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INTRODUCTION: Objective: to evaluate the effectiveness of the obesity intervention with three different approaches, one of them with a platform that promotes physical activity. Material and method: randomized, controlled, parallel clinical trial that compared 3 arms, multicenter study in overweight or obese patients with a follow-up of 12 months. The patients were randomized into three groups: Intervention in the primary care center with G1 intervention: Control group, which received the usual recommendations to lose weight following the SEEDO 2000 Consensus. G2: Motivational intervention of obesity (IMOAP) with trained nurse and small periodic work groups. G3: Motivational intervention of obesity (IMOAP) adding the use of a digital platform that allows physical activity to be recorded, monitored and at the same time favors the practice of this (iwopi). Variables were collected: weight, height, BMI, circumference of the waist, lipid parameters, blood pressure, glycosylated hemoglobin. Results: 185 patients were initially included in the study. Seventeen patients left the study. Thus, 168 patients completed the study: 47 in G1, 61 in G2 and 60 in G3. Of the population studied, 57.1% were women. observing a general average weight reduction at the end of the study of 4.37 kg, being 5.34 kg in the group 2.6.29 kg in the group 3 and 1.25 kg in the control group (G1). It was also observed that cholesterol levels in three groups were reduced. at did not reach a statistically significant value. The clinically relevant parameters were: group 1 (control) versus group 2 (IMOAP): relative risk (RR), 0.10 to 0.46; relative risk reduction (RRR), 0.54 to 0.90; absolute risk reduction (ARR), from 0.30 to 0.61; number needed to treat (NNT), 3 to 2. Group 1 versus group 3 (IMOAP-PA): RR, 0.07 to 0.30; RRR, 0.70 to 0.93; ARR, 0.61 to 0.86; NNT: 2 to 1. Group 2 versus group 3: RR, 0.54 to 0.84; RRR, 0.16 to 0.46; ARR, 0.14 to 0.43; NNT, 7 to 2. Conclusions: The digital health platform that stimulates physical activity added to an interventionist motivation in overweight or obese patients is a significant additional benefit in terms of weight loss results, reduction of BMI and lipid profile in patients affected by overweight or obesity and a more effective cost.

INTRODUCCIÓN: Objetivo: evaluar la efectividad de la intervención de la obesidad con tres enfoques diferentes, uno de ellos con una plataforma que promueve la actividad física. Material y métodos: ensayo clínico aleatorizado, controlado, paralelo que comparó 3 brazos, estudio multicéntrico en pacientes con sobrepeso u obesos con un seguimiento de 12 meses. Los pacientes fueron asignados al azar en tres grupos: Intervención en el centro de Atención Primaria con intervención G1: Grupo control, el cual recibía las recomendaciones habituales de perder peso siguiendo el Consenso SEEDO 2000 G2: Intervención motivacional de la obesidad (IMOAP) con enfermera entrenada y pequeños grupos de trabajo periódico. G3: Intervención Motivacional de la obesidad (IMOAP) añadiendo el uso de una plataforma digital que permite registrar la actividad física, Se recolectaron variables: peso, talla, IMC, circunferencia de la cintura, parámetros lipídicos, presión arterial, hemoglobina glicosilada. Resultados: 185 pacientes fueron incluidos inicialmente en el estudio. 17 pacientes abandonaron el estudio. De ese modo, 168 pacientes completaron el estudio: 47 en G1, 61 en G2 y 60 en G3. De la población estudiada, el 57,1% eran mujeres. Se observa una reducción de peso promedio general al final del estudio de 4,37 kg, siendo 5,34 kg en el grupo 2,6,29 kg en el grupo 3 y 1,25 kg en el grupo control (G1). También se observó que los niveles de colesterol en tres grupos se redujeron. El IMC mostró una reducción promedio general de -1,56, siendo -1,70 en G2, -2,26 en G3 y 0,47 en G1. Los parámetros clínicamente relevantes fueron: grupo 1 (control) versus grupo 2 (IMOAP): riesgo relativo (RR), 0,10 a 0,46; reducción del riesgo relativo (RRR), 0.54 a 0.90; reducción del riesgo absoluto (ARR), de 0.30 a 0.61; número necesario para tratar (NNT), 3 a 2. Grupo 1 versus grupo 3 (IMOAP-PA): RR, 0.07 a 0.30; RRR, 0,70 a 0,93; ARR, 0,61 a 0,86; NNT: 2 a 1. Grupo 2 versus grupo 3: RR, 0.54 a 0.84; RRR, 0,16 a 0,46; ARR, 0,14 a 0,43; NNT, 7 a 2. Conclusiones: la plataforma de salud digital que estimula actividad física agregada a una motivación intervencionista en pacientes con sobrepeso u obesidad es un beneficio adicional significativo en términos de resultados de pérdida de peso, reducción del IMC y perfil de lípidos en pacientes afectados por sobrepeso u obesidad y un costo más efectivo.

