Assessing the likelihood of contracting COVID-19 disease based on a predictive tree model: A retrospective cohort study.

BACKGROUND: Primary care is the major point of access in most health systems in developed countries and therefore for the detection of coronavirus disease 2019 (COVID-19) cases. The quality of its IT systems, together with access to the results of mass screening with Polymerase chain reaction (PCR) tests, makes it possible to analyse the impact of various concurrent factors on the likelihood of contracting the disease. METHODS AND FINDINGS: Through data mining techniques with the sociodemographic and clinical variables recorded in patient's medical histories, a decision tree-based logistic regression model has been proposed which analyses the significance of demographic and clinical variables in the probability of having a positive PCR in a sample of 7,314 individuals treated in the Primary Care service of the public health system of Catalonia. The statistical approach to decision tree modelling allows 66.2% of diagnoses of infection by COVID-19 to be classified with a sensitivity of 64.3% and a specificity of 62.5%, with prior contact with a positive case being the primary predictor variable. CONCLUSIONS: The use of a classification tree model may be useful in screening for COVID-19 infection. Contact detection is the most reliable variable for detecting Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases. The model would support that, beyond a symptomatic diagnosis, the best way to detect cases would be to engage in contact tracing.

Risk of underdiagnosis of hypertension in schizophrenia patients.

AIM: Arterial hypertension requires proper screening and management, and its underdiagnosis in patients with schizophrenia (SZ) and/or antipsychotic treatment has been postulated. The objective of the study is to assess whether there are differences in the proportion of screened patients with a blood pressure >140/90 mmHg that are undiagnosed or not confirmed later (risk of underdiagnosis). METHODS: Cross-sectional study of clinical records from SIDIAPQ (Spain) during the 2006-2011 period. Three groups were studied: SZ, no SZ but under antipsychotic treatment, and control groups. Patients with established hypertension, cardiovascular disease, dementia, or diagnosis of SZ or starting with antipsychotic treatment during this period were excluded. RESULTS: The SZ group had a lower risk of underdiagnosis than the control group (OR 0.91; 95% CI: 0.83-0.99; p < 0.05), at the expense of men (OR 0.8; 95% CI: 0.71-0.9; p < 0.001) and patients younger than 50 years of age (OR: 0.84; 95% CI: 0.74-0.93; p < 0.003). In the no SZ but under antipsychotic treatment group there were some differences, but not in the overall results. CONCLUSION: Preventive management of hypertension seemed to be sufficient for SZ and antipsychotic treatment patients. The lower prevalence of hypertension found in these groups may be due to other factors (blood pressure-lowering effect of psychoactive drugs or smoking) but these hypotheses must be evaluated with specific studies.

Screening of cardiovascular risk factors in patients with schizophrenia and patients treated with antipsychotic drugs: are we equally exhaustive as with the general population?

Many studies have previously shown increased cardiovascular risk factors related to schizophrenia independently from the use of antipsychotic drugs. However, a poorer effort in clinical detection and management of cardiovascular risk in patients with severe mental illness could also explain these results. To test this hypothesis, we analyzed the differences in screening and incidence of cardiovascular risk factors between schizophrenia, non-schizophrenic patients on treatment with antipsychotic drugs (NS-TAD) and the general population. Data from adult subjects assessed by high-quality register general practitioners from 2006 to 2011 were extracted from the Catalonian SIDIAP database. The schizophrenia, NS-TAD, and control groups were compared in terms of measurements and incidence of diabetes, dyslipidemia, obesity, hypertension, and smoking. A total of 4911 patients in the schizophrenia group, 4157 in NS-TAD group, and 98644 in the control group were included. Schizophrenia patients were screened for dyslipidemia and diabetes more frequently than the control group, while for obesity or hypertension, they were screened equal to controls. Also, as compared to the control group, the NS-TAD group was more frequently screened for obesity with no differences in dyslipidemia and diabetes and less frequently for hypertension. Smoking was less frequently screened in both study groups. The incidence of all risk factors studied in both study groups was higher than or equal to the control group, except for hypertension, which had lower incidence. The lack of screening of risk factors does not appear decisive in the increased cardiovascular risk of patients diagnosed with schizophrenia seen in primary care. Studies evaluating the possible under diagnosis of the risk factors are required. ABBREVIATIONS: Schizophrenia (SZ); Treatment with antipsychotic drugs (TAD); Cardiovascular risk factor/s (CVRF); Without schizophrenia but on therapy with antipsychotic drugs (NS-TAD); Defined Daily Dose (DDD).

Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study.

