"Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records".

BACKGROUND: The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia. METHODS: We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people older than 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data. RESULTS: We analysed 740,820 new chronic diseases' diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81% to 16.15%). CONCLUSIONS: Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.

Reduced humoral response 3 months following BNT162b2 vaccination in SARS-CoV-2 uninfected residents of long-term care facilities.

BACKGROUND: SARS-CoV-2 vaccination is the most effective strategy to protect older residents of long-term care facilities (LTCF) against severe COVID-19, but primary vaccine responses are less effective in older adults. Here, we characterised the humoral responses of institutionalised seniors 3 months after they had received the mRNA/BNT162b2 vaccine. METHODS: plasma levels of SARS-CoV-2-specific total IgG, IgM and IgA antibodies were measured before and 3 months after vaccination in older residents of LTCF. Neutralisation capacity was assessed in a pseudovirus neutralisation assay against the original WH1 and later B.1.617.2/Delta variants. A group of younger adults was used as a reference group. RESULTS: three months after vaccination, uninfected older adults presented reduced SARS-CoV-2-specific IgG levels and a significantly lower neutralisation capacity against the WH1 and Delta variants compared with vaccinated uninfected younger individuals. In contrast, COVID-19-recovered older adults showed significantly higher SARS-CoV-2-specific IgG levels after vaccination than their younger counterparts, whereas showing similar neutralisation activity against the WH1 virus and an increased neutralisation capacity against the Delta variant. Although, similarly to younger individuals, previously infected older adults elicit potent cross-reactive immune responses, higher quantities of SARS-CoV-2-specific IgG antibodies are required to reach the same neutralisation levels. CONCLUSIONS: although hybrid immunity seems to be active in previously infected older adults 3 months after mRNA/BNT162b2 vaccination, humoral immune responses are diminished in COVID-19 uninfected but vaccinated older residents of LTCF. These results suggest that a vaccine booster dose should be prioritised for this particularly vulnerable population.

The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents.

BACKGROUND: Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS: We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS: A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

Determinantes de la frecuentación en Atención Primaria en Cataluña / Primary Care frequentation determinants in Catalonia

OBJETIVO: Determinar qué variables definen el tiempo de asistencia anual medio por paciente en Atención Primaria (AP) en Cataluña, para mejorar la adecuación de la asignación presupuestaria. DISEÑO: Estudio ecológico transversal. Emplazamiento: Los Equipos de Atención Primaria (EAP) del Institut Català de la Salut (ICS) en 2016. PARTICIPANTES: Los 285 EAP del ICS, que dan cobertura a un 75% de los ciudadanos mayores de 14 años en Cataluña. Mediciones principales: Tiempo medio de visita anual en medicina familiar por paciente para cada EAP. Se estudió cómo este tiempo dependía de potenciales variables explicativas, a nivel de EAP, mediante modelos de regresión lineal. RESULTADOS: El tiempo medio de visita por paciente/año fue de 49 minutos, variando entre 23-87 minutos, según el EAP. Los EAP con población asignada de más edad, más comorbilidad, más atención domiciliaria, peor índice socioeconómico, mayor número de pensionistas jóvenes y mayor dispersión tuvieron más tiempo de visita, mientras que los EAP con más población y más mujeres tuvieron menos tiempo de visita. Estas variables explicaron un 64% de la variabilidad del tiempo de visita. CONCLUSIONES: La asignación presupuestaria en AP se puede basar en un modelo que incorpore las principales determinantes de la frecuentación de la población y se adecúe a las necesidades reales de ésta. Sería necesario profundizar en aquellos factores que dependen del profesional o de las organizaciones sanitarias para acabar de encontrar un modelo óptimo de asignación de recursos en la AP

AIM: To determine which variables determine the average annual attendance time per patient in Primary Care (PC) in Catalonia to improve the adequacy of the budget allocation. DESIGN: Cross-sectional ecological study. SETTING: The Primary Care health centers (EAP) from the Institut Català de la Salut (ICS) in 2016. PARTICIPANTS: The 285 EAPs from the ICS, which cover 75% of citizens over 14 years of age in Catalonia. MAIN MEASUREMENTS: Annual average time of visits by a family doctor per patient for each EAP. It was studied how this time depended on potential explanatory variables, at the EAP level, using linear regression models. RESULTS: the average visit time per patient/year was 49 minutes, varying between 23-87 minutes according to EAP. The EAPs with older population, more comorbidity, more home care, worse socioeconomic index, greater number of young pensioners and greater dispersion had more visiting time, while the EAPs with more population and more women expended less time to visit. These variables explained 64% of the visit time variability. CONCLUSIONS: The budget allocation in PC can be based on a model that incorporates the main determinants of patient' frequentation and adapts to their real needs. It would be necessary to deepen those factors that depend on the professional or health organizations to finish finding an optimal model of resource allocation in the PC

[Primary Care frequentation determinants in Catalonia]. / Determinantes de la frecuentación en Atención Primaria en Cataluña.

AIM: To determine which variables determine the average annual attendance time per patient in Primary Care (PC) in Catalonia to improve the adequacy of the budget allocation. DESIGN: Cross-sectional ecological study. SETTING: The Primary Care health centers (EAP) from the Institut Català de la Salut (ICS) in 2016. PARTICIPANTS: The 285 EAPs from the ICS, which cover 75% of citizens over 14 years of age in Catalonia. MAIN MEASUREMENTS: Annual average time of visits by a family doctor per patient for each EAP. It was studied how this time depended on potential explanatory variables, at the EAP level, using linear regression models. RESULTS: the average visit time per patient/year was 49 minutes, varying between 23-87 minutes according to EAP. The EAPs with older population, more comorbidity, more home care, worse socioeconomic index, greater number of young pensioners and greater dispersion had more visiting time, while the EAPs with more population and more women expended less time to visit. These variables explained 64% of the visit time variability. CONCLUSIONS: The budget allocation in PC can be based on a model that incorporates the main determinants of patient' frequentation and adapts to their real needs. It would be necessary to deepen those factors that depend on the professional or health organizations to finish finding an optimal model of resource allocation in the PC.

Arboviral infections diagnosed in a European area colonized by Aedes albopictus (2009-2013, Catalonia, Spain).

BACKGROUND: The invasive mosquito Aedes albopictus, with proven vectorial ability to transmit European autochthonous cycles of dengue and chikungunya virus, has currently colonized every coastal department of Eastern Spain. The main objective of the study was to define the epidemiological and clinical characteristics as well as the trends of these two arboviral diseases in a European area heavily colonized by Ae. albopictus. METHOD: A voluntarily-based, prospective and multicenter surveillance study was performed in all medical units of the North Metropolitan area of Barcelona (406,000 inhabitants, Catalonia; Spain) with diagnostic capability from 2009 to 2013. Since any possible increase in arboviral cases could be justified by changes in traveling behaviors along the study period (especially longer trips) the trend showed by these two arboviral diseases was compared with that displayed by malaria cases during the same period. RESULTS: 38 out of 52 (73.1%) suspected cases could be serologically confirmed (IgM+): dengue 34/38 (89.5%) and chikungunya 4/38 (11.5%). No autochthonous cases were identified. The overall incidence of both arboviruses was 0.19 cases/10,000 inhabitants-year (95% CI: 0.07-0.3); dengue = 0.17 cases/10,000 inhabitants-year (95% CI: 0.05-0.3), and chikungunya = 0.02 cases/10,000 inhabitants-year (95% CI: 0.001-0.03). The Incidence Relative Risk of arboviral disease between 2009 and 2013 shown a significant trend (IRR = 1.27. IC 95%: 1.01-1.59; p = 0.043) when compared with that displayed by malaria (IRR = 1.04. IC 95%: 0.924-1.192). If no unexpected circumstances concur, the arboviral disease incidence tax would equal that of malaria about 2021-2022. CONCLUSIONS: The incidence of dengue and chikungunya is steadily increasing in the North Metropolitan area of Barcelona, a region densely colonized by Ae. albopictus, at the entire expense of imported cases (especially Visiting Friends and Relatives travelers). To date, no secondary autochthonous cases have been identified and, thus, they have not taken part in this rise.

The role of Fcγ receptor polymorphisms in the response to anti­tumor necrosis factor therapy in psoriasis A pharmacogenetic study.