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OBJECTIVE: To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. MATERIAL AND METHODS: The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. RESULTS: All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). CONCLUSIONS: All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.

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OBJECTIVE: To assess the effect on lipid parameters most associated with excess weight (triglycerides [TG], cholesterol, and high density lipoprotein [HDL-C]) of an intervention to reduce weight in overweight and obese patients. METHODS: A randomised, controlled, double blind clinical trial, with three groups, and a follow-up of 12 months. Patients included in the study were randomised into three intervention groups: Obesity motivational intervention group with previously trained nurse (G1), lower intensity consultation, non-motivational group, with digital platform support (G2), and a third group that received a recommendation to lose weight and usual follow-up (G3). The anthropometric variables measured were height, weight, and abdominal/waist circumference, and laboratory results, total cholesterol, TG and HDL cholesterol). RESULTS: The study include 176 patients, of whom 60 were randomised to G1, 61 to G2, and 59 to G3. All groups significantly decreased body weight at the end of the study, with a decrease in G1 (-5.6kg), followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean loss of -3.9kg. There was a also significant decrease (P<.05) in total cholesterol and TG, and an increased HDL-C. These changes were more marked in the G1 group (the group that lost more weight). The clinical relevance indicators that were significant were: in the case of TG: G1/G3: relative risk: 1.42 (95% CI: 1.11-1.80); relative risk reduction: 41.7% (11.4-80.2); absolute risk reduction: 25% (9.2-40.8) and NNT: 5 (3-11). In the case of G1/G2 HDL-C: relative risk: 1.32 (1.07-1.63); relative risk reduction: 32.2% (7.4-62.6); absolute risk reduction: 21.1% (6.4-35.8) and NNT: 5 (3-16). CONCLUSIONS: Weight reduction is accompanied by favorable changes in the lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

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El objetivo fue evaluar una intervención para incrementar la tasa de pesquisa de lesiones precursoras de cáncer colorrectal (CCR) en allegados a pacientes con CCR. Se realizó un ensayo clínico aleatorizado doble ciego entre 2007 y 2008. A todos los pacientes operados de CCR en el Hospital Italiano de Buenos Aires (HIBA) se les ofreció sugerir personas allegadas (familiares o amigos) para invitar a realizar rastreo de CCR (n=113). A los del grupo intervención se los invitó a una reunión informativa y motivacional sobre la naturaleza y el curso del CCR y el rastreo de CCR. Los resultados muestran que comparados con los del grupo “control”, las tasas de rastreo de CCR fueron mayores en los asignados la intervención motivacional (22% vs.40%; p < 0,04). Obtuvimos como conclusiones que una intervención motivacional telefónica que incluyó la invitación a una charla informativa fue eficaz para incrementar la tasa de pesquisa de lesiones precursoras de CCR en allegados de personas con cirugía reciente de CCR. Palabras Clave: intervención motivacional, rastreo de cáncer colorrectal, ensayo clínico aleatorizado, eficacia, prevención secundaria.