BACKGROUND: The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking. OBJECTIVES: To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose. METHODS: A qualitative, descriptive-interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer's notes. Data were analyzed with the ATLAS TI 6.0 programme. RESULTS: Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers. CONCLUSIONS: Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal contact in the smoking cessation programme.

Psicosis, riesgo cardiovascular y mortalidad asociada: ¿vamos por el buen camino? / Psychosis, cardiovascular risk and associated mortality: Are we on the right track?

Los pacientes con patología psicótica tienen un mayor riesgo de mortalidad precoz. Además de las causas no naturales (accidentes, suicidio), la causa cardiovascular (CV) está de 2 a 4 veces más presente que en población general. Esta revisión no sistemática de MEDLINE pretende esclarecer el papel de todos los condicionantes implicados. La patología psicótica se relaciona con hábitos de vida poco saludables tales como el tabaquismo, la dieta no equilibrada o el sedentarismo. Los fármacos neurolépticos también han sido estudiados como desencadenantes de obesidad y síndrome metabólico. Por tanto, los pacientes psicóticos parecen predispuestos a sufrir muchos de los factores de riesgo CV «clásicos». No es de extrañar que las puntuaciones en las escalas de riesgo cardiovascular (RCV) (Framingham, SCORE) sean superiores a las de la población general. También encontramos publicaciones en las que evidencian mayor dificultad en el manejo de la prevención primaria y secundaria de la enfermedad CV. Además, algunos factores bioquímicos (niveles plasmáticos de cortisol, ACTH, homocisteína, PCR) podrían indicar una vulnerabilidad de la psicosis per se, así como los hallazgos sobre hiperglucemia y resistencia a la insulina en psicóticos no tratados con psicofármacos. Estos factores «no-clásicos» podrían alteran la validez de las escalas de RCV diseñadas para población general. Por otro lado, los fármacos antipsicóticos podrían controlar factores intrínsecos de la psicosis (han demostrado disminuir la mortalidad global), no quedando claro su papel en la mortalidad CV

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic» CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear

[Psychosis, cardiovascular risk and associated mortality: are we on the right track?]. / Psicosis, riesgo cardiovascular y mortalidad asociada: ¿vamos por el buen camino?

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic¼ CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear.

Effectiveness of an intensive E-mail based intervention in smoking cessation (TABATIC study): study protocol for a randomized controlled trial.

BACKGROUND: Intensive interventions on smoking cessation increase abstinence rates. However, few electronic mail (E-mail) based intensive interventions have been tested in smokers and none in primary care (PC) setting. The aim of the present study is to evaluate the effectiveness of an intensive E-mail based intervention in smokers attending PC services. METHODS/DESIGN: Randomized Controlled Multicentric Trial. STUDY POPULATION: 1060 smokers aged between 18-70 years from Catalonia, Salamanca and Aragón (Spain) who have and check regularly an E-mail account. Patients will be randomly assigned to control or intervention group. INTERVENTION: Six phase intensive intervention with two face to face interviews and four automatically created and personal E-mail patients tracking, if needed other E-mail contacts will be made. Control group will receive a brief advice on smoking cessation. OUTCOME MEASURES: Will be measured at 6 and 12 months after intervention: self reported continuous abstinence (confirmed by cooximetry), point prevalence abstinence, tobacco consumption, evolution of stage according to Prochaska and DiClemente's Stages of Change Model, length of visit, costs for the patient to access Primary Care Center. STATISTICAL ANALYSIS: Descriptive and logistic and Poisson regression analysis under the intention to treat basis using SPSS v.17. DISCUSSION: The proposed intervention is an E-mail based intensive intervention in smokers attending primary care. Positive results could be useful to demonstrate a higher percentage of short and long-term abstinence among smokers attended in PC in Spain who regularly use E-mail. Furthermore, this intervention could be helpful in all health services to help smokers to quit. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01494246.

Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity.

