Protocol for an observational cohort study on psychological, addictive, lifestyle behavior and highly prevalent affective disorders in primary health care adults

Depression and anxious symptoms are prevalent in the general population, and their onset and persistence may be linked to biological and psychosocial factors, many of which are lifestyle-related. The way we manage our care, physical and emotional health and/or discomfort is highly influenced by our own abilities, skills and attitudes despite life’s circumstances. The main aim of this protocol to analyze the relationship between psychological constructs (self-efficacy, activation, health literacy, resilience, personality traits, sense of coherence, self-esteem), and the presence of affective-emotional problems (anxiety, depression) and addictions in primary health care.MethodsThis is a protocol of a prospective longitudinal cohort study including people of 35–74 years old of Aragon primary health care centers (Spain). Three evaluations will be conducted: baseline evaluation, and follow-up assessments five and ten years after recruitment. The primary outcomes will be severity of depression, severity of anxiety, and addictive behaviors. A detailed set of secondary outcomes will be assessed across all three assessments. This will include psychosocial or personal factors on health behavior, social support, lifestyle patterns, quality of life, the use of health and social resources, and chronic comorbid pathology.DiscussionThe analysis of the impact of psychological constructs and lifestyles on the mental health of people and communities will provide evidence that will make it possible to better address and prevent these prevalent problems and address their improvement from a more global and holistic perspective. The evaluation of psychological constructs should be incorporated into health services to improve people’s ability their self-care, the level of knowledge of managing their disease and their physical, mental and social health.Clinical trial registrationhttps://www.isrctn.com/, identifier ISRCTN12820058

Evaluación de los conocimientos del personal de salud, sobre lineamientos técnicos para la atención integral de niños y niñas menores de diez años, en la Unidad Comunitaria de Salud Familiar Intermedia Nahulingo, en el periodo de marzo a julio del 2019

En el marco de la importancia de las atenciones preventivas de la niñez nace una estrategia AIEPI que significa atención integral de las enfermedades prevalentes de la infancia, fue adoptada por varios países y entidades con el objetivo de mejorar la atención de un grupo etario específico de la población, y a la vez lograr la disminución de la mortalidad infanti

Online multimodal rehabilitation programme to improve symptoms and quality of life for adults diagnosed with long COVID-19: a Randomised Clinical Trial protocol

Long COVID is a multisystemic condition which affects quality of life and implies a multidisciplinary treatment approach. There is still limited evidence on management techniques for this syndrome. “Telerehabilitation” could be an important tool when addressing the symptoms of this patients with the aim of increasing their quality of life. The purpose of this trial is to analyse the effectiveness of an online multimodal rehabilitation programme to improve the symptomatology of people with long COVID and their quality of life.MethodsA pragmatic randomised controlled trial will be performed with two parallel groups: (1) usual treatment by the primary care practitioner (Treatment as usual, TAU; control group) and (2) TAU plus the use of an online multimodal rehabilitation programme, including videoconferences and content published on a Moodle platform (intervention group). The data will be collected before and after the intervention. A follow-up will take place 3 months later.DiscussionThere is still a lack of knowledge regarding the management of the symptoms of long COVID. This creates the need to add scientific evidence about the care of this disease, considering that multidisciplinary social and health teams can offer the necessary care so that these patients can recover their previous quality of life.Clinical trial registration: The protocol for this study was registered with the ISRCTN Registry [registration number: ISRCTN15414370] on 28 December 2022

Biomarkers as prognosis of Covid-19 disease: retrospective cohort study

Coronavirus infection has been the cause of millions of deaths worldwide. Some analytical parameters on admission could help predict prognosis and mortality. This study aims to describe the main Laboratory findings of hospitalized patients with COVID-19 and to identify the relationship between intensive care unit access, length of stay and in-hospital mortality. Methods: A retrospective cohort study was performed. Demographic and analytical variables of all patients diagnosed with COVID-19 hospitalized in Aragon (Spain) between March and June 2020 were analyzed. Results: We describe the characteristics of 2640 patients hospitalized with COVID-19, 85% were significantly older, with a median age of 72.3 ± 16.7 years, predominantly male (52.8%). The in-hospital mortality rate was 30%. Patients admitted to the intensive care unit had significantly higher baseline levels of hematocrit, fibrinogen, lactate dehydrogenase, leukocytes and neutrophils (p<0.001 in all). On the other hand, these patients had lower levels of eosinophils, lymphocytes and monocytes (p<0.001 in all). Only hemoglobin and D-dimer showed a significant and positive correlation with longer hospital and ICU stays (r=0.050 with p=0.031; r=0.203 with p=0.008; r=0.175 with p<0.001 and r=0.199 with p=0.001, respectively. Multivariable regression based on death showed that age, higher values of lactate dehydrogenase, neutrophils and lower values of eosinophils and female sex could explain up to 30% of the probability of death. Conclusion: Laboratory parameters can help clinicians predict the severity of COVID-19 and subsequently improve prognosis and decrease mortality rates. However, more studies are needed to better understand these changes and their relationship to prognosis

Relationship between initial symptoms and the prognosis, sex, and demographic area of patients with COVID-19

