Llargues E.,Granollers General Hospital |
Recasens A.,Granollers General Hospital |
Vila M.,Granollers General Hospital |
Perez M.J.,Catalan Institute of Health |
And 6 more authors.
Journal of Epidemiology and Community Health | Year: 2011
Background: Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. Objective: To evaluate the efficacy of an intervention on food habits and physical activity in school children. Methods: A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5-6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. Results: Two years after the beginning of the study, the body mass index of the children in the control group was 0.89 kg/m 2 higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. Conclusions: The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.
Serna M.C.,University of Lleida |
Serna M.C.,Catalan Institute of Health |
Cruz I.,Idiap Research Institute |
Cruz I.,Catalan Institute of Health |
And 3 more authors.
European Psychiatry | Year: 2010
Background: Many patients discontinue antidepressant therapy long before the six-month minimum duration recommended for the treatment of major depression and many other diagnoses. Purpose: To estimate the duration of antidepressant treatment and to analyse the following factors in relation to treatment adherence: age, sex, polypharmacy and type of drug. Methods: Retrospective cohort followed up for five years (2003-2007) based on prescription database. Selection criteria: Users who had received at least one antidepressant prescription in 2003 and who had not received antidepressants during the previous 12 months. Variables studied: Age, sex, drug, polypharmacy, period of treatment, packs dispensed. Adequate adherence was defined as dispensation of medication during at least 80% of the treatment period, and compliance was defined as good when, in addition, the treatment lasted more than four months. Results: Of the 7525 patients selected, 56% abandoned medication during the first four months. Men were more likely to give up medication before time than women. Good compliance was recorded in 22% of patients and was twice as frequent in patients with high levels of polypharmacy than in those with low levels (31% vs. 15.3%). Patients receiving maprotiline, venlafaxine, mirtazapine, citalopram, clomipramine and fluoxetine presented the highest percentages of good compliance. Conclusions: Only one out of five patients complied with treatment for over four months. Treatment periods were shorter in men. In chronic processes, patients receiving polypharmacy presented the best compliance. © 2009 Elsevier Masson SAS.
Bjorkhem-Bergman L.,Karolinska University Hospital |
Andersen-Karlsson E.,Karolinska Institutet |
Diogene E.,Catalan Institute of Health |
Melien O.,Norwegian Directorate of Health |
And 6 more authors.
European Journal of Clinical Pharmacology | Year: 2013
Purpose: In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. Methods: The "Stockholm model " consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. Results: The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. Conclusion: The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care. © Springer-Verlag 2013.
PubMed | Granollers General Hospital, Health Promotion Research, Unitat de Suport a la Recerca Metropolitana Nord, Public Health Agency and Catalan Institute of Health
Type: | Journal: European journal of public health | Year: 2016
The prevalence of obesity among children is increasing, but treating obesity is difficult and has poor outcomes. We assessed the 4-year impact of a school-based educational intervention on physical activity, body mass index (BMI) and the prevalence of overweight and obesity.A 6-year cluster-randomised study was used to evaluate an intervention programme for children in primary school in 2006-08. The intervention promoted healthy eating habits and physical activity in the school setting through the investigation, vision, action and change educational methodology that involves children as active participants in healthy change. BMI and physical activity were measured in 2006, 2008, 2010 and 2012. Multilevel mixed-effects linear regression was used to assess change in BMI over time.The effect of the intervention was maintained 4 years after completion. Average increase in BMI was greater in the control than in the intervention group (3.85 2.82 vs. 2.79 2.37); the mean difference was 1.06 (95% confidence interval: 0.14-1.97). In the intervention group, the prevalence of overweight and obesity decreased (1.4 and 3.7%, respectively). In the control group, the prevalence of overweight increased (9.4%) and the prevalence of obesity decreased (1.6%). The control group spent more time in sedentary activities. No differences were observed in physical activities.Control of weight gain was sustained 4-years after an educational intervention during the first 2 years of primary school. Future interventions to prevent obesity should build on principles viewing children as active agents of healthy change.ClinicalTrials.gov NCT01156805.
