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Background: The exponential growth of digital healthcare data is fueling the development of Knowledge Discovery in Databases (KDD). Extracting temporal relationships between medical events is essential to reveal hidden patterns that can help physicians find optimal treatments, diagnose illnesses, detect drug adverse reactions, and more. This paper presents an approach for the extraction of patient evolution patterns from electronic health records written in Catalan and/or Spanish. Methods: We propose a robust formulation for extracting Temporal Association Rules (TARs) that goes beyond simple rule extraction by considering the sequence of multiple visits. Our highly configurable algorithm leverages this formulation to extract Temporal Association Rules from sequences of medical instances. We can generate rules in the desired format, content, and temporal factors while accounting for different levels of abstraction of medical instances. To demonstrate the effectiveness of our methodology, we applied it to extract patient evolution patterns from clinical histories of multimorbid patients suffering from heart disease and stroke who visited Primary Care Centers (CAP) in Catalonia. Our main objective is to uncover complex rules with multiple temporal steps, that comprise a set of medical instances. Results: As we are working with real-world, error-prone data, we propose a process of validation of the results by expert practitioners in primary care. Despite our limited dataset, the high percentage of patterns deemed correct and relevant by the experts is promising. The insights gained from these patterns can inform preventive measures and help detect risk factors, ultimately leading to better treatments and outcomes for patients. Conclusion: Our algorithm successfully extracted a set of meaningful and relevant temporal patterns, especially for the specific type of multimorbid patients considered. These patterns were evaluated by experts and demonstrated the ability to predict risk factors that are commonly associated with certain diseases. Moreover, the average time gap between the occurrence of medical events provided critical insight into the term of these risk factors. This information holds significant value in the context of primary healthcare and preventive medicine, highlighting the potential of our method to serve as a valuable medical tool. [ABSTRACT FROM AUTHOR]

Background: Many countries today are undergoing a paradigm shift in mental health policies towards a recovery-oriented and rights-based approach. From this perspective, self-determination and self-management are fundamental factors for recovery. Despite this shift, there is still a lack of evidence on the effectiveness of training programmes aimed at promoting self-determination and self-management in recovery processes implemented in southern European or Spanish-speaking countries. The aim of this paper is to present a study protocol that evaluates the effectiveness of a 12-session recovery workshop implemented in community mental health services in Catalonia (Spain). Methods/design: This is a 12-week follow-up multi-centre non-randomized controlled trial design. At least 160 users will be recruited from 13 Community Rehabilitation Services (CRS) in Catalonia. Eligible participants are adult (≥ 18 years old) users of a CRS, who sign a written consent to participate. The experimental group participates in a recovery workshop, in which people learn to develop and implement their own plan of personal recovery, which includes a Wellness Toolbox, a Maintenance Toolkit, a Personal Growth Plan, a Mirror of Relapses, a Crisis Plan, and a Learning Agenda. The control group participates in the usual activities of the CRS. Data is collected using a questionnaire of sociodemographic characteristics, personal recovery, empowerment, hope and perceived social support. The users' measurements are taken at the baseline and one week after the end of the workshop. The primary outcome measures include the Self-Identified Stage of Recovery and the Maryland Assessment of Recovery in Serious Mental Illness Scale (short version). The secondary outcome measures include the Netherlands Empowerment List, Dispositional Hope Scale, and Multidimensional Scale of Perceived Social Support. Descriptive statistics for characterizing the sample size will be performed. Multivariate analyses for repeated measures designs will be used to evaluate the primary and secondary outcomes. Between-group and within-subject comparisons will be conducted. Discussion: The results of the study will provide information on the usefulness of recovery workshops in a Mediterranean cultural context. Additionally, if this workshop is effective, it will be proposed for inclusion within the portfolio of community mental health services in Catalonia. Trial Registration: ISRCTN11695542 (Registration date: 5 July 2022). [ABSTRACT FROM AUTHOR]

Background: In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals' participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be underlying them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation. Methods: We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model. Results: We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy. Conclusions: There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID. [ABSTRACT FROM AUTHOR]

Background: Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. Methods: PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. Discussion: Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide. [ABSTRACT FROM AUTHOR]

Background: The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. Methods: Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied. Results: Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. Conclusions: The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions. [ABSTRACT FROM AUTHOR]

Background: The present paper reviews the occurrence of neoplasms in swine and presents a case series of 56 tumors submitted to the Slaughterhouse Support Network (Servei de Suport a Escorxadors [SESC] IRTA-CReSA]) from slaughtered pigs from 1998 to 2018 (April) in Catalonia (Spain). The aim of the study was to describe the spectrum of spontaneous neoplastic lesions found in slaughtered pigs and to compare the reported tumor cases with previous published data. Lymphoid neoplasms were characterized and classified using the WHO classification adapted for animals. Results: The most reported neoplasm during this period was lymphoma (28). Within lymphomas, the B-cell type was the most common, being the diffuse large B-cell lymphoma (15/28) the most represented subtype. Other submitted non-lymphoid neoplasms included melanoma (7), nephroblastoma (3), mast cell tumor (2), liposarcoma (2), osteochondromatosis (2), papillary cystadenocarcinoma (1), peripheral nerve sheath tumor (1), lymphoid leukemia (1), fibropapilloma (1), hemangiosarcoma (1), hepatoma (1), histiocytic sarcoma (1), pheochromocytoma (1) and osteosarcoma (1). Conclusions: The existence of a well-established Slaughterhouse Support Network allowed the compilation of comprehensive data for further epidemiological and pathological studies, particularly about less commonly reported lesions in livestock such as neoplasms in pigs. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents. Objectives: To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI. Design and setting: Cross-sectional study in 5 NHs conducted from January to March 2020. Methods: We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed. Results: We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p =.003), anticholinergic activity (OR = 3.50, p =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p =.041) were associated with UI. Conclusions: The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals traditional education reflects constraints to face the complex needs of people with chronic diseases in primary care settings. Since more innovative and practical solutions are required, Virtual Community of Practices (vCoP) seem to better respond to learning updates, improving professional and organizational knowledge. However, little is known about the value created in vCoPs as social learning environments. The objective of this project was to explore the value creation process of a gamified vCoP ("e-mpodera vCoP") aimed at improving the knowledge and attitudes of primary healthcare professionals (PCPs) (nurses and general practitioners) to the empowerment of people with chronic conditions. Methods: A framework analysis assessed the value creation process using a mixed methods approach. The framework provided awareness about knowledge and usefulness in a learning community through five cycles: (1) immediate value, (2) potential value, (3) applied value, (4) realized value, and (5) reframing value. Quantitative data included vCoP analytics such as logins, contributions, points, badges, and performance metrics. Qualitative data consisted of PCPs' forum contributions from Madrid, Catalonia, and Canary Islands over 14 months. Results: A total of 185 PCPs had access to the e-mpodera vCoPs. The vCoP showed the dynamic participation of 146 PCPs, along 63 content activities posted, including a total of 3,571 contributions (including text, images, links to webpages, and other files). Regarding the value creation process, the e-mpodera vCoP seems to encompass a broad spectrum of value cycles, with indicators mostly related to cycle 1 (immediate value – activities and interactions) and cycle 2 (potential value – knowledge capital); and to a lesser extent for cycle 3 (applied value – changes in practice) and for cycle 4 (realized value – performance improvement). The presence of indicators related to cycle 5 (reframing value), was minimal, due to few individual redefinitions of success. Conclusion: To reach a wider range of value possibilities, a combination of learning objectives, competence framework, challenged-based gamified platform, and pathway model of skill development seems crucial. However, additional research is required to gain clearer insights into organizational values, professionals' lifelong educational needs in healthcare, and the long-term sustainability of performance improvement. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 02/05/2016. [ABSTRACT FROM AUTHOR]

