudio observacional transversal de pacientes diagnosticados de síndrome del aceite tóxico en la historia clínica de atención primaria y una muestra de referencia sin síndrome del aceite tóxico apareados por grupo de edad y sexo. Se recogieron variables sociodemográficas, factores de riesgo cardiovascular, enfermedad cardiovascular y cerebrovascular, ansiedad, depresión, asma, enfermedad pulmonar obstructiva crónica, lumbalgia y multimorbilidad (≥2 enfermedades crónicas). Se realizó análisis descriptivo y multivariante para estudiar la asociación entre morbilidad y síndrome del aceite tóxico.Se incluyeron 3.527 pacientes (1.394 SAT) con una edad media de 66 (14) años, el 71% mujeres. Los pacientes con diagnóstico de síndrome del aceite tóxico tuvieron mayor probabilidad de presentar multimorbilidad (OR 1,36; IC95%: 1,10-1,45), diabetes (OR 1,55; IC95%: 1,29-1,86), hipertensión arterial complicada (OR 1,77; IC95%: 1,31-2,39), infarto (OR 2,23; IC95%: 1,47-3,38), depresión (OR 1,39; IC95%: 1,17-1,66) y asma (OR 1,56; IC95%: 1,23-1,97). La prevalencia de ansiedad fue menor (OR 0,35; IC95%: 0,18-0,69) así como de lumbalgia (OR 0,77; IC95%: 0,65-0,91).Los pacientes con síndrome de aceite tóxico presentan una mayor frecuencia de enfermedades crónicas y mutimorbilidad comparado con población general del mismo sexo y edad.

Los determinantes de salud primarios y secundarios explican gran parte de la morbimortalidad observada en atención primaria. Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la semFyC, para la promoción de un estilo de vida saludable mediante la metodología de intervención y las actuaciones preventivas en consumo de tabaco, consumo de alcohol, alimentación saludable, actividad física en el tiempo libre, prevención de accidentes de tráfico y sistemas de retención infantil. Se señalan las pautas más comunes de prevención clínica. Se actualizan las recomendaciones, se señalan aspectos novedosos como la definición de consumo de alcohol de bajo riesgo y se pone al día la bibliografía. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación.

Objetivo Analizar la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS). Material y métodos Se realizó un estudio cualitativo de análisis de la situación para una evaluación del PAPPS en 2 fases: 1) generación de ideas y recogida de información a través de una matriz DAFO, a través de 2 tipos de criterios, internos (fortalezas y debilidades), y externos (amenazas y oportunidades); 2) priorización de las propuestas de mejora recogidas. Selección de participantes: se identificaron informadores-clave teniendo en cuenta su relación y conocimiento del programa PAPPS. Se incluyeron a todos los integrantes de los grupos de expertos del PAPPS y miembros con participación en el pasado, así como a los componentes del organismo de coordinación, incluidos los responsables autonómicos del PAPPS. Se enviaron dos invitaciones a participar en el estudio: la primera desde el 29 diciembre de 2017 al 11 febrero de 2018, y la segunda entre el 10 y el 23 de enero de 2019. La información se obtuvo a partir de un cuestionario concebido para ser autocumplimentado. Resultados y conclusiones Respondieron el cuestionario un total de 73 sujetos. El 35% de los participantes eran miembros de los grupos de trabajo del PAPPS, siendo el grupo más numeroso, seguido de médicos de familia de otros ámbitos, con el 20,5%. El orden de priorización de las propuestas de mejora fue el siguiente: 1) unificar recomendaciones con otros grupos de trabajo de semFYC; 2) elaborar listados con «Recomendaciones No hacer» desde el punto de vista de la prevención; 3) incorporar el PAPPS en la agenda política; 4) mayor coordinación e interacción entre grupos con competencias comunes; 5) docencia en pregrado y en unidades docentes, darse a conocer también a los estudiantes de Medicina; 6) revisión, actualización y difusión a cualquier profesional de Atención Primaria.

INTRODUCTION We analyze the activities carried out by primary care (PC) physicians and nurses with respect to smoking cessation and evaluate their self-reported training, knowledge, and behavior. METHODS A cross-sectional study was conducted including 1514 PC physicians and nurses from June 2016 to March 2017, in Spain. The main variable was Good Practice (GP) in attention to smokers. To identify associated factors, a multilevel logistic regression model was used adjusted for sex, age, type of center, contract, years of employment, tobacco consumption, and self-reported training/knowledge. RESULTS Of the 792 physicians and 722 nurses, 48.6% referred to GP in smoking cessation management. The finding related to: being a non-smoker (OR=1.8; 95% CI: 1.2-2.5) or ex-smoker (OR= 1.4; 95% CI: 1.02-2.1), having a good level of knowledge (OR=1.8; 95% CI: 1.3-2.4) and training (OR=2.4; 95% CI: 1.8-3.2), and, to a lesser extent, being female (OR=1.3; 95% CI: 1.03-1.7), and work experience >10 years (OR=1.4; 95% CI: 1.03-1.9). The main GP barriers were: lack of time (45.5%), organizational problems (48.4%), and 35.4% lack of training. CONCLUSIONS The GP of PC physicians and nurses regarding smoking cessation management is related to being non-smokers or ex-smokers, and having sufficient training and knowledge. Lack of time and organizational problems were considered to be the main barriers. The promotion of training activities in the Spanish National Health Service with the support of scientific societies is required.

