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The recently published article by de Sutter et al. reflects the transformation that the coronavirus epidemic has caused in our world. With the need to adapt to the novel reality, new challenges and tasks for primary healthcare (PC) professionals have arisen. We will present here how PC has dealt with the issues emerging as the aftermath of the disease in Barcelona, Spain.

OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention. RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively. RESULTS Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P < 0.001), a mean difference of −2.5 kg (95% CI −3.1 to −1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P < 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P < 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts. CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.

[Purpose]: To assess the association between the consumption of non-soy legumes and different subtypes of non-soy legumes and serum uric acid (SUA) or hyperuricemia in elderly individuals with overweight or obesity and metabolic syndrome. [Methods]:A cross-sectional analysis was conducted in the framework of the PREDIMED-Plus study. We included 6329 participants with information on non-soy legume consumption and SUA levels. Non-soy legume consumption was estimated using a semi-quantitative food frequency questionnaire. Linear regression models and Cox regression models were used to assess the associations between tertiles of non-soy legume consumption, different subtypes of non-soy legume consumption and SUA levels or hyperuricemia prevalence, respectively., [Results]: Individuals in the highest tertile (T3) of total non-soy legume, lentil and pea consumption, had 0.14 mg/dL, 0.19 mg/dL and 0.12 mg/dL lower SUA levels, respectively, compared to those in the lowest tertile (T1), which was considered the reference one. Chickpea and dry bean consumption showed no association. In multivariable models, participants located in the top tertile of total non-soy legumes [prevalence ratio (PR): 0.89; 95% CI 0.82–0.97; p trend = 0.01, lentils (PR: 0.89; 95% CI 0.82–0.97; p trend = 0.01), dry beans (PR: 0.91; 95% C: 0.84–0.99; p trend = 0.03) and peas (PR: 0.89; 95% CI 0.82–0.97; p trend = 0.01)] presented a lower prevalence of hyperuricemia (vs. the bottom tertile). Chickpea consumption was not associated with hyperuricemia prevalence., [Conclusions]: In this study of elderly subjects with metabolic syndrome, we observed that despite being a purine-rich food, non-soy legumes were inversely associated with SUA levels and hyperuricemia prevalence., The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by J.S.-S. and J.Vid., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, and PI17/00926), the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the European Research Council (Advanced Research Grant 2013–2018, 340918) to M.Á.M.-G., the Recercaixa Grant to J.S.-S. (2013ACUP00194), Grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a Grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN Grant, and funds from the European Regional Development Fund (CB06/03). O.C. is supported by ISCIII Grant JR17/00022. M Rosa Bernal-Lopez was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER

Introduction Aim: To synthesize the available evidence in scientific papers of smokefree legislations (SFL) effects on respiratory diseases (such as asthma, chronic obstructive pulmonary disease [COPD]) and lung infections (pneumoniae, bronchitis) among all populations (adults, children or general population). Methods Systematic review and meta-analysis were carried out. PRISMA guidelines were followed. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. The inclusion criteria were: 1)Original scientific studies concerning SFL, 2) With data before and after its implementation and 3) assessment of the impact of SFL on respiratory diseases. A meta-analysis was performed using the Review Manager (RevMan, version 5.3). The effect of SFL was estimated by risk ratios (RR) and risk difference (RD). Pooled effect measures were computed applying the inverse-variance method in a random-effect model. Heterogeneity was quantified with the I2 statistic. Subgroup and sensitivity analysis were performed. Results 17 studies reported effects on asthma, 9 on COPD and 4 on lung infections admissions. All the meta-analysis concerned comprehensive SFL settings. Six studies were included in a meta-analysis for asthma admissions in general population, 5 in children and 7 in adults. There was a significant decrease of 13% after SFL in general population (RR 0.87; 95%CI 0.81, 0.93; I2 78%) and of 15% both in children (95%CI 0.79, 0.91; I2 87%) and adults (95%CI 0.73, 0.99; I2 65%). In contrast, the 6 studies for COPD admissions showed a non significant decrease of 20% after SFL (95%CI 0.63, 1.00; I2 96%). For lung infections admissions, only 2 studies showed a non significant decrease of 14% after SFL (95%CI 0.67, 1.10; I2 55%). Conclusions SFL appears to decrease rates of admissions for asthma in all populations in comprehensive settings but not for COPD or lung infections. Funding This work was supported by the Instituto de Salud Carlos III (Institute of Health Carlos III, ISCiii) of the Ministry of Economy and Competitiveness (Spain) through the Network for Prevention and Health Promotion in Primary Care (redIAPP, RD12/0005/0001; RD16/0007/0001), co-financed with European Union ERDF funds.