IMPORTANCE: Variability in genes encoding proteins involved in the immunological pathways of biological therapy may account for the differences observed in outcomes of anti­tumor necrosis factor (TNF) treatment of psoriasis. OBJECTIVE: To assess the role of 2 Fcγ receptor (FcγR) polymorphisms in the response to anti-TNF therapy in psoriasis. DESIGN: Retrospective series of patients with psoriasis who received anti-TNF therapy(infliximab, adalimumab, or etanercept) from January 1, 2007, through December 31, 2010. Patients were followed up for 12 weeks. SETTING: Two psoriasis referral centers. PARTICIPANTS: Seventy treatment-naive patients with moderate to severe psoriasis who received anti-TNF agents. INTERVENTION: Patients underwent FcγRIIA-H131R and FcγRIIIA-V158F polymorphism genotyping. MAIN OUTCOMES AND MEASURES: The Psoriasis Area and Severity Index and the body surface area were assessed at baseline and at treatment weeks 6 to 8 and 12. The polymorphism genotypes were correlated with the treatment outcomes. RESULTS: Bivariate analysis showed a nonsignificant association between FcγR low-affinity genotypes and greater improvement in the Psoriasis Area and Severity Index and body surface area at the end of treatment. Conversely, patients harboring high-affinity alleles presented a greater reduction in body surface area at the intermediate point, which remained independent in the multivariate analysis. We also detected an additive effect of both polymorphisms in the multivariate analysis. High-affinity alleles may contribute to a quicker response owing to a more efficient removal of relevant cells expressing TNF. CONCLUSIONS AND RELEVANCE: Preliminary results of this pilot study on the pharmacogenetics of FcγR and biological therapy in psoriasis suggest a role with clinical implications for FcγRIIA-H131R and FcγRIIIA-V158F polymorphisms in the outcome of anti-TNF treatment of psoriasis. These results might help dermatologists in guiding therapeutic decisions, especially in very severe cases where a quick response is needed.

Gestión de coberturas de personal en atención primaria. Automatización del cálculo / Management of needed health care workers in primary care. Automating the calculation

El Servicio de Atención Primaria de Santa Coloma de Gramenet ha diseñado un sistema que estandariza y automatiza la planificación de coberturas de personal sanitario. Está dividido en dos partes: una calculadora que en función de parámetros de actividad y presión asistencial orienta sobre el riesgo previsible derivado de nuestra planificación, y otra con indicadores centinela; el principal es el «nivel básico asistencial», definido como el porcentaje de usuarios atendidos a 2, 3 y 7 días naturales, y valora su repercusión en la asistencia a la población. Los resultados en el verano de 2010 muestran un aumento de la eficiencia al disminuir la plantilla presencial respecto al año 2009, conseguir una mejor distribución de ésta en el periodo acorde con la actividad realizada y mejorar la gestión presupuestaria. Puesto que los datos necesarios están disponibles y su cálculo es sencillo, puede ser exportable a todo nuestro ámbito (AU)

The Santa Coloma de Gramenet Primary Care Service has designed a new tool to standardize and automate the process of planning the number of needed health care workers. The tool is divided in two parts: a calculator, which gives guidance on the foreseeable risk depending on the activity and the health care workers’ workload, and sentinel indicators; the main is the “welfare basic level”, that is the percentage structure of visited patients and their delay at 2, 3 and 7 calendar days, assessing the impact on the care of the population. The results of its use in the summer of 2010 have demonstrated its efficiency by lowering the needed workers with respect to 2009, achieving a better distribution according to the workload and improving the economic management. Given that the necessary data are accessible through computerized databases and its simple use, we believe it to be exportable to other fields (AU)

Epidemiologic and biogeographic analysis of 542 VFR traveling children in Catalonia (Spain). A rising new population with specific needs.

