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Initiation of treatment of COPD with a combination of a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS) is frequent irrespective of the risk of exacerbations.We performed a retrospective, population-based, observational study aimed at comparing the effectiveness of a LABA/long-acting antimuscarinic agent (LAMA) and LABA/ICS in patients with COPD over a one-year follow-up. Data were obtained from an administrative healthcare claims database. The primary outcome was the risk of first exacerbation. A sensitivity analysis was conducted in a propensity-score matched population.The population consisted of 14,046 COPD patients; 11,329 (80.6%) initiated LABA/ICS and 2717 (19.4%) LABA/LAMA. The matched population included 1650 patients in each arm. During follow-up, 69.6% patients in the LABA/ICS group and 64.4% in the LABA/LAMA group presented an exacerbation. The mean time to the first exacerbation was 6.03 months (95% confidence interval (CI): 5.94-6.12) for LABA/ICS and 6.4 months (95%CI: 6.21-6.59) for LABA/LAMA; p0.001. The time to scalation to triple therapy was also significantly prolonged in LABA/LAMA. Similar results were obtained in the matched population. LABA/LAMA was associated with a significantly lower risk of exacerbations and escalation to triple therapy compared to LABA/ICS, except in patients with frequent exacerbations and high blood eosinophils in which no differences were observed in the time to first exacerbation.Initiation of treatment with LABA/LAMA was associated with a lower risk of exacerbation and escalation to triple therapy compared to LABA/ICS in the majority of patients with COPD in primary care.

BACKGROUND Antibiotic resistance is an individual and public health problem; multidrug-resistant infections could cause an estimated 10 million deaths worldwide by 2050. Unnecessary use of antimicrobials is the most important cause of resistance generation in the community, and an estimated 80% of antimicrobials are prescribed in primary health care, frequently for urinary tract infections (UTIs). OBJECTIVE This paper presents the protocol for the first phase of the Urinary Tract Infections in Catalonia (Infeccions del tracte urinari a Catalunya) project. We aim to examine the epidemiology of the different types of UTIs in Catalonia (an autonomous community in Spain) and their diagnostic and therapeutic management by health professionals. Furthermore, we aim to evaluate the correlation between types and total consumption of antibiotics for recurrent UTIs in 2 cohorts of women with the presence and severity of infectious complications of urological origin, especially pyelonephritis and sepsis, and 2 potentially serious infections: pneumonia and COVID-19. METHODS The study is a population-based observational cohort study including adults with a diagnosis of UTI registered in the Information System for the Development of Research in Primary Care (in Catalan: Sistema d’informació per al desenvolupament de la investigació en atenció primària), the Minimum Basic Data Sets of Hospital Discharges and Emergency Departments (in Catalan: Conjunt mínim bàsic de dades a l’hospitalització d'aguts i d’atenció urgent), and data from the Hospital Dispensing Medicines Register (in Catalan: Medicació hospitalària de dispensació ambulatòria) of Catalonia from the period between 2012 and 2021. We will evaluate the variables obtained from the databases to analyze the proportion of different types of UTIs, the percentage of adequate antibiotic treatments prescribed or received for recurrent UTIs according to the national guidelines, and the proportion of UTIs with complications. RESULTS We expect to describe the epidemiology of UTIs in Catalonia from 2012 to 2021, as well as describe the diagnostic and therapeutic management of UTIs by health professionals. CONCLUSIONS We expect to find a high percentage of UTI cases with inadequate management according to the national guidelines, considering that on many occasions UTIs are treated with second- or third-line antibiotic therapies with a preference for the longest regimens. Furthermore, the use of antibiotic suppressive therapies, or prophylaxis, in recurrent UTIs will likely be highly variable. Moreover, we aim to determine whether women with recurrent UTIs treated with antibiotic suppressive therapies have a higher incidence and severity of potentially serious future infections, with special attention to acute pyelonephritis, urosepsis, COVID-19, and pneumonia, compared to women who receive antibiotic treatment after they present with a UTI. This is an observational study of data from administrative databases that will not allow causality analysis. The limitations of the study will be handled according to the appropriate statistical methods. CLINICALTRIAL European Union Electronic Register of Post-Authorisation Studies EUPAS49724; https://www.encepp.eu/encepp/viewResource.htm?id=49725 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/44244

Malaltia pulmonar obstructiva crònica; Epidemiologia Enfermedad pulmonar obstructiva crónica; Epidemiología Chronic obstructive pulmonary disease; Epidemiology There is limited information about the initiation of triple therapy (TT) in patients with chronic obstructive pulmonary disease (COPD) in primary care. This was an observational, population-based study in patients identified from a primary care electronic medical records database in Catalonia from 2011 to 2015 aimed to identify the use of TT in patients with newly diagnosed COPD. A total of 69,668 newly diagnosed patients were identified of whom 11,524 (16.5%) initiated TT, of whom 8626 initiated TT at or immediately after COPD diagnosis. Among them, 72.3% were GOLD A/B, 14.6% were frequent exacerbators, and 7.1% had asthma–COPD overlap (ACO). Variables associated with TT initiation were: male sex, older age, previous exacerbations, ACO, a previous treatment regimen containing an inhaled corticosteroid, previous pneumonia, and history of lung cancer. A significant number of COPD patients in Primary Care initiated TT shortly after or even before an established COPD diagnosis. The current study has been funded by an unrestricted grant from AstraZeneca that was also involved in study conception and protocol development. A.N. is the recipient of a Rio Hortega contract in the 2019 Strategic Action Health Call from the Instituto de Salud Carlos III for the years 2020–2022.

Background Recent data from real world clinical practices on the use of Triple Therapy (TT) in patients with COPD are scarce. Methods Observational population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical records database in Catalonia, covering 80% of the general population. The aims were to characterize COPD patients who initiated TT and to describe treatment pathways before and after TT initiation. Time to and probability of step down or complete discontinuation of TT was described using restricted mean survival time and Kaplan•Meier analysis. Results A total of 34,018 COPD patients initiated TT during the study period. Of them, 23,867 (70.1%) were GOLD A/B. 18,453 (54.2%) were non-exacerbators, 9931 (29.2%) infrequent exacerbators, 5634 (16.5%) frequent exacerbators and 1923 (5.6%) had asthma-COPD overlap. Drugs most frequently used prior to initiation of TT were long-acting antimuscarinics (22.5%) and combination of long-acting beta2 agonists/inhaled corticosteroids (15.2%). A total of 11,666 (34.3%) stepped down and 1091 (3.2%) discontinued TT during follow-up. Step down following TT was more likely in patients with severe COPD, especially during the first year; however, discontinuation was more common among patients with mild COPD. Conclusion Most patients initiating treatment with TT were non exacerbators and continued on the same treatment over time regardless severity of disease. Stepping down was more frequent in severe patients, while discontinuation was more common among mild patients. Overall, it appears that TT is extensively used in primary care for treatment of patients with COPD.

There is controversy regarding the role of blood eosinophil levels as a biomarker of exacerbation risk in chronic obstructive pulmonary disease (COPD). Our aim was to quantify blood eosinophil levels and determine the risk of exacerbations associated with these levels and their variability.Observational, retrospective, population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical record database in Catalonia, Spain, covering 80% of the general population. Patients were classified into 4 groups using the following cut-offs: (a)150cells/μl; (b) ≥150 and300cells/μl; (c) ≥300 and500cells/μl; (d) ≥500cells/μl.A total of 57,209 patients were identified with a mean age of 70.2 years, a mean FEV1(% predicted) of 64.1% and 51.6% had at least one exacerbation the previous year. The number of exacerbations in the previous year was higher in patients with the lowest and the highest eosinophil levels compared with the intermediate groups. During follow-up the number of exacerbations was slightly higher in the group with the lowest blood eosinophil levels and in those with higher variability in eosinophil counts, but ROC curves did not identify a reliable threshold of blood eosinophilia to discriminate an increased risk of exacerbations.Our results do not support the use of blood eosinophil count as a reliable biomarker of the risk of exacerbation in COPD in a predominantly non-exacerbating population. Of note was that the small group of patients with the highest variability in blood eosinophils more frequently presented exacerbations.

BackgroundUnderstanding humoral responses and seroprevalence in SARS-CoV-2 infection is essential for guiding vaccination strategies in both infected and uninfected individuals.MethodsWe determine the kinetics of IgM against the nucleocapsid (N) and IgG against the spike (S) and N proteins of SARS-CoV-2 in a cohort of 860 health professionals (healthy and infected) in northern Barcelona. We model the kinetics of IgG and IgM at nine time points over 13.5 months from infection, using non-linear mixed models by sex and clinical disease severity.ResultsOf the 781 participants who were followed up, 478 (61.2%) became infected with SARS-CoV-2. Significant differences were found for the three antibodies by disease severity and sex. At day 270 after diagnosis, median IgM(N) levels were already below the positivity threshold in patients with asymptomatic and mild-moderate disease, while IgG(N, S) levels remained positive to days 360 and 270, respectively. Kinetic modelling showed a general rise in both IgM(N) and IgG(N) levels up to day 30, followed by a decay whose rate depended on disease severity. IgG(S) levels increased at day 15 and remained relatively constant over time.ConclusionsWe describe kinetic models of IgM(N) and IgG(N, S) SARS-CoV-2 antibodies at 13.5 months from infection and disease spectrum. Our analyses delineate differences in the kinetics of IgM and IgG over a year and differences in the levels of IgM and IgG as early as 15 days from symptoms onset in severe cases. These results can inform public health policies around vaccination criteria.Funded by the regional Ministry of Health of the Generalitat de Catalunya (Call COVID19-PoC SLT16_04; NCT04885478)

