De Salut Research Articles

Experience sampling methods for the personalised prediction of mental health problems in Spanish university students: protocol for a survey-based observational study within the PROMES-U project

IntroductionThere is a high prevalence of mental health problems among university students. Better prediction and treatment access for this population is needed. In recent years, short-term dynamic factors, which can...

A risk-organised model for clinically significant prostate cancer early detection.

A risk-organised model for clinically significant prostate cancer early detection.

Cannabis and Public Health: A Study Assessing Regular Cannabis Users Through Health Indicators.

Background and Objective: An increasing number of countries are deciding to regulate the medicinal and/or recreational use of cannabis (Cannabis sativa L.). However, there is a lack of information on the impact of regular consumption of this substance on public health. In this study, for the first time, regular cannabis consumers in Spain were assessed using health indicators, comparing these data with the general population. Methods: Various items of the Enquesta de Salut de Catalunya (ESCA) and other items related to cannabis use were selected to build a survey and administer it to a representative sample of regular cannabis users in Catalonia. Results: Most of the indicators did not show any deterioration in the health of regular cannabis users compared with the general population. It was observed that users suffered from more sleep problems and about 40% of the sample would like to discontinue cannabis use, suggesting a dependence pattern. About 30% of the sample was able to discontinue the use of prescription medications because of cannabis. Social support and sleep problems, and not cannabis use, were predictors of depression and well-being scores. Conclusions: It seems that regular cannabis use, despite contributing to problems related to sleep quality or dependence, does not have a negative impact on public health in a manner detectable using health indicators.

Estrategia de promoción de relaciones equitativas y saludables en centros educativos de Barcelona

The educational system is one of the most powerful agents of socialization; it can contribute to perpetuate the gender system and tolerance towards violence or on the contrary, to reduce violence by promoting more equitable and healthy relationship models. The Agència de Salut Pública de Barcelona set out to design a strategy to prevent violence by promoting equitable and healthy relationships at different educational levels in schools in the city of Barcelona. The objective of this article is to present the process of developing this strategy. They characteristics are: (1) use of a participatory approach to ensure the quality and coherence of the process; (2) creation of a theoretical framework for the strategy; (3) use of the intervention mapping methodology as a strategy for the diagnosis, planning, design, development and evaluation of interventions to promote equitable and healthy relationships; and (4) adaptation or design and evaluation of different programs to incorporate different educational stages. It is argued that the strategy designed is considered adequate because it plans interventions to promote equitable and healthy relationships framed within a global educational strategy that starts in the early stages of early childhood education and is continued in all compulsory educational stages. This strategy is based on a conceptual framework that takes into account the determinants and social inequalities in health and promotes an approach based on the promotion of health assets and the use of participatory methodologies.

Exploring cognitive and biological correlates of sleep quality and their potential links with Alzheimer’s disease (ALFASleep project): protocol for an observational study

IntroductionThe growing worldwide prevalence of Alzheimer’s disease (AD) and the lack of effective treatments pose a dire medical challenge. Sleep disruption is also prevalent in the ageing population and is...

Impact of intraoperative floppy IRIS syndrome in cataract surgery by phacoemulsification: Analysis of 622 cases

BackgroundSmall pupil syndromes, including IFIS, increase the risk of complications during cataract surgery if proper surgical planning is not performed. Tamsulosin is associated with a very significant increase in the risk of IFIS, due to the prolonged inactivation of alpha-1 adrenergic receptors in the smooth muscle fiber of the iris. Material and methodsSingle-center prospective observational study, carried out at the Hospital de l'Esperança - Parc de Salut Mar. Results622 eyes of 502 patients were included, of which 337 (62%) were women. The mean age of the sample is 74.8 years. 61 cases of IFIS (11%) were observed, of which 13 received treatment with Tamsulosin and 1 with Doxazosin. 23 cases of IFIS were observed in female patients. The female:male ratio was approximately 1:3. 19 cases (3%) of severe IFIS were observed, of which 6 received treatment with alpha-antagonists, with no statistically significant correlation.The mean surgical time was 13.80 min (Standard Deviation - SD: 4.01 min) in patients without IFIS and 16.93 min (SD: 4.32 min) in patients with IFIS. The relationship between the duration of the surgical procedure in minutes and the presence of IFIS was statistically significant, applying a 'two-tailed' or bilateral t-Student test with a p value of 0.01. ConclusionRegardless of the degree of severity, the diagnosis of IFIS lengthens the surgical time in cataract surgery. This represents yet another piece of evidence that supports the use of less selective alpha-1 adrenergic antagonist treatments than Tamsulosin or the performance of cataract surgery before starting these treatments.