Background: Self-care and preventive health strategies may trigger health inequities when individuals' cultural values and health beliefs are not fully understood and considered. In the case of cervical cancer (CC) screening programs immigrant women have shown lower attendance compared with native women, which increases the risk of late diagnosis and, consequently, a lower probability of survival. HPV self-sampling for CC screening has been recently added to the World Health Organization's (WHO) list of self-care interventions as a promising tool to reduce this disparity and improve screening coverage. In Catalonia, Spain, the introduction of HPV self-sampling as a part of the new population-based CC screening program, is a significant step. However, there is a lack of research addressing self-care and prevention among immigrant populations in this region. This study aims to fill this gap exploring self-care and prevention attitudes and practices among Moroccan and Pakistani women. Methods: We conducted focus groups and individual interviews with 36 Moroccan and 37 Pakistani women in Barcelona, Spain. The topic guide of the focus groups included case vignettes to stimulate the discussion and a semi-structured questionnaire was used for the interviews. Results: Our findings show that most Moroccan and Pakistani women do not prioritize self-care and prevention. They seek care for symptom treatment rather than disease prevention. In this sense, they reported not having the habit of doing regular check-ups and their self-care and prevention attitudes and practices seemed to be conditioned by cultural values. The implementation of an effective call and recall system could enhance the engagement of these populations with CC screening services. Conclusion: This study provides evidence on how universal concepts of self-care and prevention may not aligned with more collectivist societies, emphasizing the limited applicability and motivation of global self-care interventions guidelines for individuals with different cultural backgrounds and values. Therefore, the successful implementation of CC screening programs or any other self-care intervention requires the adoption of culturally appropriate strategies. [ABSTRACT FROM AUTHOR]

Background: Around 10% of people infected by SARS-COV-2 report symptoms that persist longer than 3 months. Little has been reported about sex differences in symptoms and clustering over time of non-hospitalised patients in primary care settings. Methods: This is a descriptive study of a cohort of mainly non-hospitalized patients with a persistence of symptoms longer than 3 months from the clinical onset in co-creation with the Long Covid Catalan affected group using an online survey. Recruitment was from March 2020 to June 2021. Exclusion criteria were being admitted to an ICU, < 18 years of age and not living in Catalonia. We focused on 117 symptoms gathered in 18 groups and performed cluster analysis over the first 21 days of infection, at 22–60 days, and ≥ 3 months. Results: We analysed responses of 905 participants (80.3% women). Median time between symptom onset and the questionnaire response date was 8.7 months. General symptoms (as fatigue) were the most prevalent with no differences by sex, age, or wave although its frequency decreased over time (from 91.8 to 78.3%). Dermatological (52.1% in women, 28.5% in men), olfactory (34.9% women, 20.9% men) and neurocognitive symptoms (70.1% women, 55.8% men) showed the greatest differences by sex. Cluster analysis showed five clusters with a predominance of Taste & smell (24.9%) and Multisystemic clusters (26.5%) at baseline and _Multisystemic (34.59%) and Heterogeneous (24.0%) at ≥3 months. The Multisystemic cluster was more prevalent in men. The Menstrual cluster was the most stable over time, while most transitions occurred from the Heterogeneous cluster to the Multisystemic cluster and from Taste & smell to Heterogeneous. Conclusions: General symptoms were the most prevalent in both sexes at three-time cut-off points. Major sex differences were observed in dermatological, olfactory and neurocognitive symptoms. The increase of the Heterogeneous cluster might suggest an adaptation to symptoms or a non-specific evolution of the condition which can hinder its detection at medical appointments. A carefully symptom collection and patients' participation in research may generate useful knowledge about Long Covid presentation in primary care settings. [ABSTRACT FROM AUTHOR]

Background: Slower paces of aging are related to lower risk of developing diseases and premature death. Therefore, the greatest challenge of modern societies is to ensure that the increase in lifespan is accompanied by an increase in health span. To better understand the differences in human lifespan, new insight concerning the relationship between lifespan and the age of onset of diseases, and the ability to avoid them is needed. We aimed to comprehensively study, at a population-wide level, the sex-specific disease patterns associated with human lifespan. Methods: Observational data from the SIDIAP database of a cohort of 482,058 individuals that died in Catalonia (Spain) at ages over 50 years old between the 1st of January 2006 and the 30th of June 2022 were included. The time to the onset of the first disease in multiple organ systems, the prevalence of escapers, the percentage of life free of disease, and their relationship with lifespan were evaluated considering sex-specific traits. Results: In the study cohort, 50.4% of the participants were women and the mean lifespan was 83 years. The results show novel relationships between the age of onset of disease, health span, and lifespan. The key findings include: Firstly, the onset of both single and multisystem diseases is progressively delayed as lifespan increases. Secondly, the prevalence of escapers is lower in lifespans around life expectancy. Thirdly, the number of disease-free systems decreases until individuals reach lifespans around 87–88 years old, at which point it starts to increase. Furthermore, long-lived women are less susceptible to multisystem diseases. The associations between health span and lifespan are system-dependent, and disease onset and the percentage of life spent free of disease at the time of death contribute to explaining lifespan variability. Lastly, the study highlights significant system-specific disparities between women and men. Conclusions: Health interventions focused on delaying aging and age-related diseases should be the most effective in increasing not only lifespan but also health span. The findings of this research highlight the relevance of Electronic Health Records in studying the aging process and open up new possibilities in age-related disease prevention that should assist primary care professionals in devising individualized care and treatment plans. [ABSTRACT FROM AUTHOR]

