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We determined the feasibility of abdominal aortic aneurysm (AAA) screening program led by family physicians in public primary healthcare setting using hand-held ultrasound device. The potential study population was 11,214 men aged ≥ 60 years attended by three urban, public primary healthcare centers. Participants were recruited by randomly-selected telephone calls. Ultrasound examinations were performed by four trained family physicians with a hand-held ultrasound device (Vscan®). AAA observed were verified by confirmatory imaging using standard ultrasound or computed tomography. Cardiovascular risk factors were determined. The prevalence of AAA was computed as the sum of previously-known aneurysms, aneurysms detected by the screening program and model-based estimated undiagnosed aneurysms. We screened 1,010 men, with mean age of 71.3 (SD 6.9) years; 995 (98.5%) men had normal aortas and 15 (1.5%) had AAA on Vscan®. Eleven out of 14 AAA-cases (78.6%) had AAA on confirmatory imaging (one patient died). The total prevalence of AAA was 2.49% (95%CI 2.20 to 2.78). The median aortic diameter at diagnosis was 3.5 cm in screened patients and 4.7 cm (p<0.001) in patients in whom AAA was diagnosed incidentally. Multivariate logistic regression analysis identified coronary heart disease (OR = 4.6, 95%CI 1.3 to 15.9) as the independent factor with the highest odds ratio. A screening program led by trained family physicians using hand-held ultrasound was a feasible, safe and reliable tool for the early detection of AAA.

ObjectivesPrimary care is well positioned to identify and address loneliness and social isolation in older adults, given its gatekeeper function in many healthcare systems. We aimed to identify and characterise loneliness and social isolation interventions and detect factors influencing implementation in primary care.DesignScoping review using the five-step Arksey and O’Malley Framework.Data sourcesMEDLINE, CINAHL, EMBASE, COCHRANE databases and grey literature were searched from inception to June 2021.Eligibility criteriaEmpirical studies in English and Spanish focusing on interventions addressing social isolation and loneliness in older adults involving primary care services or professionals.Data extraction and synthesisWe extracted data on loneliness and social isolation identification strategies and the professionals involved, networks and characteristics of the interventions and barriers to and facilitators of implementation. We conducted a thematic content analysis to integrate the information extracted.Results32 documents were included in the review. Only seven articles (22%) reported primary care professionals screening of older adults’ loneliness or social isolation, mainly through questionnaires. Several interventions showed networks between primary care, health and non-healthcare sectors, with a dominance of referral pathways (n=17). Two-thirds of reports did not provide clear theoretical frameworks, and one-third described lengths under 6 months. Workload, lack of interest and ageing-related barriers affected implementation outcomes. In contrast, well-defined pathways, collaborative designs, long-lasting and accessible interventions acted as facilitators.ConclusionsThere is an apparent lack of consistency in strategies to identify lonely and socially isolated older adults. This might lead to conflicts between intervention content and participant needs. We also identified a predominance of schemes linking primary care and non-healthcare sectors. However, although professionals and participants reported the need for long-lasting interventions to create meaningful social networks, durable interventions were scarce. Sustainability should be a core outcome when implementing loneliness and social isolation interventions in primary care.

Background Early identification of cardiac syncope is critical because it is associated with adverse outcomes in the emergency department. However, the optimal observation duration remains unclear. In this study, we evaluated factors associated with ED observation time in patients with syncope, determined the timing of cardiac findings, and identified the clinical features that distinguish cardiac from neurally mediated or orthostatic syncope. Methods A cohort study was conducted in the emergency department of an urban hospital, including 400 adult patients with syncope. Patients with transient loss of consciousness due to syncopal causes were excluded. The primary outcome was the presence and timing of cardiac findings (rhythm, structural cardiogenic, or both) during the observation period in the emergency department. Data were extracted from the electronic health records. Logistic regression was used to identify factors associated with cardiac syncope and time spent in the emergency department. Cumulative and incidence rate analyses of the time until a cardiac finding within 24 h were estimated using a time-to-event function. Results Cardiac syncope was associated with older age (OR: 1.04 per year; 95% CI: 1.02–1.07), prior pacemaker or ICD implantation (OR: 4.17; 95% CI: 1.50–11.6), absence of autonomic symptoms (OR: 0.16; 95% CI: 0.08–0.31), and abnormal electrocardiogram findings (OR: 6.84; 95% CI: 3.00–15.6), and higher rates of hospital admission (OR: 31.7; 95% CI: 14.1–71.3) and pacemaker implantation (OR: 63.0; 95% CI: 18.5–245). Cardiac findings were confirmed in 70.5% of patients initially classified as having cardiac syncope (OR: 33.0; 95% CI: 15.3–71.2). Most cardiac findings (70.9%) occurred within the first 12 h (incidence density: 1.04 vs. 0.54 per 100 patient-hours). The cumulative incidence increased from 12.5% at 12 h to 23.3% at 24 h, then slowed. Conclusion Most cardiac findings were identified within the first 12 h of observation. These results support a selective strategy in which prolonged monitoring (≥ 12 h) may be reserved for patients with predefined clinical conditions, electrocardiographic markers, or concerns regarding underlying heart disease at initial assessment. Clinical trial number Not applicable.