BACKGROUND: Health surveys (HS) are a well-established methodology for measuring the health status of a population. The relative merit of using information based on HS versus electronic health records (EHR) to measure multimorbidity has not been established. Our study had two objectives: 1) to measure and compare the prevalence and distribution of multimorbidity in HS and EHR data, and 2) to test specific hypotheses about potential differences between HS and EHR reporting of diseases with a symptoms-based diagnosis and those requiring diagnostic testing. METHODS: Cross-sectional study using data from a periodic HS conducted by the Catalan government and from EHR covering 80% of the Catalan population aged 15 years and older. We determined the prevalence of 27 selected health conditions in both data sources, calculated the prevalence and distribution of multimorbidity (defined as the presence of ≥2 of the selected conditions), and determined multimorbidity patterns. We tested two hypotheses: a) health conditions requiring diagnostic tests for their diagnosis and management would be more prevalent in the EHR; and b) symptoms-based health problems would be more prevalent in the HS data. RESULTS: We analysed 15,926 HS interviews and 1,597,258 EHRs. The profile of the EHR sample was 52% women, average age 47 years (standard deviation: 18.8), and 68% having at least one of the selected health conditions, the 3 most prevalent being hypertension (20%), depression or anxiety (16%) and mental disorders (15%). Multimorbidity was higher in HS than in EHR data (60% vs. 43%, respectively, for ages 15-75+, P <0.001, and 91% vs. 83% in participants aged ≥65 years, P <0.001). The most prevalent multimorbidity cluster was cardiovascular. Circulation disorders (other than varicose veins), chronic allergies, neck pain, haemorrhoids, migraine or frequent headaches and chronic constipation were more prevalent in the HS. Most symptomatic conditions (71%) had a higher prevalence in the HS, while less than a third of conditions requiring diagnostic tests were more prevalent in EHR. CONCLUSIONS: Prevalence of multimorbidity varies depending on age and the source of information. The prevalence of self-reported multimorbidity was significantly higher in HS data among younger patients; prevalence was similar in both data sources for elderly patients. Self-report appears to be more sensitive to identifying symptoms-based conditions. A comprehensive approach to the study of multimorbidity should take into account the patient perspective.

[What do men between 50 and 70 know about the effectiveness, the benefits, and the risks of prostate cancer screening?]. / Conocen los varones de 50-70 años la efectividad, los beneficios y los riesgos del cribado del cáncer de próstata?

OBJECTIVE: To evaluate the understanding of the population on prostate cancer screening. DESIGN: Descriptive study. SETTING: Primary care teams in the province of Barcelona, Spain, from april to september 2005. PARTICIPANTS AND CONTEXT: Men between 50 and 70 years old without prostate symptoms and seen in the clinics of 12 primary care teams. METHOD: Systematic sample. VARIABLES: age, marital status, educational level, and self-perceived health status. Appraisal of knowledge through a 14-question questionnaire referring to the key ideas, previously defined by a group of experts, requisite before deciding on prostate cancer screening. RESULTS: N=221. Mean age, 59.9 (SD, 5.9); educational level, primary or lower: 63.4%; 89.1% (95% CI, 84.4-92.6) did not have sufficient knowledge about prostate cancer screening. In the questions on what PSA is and what it is for, over 50% said they did not know; 63.3% recognised that prostate cancer was a highly prevalent illness; 84.6% replied that early detection of prostate cancer avoids deaths; 49.8% did not know whether the doctor had doubts on this question; and 38.9% thought he didn't. There were no differences in knowledge for any of the variables studied. CONCLUSIONS: Although prostate cancer screening is widely known about, the information of the population is scant and often wrong. Existing scientific uncertainty on the use of screening is the aspect that is least known by users.

¿Conocen los varones de 50-70 años la efectividad, los beneficios y los riesgos del cribado del cáncer de próstata? / What do men between 50 and 70 know about the effectiveness, the benefits, and the risks of prostate cancer screening

Objetivo. Valorar los conocimientos de la población sobre el cribado del cáncer de próstata. Diseño. Estudio descriptivo. Emplazamiento. Equipos de atención primaria (EAP) de la provincia de Barcelona, durante el período comprendido entre abril y septiembre de 2005. Participantes y contexto. Participaron varones de 50-70 años de edad atendidos en las consultas de 12 EAP, sin sintomatología prostática. Método. Se realizó una muestra sistemática. Las variables analizadas fueron: edad, estado civil, nivel de estudios y estado de salud autopercibido. Se llevó a cabo una valoración de los conocimientos mediante un cuestionario de 14 preguntas referidas a las ideas clave (previamente definidas por un grupo de expertos) que son necesarias para poder decidir sobre el cribado del cáncer de próstata. Resultados. Se incluyó a 221 varones. Su edad media era de 59,9 años (desviación estándar [DE] = 5,9); el 63,4% tenía un nivel de estudios primario o inferior. El 89,1% (intervalo de confianza del 95%, 84,4-92,6) no tienen conocimientos suficientes sobre el cribado del cáncer de próstata. En las preguntas referentes a qué es y para qué sirve el antígeno prostático específico, más del 50% responde que no lo saben. El 63,3% reconoce que el cáncer de próstata es una enfermedad con una alta prevalencia. El 84,6% responde que la detección precoz del cáncer de próstata evita muertes. El 49,8% no sabe si el médico tiene dudas sobre este tema y el 38,9% cree que no las tiene. No existen diferencias en los conocimientos para ninguna de las variables estudiadas. Conclusiones. A pesar de la amplia extensión del cribado del cáncer de próstata, la información que tiene la población es muy escasa y a menudo errónea. La incertidumbre científica existente sobre la utilidad del cribado es el aspecto más desconocido por los usuarios

