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Background: The coronavirus disease 2019 (COVID-19) pandemic continues to affect the globe. After 18 months of the SARS-CoV-2 emergence, clinicians have clearly defined a subgroup of patients with lasting, disabling symptoms. While big strides have been made in understanding the acute phase of SARS-CoV-2 infection, the pathophysiology of long COVID is still largely unknown, and evidence-based, effective treatments for this condition remain unavailable. Objectives: To evaluate the efficacy of 10 mg oral montelukast every 24 h versus placebo in improving quality of life associated with mild to moderate respiratory symptoms in patients with long COVID as measured with the COPD Assessment Test (CAT) questionnaire. The secondary objectives will evaluate the effect of montelukast versus placebo on improving exercise capacity, COVID-19 symptoms (asthenia, headache, mental confusion or brain fog, ageusia, and anosmia), oxygen desaturation during exertion, functional status, and mortality. Methods and analysis: Phase III, randomized, double-blind clinical trial. We will include 18- to 80-year-old patients with SARS-CoV-2 infection and mild to moderate respiratory symptoms lasting more than 4 weeks. Participants will be randomly allocated in a 1:1 ratio to the intervention (experimental treatment with 10 mg/day montelukast) or the control group (placebo group), during a 28-day treatment. Follow-up will finish 56 days after the start of treatment. The primary outcome will be health-related quality of life associated with respiratory symptoms according to the COPD Assessment Test 4 weeks after starting the treatment. The following are the secondary outcomes: (a) exercise capacity and oxygen saturation (1-min sit-to-stand test); (b) Post-COVID-19 Functional Status Scale; (c) other symptoms: asthenia, headache, mental confusion (brain fog), ageusia, and anosmia (Likert scale); (d) use of healthcare resources; (e) mortality; (f) sick leave duration in days; and (g) side effects of montelukast. Ethics and dissemination: This study has been approved by the Clinical Research Ethics Committee of the IDIAPJGol (reference number 21/091-C). The trial results will be published in open access, peer-reviewed journals and explained in webinars to increase awareness and understanding about long COVID among primary health professionals. Trial registration: ClinicalTrials.govNCT04695704. Registered on January 5, 2021. EudraCT number 2021-000605-24. Prospectively registered. [ABSTRACT FROM AUTHOR]

Background Tobacco smoke pollution (TSP) has major negative effects on infant health. Our objectives were to determine the effectiveness of a brief primary care intervention directed at parents who smoke in reducing babies’ TSP exposure, and to establish variables related to greater exposure. Method A multicentre, open, cluster-randomised clinical trial in Catalonia. The 83 participating primary health paediatric teams of the Catalan Health Service recruited 1101 babies whose parents were smokers. The intervention group (IG) received a brief TSP intervention; the control group (CG) received the usual care. Outcomes were measured by parents’ reported strategies to avoid TSP exposure. Baseline clinical data and characteristics of each baby’s TSP exposure were collected, along with infant hair samples and parents’ tobacco use and related attitudes/behaviours. At 3-month and 6-month follow-up, behavioural changes to avoid TSP exposure were recorded; the association between reported parental behaviours and nicotine concentration in infant hair samples was tested in a random sample of 253 babies at baseline and 6 months. Results During follow-up, TSP-avoidance strategies improved more in the IG than in the CG: 35.4% and 26.9% ( p=0.006) at home, and 62.2% and 53.1% in cars (p=0.008). Logistic regression showed adjusted ORs for appropriate measures in the IG versus CG of 1.59 (95% CI 1.21 to 2.09) at home and 1.30 (95% CI 0.97 to 1.75) in cars. Hair samples showed that 78.7% of the babies tested were exposed. Reduced nicotine concentration was associated with improved implementation of effective strategies reported by parents at home (p=0.029) and in cars (p=0.014). Conclusions The intervention produced behavioural changes to avoid TSP exposure in babies. The proportion of babies with nicotine (>=1ng/mg) in hair samples at baseline is a concern. [ABSTRACT FROM AUTHOR]

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Little is known on how posterior canal BPPV affects health-related quality of life in patients diagnosed and treated at primary care facilities or on whether patients with subjective and objective disease perceive the effects differently. This study was designed to describe how patients diagnosed with posterior canal BPPV in primary care perceive disability. Methods: Cross-sectional descriptive study performed at two urban primary care centers. Participants were patients aged 18 years or older with suspected posterior canal BPPV recruited for baseline evaluation in a clinical trial on the effectiveness of the Epley maneuver in primary care. The recruitment period was from November 2012 to January 2015. Perceived disability was evaluated using the Dizziness Handicap Inventory – Screening version (DHI-S). Other variables collected were age and sex, a history or diagnosis of anxiety or depression, treatment with antidepressants and/or anxiolytics, and results of the Dix-Hallpike (DH) test, which was considered positive when it triggered vertigo with or without nystagmus and negative when it triggered neither. Results: The DH test was positive in 134 patients, 40.30% of whom had objective BPPV (vertigo with nystagmus). The median age of