BackgroundA method of determining the initial symptoms and main prognostic identifiers for COVID-19 can be a key tool for physicians, especially primary care physicians. Therefore, the objective of this study was to examine the prognosis of patients with COVID-19 from two different demographic regions according to baseline and main symptoms, age, and sex.MethodsAll individuals selected from both urban and rural health centers were over 18 years of age, had COVID-19 before 2 March 2021, and were followed up with a primary care physician. All patients included in this study were recruited in terms of sex, age at the time of infection, type of contact, baseline symptoms, primary and secondary symptomatology, emergency assistance, hospitalization, intensive care unit (ICU) admission, and death.ResultsA total of 219 and 214 subjects were recruited from rural and urban health centers, respectively. Subjects with COVID-19 from rural areas were significantly older in age, with a higher proportion of men, and had significantly lower baseline and main symptoms than those from urban areas. In addition, the presence of both fever and dyspnea as the initial or main symptom is significantly associated with emergency assistance, hospitalization, and death, regardless of sex, age, and demographic area. This type of illness was reported to be significantly less frequent in the rural population than in the urban population.ConclusionThe presence of both fever and dyspnea as both initial and main symptoms is a poor prognostic factor for COVID-19, regardless of age, sex, and demographic areas. In addition, women reported lower levels of fever and dyspnea, requiring minimal emergency assistance and fewer hospitalization, and a lower rate of mortality than men. During a COVID-19 infection follow-up, subjects in rural areas seem to have less access to medical care than those in urban areas

Características basales y calidad de vida de los pacientes con diabetes mellitus incluidos en el ensayo clínico aleatorizado EIRA

Fundamentos: El estudio EIRA es un ensayo clínico aleatorizado multicéntrico que pretende evaluar la efectividad de una intervención compleja multirriesgo dirigida a personas de 45-75 años atendidas en Atención Primaria. Los objetivos de este trabajo fueron describir las características basales de los pacientes con Diabetes Mellitus incluidos en la fase III del estudio EIRA, y analizar la relación que puedan tener las diferentes variables independientes con la calidad de vida. Métodos: Se analizaron los datos recogidos al inicio del estudio de todos los pacientes con Diabetes Mellitus que se incluyeron en la fase III del estudio EIRA. Se seleccionaron pacientes con dos o más estilos de vida no saludables: tabaquismo, baja adherencia a dieta mediterránea y/o bajo nivel de actividad física. La calidad de vida se midió con el cuestionario EQ-5D-5L. Se realizó un estudio descriptivo y bivariante. Las variables no siguieron una distribución normal. Se utilizaron test estadísticos no paramétricos. Para identificar factores influyentes en la calidad de vida, se utilizó regresión lineal automatizada con SPSS v19. Resultados: Se incluyeron 694 pacientes con Diabetes Mellitus (356 controles, 338 en intervención, sin diferencias significativas entre ambos grupos). Control: 37,64% mujeres, edad (mediana) 60 años. Intervención: 37,87% mujeres, edad (mediana) 60 años. Comportamientos de riesgo más prevalentes en orden descendente: baja adherencia a dieta mediterránea, bajo nivel de actividad física y tabaquismo. Las variables que influyeron significativamente en la calidad de vida fueron: GAD-7, actividad laboral, HbA1c y CIDI. Conclusiones: No existen diferencias significativas motivadas por el diseño del estudio. Es destacable la influencia de la salud mental en el EQ-5D-5L

Functionality, physical activity, fatigue and quality of life in patients with acute COVID-19 and Long COVID infection

A prominent feature of COVID-19, both in the short and long term, is the reduction in quality of life (QoL) due to low functionality scores and the presence of fatigue, which can hinder daily activities. The main objective of this study is to compare the functional status, level of physical activity, fatigue, and QoL of patients with Long COVID to other COVID-19 patients who did not develop persistent illness, and to determine whether there is a relationship between these variables and QoL. A cross-sectional study was conducted with 170 participants who had been infected with COVID-19 or had developed Long COVID. The main variables studied were functionality, physical activity, QoL and fatigue, measured using the PostCOVID-19 Functional Status Scale (PCFS), International Physical Activity Questionnaire (IPAQ), Short Form 12 (SF-12), and Fatigue Severity Scale (FSS). The main findings show a significant relationship (p &lt; 0.001) between reduced functionality, lower physical activity levels, increased fatigue severity, and poorer QoL in Long COVID patients. Furthermore, these variables are also related to worse QoL, but only functional status predicts it. In conclusion, our results have shown highly significant correlations between the group with COVID-19 and Long COVID regarding functional status, level of physical activity, QoL, and fatigue

Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study)

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45–75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions’ effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45–75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = −0.09 (95% CI: −0.29–0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: −0.32–0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01–0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64–1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55–1.73), no smoking OR = 0.61 (95% CI: 0.54–1.06), EVA adjusted mean difference = −1.26 (95% CI: −4.98–2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control

Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial

Background: The present study describes the efectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). Methods: Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45–75 years who presented at least two of the following crite‑ ria were included: smoker, low adherence to the MD or insufcient level of physical activity. The intervention group (IG) had three diferent levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor’s ofce. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. Results: Three thousand sixty-two participants were included (IG=1,481, CG=1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9–17.5; p<0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the fnal visit. Moreover, the efect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p<0.001) in IG. Conclusions: A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice