Para tratar enfermos y no solo enfermedades, y para abordar los procesos de salud-enfermedad de las personas y no solo de los enfermos, se precisa incorporar métodos clínicos que trasciendan el método clínico biomédico basado en la enfermedad e incluso en la evidencia. Este modelo ha aportado grandes beneficios, pero no está exento de grandes problemas, como el reduccionismo, el enfoque básicamente curativo y la visión individualista, y produce sesgos en la formación de nuestro estudiantado. Se evidencia que el 65% de las competencias que se deben adquirir durante el grado son competencias propias de la especialidad de la Medicina Familiar y Comunitaria (MFyC), experta en lo frecuente, lo amenazante y lo permanente. La MFyC, como disciplina académica nuclear, se caracteriza por contar con un ámbito de actuación diferenciado, un método clínico propio, que bebe de fuentes científicas no solo cuantitativas sino también cualitativas, un cuerpo de conocimientos propio y un paradigma de actuación.

BackgroundEmotional support helplines provide low-threshold assistance to people experiencing psychological distress, yet long-term evidence on reasons for contact remains limited in Spain. This study aimed to describe the distribution of psychological motives for contacting Teléfono de la Esperanza between 2004 and 2023, with particular attention to loneliness, and to examine temporal, sex-, and age-related patterns.MethodsWe conducted a retrospective observational study using anonymized routine registry data from the International Association Teléfono de la Esperanza (ASITES). The dataset included 2,194,175 contact records registered between 2004 and 2023. Descriptive analyses summarized annual volume, caller characteristics, and primary presenting problems. Annual proportions were calculated to examine temporal patterns. Associations between caller characteristics and selected primary presenting motive were examined using multinomial logistic regression, with loneliness/communication difficulties as the reference outcome category and sex, age group, and calendar year entered simultaneously as predictors. Adjusted odds ratios, 95% confidence intervals, and model-based adjusted predicted probabilities were reported.ResultsContact volume increased over time, reaching its highest levels in 2021–2023. Most contacts were by telephone, and most callers were women (67.1%); age distribution was concentrated in midlife. Loneliness/communication difficulties was the most frequent primary presenting problem among the selected motives examined (10.1%), followed by depressed mood (7.2%) and anxiety-related problems (7.0%). In the multinomial model, age group showed the largest contribution to model fit. Adjusted predicted probabilities showed a strong age gradient for loneliness/communication difficulties, increasing from 15.75% among contacts aged ≤18 years to 77.44% among those aged ≥76 years. In contrast, suicidality-related motives were concentrated in younger groups. Men had higher adjusted relative odds of suicidal ideation and suicidal crisis than women, whereas women had higher relative representation of depressed mood and grief/bereavement.ConclusionHelpline contact records reflect distinct age-, sex-, and time-related patterns of distress. Loneliness emerged as a major reason for contact, particularly in later life, supporting the value of helplines as an accessible public mental health resource and as a potential gateway for targeted prevention and referral strategies.

Improving population health management requires moving beyond an individualistic and biologistic approach in primary care towards a more holistic perspective that considers the multiple elements interacting within a community. To this end, a Community Care Strategy in Aragón (Spain) was implemented, which has been acknowledged as a successful model by the WHO Regional Office for Europe. It guides primary care teams in the development of community care through three courses of action, built upon coordinated initiatives such as its multi-level training plan. This study aims to describe the characteristics of the professionals participating in the training plan, explore their perceived usefulness of the training, and examine its association with changes in daily primary care practice. A descriptive observational quantitative study was conducted, which analyzed the characteristics of the participating professionals in the training activities from 2017 to 2022. In order to assess the effectiveness and to determine its correlation with the degree of community involvement among professionals in their daily work, an online questionnaire was distributed to all the professionals who had participated in any training activity. The questionnaire also included two open-ended questions to gather qualitative insights into participants’ opinions regarding the training. During this period, a total of 1,107 places were offered in 38 continuing training activities. Participation in training activities related to each of the three courses of action of the strategy was significantly associated with their subsequent implementation in practice (OR 2.17 CI95

