Sara Martínez-Torres

Background: Sudden death due to cardiorespiratory arrest has a high mortality rate and often occurs outside hospital settings. Prompt initiation of cardiopulmonary resuscitation (CPR) by bystanders, along with the use of an automated external defibrillator (AED), has been shown to double survival rates. Given the challenges of ensuring timely emergency response in rural areas, implementing basic CPR training programs can help improve survival outcomes. Objective: This study aimed to evaluate the effectiveness of online CPR-AED training delivered to participants from a rural area of Camp de Tarragona. Methods: This quasi-experimental study consisted of 2 phases: phase 1, evaluation of the effectiveness of online training on CPR-AED knowledge (with pretest and posttest assessments), and phase 2, evaluation of the effectiveness of online training on CPR-AED maneuvers through simulation at 1 month and 6 months after online training. The sample of the study comprised residents in a rural area of Tarragona, Spain. A descriptive statistical analysis of the study population was conducted. For quantitative data with a nonnormal distribution, the median and IQR were presented. Categorical data were described as frequencies and percentages. A bivariate analysis was performed to compare the pretraining and posttraining quantitative variables using the Student 2-tailed t test. Results: In total, 55 participants were included in the study. Of these, 74.5% (n=55) were women, the mean age was 41.5 (SD 9.1) years, and 94.5% (n=55) were employed. Overall, 52 participants completed the online training. The median time required to complete the course was 261.5 (IQR 935; range 125-327) minutes. In total, 51 participants took part in the first practical simulation, which was conducted 1 month after the theoretical training. The mean score obtained in this first simulation was 7.5 out of 10. Six months after the theoretical training, 46 participants completed a second simulation. Conclusions: Online CPR-AED training is effective in improving CPR-AED knowledge and skills in a rural population in the short and medium term.

Background: Older adults are a rapidly growing demographic and often face social isolation and limited access to outdoor activities due to mobility issues, health conditions, and environmental barriers. These limitations can negatively impact their well-being, leading to reduced physical activity, cognitive decline, and emotional distress. Virtual reality (VR) technology offers a promising solution to bridge this gap by enabling access to immersive virtual environments, which may enhance the quality of life for residents in nursing homes. Objective: The aim of this study is to assess whether the use of VR glasses in nursing homes improves the quality of life of older adults by reducing the challenges they face in participating in recreational activities outside their care facilities. Methods: This study will adopt a prospective, longitudinal quasi-experimental design conducted in nursing homes within a basic health area of Catalonia, Spain. The intervention period will span 1 year. Participants will use VR glasses to interact with virtual environments, and their quality of life will be measured using the Rivas-Borda Quality of Life Scale, based on other validated scales. Results: Outcomes will focus on variations in quality-of-life scores before and after the intervention, as determined by the Rivas-Borda Scale. Statistical analysis will include detailed metrics such as sample size, confidence intervals, and P values to evaluate the intervention’s effectiveness. Conclusions: This research seeks to confirm that VR technology can be a valuable tool for enhancing the quality of life in older adults residing in nursing homes, addressing issues like social isolation and limited access to outdoor activities in an innovative and engaging way.

Background: Social conditions in which individuals live, work, and interact have a significant impact on health. Extensive evidence suggests that place of residence influences health disparities and overall well-being. Understanding the characteristics of a population can help shape healthcare policies that contribute to improved public well-being. Objective: The aim of this research was to describe the main characteristics of the population under study, considering place of residence and other sociodemographic factors. Methods: This is a descriptive study. A tailored 79-item questionnaire was developed based on validated instruments, including variables related to sociodemographic, physical activity, rest and sleep patterns, emotional well-being, and sense of community belonging. The sample was obtained through an open invitation to the general population, ensuring representativeness in terms of sex, age, and nationality. Data were analysed using standard statistical methods for this type of study. Results: A total of 487 different response profiles were collected, representing 3.7% of the total population. Not all participants answered every question. Overall, 33.6% of respondents reported having a chronic disease, with the highest prevalence among individuals over 65 years old. Notably, those who live alone are not necessarily the ones who report feeling the loneliest. The findings highlight the need for new social and healthcare policies at the institutional level. Conclusions: No statistically significant differences were found based on place of residence, except for those related to physical activity and sense of community belonging.

Background: Home care programs in primary healthcare aim to address the health needs of elderly and frail populations, but ensuring safety in home environments can be challenging due to factors like limited supervision, environmental hazards, and the complexity of managing multiple health conditions. Fragmented information further complicates healthcare professionals’ ability to identify critical health risks and manage them effectively. Objective: This study aims to design and evaluate the effectiveness of a visual map integrated into the electronic medical record of home care patients. The goal will be to implement this tool and enhance healthcare professionals’ interventions, improving patient safety and quality of life. Methods: The study will be conducted in three phases: (1) the design of a visual map for the home care program by identifying health areas and contributing factors; (2) a cluster-randomized clinical trial across primary care centers to assess whether the visual map reduces hospital admissions, falls, and injuries while improving quality of life; and (3) a qualitative study to evaluate the impact of the visual map on the home care program. Results: It is anticipated that the visual map will reduce hospital admissions, falls, and injuries among home care patients while improving quality of life by facilitating targeted and effective professional interventions. Discussion: This visual map aims to enhance the safety of vulnerable home care patients by integrating critical health information into a practical, easy-to-implement tool. Its feasibility and potential for integration into routine primary care within the Catalan Institute of Health make it a valuable innovation with broader applicability. Trial registration: NCT04399616. Registered on 8 May 2024.