Additional file 1.

Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. The objective was to evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. A total of 740 participants completed the questionnaire. About 12.2% (95% CI [9.8-14.5]) were smokers, and 77.3% (95% CI [74.3-80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8-37.6]) practiced physical activity 2-3 times a week, and 12.1% (95% CI [9.8-14.5]) were overweight or obese. About 54.2% (95% CI [50.6-57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p 0.001) in relation to the participants' academic profiles. Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high; however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test.

Introduction Research has shown that financing drug therapy increases smoking abstinence rates, although most of these studies have been carried out in the private healthcare setting. The aim of this work is to assess the effect of subsidized pharmacological treatment on smoking cessation rates by the Spanish public healthcare system. Methods A pragmatic, randomized, clinical trial was performed by clusters. Randomization unit was the primary healthcare center and the analysis unit was the patient. Smokers consuming ≥10 cigarettes/day were randomly assigned to an intervention group that received financed pharmacological treatment or to a control group that followed usual care. The main outcome was self-reported or CO-confirmed continuous abstinence at 12 months. The main outcome, continuous abstinence rates (%), were compared between groups at 12 months post-intervention. A model was adjusted using mixed-effect logistic regression. Results A total of 1154 patients were included from 23 healthcare centers. In the intention-to-treat analysis, self-reported abstinence after 12 months in the control and intervention groups, respectively, was 9.6% (37/387) and 15.4% (118/767) (gender-adjusted OR=1.75; 95% CI: 1.1-2.8); for CO-confirmed abstinence the corresponding values were 3.1% (12/387) and 6.4% (49/767) (gender-adjusted OR=1.72; 95% CI: 0.7-4.0). Pharmacological treatment use was 35.1% (136/387) in the control group, and 58.3% (447/767) in the intervention group (adjusted OR=4.25; 95% CI: 1.8-9.9). Conclusions Subsidizing pharmacological treatment for smoking cessation increases self-reported or CO-confirmed abstinence rates under realistic conditions in the primary care setting of the Spanish public health system.

Background: Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. Objective: To evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). Methods: This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students, and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. Results: A total of 740 participants completed the questionnaire. 12.2% (95% CI [9.8–14.5]) were smokers and 77.3% (95% CI [74.3–80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8–37.6]) practiced physical activity 2–3 times a week, and 12.1% (95% CI [9.8–14.5]) were overweight or obese. 54.2% (95% CI [50.6–57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p < 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p < 0.001) in relation to the participants’ academic profiles. Conclusion: Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high, however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test. pre-print 322 KB

Chronic diseases, also known as non-communicable diseases (NCD) are one of the most important public health problems of our time. Many of these diseases can be reduced by achieving healthy lifestyles. Community interventions are very useful in reducing these types of diseases since they have a direct impact over daily conditions and are adjustable to the complex situations that they carry. This article describes the process of the creation of a collaborative platform for the design and implementation of community interventions to prevent NCDs. This platform includes six non-governmental organizations who have aligned their prevention and health promotion objectives to develop joint community interventions. The intervention levels approach, based on the socio-ecological model has been the basic model to structure the working groups of the platform. Dealing with institutional differences, complexity and variability of contexts, defining the roles and responsibilities and managing the resources are key elements to have in mind to achieve good relations and functional partnerships to design and implement effective community interventions at different levels. Institutional recognition, support and planning based on local priorities are also key elements for these kinds of platforms to be successful, sustainable and, therefore, have an impact on people&rsquo, s health.

Introduction Our aim was to ascertain how the anti-smoking legislation of 2005/2010 has affected the behavior of primary healthcare center (PHC) personnel (medical and nonmedical) with respect to their attitudes towards tobacco, its consumption and the legislative changes. Methods The sample consisted of 2040 PHC employees (1578 women, 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5% of the sample, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the antismoking legislation, a decrease in consumption was observed. Most of the participants considered that tobacco consumption affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. Results The sample was made up of 2040 PHC employees (1578 women; 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5%, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the anti-smoking legislation a decrease in consumption was observed. Most of the participants considered that tobacco affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. Conclusions Spanish primary healthcare professionals have a relatively low prevalence of smoking compared to the general population. It is necessary to implement more legislative measures to improve and maintain this outcome.