BACKGROUND: Imported diseases recorded in the European Union (EU) increasingly involve traveling immigrants returning from visits to their relatives and friends (VFR). Children of these immigrant families can represent a population of extreme vulnerability. METHODS: A randomized cross-sectional study of 698 traveling children under the age of 15 was performed. VFR traveling children and non-VFR (or tourist) children groups were compared. RESULTS: A total of 698 individuals were analyzed: 354 males (50.7%) and 344 females (49.3%), with a median age (interquartile range) of 4 (2-9) years. Of these, 578 (82.8%) had been born in the EU with 542 (77.7%) being considered as VFR, whereas 156 (22.3%) were considered tourists. VFR children were younger (4.7 vs 8.2 yr; p < 0.001), they had more frequently been born in the EU (62.8% vs 20.1%; p < 0.01) and were more frequently lodged in private homes (76.6% vs 3.2%: p < 0.001) and rural areas (23.2% vs 1.6%; p < 0.001). Furthermore, VFR remained abroad longer (51.6 vs 16.6 d; p < 0.001), the visit/travel time interval was shorter (21.8 vs 32.2 d; p < 0.001) than tourists, and consultation was within 10 days prior to the departure (26.4% vs 2.7%; p < 0.001). The risk factor most differentiating VFR children from tourists was accommodation in a rural setting [odds ratio(OR) = 5.26;95%CI = 2.704-10.262;p < 0.001]. CONCLUSIONS: VFR traveling children showed a greater risk of exposure to infectious diseases compared with tourists. Immigrant families may represent a target group to prioritize international preventive activities.

[Management of needed health care workers in primary care. Automating the calculation]. / Gestión de coberturas de personal en atención primaria. Automatización del cálculo.

The Santa Coloma de Gramenet Primary Care Service has designed a new tool to standardize and automate the process of planning the number of needed health care workers. The tool is divided in two parts: a calculator, which gives guidance on the foreseeable risk depending on the activity and the health care workers' workload, and sentinel indicators; the main is the "welfare basic level", that is the percentage structure of visited patients and their delay at 2, 3 and 7 calendar days, assessing the impact on the care of the population. The results of its use in the summer of 2010 have demonstrated its efficiency by lowering the needed workers with respect to 2009, achieving a better distribution according to the workload and improving the economic management. Given that the necessary data are accessible through computerized databases and its simple use, we believe it to be exportable to other fields.

Familial and sporadic porphyria cutanea tarda: clinical and biochemical features and risk factors in 152 patients.

Porphyria cutanea tarda is the most frequent porphyria and occurs in both sporadic and familial forms. We conducted the current study in a series of 152 consecutive patients with porphyria cutanea tarda attending the Porphyria Unit of the Hospital Clinic of Barcelona, Spain, to update the clinical manifestations of the disease and to study the sex differences, the proportion of familial forms, and the role of different risk factors in this population. Patients were classified as familial and sporadic cases according to erythrocyte uroporphyrinogen-decarboxylase activity and uroporphyrinogen-decarboxylase genotyping. In our cohort, skin fragility and blisters on the hands were the most frequent clinical manifestations. Women more frequently had facial hypertrichosis (84.8%; p = 0.004), affected areas other than the hands and face (33.3%; p = 0.008), and pruritus (27.3%; p = 0.041) compared with men. Of our patients, 11.8% did not present the typical clinical onset of the disease, with facial hypertrichosis and hyperpigmentation the more frequent complaints in these cases. Analysis of risk factors showed a high prevalence of hepatitis C virus infection (65.8%) and alcohol abuse (59.9%), both being more frequent in men (p < 0.001). Hepatitis C virus infection was the only risk factor that showed differences between the sporadic and familial forms in the logistic regression model (odds ratio, 0.05; 95% confidence interval, 0.006-0.46). In conclusion, atypical forms of presentation of porphyria cutanea tarda should be considered in order to prevent delayed diagnosis. We note the sustained role of hepatitis C virus infection in the precipitation of sporadic porphyria cutanea tarda. Therefore, in countries with a high prevalence of hepatitis C virus infection, the absence of such infection in a patient with porphyria cutanea tarda may suggest a possible familial case.

