Aim
To evaluate the effectiveness of a 12‐month multifactorial intervention by primary care nurses using health assets in increasing adherence to physical activity prescription (150 min/week) in ...patients with two or more cardiovascular risk factors.
Background
Physical activity promotion is a priority and helps to decrease mortality risk due to cardiovascular diseases. However, adherence to the habitual physical activity prescription in primary healthcare settings is low.
Design
Multicentre, single‐blind, parallel randomized (in two different branches) clinical trial.
Methods
In total, 263 participants from 20 primary healthcare centres in Mallorca completed the randomized controlled trial study (intervention group N = 128, control group N = 135). The intervention consisted in four visits and included a motivational interview and an individualized prescription of physical activity using health assets. Primary outcome measure was the number of participants performing at least 150 min of weekly physical activity. Secondary outcomes included physical activity level and physical fitness, Sense of Coherence, cardiovascular risk, sociodemographic data, trans‐theoretical stage of change, sleep quality, and depression.
Results
Adherence to the recommendation of at least 150 min of physical activity was higher in the intervention than in the control group (χ2 = 3.951, p = .047). However, this higher adherence did not suppose higher physical activity levels because no differences between groups were found in the total physical activity performed after intervention (t=−0.915, p = .361). At the end of the intervention participants randomized to the intervention group spent more time walking than participants in the control group (t = 2.260, p = .025).
Conclusion
The multifactorial intervention performed by primary care nurses induced a higher adherence to the 150‐min of weekly physical activity recommendation.
Impact
Adherence to the usual physical activity prescription in primary care is low. Physical activity prescription performed by primary care nurses and based on health assets and motivational interview can help to increase physical activity levels of patients. The main finding of the present study was that prescription using this approach was shown to be effective, leading to a higher adherence in the intervention group. This intervention is feasible in the nurse's primary healthcare setting, thus it could be implemented as the main tool when exercise is prescribed.
Trial Registration
International Standard Randomized Controlled Trial Number: ISRCTN76069254.
摘要
目的
评估初级护理护士利用健康资产对有两个或两个以上心血管危险因素的患者进行为期12个月的多重危险因素干预, 以提高对体力活动处方 (150分钟/周) 依从性的有效性。
背景
应优先提升体力活动, 其有助于降低心血管疾病而死亡的风险。然而, 在初级保健机构中, 很少有人能坚持习惯性体力活动处方。
设计
多中心、单盲、平行随机 (两个分支) 临床试验。
方法
总共有来自马略卡岛20个初级保健中心的263名参与者完成了随机对照试验研究 (干预组N=128, 对照组N=135) 。干预包括四次视察, 包括动机访谈和使用健康资产的体力活动的个性化处方。主要结果是参与者每周至少进行150分钟体力活动的人数。次要结果包括体力活动水平和身体素质、连贯性、心血管风险、社会人口统计学数据、跨理论变化阶段、睡眠质量和抑郁。
结果
干预组对至少150分钟体力活动的坚持程度高于对照组 (χ2=3.951,p=.047) 。然而, 这种更高的依从性并不意味着更高的体力活动水平, 原因是未在干预后进行的总体力活动发现组间差异 (t=‐0.915,p=.361) 。干预结束时, 随机分入干预组的参与者比对照组的参与者花在步行上的时间更长(t=2.260,p=0.025) 。
结论
由初级护理护士实施的多因素干预导致使患者更依从每周150分钟体力活动建议。
影响
在初级护理中, 很少有人坚持通常体力活动处方。由初级护理护士根据健康资产和动机访谈制定的体力活动处方有助于提高患者的体力活动水平。本研究的主要发现是, 使用该方法的处方被证明是有效的, 导致干预组的依从性更高。这种干预在护士的初级保健机构中是可行的, 因此在规定运动时, 其可以作为主要实施工具。
试验注册
国际标准随机对照试验编号:ISRCTN76069254.