Fundamento La terapia grupal es una tecnica de uso extendido en el campo de las dependencias, alcoholismo y tabaquismo. A pesar de ello, su efectividad para la deshabituacion tabaquica no ha sido aun suficientemente establecida. El objetivo fue evaluar la efectividad relativa de una intervencion grupal para la deshabituacion tabaquica frente a una intervencion individual Metodo Ensayo clinico aleatorizado de 106 fumadores interesados en dejar de fumar, asignados a dos tipos de intervencion: intervencion individual corta (IIC) e intervencion grupal (IG), usando parches de nicotina como terapia sustitutiva en ambos tipos de intervencion cuando fuera necesaria. Los resultados se miden por intencion de tratar, considerando abstinencia de periodo continua Resultados Aunque la tasa de deshabituacion tabaquica disminuyo al prolongarse el seguimiento desde los tres hasta los 6 meses en cada uno de los dos grupos de intervencion (del 39,6 al 26,4%, y del 22,6 al 15,1%, para la IG e IIC, respectivamente), la efectividad relativa fue similar durante ambos periodos y no evidencio una superioridad clara de ninguna de las intervenciones a los tres meses (riesgo relativo [RR]=1,75; intervalo de confianza [IC] del 95%, 0,96–3,18), ni a los 6 meses (RR=1,75; IC del 95%, 0,80–3,82). La adhesion a la IG fue baja: menos del 60% de los fumadores asistieron a 5 de las 7 sesiones Conclusiones Conclusiones: No se ha podido establecer una superior efectividad de la intervencion grupal para la deshabituacion tabaquica sobre una intervencion individual corta, aunque esto puede ser debido a que la primera presenta una baja adhesion. La intervencion grupal podria ser mas efectiva que la individual corta, pero no en la magnitud presumida.

Tobacco use presents an odd confluence of circumstances: it is a significant and high threat to health, and there is a lack of motivation among health workers to act accordingly. Yet we have effective interventions. It is really hard to identify any other determinant of health presenting this mixture of lethality, prevalence, and lack of care, despite having effective treatments readily available. On the other hand, smoking cessation interventions are considered as the gold standard of preventive interventions, far above other preventive measures commonly used. This has prompted the National Committee for Smoking Prevention to develop a consensus document for the Clinical Care of Smoking Cessation in Spain. The purpose of this technical and scientific document is to agree on a basic proposal of quality of care to tackle smokers to quit. This document would serve as a guideline in the clinical practice in our country. The aims of this agreement are to review the effectiveness of the existing therapies for smoking cessation, to synthesize their available evidence, and to set the basic minimum standards of care in the clinical practice of patients who smoke. The consensus sets the strategies, and the evidences that support them, in order to assist both the smokers who want to quit, and the smokers who do not, setting out the steps to intervene in the most adequate.

The Consensus on Health Assistance for Smoking Cessation in Spain, is a document reviewing the treatment evidence, as well as policy needs in relation to smoking cessation in Spain. It has been developed by technical representatives of public health administrations, at a national and autonomous level, together with representatives of the scientific societies and professional bodies which are members of the Spanish coalition on smoking prevention National Committee on Tobacco Prevention (CNPT). After approval of a new national tobacco control law 28/2005, several tobacco control policies are being developed, especially by the autonomous governments, including treatment policies. Within this framework, and as part of the requirements of the law, all parties have considered the need to review effectiveness, experimentally validated tobacco dependence treatments and practices. An initial draft written by an expert committee was presented to all parties and discussed at three meetings over a period of a year and a half. The initial draft did review primary and secondary scientific literature from 1987 to 2007 on efficacy and effectiveness of different smoking cessation interventions, including: medical advice and brief smoking cessation interventions; pharmacological aids for treating nicotine dependence; behavioral interventions; specialized intensive treatment; community interventions; and treatment for groups with special needs. Considering the available evidence; current treatment needs; policy gaps; and the criteria of risk, accessibility, efficiency, sustainability and equity; the consensus document recommends the minimal requirements which should be taken into account when developing a policy on smoking cessation in Spain.

Group therapy is a widely used technique for the treatment of tobacco, alcohol and other toxic addictions. Nevertheless, its effectiveness for smoking cessation remains to be established. Our objective was to evaluate the relative effectiveness of a group intervention versus an individual intervention for smoking cessation.Randomized clinical trial of 106 smokers wishing to quit their addiction, who were assigned to two types of intervention: Short Individual Intervention (SII) and Group Intervention (GI). Nicotine patches were administered as supplemental therapy when needed in both instances. Results were assessed by intention to treat analysis.Although smoking cessation rates decreased in parallel with longer follow-up periods in each intervention group (from 39.6 to 26.4% and from 22.6 to 15.1% for GI and SII groups, respectively, at 3 and 6-months), the relative effectiveness was similar during both periods and there was no better response to any intervention at 3-months (relative risk [RR] = 1.75; CI95%, 0.96-3.18) and at 6-months (RR = 1.75; CI95%, 0.80-3.82). Compliance with GI was low and less than 60% of smokers attended to 5 out of 7 GI sessions.Group intervention (GI) is not more effective than short individual intervention to quit smoking. However, this fact could be due to the low compliance observed with regard to smokers' attendance to GI sessions.