the patients was 52 years (interquartile range [IQR], 39.00–68.50 years) and 76.1% were women. The median total score on the DHI-S was 16 out of 40 (IQR, 8.00–22.00). Scores were higher (greater perceived disability) in women (p < 0.001) and patients with subjective BPPV (vertigo without nystagmus) (p = 0.033). The items perceived as causing the greatest disability were feeling depressed (67.1%) and worsening of the condition on turning over in bed (88%). Conclusions: Patients diagnosed with posterior canal BPPV in primary care perceive their condition as a disability according to DHI-S scores, with higher levels of disability reported by women and patients with subjective BPPV. Feelings of depression and turning over in bed were associated with the greatest perceived difficulties. Trial registration: ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513 [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of the risk of depression, major defining characteristics and factors associated with., Design: Sub-study of comprehensive geriatric assessment cross-study., Setting: Primary health center., Participants: For an estimated 14% prevalence we need a sample of 288 people. From 3854, 290 people ≥75 years were selected. Excluding terminals, chemotherapy, recent surgery, temporary residence, mental retardation, serious psychiatric illness, or under home care., Outcome: risk of depression (≥2 points on the Goldberg depression subscale., Dependent Variables: Sociodemographic and five study areas of the Comprehensive Geriatric Assessment: medical -comorbidity, polypharmacy, falls and hospital admissions-, functional -Up&Go Test, Lawton-Brody and Barthel Index-, nutritional -Mini Nutritional Assessment (MNA)-, mental-affective -Pfeiffer Questionnaire and Goldberg scale-, and social. Descriptive analysis and logistic regression., Results: We obtained 290 interviews, with 102 (35.1%) male and mean age of 79.4 years (SD:3.2). The prevalence of the risk of depression was 37.2%, 26.5% in men and 43.1% in women (p=0.005). Association of risk of depression is observed with arterial hypertension (OR:3.87 95% CI:1.61-9.34), cancer (OR:4.12 95%, CI:1.58-10.76), lack of leisure activity (OR:2.75 95%, CI:1.33-5.67), increase of anxiety scale (OR:1.87 95%, CI:1.57-2.22) and decrease in MNA (OR:0.78 95%, CI:0.68-0.9)., Conclusions: The prevalence of risk of depression is higher than expected, although overestimated until being confirmed with a diagnostic test. We appreciate new associations of comorbidity variables with risk of depression and corroborate other known. The studied factors that were associated with the risk of depression should be included in future studies of geriatric depression., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Objective: To identify the percentage of the population over 18 years with high complexity or high dependency using the case management model., Method: Observational, cross-sectional, descriptive study. Community level. Simple random sampling. Sample size calculation: 551 individuals were needed, with a rate of replacement for losing participation of 40%., Variables: High complexity ≥ 4 of following criteria: age, comorbidity, high drug consumption, terminal disease, hospital admissions, visits to Emergency Departments, falls, functional dependency, mental deterioration, to live alone or with family with capacity for limited support; High dependency (Barthel ≤ 30 and/or Pfeiffer ≥ 8; social-demographic variables; health services use; chronic diseases; specific treatments and caregiver data., Analysis: Descriptive for all variables and associated factors (95% CI). Correlation between variables was studied using the Kappa index., Results: A total of 327 patients were studied, with a mean age of 49 years (SD = 18), of whom 179 (54.7%) were women. Six individuals had high complexity (1.8%, 95% CI: 0.38%-3.29%), 4 women (67%), 5 > 75 years old (83%) and 1 < 65 years old, mean age = 79.5 years (SD = 12.6). Five women presented high dependency (1.5%, 95% CI: 0.49-3.53), 4 > 75 years old (80%) and 1 < 65 years old, mean age = 82 years (SD = 14.8). Seven individuals in total presented high complexity and/or high dependency criteria (2.14%, 95% CI: 0.86-4.3), 5 women (71.4%); 6 > 75 years old and 1 < 65 years old, mean age = 81.3 years (SD = 12.4). Prevalence > 65 years (8.3%) and < 65 (0.6%) (P = .001). Correlation Kappa Index between high complexity and high dependency variables was 0.723., Discussion: The percentage of patients who had high complexity or high dependency compared to the general population is significant, although lower than expected. In the planning of future programs for case management those persons who have high dependency and aged less than 65 years should also be taken into account along with those who have high complexity., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Background and Objectives: To study the association between blood pressure and mortality in a cohort of over 80 years olders of the community after four years of follow up., Patients and Methods: An observational study cohort of 323 individuals aged over 80 years the population of Martorell. We collected sociodemographic data, comorbidity, evaluation of the basic activities of daily living and the average blood pressure. The mortality and its causes were evaluated after four years of follow up. The association between blood pressure and mortality was investigated using Cox survival analysis., Results: One hundred and thirty-five (41.8%) patients died, resulting in a mortality rate of 14.5% for year. In 60% of cases the cause of death was of cardiovascular origin. Subjects with systolic blood pressure (SBP) < 130 mm Hg had a mortality of 63.5% compared