The objective was to evaluate an intervention to increase the screening rate for colorectal cancer precursor lesions in close relatives of patients operated for CRC. Our methods were double blind randomized clinical trial between 2007 and 2008. All patients who had undergone surgery for CRC in the Hospital Italiano de Buenos Aires (HIBA) were offered to suggest a significant other (family or friend) to be invited to perform CRC screening (n=113). People of the intervention group were invited to attend a meeting that included information on the nature and course of the CRC and strategies to find precursor lesions (or incipient stages) of CRC. As results we found that compared to the "control" group, screening rates were higher in individuals assigned to the motivational intervention (22 % vs.40 %, p < 0.04).We concluded that a motivational intervention was effective to increase the rate of CRC cancer precursor lesions screening in relatives of people with recent CRC surgery. Key words: colorectal cancer screening, motivational intervention, randomized clinical trial, efficacy, secondary prevention.

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Se presenta una conceptualización acerca de la Intervención Motivacional basada en el análisis de los acontecimientos propios del Proceso Motivacional y se mencionan algunas microteorías motivacionales que proponen diversos constructos hipotéticos y variables intermediarias que explican el curso que sigue la conducta saludable en el estilo de vida de las personas, conformando lo que se considera como una Dimensión Psicológica de la Promoción y de la Prevención en Salud. Se hace un intento de definición de la Intervención Motivacional y se propone un modelo de Formulación Motivacional para darle contexto y fundamento. Se describen los temas a los que se ha aplicado la Intervención Motivacional a lo largo de la existencia formal y sistemática de este concepto, y los temas de análisis teórico y metodológico actuales, para lo cual se toman los reportes que incluyen ambos términos (Motivational, & Intervention) en los resúmenes de publicaciones indizadas en la base de datos Medline, en el período 1991-2013...

A conceptualization is presented of Motivational Intervention based upon the analysis of occurrences which are part and parcel of the Motivational Process, and some motivational micro-theories are mentioned as well which propose a variety of hypothetical constructs and intervening variables accounting for the course that healthy behavior follows within the lifestyles of people, comprising what is considered to be a Psychological Dimension of Health Promotion and Prevention. An approach to the definition of Motivational Intervention is provided, and to support it and contextualize it, a model of Motivational Formulation is proposed. The topics to which Motivational Intervention has been applied throughout the formal and systematic existence of the concept are described, as well as issues of current theoretical and methodological analyses, by analyzing reports including both terms (Motivational, & Intervention) in the abstracts of indexed publications in the Medline database, between 1991 and 2013...

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The mortality of trauma patients has improved significantly in recent decades due to a combination of factors: medical care, educational campaigns and structural changes. Generalization of out-of hospital emergence medical services and the hospital care in specific centers for traumatized has undoubtedly contributed to this decline, but other factors such as periodic campaigns to prevent workplace and traffic accidents, as well as improvements in the road network have played a key role. The challenge now is to continue to decrease mortality, for which is essential an analysis of the situation to detect potential areas of improvement. The application of diagnostic or therapeutic actions with scientific evidence is associated with lower mortality, but as in other areas of medicine, the application of scientific evidence in trauma patients is barely 50%. Moreover, nearly 90% of trauma deaths occur in the crash site or in the first 72h of hospitalization, the vast majority as a result of injuries incompatible with life. In these circumstances it is clear that prevention is the most cost-effective activity. As medical practitioners, our role in prevention is mainly focused on the secondary prevention to avoid recidivism, for which it is necessary to identify risk factor (frequently alcohol, illegal drugs, psychotropic medication etc.) and implement a brief motivational intervention. This activity can reduce recidivism by nearly 50%. In Spain, the activity in this field is negligible therefore measures should be implemented for dissemination of secondary prevention in trauma.