Enfermedades infecciosas importadas asociadas a los desplazamientos internacionales de inmigrantes adultos en visita a familiares y amigos / Imported infectious diseases associated with international trips by adult immigrants to visit family and friends

Objetivo: Valorar las enfermedades infecciosas importadas por inmigrantes que realizaron visitas a familiares y amigos (VFA). Métodos: Estudio transversal descriptivo de todas las enfermedades infecciosas importadas en pacientes adultos 01/2001-12/2008. Los grupos de estudio definidos fueron: a) inmigrantes VFA; b) turistas, y c) inmigrantes no viajeros. Las enfermedades se clasificaron según su tipo en cosmopolitas y endémicas tropicales; según su gravedad en a) leves, b) graves, y c) potencialmente letales. Resultados: Se analizaron 761 individuos; edad: 31,7 (DE: 12,4) años; inmigrantes VFA=90, turistas=269, inmigrantes no-viajeros=402. Los inmigrantes VFA acudieron menos a las Consultas de Consejo a Viajeros que los turistas (32,2% frente a 57,2%; p <0,001) y viajaron con mayor frecuencia a África subsahariana (33,3% frente a 20,4%; p=0,01). Las enfermedades potencialmente letales fueron más frecuentes en inmigrantes VFA con OR = 5,16 (IC95%: 2,08–12,8) en relación a turistas y OR=7,17 (IC95%: 2,82–18,2) a inmigrantes no viajeros. Conclusiones: Los inmigrantes VFA viajaron con más frecuencia al África subsahariana e importaron más enfermedades de curso agudo potencialmente letal (AU)

Objective: To describe the infectious diseases imported by immigrants visiting friends and relatives in their countries of origin. Methods: We performed a cross-sectional descriptive study of all imported infectious diseases among adult patients between 01/2001-12/2008. The study population was classified in 3 groups: a)immigrants visiting friends and relatives; b) tourists, and c) non-travelling immigrants. Diseases were classified as (a) cosmopolitan or (b) tropical endemic, and, according to their severity as (a) mild, (b) serious, and (c) potentially lethal. Results: A total of 761 patients were analyzed. The mean age was 31.7 (SD: 12.4) years. Of these, there were 90 immigrants visiting friends and relatives, 269 tourists and 402 non-travelling immigrants. Immigrants visiting friends and relatives attended International Health Centres prior to travel significantly less than tourists (32.2% vs. 57.2%; p <0.001) and more frequently travelled to sub-Saharan Africa (33.3% vs. 20.4%; p=0.01). Imported diseases considered as potentially lethal were more likely among immigrants visiting friends and relatives than tourists [OR=5.16 (95%CI: 2.08–12.8)] and non-travelling immigrants [OR=7.17 (95%CI: 2.82–18.2)]. Conclusions: Immigrants visiting friends and relatives travelled more to sub-Saharan Africa and more frequently imported potentially lethal acute diseases (AU)

[Imported infectious diseases associated with international trips by adult immigrants to visit family and friends]. / Enfermedades infecciosas importadas asociadas a los desplazamientos internacionales de inmigrantes adultos en visita a familiares y amigos.

OBJECTIVE: To describe the infectious diseases imported by immigrants visiting friends and relatives in their countries of origin. METHODS: We performed a cross-sectional descriptive study of all imported infectious diseases among adult patients between 01/2001-12/2008. The study population was classified in 3 groups: a) immigrants visiting friends and relatives; b) tourists, and c) non-travelling immigrants. Diseases were classified as (a) cosmopolitan or (b) tropical endemic, and, according to their severity as (a) mild, (b) serious, and (c) potentially lethal. RESULTS: A total of 761 patients were analyzed. The mean age was 31.7 (SD: 12.4) years. Of these, there were 90 immigrants visiting friends and relatives, 269 tourists and 402 non-travelling immigrants. Immigrants visiting friends and relatives attended International Health Centres prior to travel significantly less than tourists (32.2% vs. 57.2%; p <0.001) and more frequently travelled to sub-Saharan Africa (33.3% vs. 20.4%; p=0.01). Imported diseases considered as potentially lethal were more likely among immigrants visiting friends and relatives than tourists [OR=5.16 (95%CI: 2.08-12.8)] and non-travelling immigrants [OR=7.17 (95%CI: 2.82-18.2)]. CONCLUSIONS: Immigrants visiting friends and relatives travelled more to sub-Saharan Africa and more frequently imported potentially lethal acute diseases.