Altres ajuts: Pla Estratègic de Recerca i Innovació en Salut (PERIS), SLT002/16/00058 Background: The acquisition of multiple chronic diseases, known as multimorbidity, is common in the elderly population, and it is often treated with the simultaneous consumption of several prescription drugs, known as polypharmacy. These two concepts are inherently related and cause an undue burden on the individual. The aim of this study was to identify combined multimorbidity and polypharmacy patterns for the elderly population in Catalonia. Methods: A cross-sectional study using electronic health records from 2012 was conducted. A mapping process was performed linking chronic disease categories to the drug categories indicated for their treatment. A soft clustering technique was then carried out on the final mapped categories. Results: 916,619 individuals were included, with 93.1% meeting the authors' criteria for multimorbidity and 49.9% for polypharmacy. A seven-cluster solution was identified: one non-specific (Cluster 1) and six specific, corresponding to diabetes (Cluster 2), neurological and musculoskeletal, female dominant (Clusters 3 and 4) and cardiovascular, cerebrovascular and renal diseases (Clusters 5 and 6), and multi-system diseases (Cluster 7). Conclusions: This study utilized a mapping process combined with a soft clustering technique to determine combined patterns of multimorbidity and polypharmacy in the elderly population, identifying overrepresentation in six of the seven clusters with chronic disease and chronic disease-drug categories. These results could be applied to clinical practice guidelines in order to better attend to patient needs. This study can serve as the foundation for future longitudinal regarding relationships between multimorbidity and polypharmacy.

This is a multicentric, descriptive, cross-sectional study of child and adolescent sexual abuse in women over 18 years in 24 primary care sexual and reproductive health centers in Catalonia. A total of 1,013 women were recruited; 345 (37.6%, 95% CI: 34.6-40.9) reported exposure to child sexual abuse: 32.4% disclosed being touched in a sexual way, and 9.6% reported completed sexual intercourse. Abuse occured before the age of 13 in 63.4% of respondents. The perpetrator was a relative or an acquaintance in almost 80% of cases. The risk was higher among women of Central or South American origin (OR: 2.86; 95% CI: 1.33-6.12). Only 31.9% of women disclosed the abuse and 17.3% were blamed. Abuse that involved attempted or completed sexual intercourse was significantly associated with recurrence, physical violence, and revictimization in adulthood.

Mònica Monteagudo,1,2 Montse Roset,3 Teresa Rodriguez-Blanco,1,2 Laura Muñoz,4 Marc Miravitlles5 1Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; 2Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; 3IMS Health, Barcelona, Spain; 4Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain; 5Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain Objective: To describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia.Design: We performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. Adescriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts.Results: A total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0–8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months.Conclusion: Patients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy. Keywords: COPD, treatment, primary care, adherence

MPOC; Tabaquisme EPOC; Tabaquismo COPD; Smoking Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are treated with ICSs. We conducted a systematic review including a diversity of types of study designs and safety outcomes with the objective of describing the risk of adverse effects associated with the long-term use of ICSs in patients with COPD. A total of 90 references corresponding to 83 studies were included, including 26 randomised clinical trials (RCTs), 33 cohort studies, and 24 nested case–control (NCC) studies. Analysis of 19 RCTs showed that exposure to ICSs for ≥1 year increased the risk of pneumonia by 41% (risk ratio 1.41, 95% CI 1.23–1.61). Additionally, cohort and NCC studies showed an association between ICSs and risk of tuberculosis and mycobacterial disease. There was a strong association between ICS use and local disorders such as oral candidiasis and dysphonia. The association between ICSs and the risk of diabetes and fractures was less clear and appeared significant only at high doses of ICSs. Since most patients with COPD are elderly and with frequent comorbidities, an adequate risk–benefit balance is crucial for the indication of ICSs. This study was funded by an unrestricted grant from Boehringer Ingelheim.