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Se realizó un estudio de corte empírico-analítico, siguiendo un diseño cuasi experimental, con el fin de someter a prueba y evaluar el impacto de un programa motivacional de terapia breve para el control del consumo de alcohol en bebedores perjudiciales. La variable independiente fue el programa de intervención, estructurado con base en principios de entrevista motivacional y de autocontrol cognitivo. La variable dependiente estuvo constituida por indicadores de consumo (intensidad, frecuencia y riesgo), la etapa motivacional ante el cambio, el estado de los procesos de cambio y las expectativas acerca del consumo. La medición de todas las variables se realizó en tres momentos a través del uso de instrumentos previamente validados: a) preintervención, b) al finalizar la intervención y c) cinco semanas después de terminar el tratamiento. Participaron 180 estudiantes universitarios previamente detectados como bebedores perjudiciales, quienes fueron asignados al azar a uno de tres grupos: a) terapia motivacional individual, b) terapia motivacional grupal y c) ausencia de terapia. Se observó que ambas terapias motivacionales (individual y grupal) condujeron a una disminución significativa en los indicadores de consumo y a una mejoría en el uso de los procesos de cambio responsables del mismo. Sin embargo, la intervención grupal condujo a un impacto superior al de la intervención individual en aspectos como: a) frecuencia de consumo, b) autoeficacia ente situaciones de alto riesgo de consumo, c) percepción de vulnerabilidad y daño y d) uso de procesos conductuales asociados al cambio y al mantenimiento del mismo.

An empirical-analytic study was carried out using a quasi-experimental design with the aim of testing and assessing the impact of a brief intervention motivational program for the control of alcohol consumption in problem drinkers. The independent variable in this study was the intervention program, as structured upon the principles of motivational interviewing and cognitive self-control. Indicators of consumption (intensity, frequency, and risk) were the dependent variable, as were the motivational stage towards change, the state of change processes, and the expectations on consumption. Measurement of all variables was carried out with the use of previously validated instruments in three moments: a) pre-intervention; b) end of intervention and; c) five weeks after treatment. 180 college students, previously detected as heavy drinkers were randomly assigned to one of three groups: (a) Individual motivational interviewing, (b) Group motivational interviewing, and (c) no intervention. Both of the motivational interventions (individual and group) led to a significant decrease in indicators of consumption and to an improvement in the use of those change processes responsible for it. Nevertheless, group intervention led to a more significant impact than individual intervention in aspects such as: (a) consumption frequency and intensity; (b) self-efficacy in situations of a high consumption risk; (c) perception of vulnerability and damage; and (d) use of behavioral processes associated with change and its maintenance.

A fim de provar e avaliar o impacto de um programa motivacional de terapia breve para controlar o consumo de álcool em bebedores prejudiciais levou-se a cabo um estudo empírico-analítico com desenho quase experimental. O programa de intervenção constituiu a variável independente, baseado em princípios de entrevista motivacional e de autocontrole cognitivo. A variável dependente foram os indicadores de consumo (intensidade, freqüência e risco), etapa motivacional ante a mudança, estado dos processos da mudança e expectações acerca do consumo. As variáveis foram medidas em três momentos com instrumentos validados previamente: 1. pré-intervenção, 2. ao finalizar a intervenção e 3. cinco semanas depois de acabado o tratamento. No estudo participaram 180 estudantes universitários detectados previamente como bebedores prejudiciais, designados aleatoriamente a uno de três grupos: 1. terapia motivacional individual, 2. terapia motivacional grupal e 3. ausência de terapia. Ambas as terapias motivacionais (individual e grupal) levaram à redução importante dos indicadores de consumo e a melhorar o uso dos processos de mudança responsáveis do consumo. No entanto, a intervenção grupal conduziu a um impacto maior do que a intervenção individual em aspetos como freqüência de consumo, auto-eficácia em situações de alto risco de consumo, percepção de vulnerabilidade e dano, e uso de processos comportamentais associados à mudança e à conservação desta.

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