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In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. To determine clinical factors of a poor prognosis in patients with COVID-19 infection. Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts.

ObjectivesSome migrant groups are disproportionately affected by key infectious diseases in European countries. These pose a challenge for healthcare systems providing care to these groups. We aimed to explore the views of general practitioners (GPs) on the acceptability, adaptability and feasibility of a multidisease screening programme based on an innovative clinical decision-support system for migrants (the ISMiHealth tool), by examining the current gaps in healthcare provision and areas of good practice and the usefulness and limitations of training in the health needs of migrants.MethodsWe undertook a qualitative descriptive study and carried out a series of focus groups (FGs) taking a pragmatic utilitarian approach. Participants were GPs from the four primary healthcare (PHC) centres in Catalonia, Spain, that piloted an intervention of the ISMiHealth tool. GPs were recruited using purposive and convenience sampling. FG discussions were transcribed and analysed using thematic content analysis.ResultsA total of 29 GPs participated in four FGs. Key themes identified were: (1) GPs found the ISMiHealth tool to be very useful for helping to identify specific health problems in migrants, although there are several additional barriers to screening as part of PHC, (2) the importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental health, (3) the important role of PHC in healthcare provision for migrants and (4) key proposals to improve screening of migrant populations. GPs also highlighted the urgent need, to shift to a more holistic and adequately resourced approach to healthcare in PHC.ConclusionsGPs supported a multidisease screening programme for migrant populations using the ISMiHealth tool, which aided clinical decision-making. However, intercultural participatory approaches will need to be adopted to address linguistic and cultural barriers to healthcare access that exist in migrant communities.

Introduction: The global world in which we live reminds us, in a more or less constant way, that health and disease know no borders or laws. Old infectious diseases that in the past had been diagnosed only in the tropics, have in recent times become reemerging diseases that could be suspected in any context. The movements of people that are currently taking place for leisure, work, economic or social reasons are changing their flows with consequences on changes in the determinants of health.Movements of people entail movements of diseases and this, in turn, calls for prevention needs and training of professionals who care for patients, whatever their origin.Description: In 2009 a working group was created that brought together professionals from the hospital setting (AH) and primary care (AP) in order to work together in the field of international health. The territory where the group was created covers an area of 45 square kilometers with an assigned urban population of 540,000 people spanning four municipal districts. In this area, activity is concentrated in four hospitals and nineteen AP centres of four different suppliers. There is a reference service in tropical medicine and international health in only one of the hospitals. The objective of the creation of the group was, in its beginnings, to standardize performance against imported tropical disease in the territory.Results: The group has been growing progressively since its inception, incorporating doctors and nurses of AP and AH and trying to give representation to all the territory. There is a base of professionals who provide stability, and a wide representation of professionals in training (residents) brings dynamism to the group.The work dynamic is based on regular meetings with the following objectives:- Increase awareness of international health- Improve clinical management of imported diseases: clinical safety, consensus, efficiency and pragmatism- Start research in the field of the working group.The tools we work with are:- Coordination and shared vision- Standardization of clinical practice of the territory- Self-training and external training groups in the territory- Exploring possibilities in the field of research.It is structured in three areas: health care, training and researchHealthcare: Improving communication between AP and AH and the quality of care to patients with imported diseases. Clinical routes of major imported diseases have been created, and communication through email and telephone contact have been provided. In AH the number as well as the reason of the queries proceeding from AP are recorded and AP professionals are assured \"feed-back\" with discharge reports that record procedures performed and diagnosis.Training: Improve academic training and exchange of ideas between AP and AH. An annual day of International Health and AP in symposium format with free access is held. Communication via mail and/or groupWhatsApp has been set up among group members to share news and items of interest in international health.Research: Start simple research work within AP with a practical focus on improving clinical practice. Currently we are working in the screening of infectious diseases in immigrants.Discussion: Healthcare activity is enabling us to improve attention to imported pathology and to conduct patient flow between levels in a coordinated and efficient way. We must improve implementation throughout the territory and ensure the safe transfer of information from one level to another.Educational activity is meeting the needs that are perceived by conducting symposiums. Pressure exerted by healthcare and the difficulty to have access to training are the most important problems detected.Research activity has its main obstacle in the difficulty to extract data from computerized medical records in the various centers because of inefficient records and the few hours available to primary care professionals to perform this activity.Conclusions: Combined work between AP and AH has allowed the homogenization of attention against imported pathology.Channels of communication have been created between both areas to provide safer and more efficient management of patients.Training offered to professionals in the region has met with good response and a high level of satisfaction.We are working on research related to international health to improve clinical practice.The model is transferable to other contexts in which the two levels of action coexist.

Abstract Background There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). Methods A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). Results A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March–December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63–2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23–10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43–5.00); P = 0.02] and was observed as well for the parasitic infections’ group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60–3.57; P < 0.001). Conclusions The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.

IntroductionISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysisThis study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and disseminationThe study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration number NCT05868005.

Title: Screening for infectious pathology and other health conditions in migrant population in primary care.Introduction: Migration is an omnipresent phenomenon that affects all communities. The migrant population has specific health needs related to their country of origin and the migratory route, different from those of the native population, and which can sometimes go unnoticed in our health system.Primary Care (PC) is the gateway to the Spanish health system. If professionals are sensitive to the health needs of this group, a great impact can be generated on their health.Hypothesis: If PC health professionals are provided with tools and knowledge to identify andaddress certain health conditions early, the health of the migrant population will improve. The evidence of screening in the migrant population is low and most of the time, it is not contextualized at PC care level. There are recommendations on screening in the immigrant population, most of them based on expert opinions, but in many cases the implementation depends on health professionals.Goals:The main objective of our work is to improve the health of the migrant population through the early detection of certain infectious diseases and other health conditions such as mental health (MH) and female genital mutilation (FGM).Specific aims:1. To identify and evaluate good health practices in migrant care and to develop recommendations adapted to the PC context regarding infectious diseases including imported diseases, MH and FGM2. To raise awareness and to train PC professionals in the health needs of the migrant population.3. To evaluate through a pilot study the feasibility and effectiveness of the implementation of a screening program using a computer tool incorporated into the PC clinical history that would help the health professional in the decision-making process.4. To analyze the prevalence of pathologies included in the screening program.Methods:1. A literature review of national and international guidelines on health care and screening in immigrant population was carried out to develop recommendations adapted to the territory and PC which could be integrated into the digital tool.2. A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centers in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The alert generates for each migrant patient who comes to the PCC for any reason, recommendations for screening conditions according to sex, age, and country of origin, variables collected in all PC users. In all centers, training was carried out on the health needs of the migrant population and referral circuits to specialized care were designed if necessary. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using a differences-in-differences analysis. This study is registered on international standard randomised controlled trial (ISRCTN14795012). Health data were extracted in an anonymized manner from the SIDIAP database (2012-2018).3. Prevalence of all condition included in the screening programme and regression models.4. Focus groups were subsequently held to find out the professionals' opinions on the usefulness of the alert, the training received and other perceptions regarding care for migrants.Main results:After a review of the existing literature and a consensus of experts, screening recommendations were based on coming from an endemic country for strongyloidiasis, schistosomiasis, and Chagas diseases; on a threshold level of prevalence for HIV (>1%), HBV (>2%), and HCV (>2%), and on incidence (>50 cases/100,000-inhabitants) for active tuberculosis in immigrants with <5 years in Europe. Exploring the risk of FGM is recommended in women from countries where this practice is prevalent. Evaluation of MH status is recommended for people from areas of conflict and violence.A total of 15,780 migrants registered at least one visit during the intervention period. 92.51% met the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [OR: 2.08, 95%CI 1.63-2.64, p<0.001]. The intervention centers raised their overall monthly diagnosis rate to 5.80 (1.23-10.38, p=0.013) extra diagnoses compared with the control centers.2,410 individuals were tested for at least one infection. Of the 508 (21.1%) migrants diagnosed with at least one condition, a higher proportion originated from Sub-Saharan Africa (207, 40.8%), followed by South-East Europe (117, 23.0%), (p-value<0.001). The proportion of migrants diagnosed with Chagas disease was 5/122(4.1%,0.5-7.7), for strongyloidiasis 56/409(13.7%, 10.3-17.0) and 2/101(2.0%, 0.0-4.7) for schistosomiasis, 67/1,176(5.7%, 4.4-7.0) for HIV; 377/1,478 (25.5%, 23.3-27.7) for HBV, and 31/1,433(2.2%, 1.4-2.9) for HCV.There were 3.7% of migrants diagnosed with at least one MS problem, the majority being women (65.8%). Of the 547 MH diagnoses diagnosed in 520 patients, 0.5% were mood disorders, 2.5% were anxiety disorders and 0.9% were sleep disorders. Overall, mental disorders were more frequent in migrants from Latin America and migrants who had arrived more recently in Spain.A total of 29 PC physicians participated in 4 focus groups. The main themes identified were:GPs found the ISMiHealth tool to be very useful for identifying specific health problems in migrants, although there are several additional barriers to screening.The importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental healthThe important role of PC in healthcare provision for migrantsKey proposals to improve screening of migrant populations. GPs also highlighted the urgent need to shift to a more holistic and adequately resourced approach to healthcare in PC.Conclusions:The ISMiHealth tool has improved the implementation of the screening program in migrant population in PC. Screening of migrants and detection of pathologies has increased in the period studied. PC professionals have been sensitized to the health needs of the migrant group. It is necessary to promote research to state and international levels to be able to serve more efficiently the migrant population in PC.