Introduction ISMiHealth 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 analysis This 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 dissemination The 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.

The initial APEAS study, conducted in June 2007, examined adverse events (AEs) in Spanish Primary Healthcare (PHC). Since then, significant changes have occurred in healthcare systems. To evaluate these changes, a study was conducted in the Camp de Tarragona PHC region (CTPHC) in June 2019. This cross-sectional study aimed to identify AEs in 20 PHC centres in Camp de Tarragona. Data collection used an online questionnaire adapted from APEAS–2007, and a comparative statistical analysis between APEAS–2007 and CTPHC–2019 was performed. The results revealed an increase in nursing notifications and a decrease in notifications from family doctors. Furthermore, fewer AEs were reported overall, particularly in medication-related incidents and healthcare-associated infections, with an increase noted in no-harm incidents. However, AEs related to worsened clinical outcomes, communication issues, care management, and administrative errors increased. Concerning severity, there was a decrease in severe AEs, coupled with an increase in moderate AEs. Despite family doctors perceiving a reduction in medication-related incidents, the overall preventability of AEs remained unchanged. In conclusion, the reporting patterns, nature, and causal factors of AEs in Spanish PHC have evolved over time. While there has been a decrease in medication-related incidents and severe AEs, challenges persist in communication, care management, and clinical outcomes. Although professionals reported reduced severity, the perception of preventability remains an area that requires attention.

Background: Tobacco consumption during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant smokers and their foetus. Even though pregnant smokers are conscious about the negative effects of tobacco consumption, they also had barriers for smoking cessation and most of them continue smoking, being a major public health problem. The aim of this study is to determine the effectiveness of an application (App) for mobile devices, designed with a gamification strategy, in order to help pregnant smokers to quit smoking during pregnancy and in the long term. Methods: This study is a multicentre randomized community intervention trial. It will recruit pregnant smokers (200 participants/group), aged more than 18 years, with sporadically or daily smoking habit in the last 30 days and who follow-up their pregnancy in the Sexual and Reproductive Health Care Services of the Camp de Tarragona and Central Catalonia Primary Care Departments. All the participants will have the usual clinical practice intervention for smoking cessation, whereas the intervention group will also have access to the App. The outcome measure will be prolonged abstinence at 12 months after the intervention, as confirmed by expired-carbon monoxide and urinary cotinine tests. Results will be analysed based on intention to treat. Prolonged abstinence rates will be compared, and the determining factors will be evaluated using multivariate statistical analysis. Discussion: The results of this study will offer evidence about the effectiveness of an intervention using a mobile App in smoking cessation for pregnant smokers, to decrease comorbidity associated with long-term smoking. If this technology is proven effective, it could be readily incorporated into primary care intervention for all pregnant smokers. Trial registration: Clinicaltrials.gov ID NCT05222958. Trial registered 3 February 2022.

Type-2 diabetes mellitus (T2DM) is a chronic metabolic disorder. The incidence and prevalence of patients with T2DM are increasing worldwide, even reaching epidemic values in most high- and middle-income countries. T2DM could be a risk factor of developing complications in other diseases. Indeed, some studies suggest a bidirectional interaction between T2DM and COVID-19. A growing body of evidence shows that COVID-19 prognosis in individuals with T2DM is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with T2DM after SARS-CoV-2 infection. The most common treatments for T2DM may influence SARS-CoV-2 and their implication in infection is briefly discussed in this review. A better understanding of the link between TD2M and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients.

While chemokines were originally described for their ability to induce cell migration, many studies show how chemokines also take part in a variety of other cell functions, acting as adaptable messengers in the communication between a diversity of cell types. In the nervous system, chemokines participate both in physiological and pathological processes, and while their expression is often described on glial and immune cells, growing evidence describe the expression of chemokines and their receptors in neurons, highlighting, their potential in auto- and paracrine signalling. In this study we analysed the role of nociception in the neuronal chemokinome, and their role in axonal growth. We found that stimulating TRPV1 ⁺ nociceptors induces a transient increase in CCL21. Interestingly we found that, this CCL21 increases neurite growth of large diameter proprioceptors in vitro . Consistent with this, we show that proprioceptors express the CCL21 receptor CCR7, and a CCR7 neutralizing antibody dose-dependently attenuates CCL21-induced neurite outgrowth. Mechanistically, we found that CCL21 binds locally to its receptor CCR7 at the growth cone, activating the downstream MEK-ERK pathway, that in turn activates N-WASP, triggering actin filament ramification in the growth cone, resulting in increased axonal growth.

Neural tissue has limited regenerative ability, to cope with that, in the recent years a diverse set of novel tools have been used to tailor neurostimulation therapies and promote functional regeneration after axonal injuries. In this report, we explore cell-specific methods to modulate neuronal activity, including opto- and chemogenetics to assess the effect of specific neuronal stimulation in the promotion of axonal regeneration after injury. We found that opto- or chemogenetic modulations of neuronal activity on both dorsal root ganglia and corticospinal motor neurons increase their axonal growth capacity only on permissive substrates.