Salas-Salvado J.,Rovira i Virgili University |
Bullo M.,Rovira i Virgili University |
Ros E.,Institute dInvestigacions Biomediques August Pi i Sunyer |
Covas M.-I.,Institute Of Recerca Hospital Del Mar |
And 14 more authors.
Annals of Internal Medicine | Year: 2014
Background: Interventions promoting weight loss can reduce the incidence of type 2 diabetes mellitus. Whether dietary changes without calorie restriction also protect from diabetes has not been evaluated. Objective: To assess the efficacy of Mediterranean diets for the primary prevention of diabetes in the Prevención con Dieta Mediterránea trial, from October 2003 to December 2010 (median follow-up, 4.1 years). Design: Subgroup analysis of a multicenter, randomized trial. (Current Controlled Trials: ISRCTN35739639) Setting: Primary care centers in Spain. Participants: Men and women without diabetes (3541 patients aged 55 to 80 years) at high cardiovascular risk. Intervention: Participants were randomly assigned and stratified by site, sex, and age but not diabetes status to receive 1 of 3 diets: Mediterranean diet supplemented with extra-virgin olive oil (EVOO), Mediterranean diet supplemented with nuts, or a control diet (advice on a low-fat diet). No intervention to increase physical activity or lose weight was included. Measurements: Incidence of new-onset type 2 diabetes mellitus (prespecified secondary outcome). Results: During follow-up, 80, 92, and 101 new-onset cases of diabetes occurred in the Mediterranean diet supplemented with EVOO, Mediterranean diet supplemented with mixed nuts, and control diet groups, respectively, corresponding to rates of 16.0, 18.7, and 23.6 cases per 1000 person-years. Multivariate-adjusted hazard ratios were 0.60 (95% CI, 0.43 to 0.85) for the Mediterranean diet supplemented with EVOO and 0.82 (CI, 0.61 to 1.10) for the Mediterranean diet supplemented with nuts compared with the control diet. Limitations: Randomization was not stratified by diabetes status. Withdrawals were greater in the control group. Conclusion: A Mediterranean diet enriched with EVOO but without energy restrictions reduced diabetes risk among persons with high cardiovascular risk. © 2014 American College of Physicians.
Mahmud M.A.,Mekelle University |
Spigt M.,Maastricht University |
Bezabih A.M.,Mekelle University |
Pavon I.L.,Catalan Institute of Health |
And 2 more authors.
PLoS Medicine | Year: 2015
Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections. In this trial, 367 parasite-negative school-aged children (aged 6–15 y) were randomly assigned to receive both, one or the other, or neither of the interventions in a 2 × 2 factorial design. Assignment sequence was concealed. After 6 mo of follow-up, stool samples were examined using direct, concentration, and Kato-Katz methods. Hemoglobin levels were determined using a HemoCue spectrometer. The primary study outcomes were prevalence of intestinal parasite reinfection and infection intensity. The secondary outcome was anemia prevalence. Analysis was by intention to treat. Main effects were adjusted for sex, age, drinking water source, latrine use, pre-treatment parasites, handwashing with soap and nail clipping at baseline, and the other factor in the additive model. Fourteen percent (95% CI: 9% to 19%) of the children in the handwashing with soap intervention group were reinfected versus 29% (95% CI: 22% to 36%) in the groups with no handwashing with soap (adjusted odds ratio [AOR] 0.32, 95% CI: 0.17 to 0.62). Similarly, 17% (95% CI: 12% to 22%) of the children in the nail clipping intervention group were reinfected versus 26% (95% CI: 20% to 32%) in the groups with no nail clipping (AOR 0.51, 95% CI: 0.27 to 0.95). Likewise, following the intervention, 13% (95% CI: 8% to 18%) of the children in the handwashing group were anemic versus 23% (95% CI: 17% to 29%) in the groups with no handwashing with soap (AOR 0.39, 95% CI: 0.20 to 0.78). The prevalence of anemia did not differ significantly between children in the nail clipping group and those in the groups with no nail clipping (AOR 0.53, 95% CI: 0.27 to 1.04). The intensive follow-up and monitoring during this study made it such that the assessment of the observed intervention benefits was under rather ideal circumstances, and hence the study could possibly overestimate the effects when compared to usual conditions. Handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The next essential step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales. © 2015 Mahmud et al.
