BackgroundIn subjects with hypercholesterolaemia, cholesterol values remain above guideline levels. One of the limiting factors to the achievement of goals in such patients is therapeutic non-adherence. The aim of this study is to assess the effectiveness of an intervention designed to improve control of hypercholesterolaemic patients, consisting of a combined strategy that would include the delivery of printed information, treatment-compliance check cards and the dispatch of text messages as complementary measures in support of the intervention at the general practitioner’s practice.Methods/DesignA randomised, parallel-group clinical trial will be conducted at the family medicine outpatient facilities of eight health centres in three of Spain’s Autonomous Regions (Comunidades Autónomas), covering a total of 358 subjects aged 18 years or over with diagnosis of hypercholesterolaemia. Patients in the intervention group will be supplied with printed material with information on the disease and its management, mobile-telephone text messages with guideline summaries, reminders of forthcoming appointments and/or arrangements for making new appointments in the event of non-attendance, and self-report cards to check compliance with recommendations. Both groups -intervention and control- will receive routine recommendations from their physicians in accordance with current European clinical practice guidelines for hypercholesterolaemia and cardiovascular risk management. As regards the measurements to be made, the main variable is the proportion of subjects who attain the low density lipoprotein cholesterol levels set as a target across a follow-up period of 24 months. The secondary variables are as follows: adherence to recommendations on lifestyle and adherence to drug treatment; variation in lipid profiles and cardiovascular risk levels; appearance of cardiovascular events; physical activity; food consumption; smoking habit; anthropometric measures; blood pressure; health problems; use of hypolipidaemic agents; socio-demographic data; beliefs and expectations about preventive recommendations; and degree of satisfaction with the combined strategy.DiscussionShould this intervention prove effective, a recommendation could be issued on the application of this combined strategy to subjects with hypercholesterolaemia. It is a simple, relatively inexpensive intervention.Trial registrationClinicalTrials.gov: NCT02314663.

CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option. RESUMO CONTEXTO E OBJETIVO:Um clima frio para a atenção primária na academia médica constitui uma barreira para escolher Medicina de Família (MF) como opção de carreira. Este estudo foi concebido para determinar se o conhecimento e as atitudes dos estudantes de medicina em relação à MF predizem a escolha da carreira.

ResumenObjetivosConocer la cobertura vacunal antineumocócica en pacientes ≥ 65 años, así como el riesgo de enfermedad neumocócica según hayan o no recibido dicha vacunación.DiseñoEstudio transversal, seguido de cohorte histórica.EmplazamientoÁmbito urbano.ParticipantesSe seleccionaron por muestreo sistemático 2.805 personas ≥ 65 años de la ciudad de Albacete.Mediciones principalesVariable dependiente: diagnóstico de enfermedad neumocócica y fecha. Variables independientes: edad, sexo, enfermedades crónicas, medicación, vacunación antineumocócica y fecha. Se revisaron las historias clínicas informatizadas, de 1-1-2009 a octubre-diciembre de 2015. Se ha realizado un análisis descriptivo, se ha calculado el riesgo relativo de aparición de enfermedad neumocócica según la vacunación y se ha realizado un análisis de supervivencia con el programa estadístico SPSS 17.0.ResultadosLa mediana de edad era de 71 años; el 57,2% eran mujeres. Recibieron vacuna polisacárida el 46,0% (IC 95% 44,1-47,8). Solo 10 recibieron la conjugada. Fueron diagnosticadas de enfermedad neumocócica invasiva 22 personas, y de no invasiva, 153. El riesgo relativo de enfermedad neumocócica en vacunados frente a no vacunados, respectivamente para invasiva y no invasiva, era 1,59 (IC 95% 0,69-3,68) y 1,84 (IC 95% 1,33-2,54). Por regresión de Cox se demostró un mayor riesgo de enfermedad no invasiva para EPOC (1,95; IC 95% 1,32-2,89), tabaquismo (1,87; IC 95% 1,28-2,73), corticoterapia (1,73; IC 95% 1,08-2,79), vacunación polisacárida (141,41; IC 95% 5,92-3.378,49) y edad (1,11; IC 95% 1,08-1,14), con interacción entre estas 2 (0,94; IC 95% 0,91-0,98).ConclusionesExiste un mayor riesgo de presentar enfermedad neumocócica en pacientes ≥ 65 años vacunados con la polisacárida, si bien habría que considerar un efecto protector en los vacunados de mayor edad.

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