Background Insufficient epidemiological data are available on bronchiectasis in southern European populations. The aim of this study was to determine the prevalence and incidence of bronchiectasis in Catalonia, Spain and describe the characteristics of patients with an active diagnosis of bronchiectasis in 2012. Methods This study used data from a population database containing information from 5.8 million people (80% of the population of Catalonia). Patients with bronchiectasis were identified using International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes, and information on clinical characteristics and treatment was extracted. Results A total of 20895 patients with bronchiectasis were identified in 2012. The prevalence of bronchiectasis was 36.2 cases per 10 000 inhabitants, with an incidence of 4.81 cases per 10 000 inhabitants. Prevalence and incidence increased with age and were highest in men over 65 years of age. Among the whole bronchiectasis population in Primary Care, 48.6% of patients had had blood tests, 11.2% had undergone spirometry, only 2.1% had a chest X-ray, and 0.9% had undergone high-resolution computed tomography or sputum culture. 56% had at least one exacerbation and 12.5% had been admitted to hospital during the year of the study. The drugs most frequently used were inhaled corticosteroids (in 37.4% of patients) and long-acting β 2 agonists (in 36%); half of the patients received no treatment (51.8%). Conclusions The prevalence and incidence of bronchiectasis increases with age. The management of bronchiectasis in primary care was not optimal, and the disease continues to represent an important clinical burden.

Background: Reports on the determinants of health-related quality of life (HRQoL) in COPD patients have mostly been focused on clinical factors. Aim: To assess the relationship between interpersonal and environmental factors, and HRQoL in COPD patients. Methods: In this cross-sectional study recruiting 407 moderate-to-severe COPD patients from five Catalan municipalities, HRQoL was assessed using COPD Assessment Test (CAT). Interpersonal factors such as number of people in the household, grandparenting and walking the dog, were assessed by questionnaire. Neighbourhood deprivation was assessed using the census-based Urban Vulnerability Index 2001. Residential surrounding greenness was determined using satellite-derived Normalized Difference Vegetation Index (NDVI). Residential proximity was defined for those living within a recommended 300 m distance to green or blue spaces. Results: 85% patients were male (mean age 69±9 years) with a post-bronchodilator FEV1 of 56±17 %pred. In the linear model adjusted for body mass index (BMI), FEV1%pred and 6-min walk distance, living alone was related to a worse HRQoL (coefficient β: 2.85; 95% confidence interval (CI): 0.75, 4.95) and living close to a green or blue space was marginally associated with a better HRQoL (β: -1.2; 95%CI: -2.6, 0.12). Other interpersonal and environmental determinants were not associated with HRQoL in COPD. Conclusions: Living alone and lack of proximity to green or blue space can negatively affect the HRQoL in COPD patients.

Lower levels of lung function have been related to lower physical activity (PA) levels in patients with COPD. However, the characterization of COPD patients with severe lung function and high PA remains still unknown. Aim: To identify the socio-environmental, clinical and functional characteristics of patients with severe lung function and high levels of PA. Methods: We recruited 407 COPD patients from primary care and hospitals of 5 Catalan cities and collected sociodemographic, smoking history, symptoms and medical history, health related quality of life (HRQoL), forced spirometry, exercise capacity (6MWT) and environmental data. We defined ‘severe COPD’ as postBD FEV1 Results: Patients with severe COPD (37%) had lower PA than those with mild-to-moderate airflow limitation (6840 vs 7965 steps/d, p Conclusions: Although more severity of airflow limitation is associated with low PA, there is a subset of COPD patients that has severe COPD and high PA. In our cohort, these patients were characterized by lower dyspnoea, better HRQoL and higher exercise capacity.

Introduction Treatment for COPD is tailored based on clinical characteristics and severity. However, prescription patterns in COPD patients newly diagnosed in primary care may differ from guideline recommendations. Method We performed an epidemiological study with data obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million inhabitants (80% of the population of Catalonia). Patients newly diagnosed with COPD from 2007 to 2012 were identified and information about the initial treatment patterns was collected. The initial treatment was also described by phenotype and severity. Results During the study period 41,492 patients were newly diagnosed with COPD. Patients were classified as non exacerbators (28,552 patients, 69%), asthma-COPD overlap syndrome (ACOS) (2152 patients, 5.2%) and frequent exacerbators (10,888 patients, 27.6%). Among the patients in whom FEV1 was available, 13.9% were GOLD stage 1, 55.2% stage 2, 26% stage 3 and 4.8% stage 4. Globally, the most frequently prescribed treatment patterns were short-acting bronchodilators (SABD) in monotherapy (17.7%), long-acting β-2 agonists (LABA) + inhaled corticosteroids (ICS) (17.3%) and triple therapy (12.2%). The frequency of patients treated with a SABD increased from 15.9% to 19.5% during the study period, while the number of untreated patients decreased from 24.4% to 15.1%. Up to 45.2% of patients were initially treated with ICS, which were frequently prescribed in the ACOS (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non exacerbator patients. Up to 13.6% and 14.8% of GOLD 4 patients received no treatment or only SABD after diagnosis. Conclusions Initial treatment patterns in newly diagnosed COPD patients often do no comply with guidelines. The use of ICS is excessive but has decreased mainly in non exacerbator patients. Many COPD patients still remain untreated after diagnosis, although this has decreased. Some GOLD 4 patients are still receiving SABD or no treatment at all after diagnosis.

