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INTRODUCTION: Chagas disease is considered the most serious parasitosis in America, forgotten and neglected in the world, with a characteristic that has its maximum expression in the difficulties and limitations for its diagnosis and treatment. OBJECTIVE: To assess the status of seropositivity of Chagas disease in Mexico, in addition to monitoring the effectiveness of treatment in infected patients. MATERIAL AND METHODS: Systematic reviews were conducted, with searches in Crossref, Google Scholar, Scielo, PubMed and the inclusion of guides and manuals of related health programs was evaluated based on their titles, news and relevance. RESULTS: for seropositivity, the data coincide with 100% in the characterization of the risk factors, as well as in the evaluations in the Blood Transfusion Centers of the country, finding captive cases in each state that explain the persistence of the disease . When monitoring treatments and evidence of effectiveness, the following difficulties arise: prolonged duration and side effects, adding the lack of reliable healing criteria, with an effectiveness of 60-75% in acute cases and in 100% of acute congenital cases, and in chronic cases a variation of between 15 and 30 years was found. CONCLUSIONS: Although the achievements have been commendable in reducing rates, the territory has factors that allow the redistribution of the infection, the evidence on the effectiveness is scarce, there is no evidence of epidemiological follow-up of cases in Mexico with respect to healing indicator.

© 2021 by the authors. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

Introduction Personalised cancer screening aims to improve benefits, reduce harms and being more cost-effective than age-based screening. The objective of the DECIDO study is to assess the acceptability and feasibility of offering risk-based personalised breast cancer screening and its integration in regular clinical practice in a National Health System setting. Methods and analysis The study is designed as a single-arm proof-of-concept trial. The study sample will include 385 women aged 40-50 years resident in a primary care health area in Spain. The study intervention consists of (1) a baseline visit; (2) breast cancer risk estimation; (3) a second visit for risk communication and screening recommendations based on breast cancer risk and (4) a follow-up to obtain the study outcomes. A polygenic risk score (PRS) will be constructed as a composite likelihood ratio of 83 single nucleotide polymorphisms. The Breast Cancer Surveillance Consortium risk model, including age, race/ethnicity, family history of breast cancer, benign breast disease and breast density will be used to estimate a preliminary 5-year absolute risk of breast cancer. A Bayesian approach will be used to update this risk with the PRS value. The primary outcome measures will be attitude towards, intention to participate in and satisfaction with personalised breast cancer screening. Secondary outcomes will include the proportions of women who accept to participate and who complete the different phases of the study. The exact binomial and the Student's t-test will be used to obtain 95% CIs. Ethics and dissemination The study protocol was approved by the Drug Research Ethics Committee of the University Hospital Arnau de Vilanova. The trial will be conducted in compliance with this study protocol, the Declaration of Helsinki and Good Clinical Practice. The results will be published in peer-reviewed scientific journals and disseminated in scientific conferences and media. Trial registration number NCT03791008. This study was supported by the research grant 'Personalized breast cancer screening: assessment of its feasibility and acceptability in the National Health System' (PI17/00834) from the Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa'. Celmira Laza Vásquez received a grant from Santander Program scholarship 2020 as a predoctoral fellow at the University of Lleida. The non-profit organisation Oncolliga Lleida (grant number N/A) will fund part of the genomic analyses for breast cancer risk assessment.

Background and objective To determine mortality and complications of patients with traumatic brain injury (TBI) with antiplatelet or anticoagulant treatment in a hospital emergency department. Materials and methods Study of hospital cohorts of the 243 patients who attended with pure TBI to the emergency service of the Arnau de Vilanova University Hospital in Lleida between June 1, 2015 and June 1, 2016. Sociodemographic, clinical and other variables related to clinical management were collected. Presence of complications and in-hospital mortality were registered at 24 h, at 48 h and one week after TBI. Results Overall, 50.2% of patients were men, with median age of 80.8 years, and without CT-scan findings at admission in 62.3% of cases. A total of 14 patients died (5.8%). Overall mortality was associated with comorbidity, with knowledge loss and with fluctuation of the Glasgow comma scale in the acute process. Patients treated with anticoagulants (39.5%) or antiplatelet agents (33.3%) were older, with higher degree of dependency and more comorbidity, but did not present more complications. Without reaching statistical significance, higher mortality was observed during the first week in anticoagulated patients (7.3% vs. 4.8%, p = 0.585) or with antiplatelet treatment (8.6% vs. 4.3%, p = 0.241) with respect to those not treated. Conclusions No worse results have been observed in number of complications in patients with TBI treated with anticoagulant or antiplatelet treatment, so clinical management seems appropriate. The higher mortality could be explained by the greater complexity of these patients. It would be necessary to carry out more studies, preferably prospective with follow-up after discharge , in order to establish causal mechanisms between clinical management and mortality or associated complications to TBI.