BackgroundLong COVID (postacute sequelae of SARS-CoV-2 infection) is a heterogeneous condition with persistent multisystem symptoms and substantial functional burden. Integrative longitudinal studies combining clinical phenotyping, lifestyle factors, and immunobiological markers are needed to clarify determinants of symptom persistence and inform risk stratification and targeted interventions. ObjectiveThis study aims to identify clinical, biological/immunological, and sociodemographic factors associated with Long COVID status by comparing individuals with persistent symptoms to matched recovered controls, and to evaluate longitudinal changes in symptoms and secondary outcomes over follow-up. MethodsARALongCOV is a longitudinal matched case-control observational study conducted in Aragón, Spain, including adults (≥18 years of age) with confirmed SARS-CoV-2 infection. Participants are recruited through 3 sources: the Long COVID Aragón Patient Association, the Aragón Health Service database, and primary care consultations. Long COVID and recovered participants are individually matched 1:1 (without replacement) on sex/gender (exact), age (±3 years), and date of acute COVID-19 diagnosis (±30 days). Outcomes include persistent symptoms and functioning and patient-reported outcomes (quality of life, physical activity, diet, sleep, mental health, functional status, cognitive performance, pain catastrophizing, and fatigue), alongside clinical variables and biochemical/immunological markers (including inflammatory and cytokine profiles, SARS-CoV-2 antispike immunoglobulin G serology, and viral reactivation serologies). Measurements are obtained at baseline (T0) and repeated at follow-up (T1) using standardized procedures. ResultsThe study received ethics approval from the Clinical Research Ethics Committee of Aragón (PI21/278). Funding was provided by Instituto de Salud Carlos III through project PI22/01070 (cofunded by the European Union) for the period 2023-2027. Baseline assessments (T0) were initiated in late 2022/early 2023. As of February 2026, a total of 200 participants have been enrolled (n=100 Long COVID; n=100 recovered controls) and have completed T0; T1 assessments are scheduled for late 2025/early 2026 (~3-year follow-up for the earliest enrolled participants). Primary analyses will be conducted after completion of T1 assessments, with dissemination planned from the second half of 2026 and continuing through 2027. ConclusionsThis protocol describes a comprehensive, multidimensional longitudinal study designed to clarify determinants of Long COVID by integrating clinical, functional, lifestyle, and immunobiological data in matched cohorts. Findings are expected to support risk stratification, phenotype discovery, and identification of prognostic markers to inform preventive, diagnostic, and rehabilitative strategies. Trial RegistrationISRCTN Registry ISRCTN27312680; https://tinyurl.com/33cbysrk International Registered Report Identifier (IRRID)DERR1-10.2196/67133

Background:Childhood obesity remains a major public health concern, exacerbated by the COVID-19 pandemic. This study examines temporal and spatial patterns in childhood obesity and overweight in Aragón, Spain, before (2018-2019) and after (2021) pandemic lockdowns. Methods:We conducted a retrospective descriptive analysis using anthropometric data from children aged 0-14 years attending public health centres. Data were extracted from electronic medical records and classified according to national diagnostic standards. Sociodemographic indicators, including parental education and income, were derived from official datasets and geoprocessed to the Basic Health Zone (BHZ) level. Principal Component Analysis (PCA) reduced socioeconomic dimensions, whilst Geographically Weighted Regression (GWR) examined spatial associations. Results:Obesity prevalence increased from 3.8% in 2019 to 5.5% in 2021, and overweight from 14.5 to 15.8% (p < 0.001). Boys were consistently more affected than girls, though this gap narrowed post-pandemic. The largest increases were amongst children aged >6 years. Urban-rural typology alone did not fully explain the patterns; instead, intermediate-population BHZs and rural areas near urban centres exhibited higher prevalence. GWR analyses revealed spatial variability in the relationship between obesity and socioeconomic indicators, particularly in Zaragoza province, with income and education levels significantly associated with prevalence. Conclusion:The COVID-19 pandemic reversed prior improvements in childhood obesity trends in Aragón. Socioeconomic inequalities, especially related to parental education and income, strongly influence obesity distribution at the local level. Geographically targeted policies are needed to reduce disparities and prevent long-term health consequences in children.

BackgroundSmoking is a growing public health problem that has a significant impact on psychosocial functioning and quality of life. The presence of certain personal factors on health-promoting behavior influences mental well-being and less dependence on tobacco in the population.ObjetiveThe purpose of this study is to explore the association between tobacco abuse, affective disorders (depression and anxiety) and personal factors related to health behavior. We also aimed to analyze how affective problems can mediate the association between personal factors related to health behavior and tobacco abuse.MethodsDescriptive, bivariate, multivariate and mediation analyzes of data from 391 participants of 35–74 years old in primary health care centers located in Aragón (Spain) were performed between July 2021 and July 2022. The primary variable was tobacco consumption, evaluated qualitatively (presence or absence) and quantitatively, as consumption measured through the number of cigarettes.ResultsHigher patient activation and health literacy were associated with lower odds of tobacco smoking problem and lower daily cigarette consumption. Conversely, being without a partner and having more severe depressive symptoms were associated with higher odds of tobacco smoking problem and higher daily cigarette consumption. The mediation analyses suggested indirect statistical associations involving depressive symptoms in the relationships between health literacy, patient activation, and tobacco smoking outcomes. However, given the cross-sectional design, these findings should not be interpreted as evidence of causal or temporal mediation.ConclusionThe severity of depressive and anxiety symptoms and personal factors are related to tobacco smoking problem. These associations may be relevant for informing future preventive strategies aimed at reducing smoking rates in the population. However, longitudinal and intervention studies are needed to clarify the temporal and causal relationships among personal health-related factors, depressive symptoms, and tobacco smoking outcomes.Clinical Trial RegistrationIdentifier, ISRCTN12820058. https://doi.org/10.1186/ISRCTN12820058