Impacto del síndrome de iris flácido intraoperatorio (IFIS) en cirugía de cataratas mediante facoemulsificación: análisis de 622 casos

BackgroundSmall pupil syndromes, including intraoperative-floppy iris syndrome (IFIS), increase the risk of complications during cataract surgery if proper surgical planning is not performed. Tamsulosin is associated with a very significant increase in the risk of IFIS, due to the prolonged inactivation of alpha-1 adrenergic receptors in the smooth muscle fiber of the iris. Material and methodsSingle-center prospective observational study, carried out at the Hospital de l’Esperança – Parc de Salut Mar. ResultsSix hundred and twenty-two eyes of 502 patients were included, of which 337 (62%) were women. The mean age of the sample is 74.8 years. Sixty-one cases of IFIS (11%) were observed, of which 13 received treatment with Tamsulosin and 1 with Doxazosin. Twenty-three cases of IFIS were observed in female patients. The female:male ratio was approximately 1:3. Nineteen cases (3%) of severe IFIS were observed, of which 6 received treatment with alpha-antagonists, with no statistically significant correlation.The mean surgical time was 13.80min (standard deviation – SD: 4.01min) in patients without IFIS and 16.93min (SD: 4.32min) in patients with IFIS. The relationship between the duration of the surgical procedure in minutes and the presence of IFIS was statistically significant, applying a ‘two-tailed’ or bilateral t-Student test with a p value of 0.01. ConclusionRegardless of the degree of severity, the diagnosis of IFIS lengthens the surgical time in cataract surgery. This represents yet another piece of evidence that supports the use of less selective alpha-1 adrenergic antagonist treatments than tamsulosin or the performance of cataract surgery before starting these treatments.

Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency

BackgroundMunicipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions.MethodsThe ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%).ResultsSemi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities.ConclusionsThe participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.

Estudio CORCOBIA: determinación de puntos de corte de biomarcadores de enfermedad de Alzheimer en LCR en una cohorte clínica

IntroductionThe analysis of the core biomarkers of Alzheimer's disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points (COP) for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the COP of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona, and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya). MethodsProspective study including cognitively healthy subjects (n=42), subjects with amnestic mild cognitive impairment (n=35) and patients with dementia due to AD (n=48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyze amyloid beta peptides (Aβ42, Aβ40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse® G600II (Fujirebio) was performed. The values of sensitivity, specificity, predictive values and area under the curve (AUC) were calculated, determining the COP according to the Youden index by comparing the groups of cognitively healthy subjects and AD. ResultsThe resulting COP and their AUC were the following: Aβ42 750pg/ml (AUC 0.809); Aβ42/Aβ40 0.062pg/ml (AUC 0.78); pTau181 69.85pg/ml (AUC 0.81); tTau 522.0pg/ml (AUC 0.79); Aβ42/tTau 1.76pg/ml (AUC 0.86); Aβ42/pTau181 10.25pg/ml (AUC 0.86). ConclusionsThe determination of COP of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aβ42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.

The CORCOBIA study: Cut-off points of Alzheimer’s disease CSF biomarkers in a clinical cohort

IntroductionThe analysis of the core biomarkers of Alzheimer’s Disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the cut-off points of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya). MethodsProspective study including cognitively unimpaired individuals (CU, n = 42), subjects with amnestic mild cognitive impairment (aMCI, n = 35) and patients with dementia due to Alzheimer’s Disease (AD, n = 48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyse amyloid beta peptides (Aβ42, Aβ40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse G600II (Fujirebio) was performed. The values of sensitivity (SE), specificity (SP), predictive values and area under the curve (AUC) were calculated, determining the cut-off point according to the Youden index by comparing the CU and AD groups. ResultsThe resulting cut-offs and their AUC were the following: Aβ42 750 pg/mL (AUC 0.809); Aβ42/Aβ40 0.062 (AUC 0.78); pTau181 69.85 pg/mL (AUC 0.81); tTau 522.0 pg/mL (AUC 0.79); Aβ42/tTau 1.76 (AUC 0.86); Aβ42/pTau181 10.25 (AUC 0.86). ConclusionsThe determination of cut-off points of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aβ42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.

