Sociodemographic and Clinical Profile of Long COVID-19 Patients, and Its Correlation with Medical Leave: A Comprehensive Descriptive and Multicenter Study.

The persistent condition of COVID-19 is characterized by a wide range of symptoms that have had a significant impact on both the health status and occupational life of the population. In this observational and multicenter study, the relationship between the sociodemographic and clinical profile of Spanish patients diagnosed with long COVID, and the work-related disability resulting from this pathology was analyzed. The analysis included 689 responses. A descriptive analysis of the variables recorded was performed, together with a bivariate analysis to determine associations between work-related disability and variables such as gender, age, health status, disabling symptoms or comorbidities. The results obtained highlight fatigue and lack of concentration (brain fog) as the most incapacitating symptoms among patients diagnosed with long COVID. Multivariate analysis revealed that time since diagnosis (OR: 0.57, CI95%: 0.36-0.89, p: 0.013), concomitant renal insufficiency (OR: 4.04, CI95%: 1.42-11.4, p: 0.008), and symptoms like fatigue (OR: 0.56, CI95%: 0.33-0.99) and tremors (OR: 2.0, CI95%: 1.06-3.69, p: 0.029), were associated with work-related disability. These findings highlight the need to improve the health and work-related management of this condition in the healthcare system. Besides risk factor control, it is suggested to pay special attention to determining the appropriate timing of medical leave work reintegration, along with coordination between primary care and occupational health services to ensure the gradual and tailored return of patients with long COVID to the workforce.

Validity and reliability of the Berlin questionnaire for the detection of moderate or severe obstructive sleep apnea in patients aged 40 years or older detected from primary care.

Background: The obstructive sleep apnea syndrome (OSA) is a highly prevalent condition. In Spain and other countries, only 5%-9% of patients with OSA have been diagnosed and treated. The lack of accessibility to diagnosis is considered the main cause of this situation through easy-to-use screening instruments, it is necessary to check their validity and reliability in the context where they are to be used. Objective: To validate the Spanish translation of the Berlin questionnaire for screening for moderate or severe OSA in patients aged 40 years or more detected in primary care. Methods: A descriptive observational study, with a first qualitative phase of transcultural adaptation to Spanish using the translation-back-translation method. Setting: primary care level of the Spanish National Health System. A total of 255 patients recruited from 7 healthcare centers completed the study. The Berlin questionnaire was administered to the recruited patients, and subsequently, a respiratory polygraphy was performed to confirm the diagnosis of OSA. The concurrent criterion validity of the questionnaire and its reliability in terms of internal consistency and reproducibility (intra-observer agreement) were analyzed. Results: The patients' mean age was 54.76 years (SD: 6.57; 95% CI: 53.53-54.99), and 54.12% were men (95% CI: 47.96-60.27). We found that 61.57% (95% CI: 55.57-67.57) presented OSA (apnea-hypopnea index-AHI >5), and 45.5% (95% CI: 17.05-57.92) presented moderate or severe (AHI >15) OSA. The Berlin questionnaire, with a cut-off point of 4.5, showed a sensitivity of 76.77% (95% CI: 67.94-85.59), a specificity of 74.49% (95% CI: 65.35-83.63), a positive predictive value of 75.25% (95% CI: 66.34-84.16), a negative predictive value of 76.04% (95% CI: 66.98-85.10), and an area under the curve of 0.786 (95% CI: 0.721-0.851). Cronbach's alpha coefficient was 0.730 (95% CI: 0.668-0.784), and the Kappa index was 0.739 (95% CI, 0.384-1.000). Conclusion: The Spanish adaptation of the Berlin questionnaire has good validity and reliability as a test for the diagnostic screening of moderate or severe OSA in patients aged 40 years or older. The findings of our study confirm that primary care physicians should use such screening tools to predict OSA.

Clinical and Epidemiological Profiles of Primary Healthcare Professionals with COVID-19 Infection and Long COVID: An Observational Study.

