[Community reorientation of primary care in a health area: ROCAP project]. / Reorientación comunitaria de la atención primaria en un área de salud: proyecto ROCAP.

AIM: Evaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area. DESIGN: During January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email. PLACE: The scope is the 11 ZBS of a health area. PARTICIPANTS: The study population is the ZBS and the respective teams represented by the medical and nursing coordinations. INTERVENTIONS: Promote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives. MAIN MEASUREMENTS: Quantitative and qualitative analysis was carried out pre and post after the first year of intervention. RESULTS: In the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health. CONCLUSIONS: The intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

Pattern of mobile phone and internet use among 11-15-years-old.

OBJECTIVE: To assess the pattern of problematic internet and mobile use in a sample of adolescents. METHOD: Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected. RESULTS: 446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11-15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12h on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001). CONCLUSIONS: The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.

Higher reproducibility of phase derived metrics from electrocardiographic imaging during atrial fibrillation in patients remaining in sinus rhythm after pulmonary vein isolation.

BACKGROUND: Electrocardiographic imaging (ECGI) allows evaluating the complexity of the reentrant activity of atrial fibrillation (AF) patients. In this study, we evaluated the ability of ECGI metrics to predict the success of pulmonary vein isolation (PVI) to treat AF. METHODS: ECGI of 24 AF patients (6 males, 13 paroxysmal, 61.8 ± 14 years) was recorded prior to PVI. Patients were distributed into two groups based on their PVI outcome 6 months after ablation (sinus vs. arrhythmia recurrence). Metrics derived from phase analysis of ECGI signals were computed for two different temporal segments before ablation. Correlation analysis and variability over time were studied between the two recorded segments and were compared between patient groups. RESULTS: Temporal variability of both rotor duration and spatial entropy of the rotor histogram presented statistical differences between groups with different PVI outcome (p < 0.05). The reproducibility of reentrant metrics was higher (R2 > 0.8) in patients with good outcome rather than arrhythmia recurrence patients (R2 < 0.62). Prediction of PVI success based on ECGI temporal variability metrics allows for an increased specificity over the classification into paroxysmal or persistent (0.85 vs. 0.64). CONCLUSIONS: Patients with favorable PVI outcome present ECGI metrics more reproducible over time than patients with AF recurrence. These results suggest that ECGI derived metrics may allow selecting which patients would benefit from ablation therapies.