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Background: Ethnobotanical studies in metropolitan areas and urban ethnic markets have grown considerably in recent years as large cities have demonstrated to be significantly rich in biocultural diversity and in driving its evolution, as human populations migrate from one region to another. Urban spaces also represent important places of rich multicultural and multilingual interaction and exchange, where ethnobotany can act as a bridge between research and action. The purpose of this study is to present a case study on how to use ethnobotany in multicultural urban settings by studying people-plant interactions and the larger implications and applications to promote biocultural learning in these areas. Methods: We inventoried the botanical composition of fresh and dry products sold in most food stores owned by Chinese immigrants in Fondo, a neighbourhood of Barcelona's metropolitan area, in Santa Coloma de Gramenet municipality (Barcelonès county, Catalonia, Iberian Peninsula), pharmacologically validating the obtained list with the Chinese Pharmacopoeia. We also participated in multiple dissemination activities and materials (non-academic and academic), along with exchanges with the broader community in relation to this research. Results: In total, 103 plants were identified at the species level, pertaining to 88 genera and 46 botanical families. Including the infraspecific level, a total of 113 plant taxa were inventoried. One algal and six fungal species were also recorded, but not included in the analyses. Brassicaceae (12.4%) and Fabaceae (10.6%) were the most predominant families inventoried, followed by Cucurbitaceae (7.1%) and Poaceae (7.1%). Over three-quarters of all the taxa have an Asian origin (76.11%), indicating a high conservation of the use of Asian taxa. Over one-third (36.89%) of the plant parts pertain to species contained in the Chinese Pharmacopoeia, showing the relevance of medicinal plants in local stores and the preponderance of Eastern Asian food-medicine continuums. To promote ethnobotanical education programmes, over 50 dissemination activities and educational materials were produced from this study and shared with the local urban community in different fora. Conclusions: Further research in these and similar settings can provide significant ethnographic information to better understand anthropological processes and phenomena underlying migration and transculturation that can be used in an umbrella of applications, from adequate nomenclature and labelling of foreign products in local languages to multicultural integration and social cohesion programmes along with educational activities on biocultural topics. [ABSTRACT FROM AUTHOR]

Background: The consequences of cancer on working until retirement age remain unclear. This study aimed to analyse working life considering all possible labour market states in a sample of workers after sickness absence (SA) due to cancer and to compare their working life paths to those of a sample of workers without SA and with an SA due to other diseases. Methods: This was a retrospective dynamic cohort study among social security affiliates in Catalonia from 2012–2018. Cases consisted of workers with an SA due to cancer between 2012–2015 (N = 516) and were individually age- and sex-matched with those of affiliates with an SA due to other diagnoses and workers without an SA. All workers (N = 1,548, 56% women) were followed up from entry into the cohort until the end of 2018 to characterise nine possible weekly labour states. Sequence analysis, optimal matching, and multinomial logistic regression were used to identify and assess the probability of future labour market participation patterns (LMPPs). All analyses were stratified by sex. Results: Compared with workers with an SA due to cancer, male workers with no SA and SA due to other causes showed a lower probability of being in the LMPP of death (aRRR 0.02, 95% CI: 0.00‒0.16; aRRR 0.17, 95% CI: 0.06‒0.46, respectively) and, among women, a lower probability of permanent disability and death (aRRR 0.24, 95% CI: 0.10‒0.57; aRRR 0.39, 95% CI: 0.19‒0.83, respectively). Compared to workers with SA due to cancer, the risk of early retirement was lower among workers with no SA (women, aRRR 0.60, 95% CI: 0.22‒1.65; men, aRRR 0.64, 95% CI: 0.27‒1.52), although these results were not statistically significant. Conclusions: Workplaces, many of which have policies common to all diagnoses, should be modified to the needs of cancer survivors to prevent an increasing frequency of early retirement and permanent disability when possible. Future studies should assess the impact of cancer on premature exit from the labour market among survivors, depending on cancer localisation and type of treatment. [ABSTRACT FROM AUTHOR]

Background: Mental disorders have a huge impact on the European population. Two of the main causes of this impact are stigma and discrimination. The aim of this paper is to assess the stigma regarding mental disorder in Catalonia and to explore factors associated with stigma.Methods: Cross-sectional population-based survey of a representative sample of non-institutionalized adult population (n = 1872). We evaluated attitudes (CAMI: Authoritarianism, Benevolence and Support to Community Mental Health care) and intended behaviour (RIBS) regarding mental disorder and experience of discrimination. Higher scores showed more favourable attitudes and intended behavior. Mean values and percentiles of the scales were calculated. Multivariable regression models were used to assess factors associated with stigma.Results: Mean authoritarianism, benevolence and support to community mental health scores corresponded to the 66th, 90th and 78th percentile, respectively. Mean RIBS score corresponded to the 76th percentile. More favourable attitudes were associated with being male, younger, having a higher education, being Spanish, having suffered a mental disorder and having contact with a person with a mental disorder.Similarly, more favourable intended behaviour was associated with being younger, having secondary education, having Spanish nationality, belonging to a higher social class and having contact with a person with a mental disorder. People with depression or anxiety showed lower discrimination experiences than people with other mental disorders.Conclusions: The levels of stigma were generally low among the Catalan population. However, efforts should be made to decrease stigma related to authoritarianism. Interventions addressed to reducing stigma should take into account other mental disorders apart from depression or anxiety. They should be focused on older, immigrant population, people with lower educational attainment and people who have not had contact with someone with a mental disorder. [ABSTRACT FROM AUTHOR]

Background: The encouragement of healthy lifestyles for obesity prevention in young people is a public health priority. The European Youth Tackling Obesity (EYTO) project is a multicentric intervention project with participation from the United Kingdom, Portugal, the Czech Republic and Spain. The general aim of the EYTO project is to improve lifestyles, including nutritional habits and physical activity practice, and to prevent obesity in socioeconomically disadvantaged and vulnerable adolescents. The EYTO project works through a peer-led social marketing intervention that is designed and implemented by the adolescents of each participating country. Each country involved in the project acts independently. This paper describes the "Som la Pera" intervention Spanish study that is part of the EYTO project. Methods/Design: In Spain, the research team performed a cluster randomised controlled intervention over 2 academic years (2013-2015) in which 2 high-schools were designated as the control group and 2 high-schools were designated as the intervention group, with a minimum of 121 schoolchildren per group. From the intervention group, 5 adolescents with leadership characteristics, called "Adolescent Challenge Creators" (ACCs), were recruited. These 5 ACCs received an initial 4 h training session about social marketing principles and healthy lifestyle theory, followed by 24 sessions (1.30 h/session) divided in two academic years to design and implement activities presented as challenges to encourage healthy lifestyles among their peers, the approximately 180-200 high-school students in the intervention group. During the design of the intervention, it was essential that the ACCs used the 8 social marketing criteria (customer orientation, behaviour, theory, insight, exchange, competition, segmentation and methods mix). The expected primary outcomes from the Spanish intervention will be as follows: increases in the consumption of fruits and vegetables and physical activity practice along with reductions in TV/computer/game console use. The secondary outcomes will be as follows: increased breakfast consumption, engagement with local recreation and reduced obesity prevalence. The outcomes will be measured by the Health Behaviour in School-aged Children Study (HBSC) survey at baseline and at the end of the intervention. In the control group, no intervention was implemented, but the outcome measurements were collected in parallel with the intervention group. Discussion: This study described a new methodology to improve lifestyles and to address adolescent obesity. Trial registration: ClinicalTrials.gov: NCT02157402. Registered 03 June 2014. [ABSTRACT FROM AUTHOR]

Background: Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service. Methods: A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type. Results: A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages. Conclusions: This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain. [ABSTRACT FROM AUTHOR]

