BackgroundUndiagnosed airflow limitation is common in the general population and is associated with impaired health and functional status. Smoking is the most important risk factor for this condition. Although primary care practitioners see most adult smokers, few currently have spirometers or regularly order spirometry tests in these patients. Brief medical advice has shown to be effective in modifying smoking habits in a large number of smokers but only a small proportion remain abstinent after one year. The aim of this study is to evaluate the effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers.Methods/designIntervention study with a randomized two arms in 5 primary care centres. A total of 485 smokers over the age of 18 years consulting their primary care physician will be recruited.On the selection visit all participants will undergo a spirometry, peak expiratory flow rate, test of smoking dependence, test of motivation for giving up smoking and a questionnaire on socio-demographic data. Thereafter an appointment will be made to give the participants brief structured advice to give up smoking combined with a detailed discussion on the results of the spirometry. After this, the patients will be randomised and given appointment for follow up visits at 3, 6, 12 and 24 months. Both arms will receive brief structured advice and a detailed discussion of the spirometry results at visit 0. The control group will only be given brief structured advice about giving up smoking on the follow up. Cessation of smoking will be tested with the carbon monoxide test.DiscussionEarly identification of functional pulmonary abnormalities in asymptomatic patients or in those with little respiratory symptomatology may provide "ideal educational opportunities". These opportunities may increase the success of efforts to give up smoking and may improve the opportunities of other preventive actions to minimise patient risk. Comparing adult smokers in the intervention group with those in the control group, a minimum improvement expected with respect to the rates of smoking cessation would represent a large number of avoided morbimortality.Trial RegistrationClinicalTrials.gov: NCT01296295

Durante el período de tiempo del estudio, se valoró en el Servicio de Urgencias de Pediatría de nuestro hospital un total de 159.002 episodios, de los ACUTE ONSET ATAXIA IN INFANCY: ITS AETIOLOGY, TREATMENT AND FOLLOW-UP Summary. Introduction. Acute childhood ataxia is a cause of referency to the pediatric emergency room. Aim. To characterize the etiology, clinical picture, management, and outcome of acute ataxia in our hospital. Patients and methods. A prospective study was undertaken including 39 children with acute ataxia who were admitted between January 1, 2001 and December 31, 2003. Results. During the study period 159,002 episodes were evaluated, 39 children (0.024%) with acute ataxia. The most common diagnoses were post-infectious ataxia (51.2%) and toxic exposure (25.6%). The mean age at presentation in postinfectius ataxia was 55 ± 27.61 months, 60% females. A prodromal febrile illness was noted in 95%: varicella (10), nonspecific viral infection (6), mycoplasma, enterovirus, and Epstein-Barr virus. The latency from the prodromal illness to the onset of ataxia was 5.86 ± 3.78 days. Lumbar punctures were altered in 11/17. All computed tomography scans performed were normal. At follow up, one boy presented asymmetric signs of cerebellar dysfunction secondary to hemicerebellitis. The media of the patient who showed full-gait recovery was 18 days, and was complete in all children, except one boy who presented hemophagocytic lymphohistiocytosis. Toxic ingestion was the second most common cause. Boys less than 6 years were more commonly affected. Conclusions. Acute childhood ataxia are an uncommon cause of presentation to our pediatric emergency room. Postinfectious ataxia and drug ingestion are the most common diagnosis, with a usually benign and self-limited process. A thorough history and neurology examination should be guided to etiology. Neuroimaging studies and hospitalization are needed only if atypical presentation, asymmetric neurologic examination and prolonged ataxia.

This study aims to evaluate the effect of regularly reporting spirometry results during smoking cessation counseling from a primary care physician on the quit rate in adult smokers. Methods: A randomized, two-arm intervention study was conducted at six primary care centers. A total of 350 smokers, ≥18 years of age, who consulted their primary care physician, participated in the study. At the selection visit, smokers who gave their consent to participate underwent spirometry. Subsequently, an appointment (visit 0) was scheduled to complete a nicotine dependence test, a smoking cessation motivation questionnaire, and a sociodemographic questionnaire. Participants were also offered brief, structured advice on how to quit smoking, as well as detailed information on spirometry results. Patients were then randomized and scheduled for follow-up visits at 3, 6, 12, and 24 months. Both arms received brief, structured advice and detailed information on spirometry results at visit 0. At consecutive follow-up visits, the control group only received brief, structured smoking cessation advice, while the intervention group also received information on initial spirometry results at visits 3 and 6, and a spirometry retest at visit 12. Exhaled carbon monoxide testing was used to check smoking cessation. Results: The study included 350 smokers; 179 were assigned to the control group and 171 to the intervention group. Smoking cessation at one year was 24.0% in the intervention group compared to 16.2% in the control group. At two years, it was 25.2% in the intervention group and 18.4% in the control group. Overall, the adjusted odds of quitting smoking in the intervention group were 42% higher than in the control group (p = 0.018). Conclusions: Regular and detailed feedback of spirometry results with smokers increases smoking cessation. Specifically, the likelihood of quitting smoking in the intervention group is 1.42 times higher than in the control group (p = 0.018).