Juan J. Gascón-Cánovas

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study

BackgroundEvidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors.MethodsA cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior).ResultsAdherence to duration per session (70.9% ± 7.1) was more probable than adherence to frequency per week (60.7% ± 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05).ConclusionWe have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.

Self-Management of Chronic Neck and Low Back Pain and Relevance of Information Provided During Clinical Encounters: An Observational Study

UNLABELLED Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. OBJECTIVE To assess the relative influence of information provided during physical therapy on a patients adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention). DESIGN A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies. SETTING Data came from a clinical-based population in 8 primary health care centers. PARTICIPANTS Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life. RESULTS Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life (P>.05). CONCLUSIONS Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain.

Identification of potential clinically significant drug interactions in HIV-infected patients: a comprehensive therapeutic approach.

The aim of the study was to determine the prevalence of potential clinically significant drug interactions (CSDIs) in HIV‐positive individuals and to identify associated risk factors.

Malformation of the caudal fin in the freshwater mullet, Liza abu (Actinopterygii: Mugilidae) collected from Karkhe River, Iran

OBJECTIVE To identify predisposing, inhibitory and facilitating factors that may affect participation in colorectal cancer screening programs in the Roma population. METHOD Qualitative and exploratory study by focus group technique. Three focus groups of men and three groups of women were carried out, with a total of 16 men and 18 women from the Roma population, aged 50-69 years, from the province of Alicante. A discourse analysis was performed with the PRECEDE model as an analysis framework. RESULTS Several barriers to participation were identified, such as the aversion of the Roma population to talk about cancer, refusal to anticipate a diagnosis that can cause suffering to the person and their family, poor knowledge of the disease and the preventive programmes, refusal to collect and handle samples, fear and shame about the colonoscopy, acceptance of divine will, difficulties in understanding and reading, and the perception of being discriminated by their ethnicity in the health sector. However, predisposing factors to participate in the screening programme also were identified, for example willingness to receive relevant information through more appropriate pathways, as well as their confidence in professional counselling. CONCLUSION A willingness to receive the recommendation to participate and understanding information from health professionals have been identified. This will enable us to envisage potential strategies for approaching this population group. This could contribute to improved participation of the Roma population in colorectal cancer screening programmes and to open up new ways to promote preventive behaviours.

Dolor de espalda y limitación de la actividad física cotidiana en la población adulta española

Background. Low back pain is a widespread health problem that affects a great part of the Spanish adult population; it also places a constraint on developing activities of daily living. The aim of this paper is to estimate the association between daily physical activity and chronic back pain in Spain. Material and methods. This paper analyses data from the European Health Survey in Spain 2009; it presents a cross sectional epidemiological study designed to assess the health of the Spanish population, in which 22,188 people participated (10,876 men and 11,312 women over 16 years ), representative of the total Spanish population. The variables studied are: back pain indicators obtained from the European Health Status Module and the European Health Care Module included in this survey, and the daily physical activity pattern obtained from the European Module of Health Determinants. Results. The total volume of daily physical activity is similar in healthy people and those who have back pain, but a pattern of low or moderate intensity in people with chronic back pain in the last twelve months (p <0.01) was observed with greater frequency. Conclusions. People with chronic back pain do not show a lower volume of physical activity, but their physical activity pattern is often low or moderate. Developing a vigorous pattern of physical activity should be considered not only as a strategy to prevent this disease, but also as a therapeutic target in these patients.

Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria

BACKGROUND Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. MATERIAL AND METHODS The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. RESULTS About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. CONCLUSIONS Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.