Health professionals have been one of the groups most affected by the SARS-CoV-2 virus. Currently, there is little scientific evidence on the similarities and differences between COVID-19 infection and the development of long COVID in primary care (PC) workers. Therefore, it is necessary to analyse their clinical and epidemiological profiles in depth. This study was observational and descriptive, including PC professionals who were divided into three comparison groups based on the diagnostic test for acute SARS-CoV-2 infection. The responses were analysed using descriptive and bivariate analysis to examinate the relationship between independent variables and the presence or not of long COVID. Binary logistic regression analysis was also conducted, with each symptom as the dependent variable and each group as the independent variable. The results describe the sociodemographic characteristics of these population groups, revealing that women in the health sector are the most affected by long COVID and that being in this group is associated with its development. Furthermore, individuals with long COVID exhibited the highest number of symptoms and pathologies. Certain symptoms were found to be associated with long COVID development in this population, including an altered sense of smell, pneumonia, fever, and sore throat, among others. Similarly, altered senses of smell and taste, chest tightness, and joint pain, among others, were found to be associated with acute COVID-19 infection. Additionally, patients with pre-existing overweight or obesity were more likely to experience acute COVID-19 and develop long COVID. The data obtained can be crucial for improving the detection, diagnosis, and treatment of long COVID patients, ultimately leading to an enhancement in their quality of life.

Long COVID Symptomatology and Associated Factors in Primary Care Patients: The EPICOVID-AP21 Study.

Persistent COVID-19 condition includes a wide variety of symptoms and health problems of indeterminate duration. The present study examined the sociodemographic and clinical characteristics of the population with Long COVID seen in Primary Care using a questionnaire based on the existing scientific literature. It was an observational and descriptive study of the characteristics of the Spanish population with Long COVID over 14 years of age. The responses were analysed by means of a descriptive analysis of the variables recorded, in addition to a bivariate analysis to determine the existence of a relationship between persistent COVID-19 and variables such as gender, age, vaccination status or concomitant pathology. The results obtained clearly describe the sociodemographic characteristics of the population, highlighting the predominance of female gender and the prevalence of tiredness and fatigue. Furthermore, relevant information was obtained on the differences in symptomatology according to gender, age, previous pathologies and alterations derived from infection and/or vaccination. These data are important for better detection, diagnosis and treatment of Long COVID and the improvement of the quality of life of this population.

Hospital admission and vaccination as predictive factors of long COVID-19 symptoms.

Background: Since the beginning of the COVID-19 pandemic, a great variability of symptoms that affect all organs and systems of the body has been identified in patients with SARS-CoV-2 infection; this symptomatology can sometimes persist over time, giving rise to the so-called long COVID or post-COVID. The aim of this study is to delve into the clinical characterization of these patients, as well as to take into account the influence of factors such as hospitalization, admission to ICU, history of pneumonia, or vaccination status on the persistence of symptoms. Material and methods: An observational, descriptive, multicenter, and retrospective study was designed with a series of cases of people who presented long COVID, which includes univariate, bivariate, and multivariate analyses. Data were obtained from an online ad hoc questionnaire, and statistical analysis was performed using SPSS Software Version 25 (IBM-Inc., Chicago, IL, USA). Results: Hospitalization, ICU admission, history of pneumonia, and vaccination were predictive factors (positive or negative) for the following long-COVID symptoms: headache, menstrual disorders, joint pain, cough, chills, nasal congestion, back pain, abdominal pain, weight loss, eye discomfort, facial erythema, itching, tremors, dizziness, seizures, sleeping difficulty, dry eyes, palpitations, fatigue, paresthesia, dyspnea, aphonia, chest pain, high blood pressure, vomiting, memory loss, brain fog, hypothermia, low blood pressure, sputum or phlegm, lack of concentration, hair loss, and erectile dysfunction. Conclusion: This study provides evidence on the clinical characterization of patients suffering from long COVID in order to offer them the most appropriate treatments.

Feasibility of an Activity Control System in Patients with Diabetes: A Study Protocol of a Randomised Controlled Trial.