Body: There is a need to design interventions that increase physical activity (PA) in COPD patients at the long term. Aim: To assess the effectiveness of the Urban Training intervention on PA after 12 months in COPD patients. Methods: We recruited 410 COPD patients from 33 primary care centers and 5 hospitals from Catalonia in 2013-2015 and allocated them randomly 1:1 to Urban Training or Usual Care. The Urban Training intervention combined behavioral strategies (motivational interviewing, pedometers, calendars, text messages, and walking groups) and unsupervised walking in trails from outdoor public spaces specifically designed for COPD (PLoSOne 14;11(1):e0146705). Primary outcome: steps/day by accelerometer; secondary: hospital admissions, exercise capacity, body composition, health-related quality of life, anxiety and depression. Modified intention to treat (MITT) and per protocol (PP) populations were analyzed, the latter including patients adherent to their corresponding intervention. Results: Patients were 85% male, had age 69 (8.5) years, and FEV1 56 (16) % pred. 284 patients completed the follow-up. In MITT there was no difference in the number of steps, but a large difference was observed in PP approach (Table 1). There were no differences in secondary outcomes. Conclusions: The Urban Training intervention increased PA after 12 months of follow-up in adherent patients.

SummaryBackgroundA primary objective in the treatment of patients with chronic obstructive pulmonary disease (COPD) is to improve their health status.ObjectiveTo identify the factors associated with changes in health-related quality of life (HRQoL) in patients with COPD after one year of follow-up in primary care.MethodMulticenter, prospective study with one year of follow-up. The end-point was the change in total score on the Saint George's Respiratory Questionnaire (SGRQ). Patients with a clinically relevant (>4 points) decrease or increase in SGRQ total score were compared. Factors associated with the changes in HRQoL observed after one year were determined by logistic regression analysis.ResultsA total of 791 patients (mean age, 70.2 years) were analyzed. Mean FEV1 (% predicted) was 52.4%. Average total SGQR score was 37.1 (SD = 19.1) at baseline and 35.6 (SD = 18.9) at follow-up. Significantly improved HRQoL was observed in 36.7% of patients, and was associated with starting polymedication, pulmonology visits, and balanced diet; ending respiratory rehabilitation, quitting smoking; and not being a frequent exacerbator. Quality of life worsened significantly in 29.2% of patients, and was associated with worsening respiratory symptoms and increased hospital admissions.ConclusionsAlthough overall changes in HRQoL observed after one year were minimal, more than one third of patients improved significantly, and one third had significantly worse HRQoL. Clinical factors were independently associated with these changes, emphasizing the relevance to improved HRQoL of starting a healthy lifestyle and respiratory treatments and the negative impact on HRQoL of COPD symptoms onset and admissions.

Background and objective The best strategy to achieve optimal integrated management to patients with chronic obstructive pulmonary disease (COPD) in primary care (PC) is not clear. We aimed to evaluate the effectiveness of an intervention in PC based on an integrated programme, which combines diverse strategies directed at health professionals to improve quality of life and clinical outcomes of their patients with COPD. We compared the outcome with results from standard practice. Methods A prospective, multicentre, quasi-experimental study and a 12-month follow up was performed. Intervention consisted of an integrated education programme in PC. The main outcome variable was the change in total score of the St. George's Respiratory Questionnaire (SGRQ) at the end of follow up between the control and intervention group. Results A total of 801 patients participated in the study with a mean age of 70.2 years and a mean FEV1 (% predicted) of 55%. At 1-year follow up, the SGRQ score did not significantly differ. Although the intervention group showed an improvement in dietary, exercise and smoking habits, there was an increase in reported exacerbations and hospital admissions (P

Socio-ecological determinants may affect the physical activity (PA) in COPD patients, but knowledge on this topic is still scarce. Aim: To assess the association between patients9 social and environmental characteristics, and PA amount and intensity. Methods: 411 COPD patients were recruited in 5 cities from Catalonia in 2015. Social (work, marital, and socioeconomic status (SES), dog walking, grandchildren care and having lift) and environmental characteristics (surrounding greenness and distance to green or blue spaces) were collected. PA variables (walking time, time in any-intensity (>1.5 METs) and moderate-to-vigorous (>3 METs) PA and VMU/min) were measured by the MoveMonitor accelerometer during 1 week. We built multivariable linear regression models. Results: Patients were 85% male, had mean(SD) age 69(9)y, FEV 1 76(17)%pred and BMI 28(5)kg/m 2 . Walking the dog was significantly associated with higher PA amount, low SES related to spending more time in any-intensity PA, and taking care of grandchildren associated with higher PA intensity Environmental variables did not show significant relationships with PA amount or intensity. Conclusions: COPD patients who walk the dog have higher levels of PA and those taking care of grandchildren have higher PA intensity. Social characteristics should be considered when designing future PA interventions.