Background/objectives Molluscum contagiosum is the most common skin infection in children. One topical treatment used for Molluscum contagiosum is potassium hydroxide. The objective of this study was to compare the efficacy of potassium hydroxide topical treatment at different concentrations with that of placebo in terms of complete clearing of Molluscum contagiosum lesions and to assess the safety and tolerance of potassium hydroxide topical treatment. Methods This was a double-blind randomized clinical trial of three treatments (potassium hydroxide 10%, potassium hydroxide 15%, placebo) applied once daily up to complete clearing of lesions (maximum duration 60 days) in 53 children aged 2-6 years in primary health care pediatric offices in Catalonia, Spain. Results In the intention-to-treat analysis, potassium hydroxide 10% (58.8%, P = .03) and potassium hydroxide 15% (64.3%, P = .02) had efficacy superior to that of placebo (18.8%). The number of Molluscum contagiosum lesions was significantly reduced with potassium hydroxide 10% and 15%. The main efficacy outcome was achieved in 58.8% of children in the potassium hydroxide 10% group (P = .03 vs placebo) and in 64.3% of children in the potassium hydroxide 15% group (P = .02 vs placebo). Potassium hydroxide 10% and 15% were not significantly different in efficacy from each other. Potassium hydroxide 10% and placebo were better tolerated than potassium hydroxide 15%. No adverse events were reported during the study period. Conclusions Potassium hydroxide 10% and 15% demonstrated high rates of efficacy in clearing Molluscum contagiosum lesions, with potassium hydroxide 10% being better tolerated.

ResumenObjetivoDescribir el perfil clínico y de consumo farmacológico de los pacientes con registro diagnóstico de insuficiencia cardiaca (IC) en una región sanitaria, a partir de los registros informáticos. Ver si existen diferencias por sexos.DiseñoEstudio descriptivo transversal multicéntrico.EmplazamientoRegión Sanitaria de Lleida.ParticipantesToda la población adscrita a 21 centros de salud, diagnosticada de IC (3.017 de 306.229).Mediciones principalesDatos demográficos, comorbilidades y subgrupos terapéuticos en pacientes con el diagnóstico de IC en la historia clínica.ResultadosRegistro de IC 0,99%, 59% mujeres, media de edad 80 años. Antecedentes: hipertensión 67%, fibrilación auricular (FA) 31%, diabetes (DM2) 30%, obesidad 27%, dislipemia 26,5%, asma/EPOC 26%, cardiopatía isquémica (CI) 19%, accidente vascular cerebral (AVC) 11%, e insuficiencia renal (IR) 12%. Hipertensión, dislipemia y obesidad son más frecuentes en mujeres y EPOC, CI e IR en hombres. No hay diferencias en DM2, AVC ni FA. Mediana de consumo de subgrupos terapéuticos por paciente durante el 2007 de 8 (P25=6 y P75=11). Las mujeres tienen mayor prescripción de diuréticos (76% vs 71%), glucósidos cardíacos (22% vs 19.3%) e IECA/ARAII (68% vs 64%) y los hombres de tratamiento combinado IECA/ARAII+beta bloqueantes (26,9% vs 23,5%). Hay una tendencia a mayor prescripción de estos últimos en hombres sin ser significativa.ConclusionesLos pacientes diagnosticados de IC en Atención Primaria son de edad muy avanzada, presentan pluripatología asociada y consumen muchos fármacos. Existen diferencias por sexos tanto en factores de riesgo cardiovascular y enfermedades asociadas como en el perfil de consumo farmacológico.AbstractObjectiveTo assess heart failure prevalence, epidemiology, co-morbidities and polypharmacy in our region from electronic patient records. To evaluate gender differences in heart failure patients.DesignDescriptive, cross-sectional study.SettingPrimary care Lleida (Spain).ParticipantsAll patients from 21 primary care centers with the diagnosis of heart failure in medical records were included.Main outcome measurementsDemografic data, comorbidities and therapeutical subgroups in patients with a diagnosis of heart failure in their clinical record.ResultsHeart failure was found in 0.99% (3017 from 306229 patients), of whom 59% were women, and a mean age of 80 years. Comorbidities: hypertension 67%, diabetes 30%, hyperlipidemia 26.5%, obesity 27%, ischemic heart disease 19%, stroke 11%, atrial fibrillation 31%, COPD 26%, renal failure 12%. Hypertension, hyperlipidemia and obesity were more frequent in women, COPD, ischemic heart disease and renal failure in men. There were no differences in diabetes, stroke and atrial fibrillation. Patients were prescribed a median of 8 different therapeutic subgroups (P25=6 and P75=11). Women were more frequently prescribed diuretics (76%), cardiac glycosides (22%) and ACE inhibitors/angiotensin II receptor antagonists, and men ACE inhibitors/angiotensin II receptor antagonists in combination with beta-blockers.ConclusionsHeart failure patients in primary care are elderly, with significant co-morbidities and treated with a high number of drugs. Gender differences exist in cardiovascular risk factors, co-morbidities, and also in therapy.