Carles M.,Rovira i Virgili University |
Vilaprinyo E.,CIBER ISCIII |
Cots F.,CIBER ISCIII |
Gregori A.,Rovira i Virgili University |
And 6 more authors.
BMC Cancer | Year: 2011
Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care.Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios.Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY.Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area. © 2011 Carles et al; licensee BioMed Central Ltd.
PubMed | Rovira i Virgili University, University of Barcelona, University of the Balearic Islands, CIBER ISCIII and 7 more.
Type: Journal Article | Journal: Clinical nutrition (Edinburgh, Scotland) | Year: 2016
Few studies have assessed the association between consumption of red meat (RM) and processed red meats (PRM) and the incidence of metabolic syndrome (MetS) and results have been inconsistent. We investigated associations between total consumption of meat and its subtypes and incident MetS and estimated the effect of substituting RM or PRM for alternative protein-rich foods.We analyzed 1868 participants (55-80 years-old) recruited into the PREDIMED study who had no MetS at baseline and were followed for a median of 3.2 years. MetS was defined using updated harmonized criteria. Anthropometric variables, dietary habits, and blood biochemistry were determined at baseline and yearly thereafter. Multivariable-adjusted hazard ratios (HRs) of MetS were estimated for the two upper tertiles (versus the lowest one) of mean consumption of meat and its subtypes during the follow-up as exposure.Comparing the highest vs the lowest tertile of consumption, we observed an increased risk of MetS incidence, with HRs of 1.23 (95% confidence interval [CI]: 1.03-1.45) and 1.46 (CI: 1.22-1.74) for total meat and pooled RM and PRM, respectively. Compared with participants in the lowest tertile, those in the highest tertile of poultry and rabbit consumption had a lower risk of MetS incidence. The risk of MetS was lower when one-serving/day of RM or PRM was replaced by legumes, poultry and rabbit, fish or eggs.RM and PRM consumption was associated with higher risk of MetS. Replacing RM or PRM with other protein-rich foods related to a lower risk of MetS and should, therefore, be encouraged. This trial was registered at controlled-trials.com as ISRCTN35739639.
Estruch R.,Institute Salud Carlos III |
Estruch R.,University of Barcelona |
Ros E.,Institute Salud Carlos III |
Ros E.,University of Barcelona |
And 24 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. METHODS: In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. RESULTS: A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. CONCLUSIONS: Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639.) Copyright © 2013 Massachusetts Medical Society.
PubMed | Quirons Hospital, Hospital del Mar, Autonomous University of Barcelona and Catalan Institute of Health
Type: | Journal: Nursing ethics | Year: 2016
This article will explore a clinical case study of a home visit carried out by the case manager nurse. In this case, we will discuss the dilemma of finding the balance between autonomy and beneficence from the perspective of principlist ethics, virtue ethics and the ethics of care. The main conflict in this case study deals with all proposals are unsuitable and it is not necessary for a nurse to pay him a home visit, whereas for the healthcare system it is considered necessary. We could conclude that, during the home visit, the case manager aspires to achieve excellence, and throughout his clinical relationship with Francesc, searches for a series of virtues, respecting certain fundamental principles. In this way, the case managers ensure that Jaumes care is more humanised. The case has been anonymised and confidentiality maintained.