Proposal for a summary index of the non-pharmacological preventive measures adopted against SARS-CoV-2 in companies, the case of Parc de Salut Mar (Barcelona).

Construct a numerical index of non-pharmacological preventive measures against Sars-CoV-2 based on the experience of Parc de Salut Mar (PSMar), a healthcare institution in Barcelona. The construction of the index was carried out in three phases. The identification and selection of the variables to be included based on semi-structured interviews with key informants and documental revision. The definition of the dimensions (consisting of one or more variables) and, finally, the operationalisation of the index on the basis of these dimensions. The index was estimated in the PSMar, and in its two main centres, the Hospital del Mar and the Hospital de la Esperanza. Twenty-one variables were identified and categorised into six dimensions: personal protective equipment, individual organisational measures, collective organisational measures, epidemiological surveillance measures, training activities and protocol development. During the first wave, the Hospital del Mar index remained above the value obtained at the Hospital de la Esperanza, while in the second wave both indexes showed similar values until week 36, when the Hospital del Mar index began to show higher values. These oscillations were mainly due to the dimensions of personal protective equipment and training activities. The proposed index shows the difficulties in implementing the various non-pharmacological preventive measures in the first weeks of the pandemic. This tool can be useful for evaluating the activities carried out by the Occupational Risk Prevention Services in the face of the pandemic, with the appropriate adaptations to the reality of each individual company.

Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study.

To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012-2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84-0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59-0.67] and aOR = 0.95 [95% CI = 0.86-1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01-1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56-0.99] and aOR = 0.80 [95% CI = 0.68-0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66-1.28] and incident aOR = 0.72 [95% CI = 0.59-0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76-2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69-1.18]), or cancer stages. The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).

Distinctive features of First Episode of Psychosis during the Covid-19 pandemic

IntroductionCOVID19 has brought several psychosocial stressors that are having an impact on global mental health. The impact of the pandemic on the incidence of First Episode of Psychosis (FEP) is not clear.ObjectivesTo describe the clinical and sociodemographic characteristics of FEP patients diagnosed since the onset of the COVID19 pandemic and compare them with the equivalent period of the previous year.MethodsWe included all FEP patients attended at Parc de Salut Mar (Barcelona, Spain) from March 14, 2020 (when the state of emergency in Spain began) to December 31, 2020 with the same period of 2019. We assessed sociodemographic variables, duration of untreated psychosis (DUP), cannabis and alcohol use, psychiatric diagnosis, and psychiatric symptom scales. We performed a univariate analysis between the groups using U-Mann Whitney for continuous variables and Chi-Square for qualitative variables.ResultsA total of 20 FEP patients were diagnosed in each period. No differences were found in sociodemographic variables, scales scores or DUP. During COVID19 period there was a smaller proportion of cannabis users (60% vs 90%; p=0.028) and a tendency of lower weekly consumption (14.44 vs 16.42; p=0.096). There were more cases of BPD (25% vs 5%; p=0.077) and less of affective psychosis (0% vs 25%; 0.017).ConclusionsDuring the COVID-19 pandemic we did not find an increase of FEP or more severe clinical presentations. However, we identified differences in the type of FEP that could be related to the psychosocial stressors of this time.DisclosureNo significant relationships.

Prevalence of rheumatic diseases in Baix Empordà

BackgroundIn Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. Materials and methodsObservational, descriptive and cross-sectional study carried out on the population attended from 2016 to 2017 in SIBBE (Serveis de Salut Integrats del Baix Empordà), an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: "with rheumatic disease", "possible rheumatic disease" and "without rheumatic disease". ResultsIn total, 71,785 patients were distributed as: 36.2% “with rheumatic disease (n = 25,990); 6.1% with “possible rheumatic disease” (n = 4406) and 57.7% “without rheumatic disease” (n = 41,389). The group "with rheumatic disease" showed a predominance of women (59.7% vs. 44.9%) and older age (59.1 ± 17.7 vs. 45.1 ± 16.2; p < .001) compared to the group "without rheumatic disease". The presence of rheumatic disease increased progressively with age, being maximum in the group between 55–75 years. Conclusions36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Empordà population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age.