Background Bronchiectasis is a pulmonary disorder defined morphologically as a permanent airway dilatation of different etiologies such as cystic fibrosis, infections or immunodeficiencies. The true incidence and prevalence of non-cystic fibrosis bronchiectasis are not well known. To determine the prevalence and incidence of bronchiectasis (BC) not due to cystic fibrosis in primary care patients in Catalonia (Spain) in 2012. To describe the clinical characteristics and treatment patterns of BQ patients and to estimate the health burden associated with BQ.

Background: Several studies have approached the use of spirometry in the treatment of chronic obstructive pulmonary disease (COPD) in Primary Care (PC), but few have analysed its impact on the treatment of the patient with COPD. Objectives: To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, and its impact on treatment. To analyse the variation in the performing of spirometry between PC centres.

Background: Several studies have dealt with the use of spirometry in the treatment of chronic obstructive pulmonary disease (COPD) in Primary Care (PC), but few have analyzed its impact on the treatment of the patient with COPD. Objectives: To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, and its impact on treatment. To analyze the variation in the performing of spirometry between PC centers. Methodology: A multicenter, observational and cross-sectional study of COPD patients seen in PC in Catalonia (Spain) during 2004-2005. A multilevel logistic regression model was used to identify factors associated with having spirometry and to determine the variation between the different centers. Results: Twenty-one centers, including 801 patients, participated. Only 53.2% of them had diagnostic spirometry and the mean (standard deviation) FEV1(%) was 54.8% (18%). The registers of smoking habits, complementary tests and spirometry follow-up were more common among patients who had a diagnostic spirometry available compared with those who did not. No statistically significant differences were found regarding demographic, clinical, treatment and quality of life variables between patients with and without follow-up spirometry. Significant variation was observed in the percentage of diagnostic spirometries between different PC centers (variance = 0.217; p < 0.001). Conclusion: Spirometry is underused in PC and performing it during follow-up is not associated with the different treatments guidelines or with a more complete approach to the disease. There is significant variation in the performing of spirometry among PC centers.

Objective: To analyze the factors associated with sexual risk behavior in adolescent girls and boys in order to plan future school health interventions. Methods: A cross-sectional study with two-stage cluster sampling that included 97 schools and 9,340 students aged between 14 and 16 years old was carried out in 2005-2006 in Catalonia (Spain). For the survey, a self-administered paper-based questionnaire was used. The questionnaire contained items on sociodemographic variables, use of addictive substances and mood states, among other items. These variables were tested as risk factors for unsafe sexual behavior. Results: This study included 4,653 boys and 4,687 girls with a mean age of 15 years. A total of 38.7% of students had had sexual relations at least once and 82.3% of boys and 63.0% of girls were engaged in sexual risk behaviors. The prevalence of sexual relations and risk behaviors was generally higher in boys than in girls, independently of the variables analyzed. Boys had more sexual partners (P

To analyse perceived sexual satisfaction, sexual dysfunction, satisfaction with affective relationships and confidence and communication in existing relationships, related to a past history of childhood sexual abuse (CSA) and type suffered, among women treated as part of the Catalonian Sexual and Reproductive Health Care Programme (PASSIR).Multicentric, descriptive, cross-sectional study. A total of 1,013 women over the age of 18 years, who underwent psychological therapy at any of the 24 PASSIR centres, were enrolled. A structured, anonymised, self-administered Sex History Questionnaire adapted from Wyatt (1985)Dubé et al. (2005), and the Female Sexual Function Index (Rosen, 2000), were used. Statistical analysis was descriptive, bivariate and multivariate.Women who suffered childhood sexual abuse had a significantly higher prevalence of sexual dysfunction, with lower perceived sexual satisfaction. CSA with penetration or attempted penetration was associated with greater arousal difficulties and greater rejection. Women who experienced CSA were less confident and experienced greater communication difficulties with their partner.It is necessary to identify potential childhood sexual abuse among women who seek therapy due to relationship problems. It is also necessary to continue research into protective factors and therapeutic interventions to alleviate the consequences of CSA in adult life.