Purpose: Patients with diabetes mellitus have an increased risk of developing various serious health problems that could be life-threatening. These problems are associated with the difficulty of these patients in managing their lifestyle, which may even lead to the abandonment of treatment. The present study was designed to evaluate the feasibility of a multipurpose activity control solution for home activity (home activity control system), which will provide information on the activities of daily living carried out outside in real time, to improve adherence to each of the therapeutic objectives agreed on with the diabetic patient. Patients and Methods: A pilot randomised controlled feasibility study will be carried out to evaluate a home activity control system (Beprevent) in managing patients with type 2 diabetes mellitus. Twenty patients with type 2 diabetes mellitus will be included (10 in the intervention group and 10 in the control group). Data on satisfaction with the tool will be collected from professionals and patients, as well as other clinical/epidemiological data from their digital health records and several questionnaires, at baseline and six months. In addition, data will also be recorded regarding the degree of adherence to the behaviors agreed on with the patients before starting the study to assess changes throughout the study and their relationship with clinical results (glycosylated haemoglobin (HbA1c), cholesterol, etc), and to compare these outcomes between two study groups. Discussion: This project involves the incorporation of telemedicine in the management of patients with diabetes. Thus, according to the currently published bibliography, the use of smart devices in this population could help improve the quality of life of these people, reduce medical visits and improve adherence to home care patterns for diabetes mellitus. There are currently no published clinical trials or protocols that monitor activities of daily living in patients with diabetes individually using artificial intelligence (AI) devices.

The usefulness of the Spanish version of the STOP-Bang questionnaire for screening for moderate or severe sleep apnea syndrome in primary care.

Rationale: Sleep apnea-hypopnea syndrome (OSA) is a highly prevalent disease and has been related to cardiovascular diseases and occupational and traffic accidents. Currently, it is estimated that there is a significant underdiagnosis of OSA, mainly due to the difficulty accessing the tests for that purpose. Objective: To determine the usefulness of the Spanish version of the STOP-Bang questionnaire (SBQ) for screening for moderate or severe OSA in the adult population attending primary care. Methods: A descriptive observational multicenter study was conducted. Through an opportunistic search, (patients over 18 years old), were recruited in seven primary care centers. The SBQ was applied to them and home respiratory polygraphy (HRP) was subsequently performed to confirm the diagnosis of OSA. The criterion validity of the SBQ was analyzed, comparing the score obtained by the SBQ with the apnea-hypopnea index (AHI) obtained by RP, establishing the diagnosis of OSA for an AHI>5. The reliability of the questionnaire was evaluated. Results: A total of 255 subjects, 54.1% men, with a mean age of 54.76 ± 10 years, were recruited in the study. The results showed that 61.57% (95% Confidence Interval: 55.57-67.57) of the subjects presented OSA, presenting 22.75% (17.57-57.92) a mild OSA (530) (11.54-20.62). The Kuder and Richardson coefficient was 0.623 (0.335-0.788) and Cohen's Kappa coefficient was 0.871 (0.520-1.00; p < 0.001). For moderate/severe OSA screening (AHI>15) the SBQ obtained an ROC curve of 0.769 (0.704-0.833) that with an optimal cutoff of 3, achieved a sensitivity of 84.85% (77.28-92.42) and a specificity of 55.10% (44.74-65.46). Conclusions: The SBQ is very effective for detecting moderate/severe OSA. Its psychometric properties are similar to those obtained in studies on other populations. Because of its ease of use, the SBQ is a very useful tool for primary health care professionals.

Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic controlled study in primary care.