to those in the range of SBP = 140-159 mm Hg, who had a mortality of 25.5% (Hazard Ratio [HR]: 0.39; 95% CI: 0.21-0.72; p = 0.003). Female gender (HR: 0.62, 95% CI 0.39-0.97, p < 0.036), age (HR: 1.11, 95% CI: 1.04-1.18, p < 0.001), ischemic heart disease (HR: 2.14, 95% CI 1.23-3.70, p < 0.006), orthostatic hypotension (HR: 3.78, 95% CI: 1.88-7.60, p < 0.001), Barthel Index (HR: 0.97, 95% CI: 0.96-0.98, p < 0.001), and SBP = 140-159 mm Hg (HR: 0.31, 95% CI: 0.13-0.72; p = 0.007) were independent factors associated with mortality at 4 years of follow up., Conclusions: There is a high cardiovascular mortality in people aged more than 80 years. The risk factors associated with mortality are being female, older age, history of heart disease, presence of orthostatic hypotension and worse function. SBP below 130 mm Hg is associated with increased mortality., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objectives: To find out the prevalence and causes of "difficult encounters" (DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed., Design: Cross-sectional, descriptive., Setting: Urban health centre., Participants and Method: Four doctors, their 4 residents and patients who went to their clinics (March-May 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire., Variables: sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a "difficult professional" (DP) by the patient., Results: There were 415 visits; 352 questionnaires (85% participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5% according to doctors (95% CI, 5.8-11.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1% according to the patients (95% CI, 1.6-5.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81% of cases. CDE insignificant (kappa=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95% CI, 3.1-8); 53 (15.1%) had changed at some point for this reason (95% CI, 11.3-18.8) and 11 (3.1%) considered their doctor to be DP (95% CI, 1.6-5.5)., Conclusions: The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP.

Background and Objective: To describe and to analyze the evolution of the mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV), the clinical and epidemiological characteristics and the use of antiretrovirals (ARV) in the HIV infected pregnant women and their new-borns alive between 1987 and 2003 in Catalonia., Material and Method: The available clinical-epidemiological and treatment data were obtained from 4 reference hospitals that take care of most of the children born to HIV infected mothers in Catalonia. Two of the hospitals had a data base designed to the follow up of their patients, whereas in the other 2 data were gathered by reviewing clinical registries. For the analysis, 3 periods, based on the recommendations of treatment ARV during pregnancy, were settled down: 1987-1993; 1994-1996, and 1997-2003., Results: 1,105 mother-infant pairs were studied. HIV MTCT was reduced from 20.4% to 3.5% from first to third period of study (p < 0.001). The median age of the mothers increased from 24.6 to 30.5 years of age (p < 0.001). The proportion of women infected by sexual transmission increased from 17.2% to 58.8% (p < 0.001), whereas that of parenteral transmission decreased from the 79.2% to 43.5% (p < 0.001). In the last period, 74.1% of mother-child pairs received complete ARV prophylaxis regimens and 21.6% partial ones. The rate of elective caesarean-section went up from 32.2% to 58.2% (p < 0.001)., Conclusions: The rates of MTCT in our setting have followed the same trend as in other countries of our surroundings. The observed changes reflect the variations in the characteristics of the epidemic in the general population. The implementation of the recommendations on ARV prophylaxis has begun early and it has extended progressively without getting to be total. Additional strategies for the universal coverage of the screening test during pregnancy are still needed.

Background and Objective: The main strategies to avoid the vertical transmission of human immunodeficiency virus (HIV-1) is antiretroviral treatment during pregnancy, delivery and to the newborn. Nevertheless, there are scant data about safety of antiretroviral drugs and follow-up studies with a large number of pregnant women are needed. The aims of our study are: to assess toxicity associated with antiretroviral treatment, to determine vertical transmission, and to define epidemiological trends within this population. In this paper we present maternal characteristics of the cohort., Patients and Method: Observational, multicentric, collaborative study about an HIV-1 infected pregnant women cohort and their offspring (666 and 686 cases, respectively) who were born during the study period (from January or May 2000 to 31st december 2003)., Results: Most pregnant women were infected by heterosexual transmission (54%). 71% women were included in stage A of the Centers for Disease Control classification of HIV infection and 74% women have received high activity antiretroviral treatment during pregnancy. Prevalence of adverse effects treatment-related was 7%, mainly anaemia related to treatment with zidovudine. We found 6 cases of vertical transmission among 686 newborns (0.8%; 95% confidence interval, 0.3-1.8)., Conclusions: Most patients received highly active antiretroviral treatment, with a good tolerance and a low prevalence of adverse effects related to the treatment. Vertical transmission rate is very low, not higher than 1%. Apart from this, is necessary to pay attention to other phenomena like hepatitis C virus coinfection, other potentially serious adverse effects like hepatotoxicity and pregnancy-related pathologies more frequent in this population, like prematurity and gestational diabetes.