Several studies have shown an association between personality and health status. The aim of this study was to evaluate the association between personality traits, parental education and ...health-related lifestyles in a cohort of Spanish adolescents. This is a longitudinal study with a source population of 1,123 third-year students (aged 14-15) in secondary schools in Spain. At the baseline evaluation sociodemographic variables, parental education and personality (Big Five Questionnaire for Children) were collected. At 18 months of follow-up health related lifestyles, including adherence to a healthy diet (KidMed index), tobacco and alcohol consumption, physical exercise, sleep problems and recreative screen and social network time were collected. A total of 824 adolescents (73.4%) completed the 18 months assessment and 695 (84.3%) presented valid data. Higher conscientiousness was associated to a lower risk for non-adherence to Mediterranean diet (OR = 0.7, 95% CIs=0.5-0.9), tobacco (OR = 0.5, 95% CIs=0.3-0.7) and alcohol consumption (OR = 0.6, 95% CIs=0.5-0.8), excessive use of screens (OR = 0.7, 95% CIs=0.5-0.9) and social network sites (OR = 0.7, 95% CIs=0.5-0.8). Higher levels of extraversion was significantly related to a lower risk of physical inactivity (OR = 0.7, 95% CIs=0.6-0.9), but they are at a higher risk of low adherence to Mediterranean diet (OR = 1.3, 95% CIs=1.0-1.7), tobacco (OR = 2.7, 95% CIs=1.7-4.3) and alcohol consumption (OR = 1.9, 95% CIs=1.5-2.4) and excessive use of social network sites (OR = 1.6, 95% CIs=1.3-1.9). High levels of emotional instability were associated with tobacco consumption (OR = 1.5, 95% CIs=1.0-2.2) and sleep problems (OR = 2.0, 95% CIs=1.5-2.7). Finally, we found an association with lower parental education and adolescents' low adherence to Mediterranean diet (OR = 1.6, 95% CIs=1.0-2.4) and sleep problems (OR = 1.8, 95% CIs=1.0-3.0). Cluster analysis of health-related behaviours indicated the presence of two different clusters (unhealthy and healthy adolescents) that were associated with personality traits. Conscientiousness, extraversion, emotional instability and parental education are independent factors associated with the acquisition of adolescent healthy lifestyles.
Background
Metabolic dysfunction‐associated fatty liver disease (MAFLD, 2020 diagnostic criteria) and glomerular hyperfiltration share common risk factors, including obesity, insulin resistance, ...impaired glucose tolerance, diabetes, dyslipidemia, and hypertension.
Aims
To assess the prevalence of MAFLD and its association with glomerular hyperfiltration and age‐related worsening of kidney function in subjects with normoglycemia, prediabetes and type 2 diabetes mellitus (T2DM).
Methods
We analysed data recorded during occupational health visits of 125,070 Spanish civil servants aged 18–65 years with a de‐indexed glomerular filtration rate (GFR) estimated with the chronic‐kidney‐disease‐epidemiological (CKD‐EPI) equation (estimated glomerular filtration rate eGFR) ≥60 mL/min. Subjects were categorised according to fasting plasma glucose levels <100 mg/dL (normoglycemia), ≥100 and ≤ 125 mg/dL (prediabetes), or ≥126 mg/dL and/or antidiabetic treatment (T2DM). The association between MAFLD and glomerular hyperfiltration, defined as a de‐indexed eGFR above the age‐ and gender‐specific 95th percentile, was assessed by multivariable logistic regression.
Results
In the whole study group, MAFLD prevalence averaged 19.3%. The prevalence progressively increased from 14.7% to 33.2% and to 48.9% in subjects with normoglycemia, prediabetes and T2DM, respectively (p < 0.001 for trend). Adjusted odds ratio (95% CI) for the association between MAFLD and hyperfiltration was 9.06 (8.53–9.62) in the study group considered as a whole, and 8.60 (8.03–9.21), 9.52 (8.11–11.18) and 8.31 (6.70–10.30) in subjects with normoglycemia, prediabetes and T2DM considered separately. In stratified analyses, MAFLD amplified age‐dependent eGFR decline in all groups (p < 0.001).
Conclusions
MAFLD prevalence increases across the glycaemic spectrum. MAFLD is significantly associated with hyperfiltration and amplifies the age‐related eGFR decline.
Aim
To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness‐based approaches on the mental health of healthcare workers at the ...frontline against COVID‐19 in Spain.
Design
We will carry out a two‐week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention.
Methods
The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID‐19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS‐21 questionnaire—primary endpoint), insomnia (ISI), burnout (MBI‐HSS), post‐traumatic stress disorder (DTS), and self‐efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation.