Background: Influenza is a well known and common human respiratory infection, causing significant morbidity and mortality every year. Despite Influenza variability, fast and reliable outbreak detection is required for health resource planning. Clinical health records, as published by the Diagnosticat database in Catalonia, host useful data for probabilistic detection of influenza outbreaks. Methods: This paper proposes a statistical method to detect influenza epidemic activity. Non-epidemic incidence rates are modeled against the exponential distribution, and the maximum likelihood estimate for the decaying factor λ is calculated. The sequential detection algorithm updates the parameter as new data becomes available. Binary epidemic detection of weekly incidence rates is assessed by Kolmogorov-Smirnov test on the absolute difference between the empirical and the cumulative density function of the estimated exponential distribution with significance level 0 ≤ α ≤ 1. Results: The main advantage with respect to other approaches is the adoption of a statistically meaningful test, which provides an indicator of epidemic activity with an associated probability. The detection algorithm was initiated with parameter λ0 = 3.8617 estimated from the training sequence (corresponding to non-epidemic incidence rates of the 2008-2009 influenza season) and sequentially updated. Kolmogorov-Smirnov test detected the following weeks as epidemic for each influenza season: 50 − 10 (2008-2009 season), 38 − 50 (2009-2010 season), weeks 50 − 9 (2010-2011 season) and weeks 3 to 12 for the current 2011-2012 season. Conclusions: Real medical data was used to assess the validity of the approach, as well as to construct a realistic statistical model of weekly influenza incidence rates in non-epidemic periods. For the tested data, the results confirmed the ability of the algorithm to detect the start and the end of epidemic periods. In general, the proposed test could be applied to other data sets to quickly detect influenza outbreaks. The sequential structure of the test makes it suitable for implementation in many platforms at a low computational cost without requiring to store large data sets. [ABSTRACT FROM AUTHOR]

Background: The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. Methods: The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using oneway ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. Results: We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. Conclusion: The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously constructed feedback reports on individual and sector-wide performance and the support of evidence-based guidance wherever possible. Further research should address how contextual issues shape the uptake and effectiveness of quality improvement actions and how such quality improvements can be sustained. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the characteristics of first-ever cardiovascular events in type 1 diabetes may impact primary prevention strategies. This study describes the first-ever manifestation of cardiovascular disease (CVD) in patients with type 1 diabetes (T1D) in Catalonia (Spain) and evaluates differences according to age and sex. Methods: Retrospective cohort study of patients with T1D > 30 years without CVD before 2010 registered in the SIDIAP database. The occurrence of a first cardiovascular event up to the end of 2016, the type of CV event and associations with baseline characteristics were analysed. Results: Of 8412 patients, 884 suffered a first CV event (incidence rate 1.62 per 100 persons-years). Overall, peripheral vascular disease (39.5%) was the most frequent event. We observed a higher proportion of heart failure in women (21.7%) than in men (10.1%). In women, heart failure was the most frequent event in those > 65 years (40.5%). Decreased glomerular filtration rate (hazard ratio [HR] 5.42 [95% CI 4.32;6.80]), elevated albumin/creatinine ratio (HR 3.39 [95% CI [2.47;4.66], microvascular complications (HR 3.27 [95% CI 2.85;3.75]), and hypertension (HR 3.21 [95% CI [2.80;3.67]) were most strongly associated with a first CV event. HbA1c > 7.0% was associated with incident CVD only in patients aged < 55/60 years. Conclusions: Peripheral artery disease in the whole cohort, and heart failure in elder subjects are the most frequent first-ever CVD events in T1D in our region. These findings deserve to be taken into account when considering primary prevention measures and when estimating CV risk in people with T1D. [ABSTRACT FROM AUTHOR]

Background: Infection caused by Streptococcus pneumoniae, mainly invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP), are a major public health problem worldwide. This study investigated population-based incidence and risk of PP among Catalonian persons ≥ 50 years-old with and without specific underlying conditions/comorbidities, examining the influence of single and multi-comorbidities in the risk of suffering PP. Methods: Population-based cohort study involving 2,059,645 persons ≥ 50 years-old in Catalonia, Spain, who were retrospectively followed between 01/01/2017-31/12/2018. The Catalonian information system for development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities/underlying conditions), and PP cases were collected from discharge codes (ICD-10: J13) of the 68 referral Catalonian hospitals. Results: Global incidence rate (IR) was 90.7 PP cases per 100,000 person-years, with a 7.6% (272/3592) case-fatality rate (CFR). Maximum IRs emerged among persons with history of previous IPD or all-cause pneumonia, followed by haematological neoplasia (475.0), HIV-infection (423.7), renal disease (384.9), chronic respiratory disease (314.7), liver disease (232.5), heart disease (221.4), alcoholism (204.8), solid cancer (186.2) and diabetes (159.6). IRs were 42.1, 89.9, 201.1, 350.9, 594.3 and 761.2 in persons with 0, 1, 2, 3, 4 and ≥ 5 comorbidities, respectively. In multivariable analyses, HIV-infection (hazard ratio [HR]: 5.16; 95% CI: 3.57–7.46), prior all-cause pneumonia (HR: 3.96; 95% CI: 3.45–4.55), haematological neoplasia (HR: 2.71; 95% CI: 2.06–3.57), chronic respiratory disease (HR: 2.66; 95% CI: 2.47–2.86) and prior IPD (HR: 2.56; 95% CI: 2.03–3.24) were major predictors for PP. Conclusion: Apart of increasing age and immunocompromising conditions (classically recognised as high-risk conditions), history of prior IPD/pneumonia, presence of chronic pulmonary/respiratory disease and/or co-existing multi-comorbidity (i.e., two or more underlying conditions) are major risk factors for PP in adults, with an excess risk near to immunocompromised subjects. Redefining risk categories for PP, including all the above-mentioned conditions into the high-risk category, could be necessary to improve prevention strategies in middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH. Methods: A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors. Results: Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71–5.15) and Mental Health (MH) (B 5.08, 3.81–6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14–4.02; AI 2.69, 0.15–5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26–5.71), low income and perception of social isolation (AI 2.79, 0.27–5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99–5.91) on MH. Conclusion: These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes. [ABSTRACT FROM AUTHOR]