Background: We examined the adequacy of prescribing patterns for newly diagnosed COPD patients from 2007 to 2012 according to their clinical phenotype. Methods: Population database study with data from the“System for Development in Research in Primary Care”(SIDIAP) that includes information of 5.8 million of habitants.We included newly diagnosed COPD patients and identified the phenotypes:non exacerbator, asthma-COPD overlap syndrome(ACOS)and frequent exacerbator(≥2 exacerbations-year).Information about demographic characteristics and the initially prescribed treatment was collected. Results: During the study period 41492 patients were newly diagnosed with COPD.Patients were classified as non exacerbators(68.6%), ACOS(5.2%) and frequent exacerbators(26,2%).Characteristics were similar in the 3 groups, although the percentage of women was higher in the ACOS group(42.6%).After COPD diagnosis, 21.2% patients received no treatment. As initial treatment, 40.6% of non exacerbators were prescribed ICS, for 4% of them in monotherapy. The majority of patients in the ACOS group(88.8%) were treated, 69.2% patients with ICS(6.2% in monotherapy).Only 52.4% of the frequent exacerbators were treated with ICS.Prescription patterns are shown in Conclusions: Many COPD patients remain untreated after diagnosis.The use of ICS in non exacerbator patients is widespread, however its use is higher in the ACOS patients. Funded by Novartis Spain.

Background Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calculators have been developed; the REGICOR calculator has been validated for use in our population. The objective of this project is to develop an intervention with general practitioners (GPs) and evaluate its impact on prescription adequacy of cholesterol-lowering drugs in primary prevention of cardiovascular disease and in controlling the costs associated with this disease. Methods This nonblinded, cluster-randomized clinical trial analyzes data from primary care electronic medical records (ECAP) and other databases. Inclusion criteria are patients aged 35 to 74 years with no known cardiovascular disease and a new prescription for cholesterol-lowering drugs during the 2-year study period. Dependent variables include the following: RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and withdrawn during the study period; EVITA, defined as new cholesterol-lowering drugs initiated during the study period and considered inadequate; COST, defined as the total cost of inadequate new treatments prescribed; and REGISTER, defined as the recording of cardiovascular risk factors. Independent variables include the GP’s quality-of-care indicators and randomly assigned study group (intervention vs control), patient demographics, and clinical variables. Aggregated descriptive analysis will be done at the GP level and multilevel analysis will be performed to estimate the intervention effect, adjusted for individual and GP variables. Discussion The study objective is to generate evidence about the effectiveness of implementing feedback information programs directed to GPs in the context of Primary Care. The goal is to improve the prescription adequacy of lipid-lowering therapies for primary prevention. Trial registration ClinicalTrials.gov Identifier: NCT01997671. November 28, 2013.

Background The initial treatment patterns of chronic obstructive pulmonary disease (COPD) patients in Primary Care (PC) can differ from the guidelines recommendations. The aim of the present study was to quantify the undertreatment in newly diagnosed COPD patients and to describe the characteristics of the undertreated patients.

The best strategy to achieve optimal integrated management to patients with chronic obstructive pulmonary disease (COPD) in primary care (PC) is not clear. We aimed to evaluate the effectiveness of an intervention in PC based on an integrated programme, which combines diverse strategies directed at health professionals to improve quality of life and clinical outcomes of their patients with COPD. We compared the outcome with results from standard practice.A prospective, multicentre, quasi-experimental study and a 12-month follow up was performed. Intervention consisted of an integrated education programme in PC. The main outcome variable was the change in total score of the St. George's Respiratory Questionnaire (SGRQ) at the end of follow up between the control and intervention group.A total of 801 patients participated in the study with a mean age of 70.2 years and a mean FEV1 (% predicted) of 55%. At 1-year follow up, the SGRQ score did not significantly differ. Although the intervention group showed an improvement in dietary, exercise and smoking habits, there was an increase in reported exacerbations and hospital admissions (P 0.001).Implementation of an integrated education programme in a PC setting, which combines diverse strategies directed at health professionals, did not achieve the expected changes in quality of life measured by SGRQ at 1-year follow up. Nonetheless, this study observed an improvement in patients' lifestyle choices, even though this did not result in a significant change in the clinical evolution or heath status over 12 months.