Objective:To determine the prevalence and characteristics of plant-based patterns in the Spanish population and assess their potential impact on individuals with similar socio-demographic backgrounds.Design:We estimated vegetarian and vegan individuals’ national and regional prevalence and analysed their socio-demographic characteristics and weekly dietary intake patterns. Individuals with a plant-based dietary pattern were matched to a control group (1:4) with similar socio-demographic characteristics. Associations with the prevalence risk of common chronic diseases, self-reported health status, lifestyle and healthcare use were analysed with unadjusted and adjusted logistic regression models.Setting:A population-based survey of individuals residing in Spain.Participants:Data from 22 072 participants were examined.Results:The prevalence of plant-based diets was 5·62‰ (95 % CI: 4·33, 7·28), and adherents were female (68·6 %), single (62·3 %) and university-educated 41·8 %) (P < 0·001). They reported higher rates of ‘never’ consuming snacks (50 % v. 35 %), fast food (58 % v. 36 %) and sweets (33 % v. 14 %). Lifestyle factors did not differ between the plant-based and omnivorous groups; however, adherence to plant-based diets was associated with a prevalence risk of depressive symptoms (OR 2·58, 95 % CI: 1·00, 6·65), stroke (OR 7·08, 95 % CI: 1·27, 39·46) and increased consultations for mental health and complementary medicine (OR 3·21, 95 % CI: 1·38, 7·43).Conclusions:Plant-based diets are uncommon and are associated with specific socio-demographic profiles, particularly sex. When comparing individuals with similar socio-demographic characteristics, individuals with plant-based diets and omnivores had similar lifestyles. Addressing patient concerns regarding diet and personal well-being might prioritise healthy behaviours over specific dietary patterns.

Background Incorporating occupational therapists (OTs) into primary care requires adapting services to patient needs and depends on how colleagues within the multidisciplinary team perceive the OT roles and collaborate in daily practice. This study explored the feasibility, impact on the care team, and challenges of incorporating an OT into the home-based care service of a Spanish primary healthcare center. Methods A two-phase sequential exploratory mixed-methods study was conducted. First, structured interviews and a stakeholder focus group were conducted over the six months following the introduction of the OT. Thematic analysis identified factors that hindered or supported integration. Second, a cross-sectional study described patients who received OT care within 12 months of service implementation. The electronic health records provided patient profiles and OT interventions. Descriptive statistics and the Kruskal–Wallis tests were used to examine the associations between the study and patient characteristics. Results Six themes emerged: introduction of the OT role, team coordination, impact on team functioning, impact on patient and caregiver, contributions of the OT, and structural limitations and challenges. OT integration improved interdisciplinary collaboration and patient-centered care; however, initial role ambiguity and a lack of referral criteria were challenges. Over 12 months, 248 patients were visited (mean age, 88.2 years; 70.9% women), with an average of 11.1 chronic conditions. Overall, 45.6% had severe or total dependency in activities of daily living, and 43.2% reported at least one fall in the past year. OT interventions focused on risk assessment (65.6%) and home adaptation (52.5%). Patients with moderate-to-severe functional dependency received more risk assessment activities (median: 2; p  = 0.005). No significant associations were found between intervention frequency and fall history or other functional domains. Conclusions Integrating an OT into a primary health care team appears feasible and valuable. Sustainable implementation may require clear patient profiles, defined professional roles, structured integration processes, robust evaluation frameworks, and service standardization-based workforce planning.

Studies of the characteristics of informal caregivers and associated factors have focused on care-receiver disease or caregiver social and psychological traits; however, an integral description may provide better understanding of informal caregivers’ problems. A multicenter cross-sectional study in primary healthcare centers was performed in Barcelona (Spain). Participants were a random sample of informal caregivers of patients in a home-care program. Primary outcomes were health-related quality of life and caregiver burden, and related factors were sociodemographic data, clinical and risk factors, social support and social characteristics, use of healthcare services, and care receivers’ status. In total, 104 informal caregivers were included (mean age 68.25 years); 81.73% were female, 54.81% were retired, 58.65% had high comorbidity, and 48.08% of care receivers had severe dependence. Adjusted multivariate regression models showed health-related quality of life and the caregivers’ burden were affected by comorbidity, age, time of care, and dependency of care receiver, while social support and depression also showed relative importance. Aging, chronic diseases, and comorbidity should be included when explaining informal caregivers’ health status and wellbeing. The effectiveness of interventions to support informal caregivers should comprehensively evaluate caregivers when designing programs, centering interventions on informal caregivers and not care receivers’ conditions.