BACKGROUND: Very positive effects have been described in the application of pain neuroscience education (PNE) to chronic pain and migraine. However, there are few data on the applicability of this therapeutic approach in actual clinical practice in a primary care (PC) setting. The aim of this study was to explore the efficacy in fibromyalgia (FM) of an intervention based on PNE and exercise compared to treatment as usual (TAU). METHODS: Pragmatic nonrandomised controlled trial set in 5 healthcare centres and one physiotherapy centre in PC. Fifty-three women with FM (2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia) were studied, 35 in the intervention group (IG) and 18 in the control group (CG). The women in the IG were interviewed individually and then received 6 weekly sessions plus one review session (1 month later): those in the CG received their TAU. The subject assignation to the CG or the IG was determined according to their availability to attend the sessions. They all filled in several questionnaires (prior to and 1 year after the intervention) to evaluate the impact of FM in their daily lives, catastrophism, anxiety and depression, severity and impact of pain in daily personal performance and functional capacity. RESULTS: The reductions (improvements) in the scores of all tests (baseline-final) were greater in the IG (p < 0.05) when adjusted for age and baseline values, with moderate or high effect size. After 1 year, 20% (CI - 1 to 42%) more women in the IG, compared to the CG, had a FIQ score < 39 (mild functional impairment). 17/38 (49%) women in the IG no longer met FM criteria at the end of follow-up. CONCLUSIONS: An intervention based on PNE and exercise in patients with FM is feasible and seems effective in PC. TRIAL REGISTRATION: The study was retrospectively registered at ClinicalTrials.gov (Trial Registration NCT04539171 ), on 04/09/2020.

Clinical Presentation of the SARS-CoV-2 Virus Infection and Predictive Validity of the PCR Test in Primary Health Care Worker Patients of the Spanish National Health System.

BACKGROUND: Despite the impact that the SARS-CoV-2 virus infection has presented in Spain, data on the diagnostic capacity of the symptoms associated with this infection are limited, especially among patients with mild symptoms and who are detected in the primary care field (PC). The objective of the present study was to know the associated symptoms and their predictive criterial validity in SARS-CoV-2 infection among professionals working in PC. METHODS: A cross-sectional, multicenter study was carried out in the Spanish National Health System, through an epidemiological survey directed to patients who underwent the PCR test for SARS-CoV-2 in the PC setting. RESULTS: A total of 1612 patients participated, of which 86.6% were PC healthcare professionals, and of these, 67.4% family doctors. Hyposmia, with a sensitivity of 42.69% (95% CI: 37.30-48.08) and a specificity of 95.91% (95% CI: 94.78-97.03), and ageusia with a sensitivity of 39.47% (34.15-44.80) and a specificity of 95.20% (93.98-96.41) were the symptoms with the highest criteria validity indexes. CONCLUSIONS: This study identifies the specific symptoms of loss of smell or taste as the most frequently associated with SARS-CoV-2 infection, essential in the detection of COVID-19 given its high frequency and predictive capacity.

Frecuencia de aparición y validez predictiva de la disfunción olfatoria y del gusto en pacientes con infección por SARS-CoV-2 / Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection

Antecedentes y objetivo: La disfunción olfatoria (DO) y gustativa (DG) han demostrado ser síntomas de la infección por SARS-CoV-2. Sin embargo, su presencia en determinadas poblaciones, sobre todo en aquellas con cuadros clínicos leves, aún debe aclararse. El objetivo fue estimar la frecuencia de DO y DG, y su validez predictiva en pacientes detectados en Atención Primaria.Pacientes y métodosSe realizó un estudio transversal en el Sistema Nacional de Salud español. Se administró una encuesta epidemiológica dirigida a pacientes a los que se les solicitó la prueba PCR para SARS-CoV-2. Se estimaron las odds ratio (OR) para medir la magnitud de la asociación entre la DO y DG y la existencia de infección por SARS-CoV-2. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos (VPP) y negativos (VPN) de estos síntomas en la infección por SARS-CoV-2.ResultadosSe captaron 1.038 pacientes, de los cuales el 20,1% presentaban infección por SARS-CoV-2. Las DO y DG estuvieron presentes en el 64,4% (IC 95% 56,0-72,1) y el 56,2% (IC 95% 47,9-64,2) de los sujetos con infección, respectivamente. La OR para la DO fue de 12,2 (IC 95% 8,26-18,06) y para la DG de 7,95 (IC 95% 5,48-11.53). La DG presentó una sensibilidad del 41,1% (IC 95% 34,4-46,1), una especificidad del 91,9% (IC 95% 89,8-93,7), un VPP del 56,2% (IC 95% 48,0-64,2) y un VPN de 86,1% (IC 95% 83,6-88,3), mientras que la DO mostró una sensibilidad del 45,0% (IC 95% 37,6-51,5), una especificidad del 93,7% (IC 95% 91,8-95,0), un VPP del 64,4% (IC 95% 56,0-72,1) y un VPN del 87,1% (IC 95% 84,7-89,2).ConclusionesMás de la mitad de los sujetos con infección por SARS-CoV-2 presentan DO o DG. La presencia de DO o de DG podría ser de utilidad diagnostica por su capacidad para predecir la infección en más de la mitad de las ocasiones. (AU)

Background and objective: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care.Patients and methodsA cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated.ResultsOf 1,038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2).ConclusionsMore than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases. (AU)

Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection.