IntroductionTreatment of childhood obesity is a complex challenge for primary health care professionals.ObjectivesTo evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake.MethodsRandomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-intervention.ResultsAt the end of the study period, both groups achieved a similar decrease in body mass index (BMIsd) compared to baseline. Nereu Program participants (n = 54) showed greater increases in moderate-intense physical activity (+6.27% vs. -0.61%, pConclusionsAt the end of the 8-month intervention, participants in the Nereu Program group showed improvement in physical activity and dietary behaviours, compared to the counselling group.Trial registrationClinicalTrials.gov NCT01878994.

Oral bisphosphonates are first-line drugs in the treatment of osteoporosis under most guidelines, and have been shown to decrease risk of first fracture only in asymptomatic vertebral fractures and in clinical trial populations that are generally very different from the general population. Objective To compare incidence of first osteoporotic fracture in two cohorts of postmenopausal women, one treated with bisphosphonates and the other only with calcium and vitamin D. Design Retrospective population cohort study with paired matching based on data from electronic health records. Setting Women aged 60 years and older in 2005, from 21 primary care centers in a healthcare region of Spain. Participants Two groups of women aged 60 years and older (n = 1208), prescribed either calcium and vitamin D (CalVitD) or bisphosphonates (BIPHOS) with or without calcium and vitamin D, were compared for the end point of first recorded osteoporotic-related fracture, with 5-years follow-up. Main Outcome Measure Incidence of first fracture: Vertebral fracture, osteoporosis with pathological fracture, fracture of the upper humeral epiphysis, fracture of the lower radial epiphysis, or femur fracture. Results Estimated 10-year risk of fracture was 11.4% (95% confidence interval: 9.6 to 13.2), 11.8% (9.2 to 14.3) in the BIPHOS group and 11.1% (8.6 to 13.6) in the CalVitD group. No significant differences were found between groups in total fractures (Hazard ratio = 0.934 (0.67 to 1.31)) or location (vertebral, femoral, radial or humeral). Conclusions In postmenopausal women, bisphosphonates have not been shown to better decrease risk of first fracture compared with calcium and vitamin D therapy alone.