Background: Since March of 2020, the scientific community has been engaged a marathon to answer the different questions that COVID-19 pandemic has brought. During this time, Ethics Committees played an important role in reviewing the research protocols, COVID-19 or not, ensuring that the quality of scientific research is not relaxed by the hasty need for answers. Methods: Descriptive study from January 2019 to December 2021, comparing COVID-19 protocols to those not COVID-19 related protocols and comparing the work overload. Variables related to the characteristics of the research protocols (i.e. study design, funding...), the principal investigators (gender, PhD degree, professional role...) and outcomes of the Ethics Committee process (requirements of modifications and time until approval) were analyze. Results: The number of sessions increased during COVID-19 pandemics (12 in 2019, 25 in 2020 and 18 in 2021). In total 751 protocols were evaluated during the study period; 513 (68.3%) had an observational design and 434 (57.8%) had no funding. The principal investigator was a woman in 491 (65.4%) studies and a General Practitioner in 330 (43.9%). The mean of the days until the protocol approval was 42.09 days (SD 60.2) with a decrease of 20.1 days from 2019 to 2021. A total of 614 (81.7%) protocols were approved, 336 (54.7%) within the first month after their initial evaluation. Less than half of the protocols were COVID-19 related (208, 44.3%). The COVID-19 protocols main topics were impact on the population (71, 34.1%); and COVID-19 pharmacological treatments (including vaccines) showed a higher increase in 2021 (37, 30.3%). Conclusions: Despite the work overload during the pandemic due to the increase in the number of meetings and protocols, the IDIAPJGol EC reviewed all of them (COVID-19 or not) adapting to the new situation but according to its criteria of good practices to provide a quick response in the EC opinion. In Primary Health Care the most study designs have been observational studies, many of them with no funding and led by GPs. In 2021 there was an increase in the number of protocols focused on drugs, most likely related to COVID-19 vaccines studies. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy ageing. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for decreased IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the performance of diagnostic measures (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults. Methods: Cross-sectional analysis of the baseline of the ongoing VIMCI (Validity of an Instrument to Measure Intrinsic Capacity) cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients' visit. Agreement was assessed with the Gwet AC1 index. Results: ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842. Conclusion: The ICOPE screening tool showed fair performance of diagnostic measures; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify decreased IC in older people with high degree of autonomy. Since low sensitivities were found, a process of external validation would be recommended to reach better discrimination. Further studies about the ICOPE Screening tool and its performance of diagnostic measures in different populations are urgently required. [ABSTRACT FROM AUTHOR]

Background: The Results Centre is the name of a project that, since 2012, has been openly publishing the results of each healthcare centre in Catalonia, with the idea of promoting benchmarking among centres and transparency toward society. As the project evolves, it has become increasingly necessary to adapt its contents and formats. The objective of this study is to identify the preferences and expectations of healthcare leaders regarding the Results Centre.Methods: A qualitative study was conducted using the nominal group technique. Five nominal groups were created with the participation of 58 professionals (26 from hospital care, 16 from primary care, and 16 from long-term care centres). The areas of analysis were: (1) what the Results Centre of the future should be like; (2) what information needs should be addressed; and (3) what novelties should be incorporated to stimulate quality improvement. The spontaneity of ideas, intensity of recommendations, and intergroup consistency were analysed. The study was conducted in April 2019.Results: The requirements reported by the participants to be met by the Results Centre included: being a tool for benchmarking and strategic decision-making; adjusted and segmented indicators; non-clinical information (patient experience, socio-economic status, etc.); and data accessible to all stakeholders, including citizens. The ideas were consistent across the different levels of care, although the intensity of recommendations varied depending on their content.Conclusions: Regional agencies that are accountable for health outcomes should be consistently committed to adapting to the needs of different stakeholders in the health system. This project is an example of how this requirement has been addressed in Catalonia. [ABSTRACT FROM AUTHOR]

Background: Primary care plays a central role in the treatment of depression. Nonetheless, shortcomings in its management and suboptimal outcomes have been identified. Collaborative care models improve processes for the management of depressive disorders and associated outcomes. We developed a strategy to implement the INDI collaborative care program for the management of depression in primary health care centers across Catalonia. The aim of this qualitative study was to evaluate a trial implementation of the program to identify barriers, facilitators, and proposals for improvement.Methods: One year after the implementation of the INDI program in 18 public primary health care centers we performed a qualitative study in which the opinions and experiences of 23 primary care doctors and nurses from the participating centers were explored in focus groups. We performed thematic content analysis of the focus group transcripts.Results: The results were organized into three categories: facilitators, barriers, and proposals for improvement as perceived by the health care professionals involved. The most important facilitator identified was the perception that the INDI collaborative care program could be a useful tool for reorganizing processes and improving the management of depression in primary care, currently viewed as deficient. The main barriers identified were of an organizational nature: heavy workloads, lack of time, high staff turnover and shortages, and competing demands. Additional obstacles were inertia and resistance to change among health care professionals. Proposals for improvement included institutional buy-in to guarantee enduring support and the organizational changes needed for successful implementation.Conclusions: The INDI program is perceived as a useful, viable program for improving the management of depression in primary care. Uptake by primary care centers and health care professionals, however, was poor. The identification and analysis of barriers and facilitators will help refine the strategy to achieve successful, widespread implementation.Trial Registration: ClinicalTrials.gov identifier: NCT03285659 ; Registered 18th September, 2017. [ABSTRACT FROM AUTHOR]

Background: Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases.Methods: Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values.Results: We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative.Conclusions: The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries. [ABSTRACT FROM AUTHOR]

Key message: We present a structured and curated database covering 21 years of LFMC measurements in the Catalan region, along with an associated R package to manage updates and facilitate quality processing and visualisation. The data set provides valuable information to study plant responses to drought and improve fire danger prediction. Dataset access is athttps://doi.org/10.5281/zenodo.4675335, and associated metadata are available athttps://metadata-afs.nancy.inra.fr/geonetwork/srv/fre/catalog.search#/metadata/583fdbae-3200-4fa7-877c-54df0e6c5542. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is one of the complications of COVID-19. Primary care electronic health records (EHR) have shown the utility as a surveillance system. We therefore analyse the trends of pneumonia during two waves of COVID-19 pandemic in order to use it as a clinical surveillance system and an early indicator of severity.Methods: Time series analysis of pneumonia cases, from January 2014 to December 2020. We collected pneumonia diagnoses from primary care EHR, a software system covering > 6 million people in Catalonia (Spain). We compared the trend of pneumonia in the season 2019-2020 with that in the previous years. We estimated the expected pneumonia cases with data from 2014 to 2018 using a time series regression adjusted by seasonality and influenza epidemics.Results: Between 4 March and 5 May 2020, 11,704 excess pneumonia cases (95% CI: 9909 to 13,498) were identified. Previously, we identified an excess from January to March 2020 in the population older than 15 years of 20%. We observed another excess pneumonia period from 22 october to 15 november of 1377 excess cases (95% CI: 665 to 2089). In contrast, we observed two great periods with reductions of pneumonia cases in children, accounting for 131 days and 3534 less pneumonia cases (95% CI, 1005 to 6064) from March to July; and 54 days and 1960 less pneumonia cases (95% CI 917 to 3002) from October to December.Conclusions: Diagnoses of pneumonia from the EHR could be used as an early and low cost surveillance system to monitor the spread of COVID-19. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