BACKGROUND AND OBJECTIVE: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care. PATIENTS AND METHODS: A cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated. RESULTS: Of 1038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2). CONCLUSIONS: More than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases.

ANTECEDENTES Y OBJETIVO: La disfunción olfatoria (DO) y gustativa (DG) han demostrado ser síntomas de la infección por SARS-CoV-2. Sin embargo, su presencia en determinadas poblaciones, sobre todo en aquellas con cuadros clínicos leves, aún debe aclararse. El objetivo fue estimar la frecuencia de DO y DG, y su validez predictiva en pacientes detectados en Atención Primaria. PACIENTES Y MÉTODOS: Se realizó un estudio transversal en el Sistema Nacional de Salud español. Se administró una encuesta epidemiológica dirigida a pacientes a los que se les solicitó la prueba PCR para SARS-CoV-2. Se estimaron las odds ratio (OR) para medir la magnitud de la asociación entre la DO y DG y la existencia de infección por SARS-CoV-2. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos (VPP) y negativos (VPN) de estos síntomas en la infección por SARS-CoV-2. RESULTADOS: Se captaron 1.038 pacientes, de los cuales el 20,1% presentaban infección por SARS-CoV-2. Las DO y DG estuvieron presentes en el 64,4% (IC 95% 56,0­72,1) y el 56,2% (IC 95% 47,9­64,2) de los sujetos con infección, respectivamente. La OR para la DO fue de 12,2 (IC 95% 8,26−18,06) y para la DG de 7,95 (IC 95% 5,48−11.53). La DG presentó una sensibilidad del 41,1% (IC 95% 34,4­46,1), una especificidad del 91,9% (IC 95% 89,8­93,7), un VPP del 56,2% (IC 95% 48,0­64,2) y un VPN de 86,1% (IC 95% 83,6­88,3), mientras que la DO mostró una sensibilidad del 45,0% (IC 95% 37,6­51,5), una especificidad del 93,7% (IC 95% 91,8­95,0), un VPP del 64,4% (IC 95% 56,0­72,1) y un VPN del 87,1% (IC 95% 84,7­89,2). CONCLUSIONES: Más de la mitad de los sujetos con infección por SARS-CoV-2 presentan DO o DG. La presencia de DO o de DG podría ser de utilidad diagnostica por su capacidad para predecir la infección en más de la mitad de las ocasiones.

[Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection]. / Frecuencia de aparición y validez predictiva de la disfunción olfatoria y del gusto en pacientes con infección por SARS-CoV-2.

BACKGROUND AND OBJECTIVE: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care. PATIENTS AND METHODS: A cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated. RESULTS: Of 1,038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2). CONCLUSIONS: More than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases.

Características clínico-epidemiológicas de la infección por el virus SARS-CoV-2 en médicos de familia: un estudio de casos y controles / Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study