Discussion
Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context.
Impact
Despite the lack of solid evidence about their effectiveness, mobile‐based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits.
Clinical trial registration
NCT04393818 (ClinicalTrials.gov identifier).
Approved funding
May 2020.
To assess the prevalence of malnutrition in hospitalised adult patients, and to evaluate the accuracy of the most commonly used nutritional screening tools for identifying individuals at risk of ...malnutrition.
A prospective cross-sectional study was conducted on a total of 248 hospitalised patients in internal medicine wards (mean age: 75.2 years; 39.5% females). Nutritional screening was performed within 48 h of admission using the following tools: Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening Tool (NRS-2002), Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ), and Mini Nutritional Assessment Short Form (MNA-SF). The criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) were used as the gold standard for defining malnutrition. Patients were also evaluated using the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Accuracy was determined by examining sensitivity, specificity, and positive and negative predictive values, and diagnostic agreement was determined by calculation of Cohen's kappa (κ). The study is reported as per the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
The ESPEN criteria classified 20.2% of the hospitalised patients as malnourished. Overall, the MUST had the highest sensitivity (80.0%), specificity (74.7%) and positive predictive value (44.4%). For the subgroup of patients aged >65 years, the MNA-SF had high sensitivity (94.4%) but low specificity (39.0%). Based on Cohen's κ, the SGA and GLIM criteria showed low agreement with the ESPEN criteria.
The MUST was the most accurate nutritional screening tool, through the MST is more easily applied in many clinical settings. A comprehensive assessment of malnutrition that considers muscle mass is crucial for the reliable diagnosis of malnutrition.
The present findings underscore the importance of accurate assessment of the malnutrition status of hospitalised patients and the need for a reliable screening tool. No patient or public contribution.
Aim
To evaluate the effectiveness of a nurse‐led personalized telephone lifestyle intervention versus automated SMSs in the reduction of fasting plasma glucose in adults with prediabetes.
Design
The ...PREDIPHONE is a randomized controlled, parallel, two arms, superiority trial with 15 months of follow‐up. Participants will be randomized to either the intervention group (teleconsultations) or the active control group (SMSs).
Methods
A total of 428 participants will be randomized in a 1:1 ratio to one of the two arms and followed up during 9 months. The teleconsultations group will receive nurse‐led personalized advice, while the SMSs group will receive 4–5 brief SMSs a week. Participants in both groups will receive evidence‐based recommendations for diet and physical activity (PA). Outcome measures will be collected at baseline, months 4 and 9 and at month 15, to evaluate post‐intervention effects.
Discussion
Prevention of diabetes through the implementation of lifestyle interventions remains an important priority. The current pandemic situation has magnified its urgency as it heavily affected the functionality of the healthcare system. Moreover, it created the need of remotely delivering preventative interventions. This study will provide insights on the effectiveness and feasibility of a telephone‐based intervention led by nurses in the amelioration of risk factors associated with diabetes.
Impact
Findings from this study will offer health services decision‐makers sound evidence regarding an alternative method to face‐to‐face consultations that could be practical, acceptable and inexpensive, and that concretely answers the need for easily implementable prevention strategies.
Trial Registration
NCT04735640 (ClinicalTrials.gov identifier).
Protocol version
V1.0, 18/02/2021.
FUNDAMENTOS // Durante la pandemia de la COVID-19 se implementaron medidas de prevención con el propósito de reducir su transmisión comunitaria. El grado de cumplimiento con estas medidas estuvo ...influenciado por diversos factores sociodemográficos y ambientales. Sin embargo, existe escasa literatura científica que aborde el cumplimiento de las medidas preventivas en la población general. El objetivo de este estudio fue analizar la asociación entre factores sociodemográficos y ambientales, así como la adhesión al uso de mascarillas en contactos estrechos.
MÉTODOS // Se realizó un estudio transversal con 1.778 individuos, identificados mediante el rastreo de contactos estrechos de personas con SARS-CoV-2 por la Central de Coordinación de la COVID-19 de Mallorca, entre febrero y junio de 2021. Se realizó un análisis descriptivo y se utilizó un modelo de regresión logística para determinar los factores asociados al incumplimiento del uso de mascarillas.