Tobacco use presents an odd confluence of circumstances: it is a significant and high threat to health, and there is a lack of motivation among health workers to act accordingly. Yet we have effective interventions. It is really hard to identify any other determinant of health presenting this mixture of lethality, prevalence, and lack of care, despite having effective treatments readily available. On the other hand, smoking cessation interventions are considered as the gold standard of preventive interventions, far above other preventive measures commonly used. This has prompted the National Committee for Smoking Prevention to develop a consensus document for the Clinical Care of Smoking Cessation in Spain. The purpose of this technical and scientific document is to agree on a basic proposal of quality of care to tackle smokers to quit. This document would serve as a guideline in the clinical practice in our country. The aims of this agreement are to review the effectiveness of the existing therapies for smoking cessation, to synthesize their available evidence, and to set the basic minimum standards of care in the clinical practice of patients who smoke. The consensus sets the strategies, and the evidences that support them, in order to assist both the smokers who want to quit, and the smokers who do not, setting out the steps to intervene in the most adequate.

Objetivo El objetivo principal del estudio fue evaluar la eficacia del autocontrol del asma a traves de Internet. Diseno Ensayo clinico aleatorizado, multicentrico, no ciego y con un seguimiento de 12 meses. Emplazamiento Treinta y siete centros de salud, 69 medicos de familia y una consulta externa de Neumologia de Leiden y la Haya (Holanda). Poblacion de estudio Un total de 930 pacientes que reunian los criterios de seleccion fueron invitados a participar en el estudio: adultos (18 a 50 anos) con diagnostico de asma, que estaban siendo tratados con corticoides inhalados durante por lo menos 3 meses o mas durante el ultimo ano y que tenian acceso a Internet. Se excluyeron los pacientes que tuvieran enfermedades concomitantes que pudieran interferir con el tratamiento del asma, y los que estuvieran recibiendo corticoides orales de mantenimiento. Finalmente fueron 200 pacientes de los contactados los que dieron su consentimiento para participar en el estudio. Intervencion A los participantes se les aleatorizo a un grupo de autocontrol del asma por Internet (I) (101), o al grupo con el cuidado habitual (H) (99). El grupo I incluia monitorizacion semanal del control del asma y consejo sobre el tratamiento, educacion para la salud en grupo y online, y contacto personalizado a traves de la web con una enfermera especializada en asma. Los pacientes en el grupo H fueron tratados de acuerdo con las recomendaciones de las guias holandesas de asma (revisiones y ajustes del tratamiento cada 2-4 semanas en asmas inestables y revisiones medicas una o dos veces al ano en pacientes controlados). Medicion del resultado Se han medido la calidad de vida relacionada con el asma (medida por el Asthma Quality of Life Questionnaire, minima diferencia importante medida de 0,5 en una escala de 7), el control del asma (Asthma Control Questionnaire, minima diferencia importante de 0,5 en una escala de 7), los dias libres de sintomas (una noche y un dia sin sintomas de asma), la funcion pulmonar (medida del FEV1 antes de la inhalacion de los broncodilatadores), y las exacerbaciones del asma (deterioro del asma que requiere tratamiento urgente u hospitalario, o necesidad de corticoides orales por mas de 3 dias). Resultados principales La calidad de vida relacionada con el asma mejoro un 0,56 en el grupo I y 0,18 puntos en el H. Diferencia ajustada entre grupos de 0,38 (intervalo de confianza [IC] 95%, 0,20 a 0,56). Una mejora de 0,5 puntos o mas ocurrio en un 54% en el grupo I y un 27% en el grupo H. El control del asma mejoro mas en el grupo I que en el H (diferencia ajustada de –0,47 [IC 95% –0,64 a –0,30]). A los 12 meses el 63% de los pacientes del grupo I y el 52% de H refirieron estar libres de sintomas en las dos semanas previas (diferencia absoluta ajustada 10,9 [IC 0,005% a 21,3%). La medida de FEV1 prebroncodilatador cambio con 0,24 l (I) y –0,01 l (H) (diferencia ajustada de 0,25 l (IC 95% 0,03 a 0,46 l). No hubo diferencias entre las exacerbaciones entre los grupos estudiados. Conclusion El autocontrol del asma por Internet resulta en una mejora del control del asma y de la funcion pulmonar, pero no reduce las exacerbaciones, siendo la mejoria de la calidad de vida referida al asma mas ligera que clinicamente significativa.