Assessing cognitive reserve outcomes and biomarkers in first episode of psychosis: Rationale, objectives, protocol and preliminary results of the CRASH Project

IntroductionCognitive reserve (CR) has proved to predict clinical, cognitive and functional outcomes. Despite this, it is necessary to shed greater light on the identification of factors associated with CR in first psychotic episodes (FEP). The aim of this article was to describe the rationale, objectives, protocol, and preliminary results for a new project of CR. Material and methodsThe CRASH Project is a coordinated, multicenter and multimodal study of patients with a FEP with a one-year prospective longitudinal follow-up. This project is funded by the Departament de Salut of the Generalitat de Catalunya and file code SLT006/17/00345. The project was structured in four modules, each focusing on a different outcome measure: (1) General and Basic; (2) Neuroimaging; (3) Neurocognition; and (4) Biological. ResultsA total of 90 FEP patients and 100 healthy controls were enrolled in this study. There were no differences between patients and HC in terms of age (p=0.104), gender (p=0.140) and socioeconomic status (p=0.104). However, at inclusion, we found significant differences in functioning (p<0.001), CR (p<0.001), and all cognitive domains except executive functioning. Patients were clinically stable at inclusion. ConclusionsThe results obtained by this project are hoped to contribute as much towards the understanding of the illness’ physiopathology as towards the generation of new treatment designs and therapeutic strategies that allow for a personalized management according to each individual's profile, which includes CR as well as clinical characteristics.

Patient experience, satisfaction and shared decision-making in colorectal cancer screening: protocol of the mixed-methods study CyDESA

IntroductionColorectal cancer (CRC) screening programmes can reduce incidence and mortality from this condition if adherence to them is high. As patient experience and satisfaction are key factors in determining adherence...

Green CURIOCITY: a study protocol for a European birth cohort study analysing childhood heat-related health impacts and protective effects of urban natural environments

IntroductionThe European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as...

Les baraques du Jardin des Plantes vues par Schoelcher et Sèvres

In 1794 The Comité de Salut Public (the then Revolutionary committee for Public Welfare) banned wild animals from public places and had them sent to the Museum d’Histoire Naturelle (the Paris Museum of Natural History). The Architect Molinos was commissioned to build « baraques » (shacks) for their comfort. The place soon became a fashionable walking space. Schoelcher around 1810 and Sèvres in 1814 decorated porcelains after engravings by Nicolas Huet 1808) that represented the animals.

Determinants of mechanical restraint in an acute psychiatric care unit.

BACKGROUNDDespite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential.AIMTo determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR.METHODSDescriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration.RESULTSOf the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). CONCLUSIONThe presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Evolving Mortality and Clinical Outcomes of Hospitalized Subjects During Successive COVID-19 Waves in Catalonia, Spain

Background: The changes in shield strategies, treatments, emergence variants, and healthcare pathways might shift the profile and outcome of patients hospitalized with COVID-19 in successive waves of the outbreak. Methods: We retrospectively analysed the characteristics and in-hospital outcomes of all patients admitted with COVID-19 in eight university hospitals of Catalonia (North-East Spain) between Feb 28, 2020 and Feb 28, 2021. Using a mathematical model, we split admissions into four waves, one of them (summer wave) with little incidence. The main hospital outcomes included 30-day mortality and admission to intensive care unit (ICU). Findings: The analysis included 17,027 subjects admitted during the first wave (6,800; 39.9%), summer wave (1,807; 10.6%), second wave (3,804; 22.3%), and third wave (4,616; 27.1%). The highest 30-day mortality rate was reported during the first wave (17%) and decreased afterwards, remaining stable at 13% in the second and third waves (overall 30% reduction); the lowest mortality was reported during the summer wave (8%, 50% reduction). ICU admission became progressively more frequent during successive waves. In Cox regression analysis, the main independent predictors of 30-day mortality were the epidemic wave, followed by gender, age, diabetes, chronic kidney disease, and neoplasms. Interpretation: In-hospital COVID-19 mortality has decreased substantially after the first wave, but continues to be high and is highly dependent of patient’s characteristics and ICU availability. Highest mortality reductions occurred during a wave characterized by younger individuals, an increasingly frequent scenario as vaccination campaigns progress. Funding Information: This work was partially funded by the grant COVID19 6_17 (to Francesc Vidal), Direccio General de Recerca i Innovacio en Salut (Departament de Salut) and BIOCAT, Generalitat de Catalunya. Declaration of Interests: KK is a member of the UK Scientific Advisory Group for Emergencies. All other authors have nothing to declare. Ethics Approval Statement: The study protocol was approved by the independent ethics committee of the Hospital Germans Trias i Pujol (Badalona, Spain), which waived obtaining informed consent.