RESULTADOS // La edad media de los participantes fue de 42,8±17,4 años (53,6% de mujeres). El 60,8% (IC 95%: 57,8-62,3) de los contactos estrechos no utilizó mascarilla durante su contacto. No se observaron diferencias estadísticamente significativas en función del sexo o grupo etario (p=0,497 y p=0,536, respectivamente). Las situaciones de mayor incumplimiento con el uso de mascarillas se dieron en el entorno domiciliario, espacios cerrados sin ventilación y al mantener distancias cortas (p<0,001).
CONCLUSIONES // Nuestros hallazgos indican una menor adhesión al uso de mascarillas en escenarios de mayor riesgo. Frente a futuras situaciones de crisis sanitaria, se deberían diseñar intervenciones que realcen la conciencia sobre los riesgos y que promuevan una mayor adhesión a medidas de prevención y control.
Food insecurity in recent years has increased worldwide due to many planetary events such as the COVID-19 pandemic, geopolitical conflicts, the climate crisis, and globalization of markets. ...Adolescents are a particularly vulnerable group to food insecurity, as they enter adulthood with less parental supervision and greater personal autonomy, but less legislative or institutional protection. The experience of food insecurity in adolescents is influenced by several environmental factors at different levels (interpersonal, organizational, community, and societal), although they are not usually addressed in the design of interventions, prioritizing the individual behavioural factors. We present a scoping review protocol for assessing and identifying the environmental factors that could influence adolescents' food insecurity. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to prepare the protocol. The search strategy will be performed in the following databases: Pubmed/Medline, EMBASE, Biblioteca Virtual de Salud, EBSCOHost, Scopus, Web of Science, and Cochrane Library Plus. The reference list of the included studies will also be hand-searched. Grey literature will be search through the electronic database Grey Literature Report, and local, provincial, national, and international organisations' websites. Assessment of eligibility after screening of titles, abstract and full text, and the resolution of discrepancies will be performed by three independent reviewers. This scoping review will contribute to refine the "logic model of the problem" which constitutes the first step in the intervention mapping protocol. The "logic model of the problem" from the intervention mapping protocol will serve to classify and analyse the environmental factors. The findings from this review will be presented to relevant stakeholders that have a role in shaping the environmental factors.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
People with cardiovascular risk have more depression than the general population. Depression and cardiovascular risk have been commonly linked to lower sense of coherence (SOC) values, unhealthy ...lifestyles, and poor sleep quality. The aim of this study was to analyze the association between depression, health-related lifestyles, sleep quality, and SOC in a population with cardiovascular risk. A cross-sectional study was conducted in 310 participants (aged 35-75 years) with cardiovascular risk. Sociodemographic and anthropometric characteristics, cardiovascular risk, SOC score, depression levels, sleep quality, and lifestyles (physical activity, diet quality (measured as the adherence to the Mediterranean diet), and tobacco and alcohol consumption) were determined. The regression analysis showed significant associations between depression levels and sex (odds ratio (OR): 2.29; 95% CI: 1.29, 4.07), diet (OR: 0.85; 95% CI: 0.73, 0.99), body mass index (BMI) (OR: 1.06; 95% CI: 1.01, 1.12), cardiovascular disease (CVD) (OR: 2.55; 95% CI: 1.18, 5.48), sleep quality (OR: 0.26; 95% CI: 0.15, 0.46), and SOC (OR: 0.96; 95% CI: 0.94, 0.98). Protective effects of male sex, a lower BMI, no CVD, a higher adherence to the Mediterranean diet, a high sleep quality, and a higher SOC were found. In conclusion, among lifestyles determined, only diet was associated with depression levels. SOC and sleep quality were also found as significant predictors for depression levels.
En comparación con otros problemas sociales actuales, como la emergencia climática o la desigualdad de género, y a pesar de su prevalencia e impacto vital en la ciudadanía global, la inseguridad ...alimentaria (IA) parece desatendida y abandonada. No poder garantizar que todas las personas, en todo momento, tengan acceso físico, social y económico a alimentos suficientes, seguros y nutritivos que cubran sus necesidades dietéticas y las preferencias alimentarias para man-tener una vida sana y activa, supone un grave problema de justicia social.
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