Background In health sciences practice, interpersonal skills, critical thinking, and learning-to-learn are crucial transversal skills. Effective teaching necessitates the understanding of undergraduates’ views. This study explored undergraduate experiences in human biology, medicine, and nursing degrees in learning transversal skills. Methods An exploratory sequential mixed method design with qualitative data collection and a subsequent online survey study. Three focus groups were conducted with third- and fourth-year undergraduates, and data were analyzed with thematic analysis. The online survey targeted undergraduate students from all academic years to address inconclusive details. Analysis entailed descriptive statistics, and associations differences in responses by degrees were analyzed using chi-square tests or Fisher’s Exact Test. Results Thirteen undergraduates participated in focus groups and 159 in the online survey. Three thematic areas emerged: the training received and its perceived relevance, the evaluation, and the learning methods. Undergraduates expressed that transversal skills were necessary for self-personal growth and professional development; however 50.7% reported not receiving specific training. Human biology and medicine undergraduates reported less training in critical thinking compared to nursing (29.03% and 32.7% vs. 76%, p  < 0.001) and in interpersonal and relational skills (16.1% and 16.3% vs. 57%, p  < 0.001). Subjectivity is an issue compared to traditional testing, with 39.6% of undergraduates reporting knowing the assessment methods of transversal skills and 56% trusting the preparation of teaching staff. >80% of undegraduate students wanted more participatory methodologies —from classroom methodology to problem-based assessments and simulation, while plenary lectures and gamification were less preferred. Conclusion Health sciences undergraduates advocated for effectively integrating transversal skills in their programs. Nursing undergraduates showed higher satisfaction and expressed having experienced more transversal skills learning than human biology and medicine undergraduates. Undergraduates required educators to receive more support and training in adopting methodologies that facilitate transversal skill acquisition through changes in the assessment methods and substantive transformation of the program curricula.

Underdiagnosis and overdiagnosis commonly occur in Chronic Obstructive Pulmonary Disease (COPD) patients. We assessed diagnostic accuracy, clinical characteristics, healthcare utilization, and care plan registration for patients undergoing primary care. We conducted a cross-sectional, population-based study using a health record registry from four primary healthcare centers in Catalonia (Spain) for patients aged ≥15 years. The variables included sociodemographic characteristics, dyspnea, comorbidities, spirometry results, treatments, and healthcare use. Logistic regression models were used to analyze differences between patients with and without airflow limitation, and ordinal logistic regression models were used to examine the association between disease severity and healthcare use. Among the 2610 patients, 54% had spirometry data, 29.5% had confirmed airflow obstruction, and 24% were overdiagnosed according to the GOLD criteria. Patients without airflow obstruction were younger (OR: 0.98, 95% CI: 0.96–0.99) and more likely to be current smokers (OR: 1.44, 95% CI: 1.13–1.84). Airflow obstruction severity was significantly associated with increased use of emergency home ambulance use (OR: 1.7, 95% CI: 1.23–2.35), emergency department visits (OR: 1.48, 95% CI: 1.11–1.99), and hospital admission (OR: 1.8, 95% CI: 1.32–2.47), but not primary care visits and follow-up frequency. COPD is frequently overdiagnosed in primary healthcare settings. The severity of airflow obstruction is associated with increased healthcare utilization, including hospital admissions. Improved diagnostic accuracy and management may enhance COPD care and reduce healthcare costs.

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

Purpose The schedule of attitudes toward hastened death (SAHD) is widely used to assess the wish to hasten death (WTHD) among patients with life-threatening conditions. A short form of the SAHD would increase its clinical applicability in this population. Method Rasch analysis of data from 101 Spanish palliative inpatients. Item reduction involved selecting items with a high discrimination index (point-biserials ≥0.70), removing items with inadequate fit statistics, and assessing unidimensionality and local dependency. We examined the test probability function to establish an empirical risk score for suffering a WTHD and tested convergence between the original and the reduced set of items. Results A set of five items met all quality criteria. In this sample, 20.8 % of participants had a higher risk of a WTHD (p > 50 %) at a score of 3. Correlation analysis confirmed convergent validity between the original and reduced forms. Concurrent validity was confirmed by the similar correlations shown by both versions of the SAHD (5 and 20 items) with other measures. Conclusion This 5-item Spanish form of the SAHD could be a suitable alternative to the full instrument. The cut-off score derived from the Rasch analysis may be able to detect patients at risk of a WTHD.