Effect of drug interactions involving antiretroviral drugs on viral load in HIV population

Background Most studies focus on potential drug interactions, without considering the effect of these on the response to antiretroviral (ARV) therapy. We assess the effect of potential drug–drug interactions (pDDIs) that could have lowered the ARV concentration (pDDI-lowerARV) on HIV viral load. Methods Retrospective observational cohort study was conducted on all HIV-infected outpatients attending the Pharmacy Service of a regional reference hospital in Murcia (south-eastern Spain). The complete treatment was subsequently screened for pDDIs using the database ‘InteraccionesHIV.com’. The study focused on interactions involving at least one ARV drug and, especially, any pDDI-lowerARV. Results Two hundred and twenty-nine patients were included in the study. A total of 168 pDDIs were identified, of which 62 (36.9%) had the potential to lower ARV concentrations. In 77% of cases, the drug involved in the reduction of plasma concentrations was a protease inhibitor (PI), and in the rest of the drug interactions the ARV drug affected was a non-nucleoside reverse-transcriptase inhibitor. Baseline viral suppression was noted in 57.1% of patients with pDDI-lowerARV compared with 61.5% of patients without pDDI-lowerARV (p=0.605), and in 85.7% versus 79.7%, respectively, after a 24-week follow-up period (p=0.516). Conclusions This study shows that prevalence of pDDI-lowerARV was high; however, no association was found between the presence of these interactions and virological failure. These results confirm the need for further studies to understand the consequences of interactions in real-life clinical practice, since most pharmacokinetic studies tend to evaluate the ability of interaction between two drugs under controlled conditions.

Influence of equation used to estimate the renal function in dosage potentially nephrotoxic drug

Objective To evaluate the similarity (or not) of the dose recommendations according to the Cockcroft–Gault and MDRD4 (modified diet in renal disease) equations. Method A cross-sectional comparative observational test of patients suffering chronic renal illness that involved treatment using nephrotoxic drugs, admitted consecutively to the internal medicine department over a period of 6 months. The glomerular filtrate rate was calculated upon admission and at discharge using the Cockcroft–Gault and MDRD4 formulas. Grading of the disease for patients and dose adjustment recommendations of potentially nephrotoxic drugs was compared. The degree of correlation between the results obtained with both equations was assessed by means of the Pearsons coefficient (r), considering p<0.05 as significant. Results Among the 249 patients included in the study, the staging of the disease was modified in 166 and the recommended dosage would have differed in 56.0% of these. Of the 222 prescriptions of potentially nephrotoxic drugs, 145 dosage adjustment recommendations would have differed. Glomerular filtrate rates were always less when the Cockcroft–Gault equation was used, although they were closely correlated both upon admission and discharge (Pearsons r=0.83 and 0.81, respectively, p<0.001). Conclusions Although the Cockcroft–Gault and MDRD4 equations were statistically well correlated, differences in drug dose recommendations were noticeable.

Adaptación cultural al español y baremación del Adolescent Peer Relations Instrument (APRI) para la detección de la victimización por acoso escolar: Estudio preliminar de las propiedades psicométricas

BACKGROUND AND OBJECTIVES School bullying is a growing problem. The current study is aimed at culturally adapting and assessing the psychometric properties of a brief scale to measure bullying. MATERIAL AND METHODS A cross-cultural adaptation of the brief scale -Adolescent Peer Relations Instrument-Bullying (APRI)- was performed using the translation and back-translation technique. The Spanish version of APRI questionnaire was administered to a sample of 1,428 schoolchildren aged 12-14years in the region of Mar Menor in Murcia (Spain). Exploratory factor analysis, with oblique rotation, was used to assess the validity of the internal structure, the Cronbachs alpha to analyse their consistency, and the Kruskal-Wallis test to check their ability to discriminate between subjects with varying degrees of bullying according to Kidscreen-52 scale of social acceptability RESULTS: Two factors were identified in the adapted version of APRI (physical victimisation and verbal/social victimisation), similar to those in the original scale. The questionnaire has high internal consistency (Cronbachs alpha=0.94) and discrimination capacity (P<01), with significant effect sizes between degrees of bullying. CONCLUSIONS The internal structure of the APRI Spanish version is similar to the original, and its scores confirm high reliability and construct validity. Further studies need to be performed with broader age ranges and confirmatory analysis techniques, to ratify the equivalence of the adapted version with the original version.