Elena Briones

Effectiveness of an intensive E-mail based intervention in smoking cessation (TABATIC study): study protocol for a randomized controlled trial

BackgroundIntensive interventions on smoking cessation increase abstinence rates. However, few electronic mail (E-mail) based intensive interventions have been tested in smokers and none in primary care (PC) setting. The aim of the present study is to evaluate the effectiveness of an intensive E-mail based intervention in smokers attending PC services.Methods/designRandomized Controlled Multicentric Trial. Study population: 1060 smokers aged between 18–70 years from Catalonia, Salamanca and Aragón (Spain) who have and check regularly an E-mail account. Patients will be randomly assigned to control or intervention group. Intervention: Six phase intensive intervention with two face to face interviews and four automatically created and personal E-mail patients tracking, if needed other E-mail contacts will be made. Control group will receive a brief advice on smoking cessation. Outcome measures: Will be measured at 6 and 12 months after intervention: self reported continuous abstinence (confirmed by cooximetry), point prevalence abstinence, tobacco consumption, evolution of stage according to Prochaska and DiClementes Stages of Change Model, length of visit, costs for the patient to access Primary Care Center. Statistical analysis: Descriptive and logistic and Poisson regression analysis under the intention to treat basis using SPSS v.17.DiscussionThe proposed intervention is an E-mail based intensive intervention in smokers attending primary care. Positive results could be useful to demonstrate a higher percentage of short and long-term abstinence among smokers attended in PC in Spain who regularly use E-mail. Furthermore, this intervention could be helpful in all health services to help smokers to quit.Trial RegistrationClinical Trials.gov Identifier: NCT01494246.

Cluster randomized trial in smoking cessation with intensive advice in diabetic patients in primary care. ITADI Study

BackgroundIt is a priority to achieve smoking cessation in diabetic smokers, given that this is a group of patients with elevated cardiovascular risk. Furthermore, tobacco has a multiplying effect on micro and macro vascular complications. Smoking abstinence rates increase as the intensity of the intervention, length of the intervention and number and diversity of contacts with the healthcare professional during the intervention increases. However, there are few published studies about smoking cessation in diabetics in primary care, a level of healthcare that plays an essential role in these patients. Therefore, the aim of the present study is to evaluate the effectiveness of an intensive smoking cessation intervention in diabetic patients in primary care.Methods/DesignCluster randomized trial, controlled and multicentric. Randomization unit: Primary Care Team. Study population: 546 diabetic smokers older than 14 years of age whose disease is controlled by one of the primary care teams in the study. Outcome Measures: Continuous tobacco abstinence (a person who has not smoked for at least six months and with a CO level of less than 6 ppm measured by a cooximeter) , evolution in the Prochaska and DiClementes Transtheoretical Model of Change, number of cigarettes/day, length of the visit. Point of assessment: one- year post- inclusion in the study. Intervention: Brief motivational interview for diabetic smokers at the pre-contemplation and contemplation stage, intensive motivational interview with pharmacotherapy for diabetic smokers in the preparation-action stage and reinforcing intevention in the maintenance stage. Statistical Analysis: A descriptive analysis of all variables will be done, as well as a multilevel logistic regression and a Poisson regression. All analyses will be done with an intention to treatment basis and will be fitted for potential confounding factors and variables of clinical importance. Statistical packages: SPSS15, STATA10 y HLM6.DiscussionThe present study will try to describe the profile of a diabetic smoker who receives the most benefit from an intensive intervention in primary care. The results will be useful for primary care professionals in their usual clinical practice.Trial RegistrationClinical Trials.gov Identifier: NCT00954967

Perceived Organizational Justice in Care Services: Creation and multi-sample validation of a measure

Organizational justice (OJ) perceptions predict attitudes and behaviors of customers and employees across a broad range of services. Although OJ has proven predictive power and relevance, it has rarely been studied in health care settings. This stems partially from the lack of a reliable and valid measure of patients OJ in health care encounters. The objective here was to create and validate a measure of patients OJ. With that purpose, a survey study with two sampling contexts - the U.S. and Spain - was carried out in order to provide a cross-national validation of the scale in two versions: English (Perceived Organizational Justice in Care Services, PJustCS) and Spanish (Percepción de Justicia Organizacional en el Ámbito Sanitario, PJustAS). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to select the appropriate items in the final version of the instrument. Reliability and validity of the measure were tested. A total of 406 patients in the U.S. and 473 patients in Spain participated. The measures used were the newly created scale of Perceived Organizational Justice in Care Services (PJustCS/PJustAS) and scales of patients Satisfaction, Trust and Global Justice. Factor Analyses supported the four dimensional structure of the instrument for each group. Multigroup CFA substantiated invariant factor loadings and invariant structural models across both samples, hence, supporting that the instrument is applicable in its two versions: English and Spanish. Validation results showed expected positive relations of OJ with patients satisfaction, trust in clinicians and global perceived justice. These results point out the importance of health care customers perceived organizational justice in the explanation of health care dynamics. The scale has desirable psychometric properties and shows adequate validity, contributing to the potential development of the area.

