Background: Tobacco addiction is the leading cause of preventable morbidity and mortality worldwide, but only 1 in 20 cessation attempts is supervised by a health professional. The potential advantages of mobile health (mHealth) can circumvent this problem and facilitate tobacco cessation interventions for public health systems. Given its easy scalability to large populations and great potential, chatbots are a potentially useful complement to usual treatment. Objective: This study aims to assess the effectiveness of an evidence-based intervention to quit smoking via a chatbot in smartphones compared with usual clinical practice in primary care. Methods: This is a pragmatic, multicenter, controlled, and randomized clinical trial involving 34 primary health care centers within the Madrid Health Service (Spain). Smokers over the age of 18 years who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group [CG]) or an evidence-based chatbot intervention (intervention group [IG]). The interventions in both arms were based on the 5A’s (ie, Ask, Advise, Assess, Assist, and Arrange) in the US Clinical Practice Guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of patients, although participants were unblinded to group assignment. An intention-to-treat analysis, using the baseline-observation-carried-forward approach for missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. Results: The trial was conducted between October 1, 2018, and March 31, 2019. The sample included 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 (SD 10.82) years and gender ratio of 59.3% (304/513) women and 40.7% (209/513) men. Of them, 232 patients (45.2%) completed the follow-up, 104/242 (42.9%) in the IG and 128/271 (47.2%) in the CG. In the intention-to-treat analysis, the biochemically validated abstinence rate at 6 months was higher in the IG (63/242, 26%) compared with that in the CG (51/271, 18.8%; odds ratio 1.52, 95% CI 1.00-2.31; P=.05). After adjusting for basal CO-oximetry and bupropion intake, no substantial changes were observed (odds ratio 1.52, 95% CI 0.99-2.33; P=.05; pseudo-R2=0.045). In the IG, 61.2% (148/242) of users accessed the chatbot, average chatbot-patient interaction time was 121 (95% CI 121.1-140.0) minutes, and average number of contacts was 45.56 (SD 36.32). Conclusions: A treatment including a chatbot for helping with tobacco cessation was more effective than usual clinical practice in primary care. However, this outcome was at the limit of statistical significance, and therefore these promising results must be interpreted with caution. Trial Registration: Clinicaltrials.gov NCT 03445507; https://tinyurl.com/mrnfcmtd International Registered Report Identifier (IRRID): RR2-10.1186/s12911-019-0972-z

Introduction: Research has shown that financing drug therapy increases smoking abstinence rates, although most of these studies have been carried out in the private healthcare setting. The aim of this work is to assess the effect of subsidized pharmacological treatment on smoking cessation...

En el contexto del estudio “Efectividad de un bot conversacional para dejar de fumar en población adulta: ensayo clínico pragmático en Atención Primaria (Déj@lo)” (PI17/01942) que evalúa la efectividad de una intervención para ayudar a los fumadores a abandonar el tabaco a través de un bot conversacional para teléfonos inteligentes en comparación con el manejo habitual en Atención Primaria de Salud debíamos construir un chatbot sobre el que no existen aún unos estándares de calidad y nos basamos en los existentes para aplicaciones. Un bot (o chatbot) es una aplicación informática dotada de inteligencia artificial (IA) capaz de generar una conversación bidireccional entre un ser humano y una máquina (robot) a través de un interfaz conversacional o chat. En este trabajo presentamos la herramienta utilizada y los criterios que hemos seguido para su construcción y elaboración de contenidos.

Introduction: Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of ‘Subsidized pharmacological...

Background: Among chronic diseases, cognitive, neurological, and cardiovascular impairments are becoming increasingly prevalent, generating a shift in health and social needs. Technology can create an ecosystem of care integrated with microtools based on biosensors for motion, location, voice, and expression detection that can help people with chronic diseases. A technological system capable of identifying symptoms, signs, or behavioral patterns could provide notification of the development of complications of disease. This would help the self-care of patients with chronic disease and save health care costs, promoting the autonomy and empowerment of patients and their caregivers, improving their quality of life (QoL), and providing health professionals with monitoring tools. Objective: The main objective of this study is to evaluate the effectiveness of a technological system (the TeNDER system) to improve quality of life in patients with chronic diseases: Alzheimer disease, Parkinson disease, and cardiovascular disease. Methods: A multicenter, randomized, parallel-group clinical trial will be conducted with a follow-up of 2 months. The scope of the study will be the primary care health centers of the Community of Madrid belonging to the Spanish public health system. The study population will be patients diagnosed with Parkinson disease, Alzheimer disease, and cardiovascular disease; their caregivers; and health professionals. The sample size will be 534 patients (380 in the intervention group). The intervention will consist of the use of the TeNDER system. The system will monitor the patients by means of biosensors, and their data will be integrated into the TeNDER app. With the information provided, the TeNDER system will generate health reports that can be consulted by patients, caregivers, and health professionals. Sociodemographic variables and technological affinity will be measured, as will views on the usability of and satisfaction with the TeNDER system. The dependent variable will be the mean difference in QoL score between the intervention and control groups at 2 months. To study the effectiveness of the TeNDER system in improving QoL in patients, an explanatory linear regression model will be constructed. All analyses will be performed with the 95% CI and robust estimators. Results: Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment commenced in April 2021, and the expected results will be available during 2023 or 2024. Conclusions: This clinical trial among patients with highly prevalent chronic illnesses and the people most involved in their care will provide a more realistic view of the situation experienced by people with long-term illness and their support networks. The TeNDER system is in continuous development based on a study of the needs of the target population and on feedback during its use from the users: patients, caregivers, and primary care health professionals. Trial Registration: ClinicalTrials.gov NCT05681065; https://clinicaltrials.gov/ct2/show/NCT05681065 International Registered Report Identifier (IRRID): DERR1-10.2196/47331

Introduction: Electronic nicotine delivery systems may lead to challenges for public health. This study described the use of electronic cigarettes (EC) and dual consumption in the Spanish population. Material and Methods: Descriptive cross-sectional study of the 2022 Survey on Alcohol and Other Drugs in the General Population in Spain (EDADES), aged 15-64. Variables: sociodemographic, dual consumption (EC and conventional tobacco, daily and/or within the last 30 days), and perceived health status. Analysis: descriptive, multinomial logistic regression. Results: 26,337 participants, (51% men). The prevalence of dual consumers in the population was 1.55% (95%CI: 1.40-1.70). For every year increase in age, the likelihood of being an exclusive tobacco smoker increased with an OR:1.04, (IC95%:1.03-1.05). Having an income between 1,000-1,499€ and 1,500-2,499€ associated exclusive tobacco versus dual use, OR 1.52 (95% CI:1.01-2.27) and 1.92 (95% CI:1.30-2.84), respectively. Dual use associated a ‘fair’ perceived health status compared to exclusive EC users (OR:0.26; 95%CI:0.12–0.57) and exclusive conventional tobacco (OR:0.60; 95%CI:0.45–0.80), and a ‘poor/very poor’ health status compared to exclusive tobacco (OR:0.42; 95%CI:0.23–0.77). Among former EC smokers, 71% now smoked conventional tobacco exclusively. Conclusion: The prevalence of dual consumers in Spain was 1.55%. Smoking EC might lead to an increase of tobacco smokers.