Background: Frailty in older adults is a common multidimensional clinical entity, a state of vulnerability to stressors that increases the risk of adverse outcomes such as functional decline, institutionalization or death. The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥70 years in home care programmes (HC) and nursing homes (NH), and to develop the corresponding prediction models.Methods: A prospective cohort study was conducted in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005-2013). The cohort was made up of 616 individuals. Data collection included a baseline multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, and the Central Registry of Catalonia for mortality. A prognostic index for a HC and NH at 8 years was estimated for each patient. Death prior to these events was considered a competing risk event, and Fine-Gray regression models were used.Results: At baseline, mean age was 76.4 years and 55.5% were women. During follow-up, 19.2% entered a HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in a HC program. Multivariate models for a HC and NH showed that the risk of a HC entry was associated with older age, dependence on the Instrumental Activities of Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of Daily Living, number of prescriptions, and the presence of social risk.Conclusions: Prognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of older adults in primary healthcare centers. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) denotes the profile of a child with diverse acute and chronic conditions, making intensive use of the healthcare services and with special health and social needs. Previous studies show that CMC are also affected by the socioeconomic position (SEP) of their family. The aim of this study is to describe the pathologic patterns of CMC and their socioeconomic inequalities in order to better manage their needs, plan healthcare services accordingly, and improve the care models in place.Methods: Cross-sectional study with latent class analysis (LCA) of the CMC population under the age of 15 in Catalonia in 2016, using administrative data. LCA was used to define multimorbidity classes based on the presence/absence of 57 conditions. All individuals were assigned to a best-fit class. Each comorbidity class was described and its association with SEP tested. The Adjusted Morbidity Groups classification system (Catalan acronym GMA) was used to identify the CMC. The main outcome measures were SEP, GMA score, sex, and age distribution, in both populations (CMC and non-CMC) and in each of the classes identified.Results: 71% of the CMC population had at least one parent with no employment or an annual income of less than €18,000. Four comorbidity classes were identified in the CMC: oncology (36.0%), neurodevelopment (13.7%), congenital and perinatal (19.8%), and respiratory (30.5%). SEP associations were: oncology OR 1.9 in boys and 2.0 in girls; neurodevelopment OR 2.3 in boys and 1.8 in girls; congenital and perinatal OR 1.7 in boys and 2.1 in girls; and respiratory OR 2.0 in boys and 2.0 in girls.Conclusions: Our findings show the existence of four different patterns of comorbidities in CMC and a significantly high proportion of lower SEP children in all classes. These results could benefit CMC management by creating more efficient multidisciplinary medical teams according to each comorbidity class and a holistic perspective taking into account its socioeconomic vulnerability. [ABSTRACT FROM AUTHOR]

Background: The implementation of individual clinical practice guidelines in patients with multimorbidity often results in polypharmacy. Our aim was to analyse medication use according to longitudinal multimorbidity patterns (MP) and determine during a 5-year period (2012-16) which MP are associated with abnormal liver and kidney function in primary care patients over 65 years of age living in Catalonia.Methods: Design: Longitudinal study (years 2012 to 2016) based on the electronic health records contained in Information System for Research in Primary Care database of the Catalan Institute of Health (SIDIAP).Variables: age, sex, MP, medication and polypharmacy (drug exposure obtained from the Pharmacy Invoice Registry). Medicines were classified in accordance with the Anatomical Therapeutic Chemical Classification System (ATC). Glomerular filtration rate was used to determine abnormal kidney function, and serum levels of alkaline phosphatase, alanine transaminase and gamma-glutamyl transpeptidase were used to diagnose abnormal liver function.Statistics: For medication use in MP, we calculated annual mean packages of each drug in each MP, and observed/expected ratios were obtained by dividing mean packages in the cluster by mean packages of the same drug in the overall population. Logistic regression models were fitted to estimate the association between MP at baseline and abnormal kidney and liver function tests during follow up.Results: Nine hundred sixteen thousand six hundred nineteen patients were included, and 743,827 completed the follow up. We identified one polypharmacy profile per MP, and concluded that the most prescribed drugs in each pattern corresponded to the diseases overrepresented in that specific MP. The median of drugs ranged from 3 (Cluster 1 - Non-Specific) to 8 (Cluster 10 - Multisystem Pattern). Abnormal kidney function was most commonly observed in the Cluster 4 - Cardio-Circulatory and Renal (Odds Ratio [OR] 2.19; Confidence interval [CI] 95% 2.15-2.23) and Cluster 3 - Minority Metabolic Autoimmune-Inflammatory (OR 2.16; CI 95% 2.12-2.20) MP. A higher risk of abnormal liver function was observed in the Cluster 8 - Digestive (OR 3.39; CI 95% 3.30-3.49), and Cluster 4 - Cardio-Circulatory and Renal (OR 1.96; CI 95% 1.91-2.02) MP.Conclusions: A higher risk of abnormal kidney and liver function was observed in specific MP. The long-term characterisation of MP and polypharmacy illustrates the burden of chronic multimorbidity and polypharmacy in the elderly population. [ABSTRACT FROM AUTHOR]

Background: Planning population care in a specific health care setting requires deep knowledge of the clinical characteristics of the target care recipients, which tend to be country specific. Our area virtually lacks any descriptive, far-reaching publications about institutionalized older people (IOP). We aimed to investigate the demographic and clinical characteristics of institutionalized older people (IOP) ≥65 years old and compare them with those of the rest of the population of the same age.Methods: Retrospective analysis (total cohort approach) of clinical and resource-use characteristics of IOP and non-IOP older than 65 years in Catalonia (North-East Spain). Variables analysed included age and sex, diagnoses, morbidity burden-using Adjusted Morbidity Groups (GMA, Grupos de Morbilidad Ajustada)-, mortality, use of resources, and medications taken. All data were obtained from the administrative database of the local healthcare system.Results: This study included 93,038, 78,458, 68,545 and 67,456 IOP from 2011, 2013, 2015 and 2017, respectively. In this interval, an increase in median age (83 vs. 87 years), in women (68.64% vs. 72.11%) and in annual mortality (11.74% vs. 20.46%) was observed. Compared with non-IOP (p < 0.001 in all comparisons), IOP showed a higher annual mortality (20.46% vs. 3.13%), a larger number of chronic diseases (specially dementia: 46.47% vs. 4.58%), higher multimorbidity (15.2% vs. 4.2% with GMA of maximum complexity), and annual admissions to acute care (47.6% vs. 27.7%) and skilled nursing facilities (27.8% vs. 7.4%), mean length of hospital stay (10.0 vs. 7.2 days) and mean of medications taken (11.7 vs. 8.0).Conclusions: There is a growing gap between the clinical and demographic characteristics of age-matched IOP and non-IOP, which overlaps with a higher mortality rate of IOP. The profile of resources utilization of IOP compared with non-IOP strongly suggests a deficiency of preventive actions and stresses the need to rethink the care model for IOP from a social and health care perspective. [ABSTRACT FROM AUTHOR]

Background: The analysis of real-world data in clinical research is rising, but its use to study dementia subtypes has been hardly addressed. We hypothesized that real-world data might be a powerful tool to update AD epidemiology at a lower cost than face-to-face studies, to estimate the prevalence and incidence rates of AD in Catalonia (Southern Europe), and to assess the adequacy of real-world data routinely collected in primary care settings for epidemiological research on AD. Methods: We obtained data from the System for the Development of Research in Primary Care (SIDIAP) database, which contains anonymized information of > 80% of the Catalan population. We estimated crude and standardized incidence rates and prevalences (95% confidence intervals (CI)) of AD in people aged at least 65 years living in Catalonia in 2016. Results: Age- and sex-standardized prevalence and incidence rate of AD were 3.1% (95%CI 2.7–3.6) and 4.2 per 1000 person-years (95%CI 3.8–4.6), respectively. Prevalence and incidence were higher in women and in the oldest people. Conclusions: Our incidence and prevalence estimations were slightly lower than the recent face-to-face studies conducted in Spain and higher than other analyses of electronic health data from other European populations. Real-world data routinely collected in primary care settings could be a powerful tool to study the epidemiology of AD. [ABSTRACT FROM AUTHOR]