Background Chronic obstructive pulmonary disease (COPD) is a health problem that is becoming increasingly attended-to in Primary Care (PC). However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG). The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL) of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education. Method/Design Multi-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC) within the administrative area of the Costa de Ponent (near Barcelona). All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse) derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy). The sample random includes a total of 801 patients (≥ 40 years of age), recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical Research Council (MRC) and the QoL, evaluated with the St George's Respiratory Questionnaire (SGRQ). The variables are obtained at the start and the end of the intervention. Information from follow-up visits focuses on the changes in life-style activities of the patient. Discussion This study is conducted with the objective of generating evidence that shows that implementation of awareness programs directed towards health-care professionals as well as patients in the context of PC can produce an increase in the QoL and a decrease in the disease exacerbation, compared to standard clinical practice. Trial Registration Clinical Trials.gov Identifier: NCT00922545

Background Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth cause of death. Exacerbations have a negative impact on the prognosis of COPD and the frequency and severity of these episodes are associated with a higher patient mortality. Exacerbations are the first cause of decompensation, hospital admission and death in COPD. The incidence of exacerbations has mainly been estimated in populations of patients with moderate-severe COPD requiring hospital care. However, little is known regarding the epidemiology of exacerbations in patients with less severe COPD forms. It is therefore possible that a high number of these less severe forms of exacerbations are underdiagnosed and may, in the long-term, have certain prognostic importance for the COPD evolution. The aim of this study was to know the incidence and risk factors associated with exacerbations in patients with COPD in primary care. Methods and design A prospective, observational, 3-phase, multicentre study will be performed involving: baseline evaluation, follow up and final evaluation. A total of 685 smokers or ex-smokers from 40 to 80 years of age with COPD, without acute respiratory disease or any other long-term respiratory disease will be randomly selected among the population assigned to 21 primary care centres. The diagnosis of COPD and its severity will be confirmed by spirometry. Information regarding the baseline situation, quality of life and exposure to contaminants or other factors potentially related to exacerbations will be collected. A group of 354 patients with confirmed COPD of varying severity will be followed for one year through monthly telephone calls and daily reporting of symptoms with the aim of detecting all the exacerbations which occur. These patients will be evaluated again at the end of the study and the incidence of exacerbations and associated relative risks will be estimated by negative binomial regression. Discussion The results will be relevant to provide knowledge about natural history of the initial phases of the COPD and the impact and incidence of the exacerbations on the patients with mild-moderate forms of the disease. These data may be important to know the milder forms of exacerbation wich are often silent or very little expressed clinically.

Objetivos Determinar la prevalencia del estado de animo negativo entre alumnos adolescentes segun sexo, analizar la variabilidad entre escuelas y evaluar los factores asociados. Metodos Estudio transversal basado en un muestreo por conglomerados bietapico. Administramos una encuesta de salud a 9340 estudiantes de tercero y cuarto curso de Educacion Secundaria Obligatoria de 14 a 16 anos de edad, en Cataluna, durante el curso escolar 2005-06. La variable principal fue el estado de animo negativo. Se uso un modelo de regresion logistica multinivel estratificado por sexo para identificar los factores asociados al estado de animo negativo y determinar la variabilidad entre las diferentes escuelas. Resultados Aproximadamente el 19% de los adolescentes refirieron un estado de animo negativo, siendo mas prevalente entre las chicas (25%). En ellas, los factores asociados significativamente con estados de animo negativo fueron «tomar tranquilizantes» y tener trastornos alimentarios, mientras que en los chicos fueron no realizar deporte y tener una mala percepcion de su estado de salud. Hay variabilidad en la prevalencia del estado de animo negativo segun las escuelas en ambos sexos (chicas: varianza = 0,078, p

There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease (COPD). We assessed 12-month efficacy and effectiveness of the Urban Training intervention on physical activity in COPD patients. This randomised controlled trial (NCT01897298) allocated 407 COPD patients from primary and hospital settings 1:1 to usual care (n=205) or Urban Training (n=202). Urban Training consisted of a baseline motivational interview, advice to walk on urban trails designed for COPD patients in outdoor public spaces and other optional components for feedback, motivation, information and support (pedometer, calendar, physical activity brochure, website, phone text messages, walking groups and a phone number). The primary outcome was 12-month change in steps·day−1 measured by accelerometer. Efficacy analysis (with per-protocol analysis set, n=233 classified as adherent to the assigned intervention) showed adjusted (95% CI) 12-month difference +957 (184–1731) steps·day−1 between Urban Training and usual care. Effectiveness analysis (with intention-to-treat analysis set, n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients) showed no differences between groups. Leg muscle pain during walks was more frequently reported in Urban Training than usual care, without differences in any of the other adverse events. Urban Training, combining behavioural strategies with unsupervised outdoor walking, was efficacious in increasing physical activity after 12 months in COPD patients, with few safety concerns. However, it was ineffective in the full population including unwilling and self-reported non-adherent patients., Urban Training in COPD increased physical activity after 12 months but not in self-reported non-adherent patients http://ow.ly/dc2C30lnAEs