Objective. To evaluate the understanding of the population on prostate cancer screening. Design. Descriptive study. Setting. Primary care teams in the province of Barcelona, Spain, from april to september 2005. Participants and context. Men between 50 and 70 years old without prostate symptoms and seen in the clinics of 12 primary care teams. Method. Systematic sample. Variables: age, marital status, educational level, and self-perceived health status. Appraisal of knowledge through a 14-question questionnaire referring to the key ideas, previously defined by a group of experts, requisite before deciding on prostate cancer screening. Results. N=221. Mean age, 59.9 (SD, 5.9); educational level, primary or lower: 63.4%; 89.1% (95% CI, 84.4-92.6) did not have sufficient knowledge about prostate cancer screening. In the questions on what PSA is and what it is for, over 50% said they did not know; 63.3% recognised that prostate cancer was a highly prevalent illness; 84.6% replied that early detection of prostate cancer avoids deaths; 49.8% did not know whether the doctor had doubts on this question; and 38.9% thought he didn't. There were no differences in knowledge for any of the variables studied. Conclusions. Although prostate cancer screening is widely known about, the information of the population is scant and often wrong. Existing scientific uncertainty on the use of screening is the aspect that is least known by users

[Follow-up and monitoring of hypertension. Is this performed the same in the autochthonous and immigrant populations?]. / Seguimiento y control de la hipertensión arterial. Se efectúa igual en la población autóctona y en la inmigrante?

OBJECTIVES: To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. DESIGN: Cross-sectional, observational study. SETTING: Urban primary care team, Spain. PARTICIPANTS: All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. MAIN MEASUREMENTS: The main variable was hypertension control the last time BP was taken (BP

Seguimiento y control de la hipertensión arterial. ¿Se efectúa igual en la población autóctona y en la inmigrante? / Follow-up and monitoring of hypertension. Is this performed the same in the autochthonous and immigrant populations?

Objetivo. Evaluar el grado de control de la presión arterial (PA) en la población autóctona y la inmigrante y determinar las variables asociadas a un buen control. Diseño. Estudio observacional, transversal. Emplazamiento. Equipo urbano de atención primaria. Participantes. Todos los pacientes con hipertensión arterial (HTA), atendidos entre el 1 de enero de 2000 y el 1 de julio de 2005, de los que se conocía el origen: en total 1.063 pacientes, 931 autóctonos y 132 inmigrantes. Mediciones principales. La variable principal fue el control de la HTA según la última toma de PA (PA ≤ 140/90 y ≤ 130/80 en diabéticos). Además, se recogió: país de origen, edad, sexo, índice de masa corporal, factores de riesgo cardiovascular (diabetes, dislipemia, tabaquismo), exploraciones complementarias (analítica anual y electrocardiograma bienal) y fármacos prescritos. Se realizó una regresión logística para estimar el efecto del origen en el control de la PA. Resultados. Se consiguió un buen control en un 39,2% de los autóctonos y en un 25% de los inmigrantes (odds ratio [OR] = 1,6; intervalo de confianza [IC] del 95%, 1,2-2,1). No obstante, el análisis multivariable señala la edad (OR = 1,029; IC del 95%, 1,017-1,040) como único factor asociado al buen control de la PA. Conclusiones. El origen del paciente no influye en el control de la PA

Objectives. To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. Design. Cross-sectional, observational study. Setting. Urban primary care team, Spain. Participants. All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. Main measurements. The main variable was hypertension control the last time BP was taken (BP ≤140/90 mm Hg and ≤130/80 mm Hg in diabetics). In addition, data on country of origin, age, gender, body mass index, cardiovascular risk factors (diabetes, lipaemia, tobacco dependency), further examinations (annual blood analysis and ECG every 2 years) and prescribed medication were recorded. Logistic regression was used to calculate the effect of origin on blood pressure monitoring. Results. Good BP control was achieved in 39.2% of autochthonous patients and 25% of immigrants (odds ratio [OR], 1.6; 95% confidence interval [CI], 95% CI, 1.2-2.1). Nevertheless, multivariate analysis indicated age (OR, 1.029; 95% CI, 1.017-1.040) as the sole factor determining good or bad BP control. Conclusions. The origin of the patient does not affect BP control