Background: In addition to outbreaks of nosocomial influenza, sporadic nosocomial influenza infections also occur but are generally not reported in the literature. This study aimed to determine the epidemiologic characteristics of cases of nosocomial influenza compared with the remaining severe cases of severe influenza in acute hospitals in Catalonia (Spain) which were identified by surveillance.Methods: An observational case-case epidemiological study was carried out in patients aged ≥18 years from Catalan 12 hospitals between 2010 and 2016. For each laboratory-confirmed influenza case (nosocomial or not) we collected demographic, virological and clinical characteristics. We defined patients with nosocomial influenza as those admitted to a hospital for a reason other than acute respiratory infection in whom ILI symptoms developed ≥48 h after admission and influenza virus infection was confirmed using RT-PCR. Mixed-effects regression was used to estimate the crude and adjusted OR.Results: One thousand seven hundred twenty-two hospitalized patients with severe laboratory-confirmed influenza virus infection were included: 96 (5.6%) were classified as nosocomial influenza and more frequently had > 14 days of hospital stay (42.7% vs. 27.7%, P < .001) and higher mortality (18.8% vs. 12.6%, P < .02). The variables associated with nosocomial influenza cases in acute-care hospital settings were chronic renal disease (aOR 2.44 95% CI 1.44-4.15) and immunodeficiency (aOR 1.79 95% CI 1.04-3.06).Conclusions: Nosocomial infections are a recurring problem associated with high rates of chronic diseases and death. These findings underline the need for adherence to infection control guidelines. [ABSTRACT FROM AUTHOR]

Background: Despite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres.Methods/design: A cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out.Discussion: The ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines.Trial Registration: ClinicalTrials.gov, NCT03931577. [ABSTRACT FROM AUTHOR]

Background: Mumps is a vaccine-preventable disease but outbreaks have been reported in persons vaccinated with two doses of MMR vaccine. The objective was to describe the demographic features, vaccination effectiveness and genetic mumps virus diversity among laboratory-confirmed cases between 2007 and 2011 in Catalonia.Methods: Cases and outbreaks of mumps notified to the notifiable diseases system of Catalonia between 2007 and 2011 retrospectively registered were included. Public health care centres provided written immunization records to regional public health staff to determine the vaccination history. Saliva and serum specimens were collected from suspected cases for laboratory-confirmation using real-time reverse-transcriptase PCR (rtRT-PCR) or serological testing. Phylogenetic analysis of the complete SH gene (316 nucleotides) and complete coding HN protein (1749 nucleotides) sequences was made. Categorical variables were compared using the Chi-square or Fisher's tests and continuous variables using the Student test. Vaccination effectiveness by number of MMR doses was estimated using the screening method.Results: During the study period, 581 confirmed cases of mumps were notified (incidence rate 1.6 cases/100,000 persons-year), of which 60% were male. Three hundred sixty-four laboratory-confirmed cases were reported, of which 44% were confirmed by rtRT-PCR. Of the 289 laboratory-confirmed cases belonging to vaccination cohorts, 33.5% (97) had received one dose of MMR vaccine and 50% (145) two doses. Based on phylogenetic analyses of 316-nucleotide and 174-nucleotide SH sequences, the viruses belonging to viral genotypes were: genotype G (126), genotype D (23), genotype H (2), genotype F (2), genotype J (1), while one remained uncharacterized. Amino acid differences were detected between circulating strains and the Jeryl Lynn vaccine strains, although the majority of amino acid substitutions were genotype-specific. Fifty-one outbreaks were notified that included 324 confirmed mumps cases. Genotype G was the most frequent genotype detected. The family (35%), secondary schools (25%) and community outbreaks (18%) were the most frequent settings.Conclusions: Our study shows that genotype G viruses are the most prevalent in Catalonia. Most cases occurred in people who had received two doses of MMR, suggesting inadequate effectiveness of the Jeryl Lynn vaccine strain. The possible factors related are discussed. [ABSTRACT FROM AUTHOR]

Background: Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants).Methods: The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability.Discussion: The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection.Trials Registration: NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018). [ABSTRACT FROM AUTHOR]

Background: The integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system.Methods: A descriptive-interpretative qualitative study was conducted using a phenomenological approach. A two-stage theoretical sample was selected: (i) the study contexts: healthcare areas in Catalonia with different services management models; (ii) users ≥ 18 years of age who were attended to at both care levels for the same health problem. Data were collected by means of individual semi-structured interviews with patients (n = 49). All interviews were recorded and transcribed. A thematic content analysis was conducted segmented by study area, with a mixed generation of categories and triangulation of analysts.Results: Patients in all three areas generally perceived that continuity of clinical management across levels existed, on referring to consistent care (same diagnosis and treatment by doctors of both care levels, no incompatibilities of prescribed medications, referrals across levels when needed) and accessibility across levels (timeliness of appointments). In terms of continuity of information, patients in most areas mentioned the existence of information sharing via computer and its adequate usage. Only a few discontinuity elements were reported such as long waiting times for specific tests performed in secondary care or insufficient use of electronic medical records by locum doctors. Different factors influencing continuity were identified by patients, relating to the health system itself (clear distribution of roles between primary and secondary care), health services organizations (care coordination mechanisms, co-location, insufficient resources) and physicians (willingness to collaborate, commitment to patient care, the primary care physician's technical competence).Conclusions: Care continuity across care levels is experienced by patients in the areas studied, with certain exceptions that highlight where there is room for improvement. Influencing factors offer valuable insights on where to direct coordination efforts. [ABSTRACT FROM AUTHOR]

Background: Lifestyle is intimately related to health. A questionnaire that specifically scores the healthiness of lifestyle of Catalan adolescents is needed. The objective of this study was to develop and validate a scoring questionnaire called VISA-TEEN to assess the healthy lifestyle of young Catalans that can be answered quickly and user-friendly.Methods: A lifestyle questionnaire was developed based on the analysis of contributions from two focus groups, one with adolescents and the other with people who work with them (teachers and doctors). A panel of experts validated the content of items that were ultimately selected for the VISA-TEEN questionnaire. Three hundred ninety-six adolescents (215 boys and 181 girls, age = 13-19 years) completed the VISA-TEEN. Internal consistency was assessed using Cronbach's alpha (α) reliability coefficient. Test-retest reliability, using an intraclass correlation coefficient (ICC), was calculated based on scores attained two weeks apart. Construct validity was assessed by the extraction of components with an exploratory factor analysis. The relationship between the scores was measured using the health-related quality of life (HRQoL) KIDSCREEN-10 Index (the relationship was assessed by calculating Pearson's r correlation coefficient). The association of scores in the VISA-TEEN for self-rated health (SRH) was also examined by executing an analysis of variance (ANOVA) between the different categories of this variable. We also calculated the index of fit for factor scales (IFFS) for each component, as well as the discriminatory power of the instrument using Ferguson's δ (delta) coefficient.Results: The VISA-TEEN questionnaire showed acceptable reliability (α = 0.66, αest = 0.77) and a very good test-retest agreement (ICC = 0.860). It could be broken down into the following five components, all with an acceptable or very good IFFS (0.7-0.96): diet, substance abuse, physical activity, Rational Use of Technological Leisure (RUTL), and hygiene. Scores on the VISA-TEEN showed significant correlation with the KIDSCREEN index (r = 0.21, p < 0.001) and were associated with SRH (p < 0.001). The discriminatory power was found to be δ = 0.97.Conclusions: The VISA-TEEN questionnaire developed to study the lifestyle of Catalan adolescents is a valid instrument to apply in this population as it is shown in the present psychometric tests to understand the role of lifestyle in the health of teenagers or to test the efficacy of health campaigns intended to improve teenagers' lifestyle. [ABSTRACT FROM AUTHOR]