The PREDIMED (in Spanish: PREvención con DIeta MEDiterránea) primary prevention trial1–3 reported in 2013 that long-term adherence to an energy-unrestricted Mediterranean diet (MedDiet), supplemented with either extra-virgin olive oil (EVOO) or nuts, reduced cardiovascular disease (CVD). PREDIMED showed a 30% relative reduction in the composite cardiovascular primary endpoint (stroke, myocardial infarction or cardiovascular death).2,,3 However, the PREDIMED trial tested only the composition of the diet, but did not test other lifestyle interventions (i.e. energy reduction, increased physical activity (PA) and behavioural modification) frequently applied in the context of the current unprecedented obesity pandemic.4,,5 With the exception of the null results of the Look-AHEAD trial,6 and the successful results of the EXERDIET-HTA study that found improvements in blood pressure, cardio-respiratory fitness and body composition (though they encouraged adherence to an hypocaloric DASH diet, instead of a Mediterranean diet),7 lifestyle interventions including such components have never been tested in long-term randomized trials using hard cardiovascular events as endpoints.

Aims The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations. Materials and methods Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment. Results A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1–36%) than for asthma (5–31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies. Conclusions Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma

Objetivo Determinar el efecto en asmaticos del uso regular de beta-2-agonistas (B2A) en funcion respiratoria y en funcion de receptores beta-2. Fuentes de datos Ensayos clinicos entre 1966 y 2003. Fuentes: Embase, Medline y CINAHL. Seleccion de estudios Se identificaron 5.000 articulos, 198 de los cuales se consideraron relevantes, y 22 cumplieron criterios de inclusion. Se incluyeron ensayos con placebo, aleatorizados, doble ciego, con administracion regular de B2A (por via inhalatoria u oral) al menos durante 1 semana. La principal intervencion fue administracion de B2A regularmente. La medida de valoracion usada fue el volumen espiratorio forzado en el primer segundo (FEV1) antes y despues de ultima dosis del farmaco. Extraccion de datos La medida valorada fue un cambio en FEV1 entre el grupo activo y el placebo, como respuesta al tratamiento con B2A, con provocacion de broncoconstriccion, con un 20% de reduccion del FEV1; in vitro se valoro funcion del receptor beta-2 de leucocitos. Los estudios incluian a 323 participantes, un 53% de ellos varones. Cada ensayo incluyo de media a 15 pacientes. La duracion media de los ensayos fue de 3 semanas (1-6 semanas). La edad media ± desviacion estandar (DE) fue de 33,5 ± 10,3 anos. El FEV1 fue de 2,9 ± 0,4 l sin diferencias entre los B2A y el placebo. Se incluyeron B2A de accion corta (albuterol, broxaterol, salbutamol y terbutalina) y de accion larga (eformoterol, formoterol y salmeterol); por via oral se utilizo procaterol. Resultados principales El uso regular de B2A comparado con placebo no cambio el resultado del FEV1. El cambio en la respuesta del pico de FEV1 con la administracion de B2A regular fue del–17,8% (intervalo de confianza del 95%, –27,2 a –8,5%). Se observo una reduccion en la curva de dosisrespuesta del pico de FEV1 comparada con placebo del –34,8% (IC del 95%, –45,7 a –24%). La densidad de los receptores beta-2 de leucocitos postratamiento fue del –18,3% (IC del 95%, –31,6 a –5,1%), la afinidad de union con los receptores, del –23,1% y la respuesta in vitro al isoproterenol, del –32,7%. Conclusion La administracion regular de B2A comparada con placebo durante 1-6 semanas reduce significativamente la respuesta broncodilatadora. Esta tolerancia esta asociada con una reduccion de la densidad de los receptores beta-2 de los leucocitos y una disminucion de la afinidad en la union con los receptores, con resultados similares con B2A de corta y larga duracion. La tolerancia a los efectos empieza a desarrollarse desde minutes a horas tras la administracion. Esta tolerancia podria explicar la asociacion entre los B2A y el incremento del riesgo de ataques fatales. El uso de B2A tiene efectos adversos en la funcion respiratoria, por lo que los autores concluyen que la principal terapia para el asma seria probablemente la inhalacion de corticoides, con lo que se evitarian los efectos adversos del uso regular de los B2A. No consta ningun conflicto de intereses. No hay fuente de financiacion.