Background: Obesity is mainly attributed to environmental factors. In developed countries, the time spent on physical activity tasks is decreasing, whereas sedentary behaviour patterns are increasing. The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multicomponent intervention (Nereu programme) and compared it to counselling intervention such as a health centre intervention programme for the management of children"s obesity. Methods/Design: The study design is a randomized controlled multicenter clinical trial using two types of interventions: Nereu and Counselling. The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention. This programme is based on a multidisciplinary intervention consisting of 4 components: physical activity sessions for children, family theoretical and practical sessions for parents, behaviour strategy sessions involving both, parents and children, and lastly, weekend extra activities for all. Counselling is offered to the family in the form of a monthly physical health and eating habits session. Participants will be recruited according the following criteria: 6 to 12 year-old-children, referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile (less than 2 hours per week of physical activity), they must live in or near the municipality of Lleida (Spain) and their healthcare paediatric unit must have previously accepted to cooperate with this study. The following variables will be evaluated: a) cardiovascular risk factors (anthropometric parameters, blood test and blood pressure), b) sedentary and physical activity behaviour and dietary intake, c) psychological aspects d) health related quality of life (HRQOL), e) cost-effectiveness of the intervention in relation to HRQOL. These variables will be then be evaluated 4 times longitudinally: at baseline, at the end of the intervention (8 months later), 6 and 12 months after the intervention. We have considered necessary to recruit 100 children and divide them in 2 groups of 50 to detect the differences between the groups. Discussion: This trial will provide new evidence for the long-term effects of childhood obesity management, as well as help to know the impact of the present intervention as a health intervention tool for healthcare centres. Trial registration: ClinicalTrials.gov, NCT01878994 This research is partially funded by the Instituto de Salud Carlos III in Spain, from the Ministry of Economy and Competitiveness with the expedient number PI12/02220, the Diputació de Lleida, the Department of Health of the Generalitat de Catalunya and the City Council of Lleida “La Paeria - Ajuntament de Lleida”. This research was supported by the Institute of Physical Education of Catalonia (INEFC), University of Lleida, Spain, (VCP/3570/2010, de 29 d’octubre, DOGC NÚM. 5753 – 11.11.2010; VCP/28/2009, 14 of January, DOGC NÚM. 5302 – 22/01/1999).

Background Molluscum contagiosum is a non-severe pediatric viral infection. Because it is highly contagious and current treatments have negative aesthetic and psychological effects, we want to test an alternative treatment in the primary care setting, consisting of two different concentrations of potassium hydroxide solution. Methods/design The study design is a double-blind, randomized clinical trial, using three types of topical treatment. The treatment consist of daily applications of potassium hydroxide (KOH) in aqueous solution at 10% and 15% concentration, and a placebo administered in the control group. Four follow-up visits (at 15, 30, 45 and 60 days) are planned to evaluate treatment effectiveness and patient tolerance. The main outcome measure of the trial will be the healing rate, defined as lesion disappearance in the affected zones after the topic application of the experimental treatment. Secondary measures will be the principal characteristics and evolution of the affected zone (surface area, number of lesions, size and density of lesions), treatment tolerance (hyperpigmentation, itching, burning, pain), recurrence rate and the natural evolution of lesions in the control group. Discussion KOH can potentially be an effective and safe treatment for MC in primary care, and can also reduce referrals to dermatologists and hospital pediatric departments. In addition, KOH may be a valid and less expensive alternative to current invasive treatments (surgical excision). Trial Registration ClinicalTrials.gov: NCT01348386

Background Gender-related differences are seen in multiple aspects of both health and illness. Ischemic heart disease (IHD) is a pathology in which diagnostic, treatment and prognostic differences are seen between sexes, especially in the acute phase and in the hospital setting. The objective of the present study is to analyze whether there are differences between men and women when examining associated cardiovascular risk factors and secondary pharmacological prevention in the primary care setting. Methods Retrospective descriptive observational study from January to December of 2006, including 1907 patients diagnosed with ischemic heart disease in the city of Lleida, Spain. The clinical data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies with official prescriptions. Data was analyzed using bivariate descriptive statistical analysis as well as logistic regression. Results There were no gender-related differences in screening percentages for arterial hypertension, diabetes, obesity, dyslipemia, and smoking. A greater percentage of women were hypertensive, obese and diabetic compared to men. However, men showed a tendency to achieve control targets more easily than women, with no statistically significant differences. In both sexes cardiovascular risk factors control was inadequate, between 10 and 50%. For secondary pharmaceutical prevention, the percentages of prescriptions were greater in men for anticoagulants, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, with age group variations up to 10%. When adjusting by age and specific diagnoses, differences were maintained for anticoagulants and lipid-lowering agents. Conclusion Screening of cardiovascular risk factors was similar in men and women with IHD. Although a greater percentage of women were hypertensive, diabetic or obese, their management of risk factors tended to be worse than men. Overall, a poor control of cardiovascular risk factors was noted. Taken as a whole, more men were prescribed secondary prevention drugs, with differences varying by age group and IHD diagnosis.

