[Implementation of a social prescribing protocol in Aragon's primary care teams]. / Implementación de un protocolo de recomendación formal de activos para la salud en los equipos de atención primaria aragoneses.

OBJECTIVE: To analyze the implementation of social prescribing guideline in primary care Aragón. DESIGN: Observational, descriptive, cross-sectional study. LOCATION: One hundred twenty-three primary care teams of Aragón. PARTICIPANTS: Social prescribing made with the protocol «Recomendación Activos - AP¼ of electronic health record of primary care Aragón from September 2018 to March 2021. MAIN MEASUREMENTS: The most relevant variables of the protocol were described: age, sex, province, health sector, basic health area, health problem, aspect to be enhanced, asset for health recommended, type of professional, degree of assistance, satisfaction and improvement. RESULTS: The protocol was used 2109 times, 1482 recommendations were made and 428 follow-ups were performed. The use of the protocol increased progressively until March 2020. A total of 1431 people received one recommendation and 51 received more than one recommendation. The average age of the beneficiaries was 67.9years. 74.8% of recommendations were addressed to women. Diagnoses related to social and psychological problems were the most frequently recommended, and the physical sphere was the aspect most promoted. Most social prescribing was linked to physical activity and resources for the promotion of personal autonomy. More than 90% of the people regularly attended the activity, the average satisfaction was 4.8 (0/5) and the degree of improvement 4.3 (0/5). CONCLUSIONS: The implementation of asset for health recommended within the Aragon community care strategy is working, however, some aspects need to be reviewed. It is necessary to continue generating evidence to be able to adapt and make this process more efficient.

Imported malaria cases: the connection with the European ex-colonies.

BACKGROUND: Imported malaria is increasing in non-endemic areas due to the increment of international travels, migration and, probably, other unknown factors. The objective of this study was to describe the epidemiological and clinical characteristics of malaria cases in a region of Spain; analyse the possible association between the variables of interest; compare this series with others; and evaluate the characteristics of imported malaria cases according to the country of origin, particularly cases from Equatorial Guinea (Spanish ex-colony) and from the rest of sub-Saharan Africa. METHODS: A descriptive observational study was carried out with a retrospective data collection of cases of malaria reported in Aragon from 1996 to 2017. Univariate and bivariate analysis of clinical-epidemiological variables was performed. In addition, an analysis of cases from sub-Saharan Africa was carried out using logistic regression, calculating odds ratio with its 95% confidence interval. RESULTS: 609 cases of malaria were recorded in Aragon from 1996 to 2017. An autochthonous case in 2010. 50.33% were between 15 and 39 years old. 45.65% of the cases were notified of the 4-weeks 9 to 12. 82.6% reside in the main province, urban area, of which 65.4% were VFR (Visiting Friends and Relatives), 23.8% new immigrants and 10.9% travellers. The infectious Plasmodium species par excellence was Plasmodium falciparum (88%). Analysing the cases from sub-Saharan Africa (95.2% of the total), 48.1% were from Equatorial Guinea. Comparing these with the cases from the rest of sub-Saharan Africa, it was observed that the cases from the Spanish ex-colony have association with the female gender, being under 5 years old, residing in the main province (urban area) and being a new immigrant. CONCLUSIONS: The epidemiological profile of imported malaria cases can be defined as VFR between 15 and 39 years old, coming from sub-Saharan Africa, particularly from Equatorial Guinea. Immigrants education about the importance of chemoprophylaxis when travelling to visit friends and relatives, emphasizing on those who are originally from the ex-colonies of destination country, is necessary; as well as to raise awareness among health professionals to make advice in consultations, specially before summer vacations.

Pilot study of an online brief mindfulness-based intervention to improve the well-being of managers and reduce their stress at work.

Objectives. The COVID-19 pandemic, remote work and new technologies have heightened workplace pressures. Effective response and essential organizational changes require business leaders to be more adaptable, with managers' presence playing a pivotal role in successful implementation. The study assesses a brief mindfulness-based emotional regulation for managers (MBERM) intervention, to reduce workplace stress and enhance managerial well-being. Methods. An 8-week non-randomized controlled trial was conducted with a waiting list control group and an intervention group. Pre-post differences were measured by Student's t test or Wilcoxon test, and effect size calculated using the Hedge's g formula. The sample included 23 managers (17 men and six women) with average age 50 years. The study assessed anxiety and depressive symptoms, psychological flexibility, perceived self-efficacy, general work-related well-being, perceived stress and mindfulness. Results. Statistically significant changes were observed in the intervention group in depression, anxiety, work-related acceptance and action, general self-efficacy, exhaustion, alienation, stress and non-reactivity. The control group showed no statistically significant changes in any of the variables. Conclusion. The MBERM intervention could improve the emotional and work-related well-being of managers and reduce stress levels and burnout. Further study of this intervention is needed to promote adherence and ensure a long-term improvement.

Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year.

Background: Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain. Methods: A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization. Results: We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported. Conclusion: Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.

Protocol for an observational cohort study on psychological, addictive, lifestyle behavior and highly prevalent affective disorders in primary health care adults.

Background: Depression and anxious symptoms are prevalent in the general population, and their onset and persistence may be linked to biological and psychosocial factors, many of which are lifestyle-related. The way we manage our care, physical and emotional health and/or discomfort is highly influenced by our own abilities, skills and attitudes despite life's circumstances. The main aim of this protocol to analyze the relationship between psychological constructs (self-efficacy, activation, health literacy, resilience, personality traits, sense of coherence, self-esteem), and the presence of affective-emotional problems (anxiety, depression) and addictions in primary health care. Methods: This is a protocol of a prospective longitudinal cohort study including people of 35-74 years old of Aragon primary health care centers (Spain). Three evaluations will be conducted: baseline evaluation, and follow-up assessments five and ten years after recruitment. The primary outcomes will be severity of depression, severity of anxiety, and addictive behaviors. A detailed set of secondary outcomes will be assessed across all three assessments. This will include psychosocial or personal factors on health behavior, social support, lifestyle patterns, quality of life, the use of health and social resources, and chronic comorbid pathology. Discussion: The analysis of the impact of psychological constructs and lifestyles on the mental health of people and communities will provide evidence that will make it possible to better address and prevent these prevalent problems and address their improvement from a more global and holistic perspective. The evaluation of psychological constructs should be incorporated into health services to improve people's ability their self-care, the level of knowledge of managing their disease and their physical, mental and social health. Clinical trial registration: https://www.isrctn.com/, identifier ISRCTN12820058.

Functionality, physical activity, fatigue and quality of life in patients with acute COVID-19 and Long COVID infection.

A prominent feature of COVID-19, both in the short and long term, is the reduction in quality of life (QoL) due to low functionality scores and the presence of fatigue, which can hinder daily activities. The main objective of this study is to compare the functional status, level of physical activity, fatigue, and QoL of patients with Long COVID to other COVID-19 patients who did not develop persistent illness, and to determine whether there is a relationship between these variables and QoL. A cross-sectional study was conducted with 170 participants who had been infected with COVID-19 or had developed Long COVID. The main variables studied were functionality, physical activity, QoL and fatigue, measured using the PostCOVID-19 Functional Status Scale (PCFS), International Physical Activity Questionnaire (IPAQ), Short Form 12 (SF-12), and Fatigue Severity Scale (FSS). The main findings show a significant relationship (p < 0.001) between reduced functionality, lower physical activity levels, increased fatigue severity, and poorer QoL in Long COVID patients. Furthermore, these variables are also related to worse QoL, but only functional status predicts it. In conclusion, our results have shown highly significant correlations between the group with COVID-19 and Long COVID regarding functional status, level of physical activity, QoL, and fatigue.

A multiple health behaviour change intervention to prevent depression: A randomized controlled trial.

OBJECTIVE: To examine the effectiveness of a 12-month MHBC intervention in the prevention of onset depression in primary health care (PHC). METHODS: Twenty-two PHC centres took part in the cluster-randomized controlled trial. Patients were randomized to receive either usual care or an MHBC intervention. The endpoints were onset of major depression and reduction of depressive symptoms in participants without baseline depression at a 12-month follow-up. RESULTS: 2531 patients agreed and were eligible to participate. At baseline, around 43% were smokers, 82% were non-adherent to the Mediterranean diet and 55% did not perform enough physical activity. The intervention group exhibited a greater positive change in two or more behaviours (OR 1.75 [95%CI: 1.17 to 2.62]; p = 0.006); any behaviour (OR 1.58 [95%CI: 1.13 to 2.20]; p = 0.007); and adherence to the Mediterranean diet (OR 1.94 [95%CI: 1.29 to 2.94]; p = 0.002), while this increase was not statistically significant for smoking and physical activity. The intervention was not effective in preventing major depression (OR 1.17; [95% CI 0.53 to 2.59)]; p = 0.690) or reducing depressive symptoms (Mean difference: 0.30; [95% CI -0.77 to 1.36]; p = 0.726) during follow-up. CONCLUSIONS: As compared to usual care, the MHBC intervention provided a non-significant reduction in the incidence of major depression. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03136211.

