[Evaluation of the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in primary care: the PREseAP Study]

OBJECTIVES

To assess the efficacy of a comprehensive secondary prevention programme to reduce morbidity and mortality in patients who have suffered a cardiovascular (CV) event; to control CV risk factors and prophylactic treatment in order to prevent recurrence; and to improve the quality of life of patients with cardiovascular disease.

DESIGN

Randomised, pragmatic, open clinical trial in primary care.

SETTING

A total of 42 primary care centres of 8 different areas in Spain.

PARTICIPANTS

Men and women below 86 years old, diagnosed with coronary disease and/or stroke and/or peripheral vascular disease in the preceding year, and who have no serious or terminal disease.

INTERVENTION

Primary care centres will be randomised to following usual care (control group), or to following a comprehensive programme of secondary prevention (intervention group).

MAIN MEASUREMENTS

Cardiovascular fatal events, cardiovascular non-fatal events, total mortality and health-related quality of life (SF-36).

[Preventive care and health promotion in primary care: comparison between the views of Spanish and European doctors]

OBJECTIVE

Disease prevention and health promotion are important tasks in the daily practice of all general practitioners (GPs). The objective of this study was to explore the knowledge and attitudes of European and Spanish GPs in implementing evidence-based health promotion and disease prevention recommendations in primary care, to describe GPs' perceived barriers to implementing these recommendations, and to assess how GPs' own health behaviors affect their work with their patients.

DESIGN

A postal multinational survey was carried out from June 2000 to May 2001.

SETTING

A random sample of GPs listed from national colleges of each country. Participants. A total of 2082 GPs from 11 European countries participated in the survey. In Spain a total of 270 GPs participated.

RESULTS

Spanish GPs carried out more frequently most of the health promotion or disease prevention activities than the European GPs. Spanish GPs carried out less often those no evidence-based activities. The most important barrier reported was heavy workload/lack of time. Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found. GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs (39.34% vs 48.18%; P < .01). GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs (59.14% vs 49.70%;P < .01). No differences were observed for Spanish GPs.

CONCLUSIONS

Significant gaps between GP's knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention in primary care. Spanish GPs carried out more frequently evidence-base recommendations for health promotion and disease prevention by age and sex.

Healthy diet in primary care: views of general practitioners and nurses from Europe

BACKGROUND

Most of the national colleges of general practitioners (GPs) do not have their own dietary/nutritional tools, and GPs and nurses do not have the time, knowledge, or skills to advise their patients about desirable dietary practices.

OBJECTIVE

To assess the usefulness of a simple and practical guide on healthy diet to be used by European GPs and nurses.

DESIGN

A postal survey was mailed to 171 GPs and nurses from 12 European countries to obtain information about the usefulness of a guide on healthy diet developed by EUROPREV.

RESULTS

The perception of health professionals is that the main source of information on healthy diet for the population was the media. In all, 95% of GPs and nurses reported that the guide was useful; 93, 95, and 82% reported that the concepts were concise, easy to understand, and realistic, respectively. Also, 77% reported that the type of counselling recommended was feasible and could be applied, 94% reported that the implementation measures proposed could be effective and 88% reported that the Traditional Mediterranean Diet Pyramid is useful, but some concerns about the content were mentioned.

CONCLUSIONS

GPs and nurses from Europe think that a practical guide on healthy diet developed by EUROPREV could be used to advise patients in primary care, although the Traditional Mediterranean Diet Pyramid should be modified.

[Psittacosis: report of 7 cases]

The development and systematic use of microserological techniques have allowed to identify the etiology of a higher number of respiratory diseases, that could hardly have been considered some years ago and that now are known to play a more common role in clinical practice than usually thought. In the present study, the clinical, radiological and epidemiological features of seven patients are reported; they were seen in our health center during a 16 month period and the diagnosis of Chlamydia psittaci pneumonia was made by serological studies. All patients were treated with erithromycin, with favorable clinical and radiological outcome. Psittacosis is a condition that should be considered as a cause of community acquired pneumonia even in the absence of suggestive epidemiological background.