Exercise is related to many individual health outcomes but impact evaluations of exercise programmes are seldom conducted. The purpose of the study is to evaluate the feasibility of an exercise prescription intervention in primary health-care settings (CAMINEM Programme) located in two socially disadvantaged neighbourhoods. The CAMINEM was a pragmatic-driven intervention with opportunistic recruitment. It followed the 5As framework for health promotion and also the exercise training principles. Feasibility was evaluated using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Patients with non-communicable chronic diseases participated in a 12-month home-based moderate-intensity exercise program, counselled by exercise physiologists. Participants were grouped according to their physical activity behaviour at baseline and 6-month adherence. CAMINEM reached 1.49% (n = 229) of the eligible population (N = 15,374) and included a final sample of 178. Health outcomes for adhered participants followed positive patterns. Non-adhered participants visited their practitioner more compared to adhered participants. Thirty-three practitioners (40%) referred patients. Nurses referred four times more than physicians (81% and 19% respectively). The delivery of exercise prescriptions proved to be easy to complete and record by participants as well as easy to monitor and adjust by the exercise physiologists. One out of four participants adhered during the 12-month intervention. This intervention has been feasible in primary care in Catalonia, Spain, to safely prescribe home-based exercise for several conditions. This research was funded by the Secretaria General de l’Esport and the Departament d’Innovació, Universitats i Empresa, Generalitat de Catalunya with a competitive grant for junior researchers, grant number 006780 Ordre 001.

Background: The primary aim of this study is to evaluate the effectiveness of different doses (intensity) of supervised exercise training — concomitant with lifestyle counselling — as a primary care intervention tool for the management of metabolic syndrome risk factors in low-active adults with one or more such factors (programme name in Catalan: Bellugat de CAP a peus). Methods/Design: Three-arm, randomized controlled clinical trial implemented in the primary care setting, with a duration of 40 weeks (16 weeks intervention and 24-week follow-up). Adults aged 30 to 55 years with metabolic risk factors will be randomized into three intervention groups: 1) aerobic interval training (16 supervised training lessons) plus a healthy lifestyle counselling programme (6 group and 3 individual meetings); 2) low-to-moderate intensity continuous training (16 supervised training lessons) plus the same counselling programme; or 3) the counselling- programme without any supervised physical exercise. The main output variables assessed will be risk factors for metabolic syndrome (waist circumference, blood pressure, and levels of plasma triglycerides, high-density lipoproteins and glucose), systemic inflammation, cardiorespiratory fitness, physical activity and sedentary behaviour, dietary habits, health-related quality of life, self-efficacy and empowerment. Economic factors will also be analysed in order to determine the cost-effectiveness of the programme. These variables will be assessed three times during the study: at baseline, at the end of the intervention, and at followup. We estimate to recruit 35 participants per group. Discussion: The results of this study will provide insight into the immediate and medium-term effects on metabolic risk and lifestyle of a combined approach involving aerobic interval training and a multidisciplinary behavioural intervention. If effective, the proposed intervention would provide both researchers and practitioners in this field with a platform on which to develop similar intervention programmes for tackling the repercussions of an unhealthy lifestyle. Trial registration: Clinical trials.gov. NTC02832453. Registered 6 July 2016 (retrospectively registered). The study has been peer-reviewed (blinded) and quoted (6.4/7) by the AGAUR (Agency for Management of University and Research Grants) of the government of Catalonia (Generalitat de Catalonia). GE has been granted for hers’ participation to the study as a PhD student. (Ref: 2014-PINEF-00003. PRE/2448/2014, de 30 October, DOGC num 6743–5.11.2014). This funding source had no role in the design of this study and will not have any role during its execution, analyses or interpretation of the data. The study is mainly supported by the National Institute of Physical Education (INEFC)-Centre de Lleida. The funding covers central organisation, design, management, assessments, and analysis and reporting of the study. INEFC has also provided funding’s to support the printing of educational resources (Funding’s to research-2015) and partially blood analysis reagents (Funding’s to research-2016). The Catalonian Health Institute (ICS) provides the setting for the counselling sessions and supports recruitment, phlebotomy and general blood analysis. Ekke’s sport centre (local sport centre) provides the setting and the necessary equipment for the physical exercise sessions. The department of Experimental Medicine of the University of Lleida supports blood specimens’ storage and metabolomics/lipidomics and miRNA blood analysis. The Primary Care Research Institute (IDIAP) Jordi Gol provides support for the randomization and statistical analysis of data. The Development of Healthy Organizations and Territories (DOTS) group of the University of LLeida and the Diputació de Lleida provided funding’s to support partially miRNA blood analysis and the execution of physical activity sessions (Funding to research 25-07-2016).