Depressive and Anxious Symptoms Increase with Problematic Technologies Use Among Adults: The Effects of Personal Factors Related to Health Behavior.

Background: Depression and anxiety disorders are a significant and growing health problem that has a significant impact on psychosocial functioning and quality of life. The onset and severity of mental health problems have been related to various biological, psychosocial, and behavioral variables. Purpose: The purpose of this study was to explore the association among the severity of depression and anxiety, problematic information and communications technology (ICT) use, and some related personal factors with health behavior among adults. It also analyzes the moderating role of personal factors in the relationship between the problematic use of ICT and anxiety and depression. Patients and Methods: Descriptive, bivariate, multivariate and moderation analyzes of data from 391 participants of 35-74 years old in primary health care centers located in Aragón (Spain) were performed between July 2021 and July 2022. The primary outcome was the severity of depressive and anxious symptoms as continuous variable. Results: Low sense of coherence (ß = -0.058; p = 0.043), low self-esteem (ß = -0.171; p=0.002), and low self-efficacy (ß = -0.122; p= 0.001), are predictors of having more severe depressive symptoms. Furthermore, low self-esteem (ß = -0.120; p= 0.012), low self-efficacy (ß = -0.092; p=0.004), and high problematic use of ICT (ß = 0.169; p = 0.001), are predictors of having more severe anxiety symptoms. Moderation analyzes were significant in the effect of self-efficacy (b = -0.040, p=0.001) and resilience (b = -0.024, p=0.033) on the relationship between problematic ICT use and anxiety. Conclusion: The problematic use of ICT and personal factors are related to depressive and anxiety symptoms. The interrelationship between problematic ICT use, personal factors, and depression needs to be further explored.

[Analysis of community agendas in primary care and factors associated with their implementation]. / Análisis de las agendas comunitarias en atención primaria y factores asociados a su implantación.

OBJECTIVE: To describe the community agendas created by the Aragonese Primary Care Teams (PCT), to analyze the characteristics of said PCT, and to explore factors related to their implementation. METHOD: Descriptive observational study of the community agendas and the Aragonese PCT that have created them since the implementation of the Aragonese Community Care Strategy (ACCS) in 2016 until March 2021. Bivariate and multivariate analysis of the characteristics of these PCT that have created the agenda with respect to those who have not developed it. RESULTS: 75 of the 123 Aragonese PCT (61%) have created the community agenda. 74.7% of them also have an active Health Council. 45 of the 75 agendas are of the advanced type, with 41 PCT that had carried out the zone health diagnosis and 28 PCT that made asset recommendations. It was observed how the creation of the community agenda is related to being a PCT belonging to a semi-urban basic health zone (odds ratio [OR]: 3.02; 95% confidence interval [95% CI]: 1.22-7.47; p=0.017) and that at least one professional would have received specific training (OR: 5.29; 95% CI: 1.09-25.72; p=0.039). CONCLUSIONS: The community agenda is a tool that supports the development of community care for PCT. The training provided by the ACCS has been shown to be key to the development of the agendas, and this work must continue, with special emphasis on the PCT belonging to rural or urban basic health zones, since they are the ones that are experiencing the greatest difficulties.

Incidental finding of rare hemoglobin: hemoglobin Bari in northeast Spain.

Objectives: Cation exchange high-performance liquid chromatography (HPLC) is one of the techniques available for determining glycated hemoglobin (HbA1c) and also the method of choice for structural hemoglobinopathies screening. The objective of this case is to show how in a routine HbA1c test it is possible to incidentally find a hemoglobinopathy. Case presentation: In a routine blood analysis, an abnormal value for the hemoglobin A2 (HbA2) was obtained during the study of HbA1c with HPLC on the ADAMS™ A1c HA-8180T. After suspecting it could be due to the presence of a hemoglobinopathy, the study of possible variants was expanded using electrophoresis and HPLC on the Hydrasys and Variant II analysers, respectively. Since it could not be identified by these conventional methods, a genetic study was also carried out using Sanger sequencing. The patient presented a low HbA2 (1.3 %) and a 24.9 % variant with a retention time of 1.95 min, compatible with alpha-globin chain variant. In the genetic study, the pathogenic variant c.138C>G was detected in the HbA2 gene in heterozygosis, which resulted in the expression of the structural hemoglobinopathy known as hemoglobin Bari. Conclusions: The initial screening for structural hemoglobinopathies allows its identification or suspicion especially when it was performed with HbA1c analysis, requiring subsequent confirmation and diagnosis by other techniques.