Background: Emotional distress is common in adolescence, and self-care strategies are frequently preferred to address it. The aim of this article is to analyze the self-care strategies among adolescents and young people diagnosed with depression or with self-perceived depressive distress in Catalonia using a qualitative design. Methods: We analyzed the self-care strategies of 105 young people (17-21 years of age) in Catalonia who had participated in a national survey on adolescents. The sample was divided into thirds, with 37 who had a previous diagnosis of depression, 33 who had self-perceived emotional distress, and 35 controls. The participants' narratives on self-care strategies for emotional distress were elicited through in-depth semi-structured interviews. The data were managed using ATLAS-Ti 6.5 software18. We applied hermeneutic theory and the ethnographic method to analyze the interviews. Results: The ten self-care strategies identified in the analysis were grouped into four areas covering the various pathways the young people followed according to whether they had a diagnosis of depression or their depressive distress was self-perceived. The young people feel responsible for their emotional distress and consider that they are capable of resolving it through their own resources. Their strategies ranged from their individuality to sociability expressed through their relationships with others, membership of groups or other self-care strategies (relaxation, meditation, naturopathy, etc.). Conclusions: The study results highlight the importance of sensitivity in considering young people's self-care strategies as another option in the care of emotional distress. [ABSTRACT FROM AUTHOR]

Background: A key question in evolutionary biology is the relationship between species traits and their habitats. Caves offer an ideal model to test the adjustment of species to their surrounding temperature, as they provide homogeneous and simple environments. We compared two species living under different thermal conditions within a lineage of Pyrenean beetles highly modified for the subterranean life since the Miocene. One, Troglocharinus fonti, is found in caves at 4-11°C in the ancestral Pyrenean range. The second, T. ferreri, inhabits the coastal area of Catalonia since the early Pliocene, and lives at 14-16°C. Results: We found no differences in their short term upper thermal limit (ca. 50°C), similar to that of most organisms, or their lower thermal limit (ca. -2.5°C), higher than for most temperate insects and suggesting the absence of cryoprotectants. In longer term tests (7 days) survival between 6-20°C was almost 100% for both species plus two outgroups of the same lineage, but all four died between 23-25°C, without significant differences between them. Conclusions: Our results suggest that species in this lineage have lost some of the thermoregulatory mechanisms common in temperate insects, as their inferred default tolerance range is larger than the thermal variation experienced through their whole evolutionary history. [ABSTRACT FROM AUTHOR]

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The article focuses on the research article presented by Maria Rubio-Valera and colleagues on the factors that affect the relationship between general practitioners (GPs) and community pharmacists (CPs) at Catalonia and Balearic Islands in Spain. It mentions that intervention of pharmacists in healthcare team improves patient's physical and mental conditions.

Introduction: This article explores the possibility of including multiple spatial scales into a mixed model for predicting the density of human-caused fire ignitions in Catalonia (North-East Spain). Methods: The location of the ignitions of all human-caused forest fires recorded in Catalonia during the period 1994-2007, including 7,847 human-caused fires, was considered as modeling data. Three spatial scales were considered in the modeling. The first or small spatial scale was defined by tiling 3,003 hexagonal plots of 1,000 ha each. The two remaining spatial scales were defined by the inclusion of the plots within municipality and county ( comarca) borders. Fire ignition density was estimated at plot level using proxy variables as predictors (elevation, presence of roads, density of pathways, and dominant land-use patterns). The administrative borders of municipality and county were used to allocate the spatial variation of ignition density not explained by the plot-level estimation. Conclusions: The results of the study highlight that human-caused ignitions present clear spatial aggregation patterns at different spatial scales, and that an analysis at a single spatial scale ignores explanatory factors affecting other scales. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area. [ABSTRACT FROM AUTHOR]

The article focuses on the study conducted to examine the effectiveness of a public healthcare strategy in order to prevent diabetes within a European primary care setting. It mentions that Type 2 diabetes is growing public health problem which can be prevented or delayed by lifestyle intervention. It also assess the effectiveness of an active real-life primary care strategy of the individuals, who has high risk for developing diabetes.

Background: The Primary Care Assessment Tool (PCAT) is an interesting set of tools for primary care research. A very short version could inform policy makers about consumer experiences with primary care (PC) through health surveys. This work aimed to investigate the validity and reliability of a selection of items from the child short edition (CS) of the PCAT. Methods: A 24 item questionnaire permitted the identification of a regular source of care and the assessment of the key attributes of first contact, ongoing care over time, coordination, services available and services received (comprehensiveness), and cultural competence. Structural validity, reliability, and construct validity were assessed using responses from 2,200 parents of a representative sample of the population aged 0 to 14 years in Catalonia (Spain) who participated in the 2006 Health Survey. Structural validity was analyzed using exploratory and confirmatory factor analyses and reliability was assessed using Cronbach's alpha. Construct validity was assessed using linear regression analysis between PC experience scores and a measure of overall user satisfaction with healthcare services. Results: A total of 2,095 (95.2%) parents provided useable responses on PC. After Confirmatory Factor Analysis (CFA), the best fitting model was a 5-factor model in which the original dimensions of first contact and ongoing care were collapsed into one. The CFA also showed a second order factor onto which all domains except services available loaded (root mean square error of approximation = 0.000; comparative fit index = 1.00). Cronbach's alpha values for one of the original scales (first-contact) was poor (alpha < 0.50), but improved using the modified factor structure (alpha > 0.70). Scores on the scales were correlated with satisfaction with healthcare services (p < 0.01), thereby providing some preliminary evidence of construct validity. Conclusions: This very short questionnaire obtained from the PCAT-CE yields information about five attributes of PC and a summary score. It has shown evidence of validity and reliability for judgments about experiences with primary care overall. If space on surveys is at a premium, the instrument could be useful as a measure of PC experiences. [ABSTRACT FROM AUTHOR]

The article presents a research study focusing on the core indicators evaluation of effectiveness of HIV-AIDS preventive-control programmes carried out by nongovernmental organizations in Catalonia, Spain. As stated, the results of the study could help to homogeneously assess the preventive-control activities carried out of AIDSNGOs. It states that furthermore, the Haddon matrix is helpful in identifying deficiencies of activities at intervention levels.