Educación ética en la Universidad a través del diálogo multicultural online

This paper presents the results of an international collaboration on ethics teaching for personal and professional values within the area of formal higher education using new communication technologies. The course design was based on the dialogic technique and was aimed at clarifying the students’ own values, defining their own positions related to ethical dilemmas, developing argumentative strategies and an ethical commitment to their profession and contribution to society. The online dialogue between heterogeneous groups of students based on their cultural background –the main innovation of this training– was possible thanks to the technological and administrative support of the participating universities. To analyze the effect of this innovative training we employed a quasi-experimental design using a control group, i.e., without the option of online dialogue with students from another culture. University students from Spain (University of Cantabria) and Chile (Universidad Autonoma de Chile) participated in this study. The positive results, which included better scores and positive assessments of both debate involvement and intercultural contact by students who participated in the new teaching program, support the main conclusion that the opening of international dialogue on moral dilemmas through new communication technologies contributes significantly to improve ethics training in higher education.

Risk levels for suffering a traffic injury in primary health care. The LESIONAT project.

BackgroundLiterature shows that not only are traffic injuries due to accidents, but that there is also a correlation between different chronic conditions, the consumption of certain types of drugs, the intake of psychoactive substances and the self perception of risk (Health Belief Model) and the impact/incidence of traffic accidents. There are few studies on these aspects in primary health care.The objectives of our study are:Main aim: To outline the distribution of risk factors associated with Road Traffic Injuries (RTI) in a driving population assigned to a group of primary health care centres in Barcelona province.Secondly, we aim to study the distribution of diverse risk factors related to the possibility of suffering an RTI according to age, sex and population groups, to assess the relationship between these same risk factors and self risk perception for suffering an RTI, and to outline the association between the number of risk factors and the history of reported collisions.Methods/DesignDesign: Cross-sectional, multicentre study.Setting: 25 urban health care centres.Study population: Randomly selected sample of Spanish/Catalan speakers age 16 or above with a medical register in any of the 25 participating primary health care centres. N = 1540.Unit of study: Basic unit of care, consisting of a general practitioner and a nurse, both of whom caring for the same population (1,500 to 2,000 people per unit).Instruments of measurement: Data collection will be performed using a survey carried out by health professionals, who will use the clinical registers and the information reported by the patient during the visit to collect the baseline data: illnesses, medication intake, alcohol and psychoactive consumption, and self perception of risk.DiscussionWe expect to obtain a risk profile of the subjects in relation to RTI in the primary health care field, and to create a group for a prospective follow-up.Trial RegistrationClinical Trials.gov Identifier: NCT00778440.

Students’ perspectives on the processes of supervision and assessment of undergraduate dissertations / Perspectiva del alumnado de los procesos de tutorización y evaluación de los trabajos de fin de grado

Abstract The introduction of the European Higher Education Area means that undergraduate dissertations (UD) are now compulsory, which represents an important change for the Spanish university system due to the important consequences this will have on academic functioning. This study provides key information on the processes of supervising and assessing UDs, from the perspective of students, as well as consequent proposals to improve them. The results obtained indicate that initiatives need to be put in place, at least in the participating institutions where the study has been developed, focused on the improvement of the time periods, means and resources needed to develop the UD, the introduction of more adequate criteria than those currently used for assessment, better training for the tutors involved, more appropriate and precise prior information for students in relation to the UD, and more preparation for students to enable them to carry out the UD.

RISK OF ROAD TRAFFIC INJURIES IN BARCELONA: BASELINE RESULTS FROM THE LESIONAT COHORT STUDY

Aim To assess the relationship between medical risk factors, and traffic collisions (TC) traffic injuries (TI) the year before recruitment. Methods Design: prospective cohorts. Setting 26 primary care practices (PC). Urban area. Barcelona (Spain). Population 1938 subjects possessing driving license, who attended one of the participating practices from March to November/2009. Measurements-outcome TC, TI the year before. Main exposures Risk-associated long-term conditions (LTC), medications, alcohol, psychoactive substance (PS) Covariates Age, gender, drivers characteristics, social class. Data collection Structured survey (checked with medical records) during the recruitment visit. Statistics Mann-Whitney-U to assess differences in TC and TI occurrence between categories. Logistic regression to assess relationship between TC, TI and drivers characteristics. Results Mean age 44 years (SD 18.7). 57.3% males. TC incidence the year before 12.6%; TI 6.1%. 51.1% had a history of LTC, and 45.2% were taking medicines. 2.7% were risk alcohol consumers, and 14% PS users. TC risk was higher among those less than 50 years (OR 2.17 (1.27 to 3.7)) and those with high-risk alcohol consumption (OR 4.14 (1.7 to 10.0)). TI occurrence was higher among those less than 50 years (OR 4.8 (1.8 to 12.4)) and in lower social classes (OR 9.9 (2.0 to 23.4)). Conclusions According to our data, preventive interventions on alcohol intake, in lower social classes and among young people, are necessary.