Objetivo: Identificar las características sociodemográficas, clínicas y epidemiológicas asociadas a la presencia de infección por el virus SARS-CoV-2 en médicos de familia que desempeñan su actividad laboral en atención primaria (AP) o en urgencias de hospital. Diseño: Estudio observacional analítico de casos y controles. Emplazamiento: Atención primaria. Participantes: Un total de 969 médicos de AP, urgencias hospitalarias y otros centros extrahospitalarios que dispusieran de RT-PCR para la detección del virus SARS-CoV-2. De estos, 133 participaron como casos (PCR positiva) y 836 como controles (PCR negativa).Intervenciones: No. Mediciones principales: Variables sociodemográficas y laborales, contacto con enfermo de COVID-19, síntomas presentes durante el proceso, primer síntoma manifestado, enfermedades crónicas previas y consumo de tabaco. Resultados: Del total de la muestra el 13,7% (IC 95%: 11,6-16,0), eran casos infectados con el SARS-CoV-2. Los síntomas declarados más frecuentemente por los infectados fueron sensación de fatiga/cansancio (69,2%; IC 95%: 60,9-77,4%), tos (56,4%; IC 95%: 47,6-65,2%) y cefalea (55,6%; IC 95%: 46,8-64,4%). Mediante regresión logística, las variables asociadas de manera independiente con la infección por virus SARS-CoV-2 en médicos de familia fueron: contacto previo con enfermo COVID-19 (OR: 2,3; IC 95%: 1,2-4,2), presentar fatiga/cansancio (OR: 2,2; IC 95%: 1,2-3,9), alteración del olfato (4,6; IC 95%: 1,7-12,5), alteración del gusto (OR: 32,0; IC 95%: 9,6-106,8), tos (OR: 3,0; IC 95%: 1,7-5,3) y fiebre (OR: 6,1; IC 95%: 3,2-11,4). Conclusiones: Los síntomas relacionados de forma independiente con la infección por el virus SARS-CoV-2 en médicos de familia fueron la fatiga, la fiebre, la tos y la alteración del gusto y del olfato. La presencia de estos síntomas podría facilitar el diagnóstico de sospecha de enfermedad COVID-19 y la selección más precoz de aquellos que precisan pruebas de confirmación.(AU)

Objective: To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies. Desing: Observational analytical case-control study. Site: Primary care. Participants: 969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative). Interventions: No. Main measurements: Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use. Results: 13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4). Conclusions: Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.(AU)

[Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study]. / Características clínico-epidemiológicas de la infección por el virus SARS-CoV-2 en médicos de familia: un estudio de casos y controles.

OBJECTIVE: To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies. DESING: Observational analytical case-control study. SITE: Primary care. PARTICIPANTS: 969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative). INTERVENTIONS: No. MAIN MEASUREMENTS: Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use. RESULTS: 13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4). CONCLUSIONS: Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.

Efecto de la educación en neurociencia del dolor en pacientes con fibromialgia: intervención grupal estructurada en atención primaria / Effectiveness of pain neuroscience education in patients with fibromyalgia: Structured group intervention in Primary Care

OBJETIVO: Evaluar la efectividad de una intervención grupal en atención primaria en pacientes con fibromialgia (FM), basada en la educación en neurociencia del dolor (Pain Neuroscience Education, PNE). DISEÑO: Estudio de intervención antes-después. EMPLAZAMIENTO: Centro de Salud urbano de Bilbao. PARTICIPANTES: Pacientes con FM (criterios diagnósticos 2010 del American College of Rheumatology), ≥ 18 años. INTERVENCIÓN: Cinco sesiones semanales (2h cada una), y una sesión de recuerdo un mes después. Mediciones principales: Cumplimiento de criterios de FM, mediante los cuestionarios WPI (número de áreas de dolor) y SS (gravedad de los síntomas), e impacto de la FM sobre la capacidad funcional (FIQ: reducción ≥ 20% y ≥ 50% sobre la puntuación basal, y proporción de pacientes con FIQ < 39 al final del estudio). Se hicieron evaluaciones al inicio, al mes de la 5.a sesión, 6 y 12 meses después. RESULTADOS: Completaron todas las evaluaciones del estudio 85/98 pacientes. Se objetivó una mejoría estadísticamente significativa en las 3 categorías estudiadas (WPI, SS y FIQ) desde la primera visita, mantenida hasta la visita final (12 meses después). Cuarenta y cinco pacientes (53%, IC: 42-63%) más que al inicio tuvieron una puntuación en el FIQ < 39 (impacto funcional no grave). Al mes de finalizar la 5.a sesión había 44 (52%, IC: 41-62%) que ya no cumplían criterios de FM y al final del seguimiento 56 (66%, IC: 55-75%). CONCLUSIONES: Una intervención basada en PNE ha mostrado ser factible en atención primaria, con resultados en el rango superior de los publicados con otros tratamientos para FM

OBJECTIVE: To evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE). DESIGN: Pre-post study. LOCATION: Urban Primary Health Centre in Bilbao. PARTICIPANTS: Patients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥ 18 years. Intervention: 5 weekly sessions (2hours each), and a reminder session one month later. MAIN MEASUREMENTS: Compliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ: ≥ 20% and ≥ 50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ < 39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up. RESULTS: All the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ < 39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%). CONCLUSIONS: An intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM

[Effectiveness of pain neuroscience education in patients with fibromyalgia: Structured group intervention in Primary Care]. / Efecto de la educación en neurociencia del dolor en pacientes con fibromialgia: intervención grupal estructurada en atención primaria.

OBJECTIVE: To evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE). DESIGN: Pre-post study. LOCATION: Urban Primary Health Centre in Bilbao. PARTICIPANTS: Patients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥18 years. INTERVENTION: 5 weekly sessions (2hours each), and a reminder session one month later. MAIN MEASUREMENTS: Compliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ:≥20% and ≥50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ<39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up. RESULTS: All the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ<39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%). CONCLUSIONS: An intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM.

[Clinical-epidemiological characteristics of the atrial fibrillation in patients 65 years of age or older diagnosed in primary care.] / Características clínico-epidemiológicas de la fibrilación auricular en pacientes de 65 años o más diagnosticados en Atención Primaria.

OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p<0.001), and as age increased (p<0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation.

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. METODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p<0,001), y más aún conforme aumentaba la edad (p<0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular.

[Analysis of the situation, evaluation and improvement proposals of the Preventive Activities and Health Promotion Program (PAPPS)]. / Análisis de la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS).

OBJECTIVE: To analyze the situation, evaluation and proposals for improvement of the Preventive Activities and Health Promotion Program (PAPPS). MATERIAL AND METHODS: A qualitative study of situation analysis was carried out for the evaluation of the PAPPS in 2 phases: 1) Generation of ideas and collection of information through a DAFO matrix, using 2 types of criteria: internal (strengths and weaknesses), and external (threats and opportunities); 2) Prioritization of the improvement proposals collected. Selection of participants: Key informants were identified taking into account their relationship and knowledge of the PAPPS program. All members of the PAPPS, expert groups and members with past participation were included, as well as the coordinators, including the autonomous leaders of the PAPPS. Two invitations to participate in the study were sent: the first from December 29, 2017 to February 11, 2018, and the second from January 10 to 23, 2019. The information was obtained from a questionnaire designed to be self-completed. RESULTS AND CONCLUSIONS: A total of 73 subjects answered the questionnaire. 35% of the participants were members of the PAPPS working groups, followed by family doctors from other areas, with 20.5%. The order of prioritization of the improvement proposals was as follows: 1) Unify recommendations with other semFYC working groups; 2) Prepare lists with "Recommendations not to do" from the point of view of prevention; 3) Incorporate PAPPS in the political agenda; 4) Greater coordination and interaction between groups with common competences; 5) Teaching in undergraduate and teaching units; 6) Review, update and dissemination of the program in Primary Care.

Características clínico-epidemiológicas de la fibrilación auricular en pacientes de 65 años o más diagnosticados en atención primaria / Clinical-epidemiological characteristics of the atrial fibrillation in patients 65 years of age or older diagnosed in primary care

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. MÉTODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p < 0,001), y más aún conforme aumentaba la edad (p < 0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular

OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p < 0.001), and as age increased (p < 0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation

Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial. / Cribado oportunista de fibrilación auricular frente a detección de pacientes sintomáticos de 65 años o más: ensayo clínico controlado por clúster.

OBJECTIVE: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged≥65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. MATERIAL AND METHODS: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the experimental group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the control group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. RESULTS: A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3 and 15.0% of the patients in the EG and the CG, respectively (P<.001). A total of 164 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95% CI 0.18-0.45). CONCLUSIONS: Case finding for atrial fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients. TRIAL REGISTRATION: The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011).