Background:Long COVID, or postacute COVID-19 syndrome, presents with persistent cognitive and psychological symptoms such as brain fog, anxiety, depression, and fatigue, significantly impacting quality of life and daily functioning. Digital health interventions offer a scalable, accessible solution to bridge care gaps, especially where conventional neuropsychological support is limited. However, evidence regarding their effectiveness for neuropsychiatric symptoms in long COVID remains fragmented. Objective:This scoping review aimed to systematically identify and map the existing evidence on digital interventions targeting cognitive and psychological symptoms in individuals with long COVID. The review also sought to categorize intervention types, assess reported outcomes, and identify methodological gaps to inform future clinical and research priorities. Methods:The review followed the Arksey and O'Malley framework and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Comprehensive searches were conducted in 4 databases (PubMed, Scopus, Web of Science, and ScienceDirect) from December 2024 to February 2025. Eligible studies included peer-reviewed and gray literature published in English or Spanish since 2020. Studies were screened and selected based on predefined inclusion and exclusion criteria. Data were extracted using a standardized charting form and synthesized narratively, with thematic grouping by intervention type. Results:Of 888 records identified, 25 (2.82%) were included. Intervention types encompassed telehealth platforms, mobile health apps, virtual reality, online cognitive and psychological therapies, game-based cognitive training, neuromodulation (transcranial direct current stimulation), and multicomponent programs. Most studies reported improvements in psychological well-being, emotional regulation, and cognitive domains such as attention and memory. However, findings varied, with some interventions showing no significant cognitive gains or sustained effects. Common limitations included small sample sizes, lack of control groups, heterogeneity in outcomes and intervention protocols, and short follow-up durations. The underrepresentation of older adults and underserved populations was also noted. Conclusions:Digital interventions show promise for addressing cognitive and psychological symptoms in long COVID, particularly when delivered as multicomponent programs. Nonetheless, the evidence base remains preliminary. Future research should prioritize high-quality randomized trials with standardized outcome measures, long-term follow-up, and diverse participant samples. Addressing barriers related to digital literacy and access will be essential to ensure equity and real-world effectiveness.

Long COVID is associated with persistent symptoms, functional impairment, and reduced health-related quality of life (HRQoL), but the factors most strongly associated with poorer HRQoL remain incompletely characterized. This study compared adults with long COVID and recovered controls and identified variables independently associated with worse HRQoL. We conducted a case–control analysis of the ARALONGCOV 2022 dataset including 170 adults with prior COVID-19: 85 with long COVID and 85 recovered controls without persistent symptoms. HRQoL was assessed with the 12-item Short Form Health Survey (SF-12) total score. Additional measures included depressive symptoms (Patient Health Questionnaire-9, PHQ-9), fatigue severity (Fatigue Severity Scale, FSS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), pain catastrophizing, post-COVID functional status (PCFS), physical activity, and distance completed during the six-minute walk test (6MWT-D). Between-group comparisons used Mann–Whitney U tests for continuous variables and chi-squared or Fisher exact tests for categorical variables. Univariable and multivariable linear regression models were fitted within long COVID cases to identify factors independently associated with SF-12 total score. Compared with recovered controls, participants with long COVID had markedly worse HRQoL (median SF-12 28.75 [IQR 21.25–39.17] vs 73.96 [62.81–77.50]; p < 0.001), more depressive symptoms (PHQ-9: 12.00 [7.00–18.00] vs 2.00 [0.00–6.00]; p < 0.001), greater fatigue (FSS: 57.00 [50.00–62.00] vs 13.00 [9.00–33.00]; p < 0.001), worse sleep quality (PSQI: 14.00 [9.00–16.00] vs 6.00 [3.00–11.00]; p < 0.001), and shorter 6MWT-D (481 [406–560] m vs 556 [491–609] m; p < 0.001). Long COVID cases were also less frequently employed (38.8

Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), affects an estimated 10–30% of infected individuals and is characterized by persistent symptoms such as fatigue, dyspnea, cognitive dysfunction, and functional impairment. Despite rapid advances in understanding acute COVID-19 and its complications, the mechanisms underpinning symptom persistence remain unclear. Viral persistence, immune dysregulation, chronic inflammation, and autoimmunity have been implicated, but few studies have jointly integrated clinical, immunological, biological, and biopsychosocial domains within the same individuals. To identify clinical, biological, immunological, and sociodemographic factors associated with Long COVID by comparing individuals with persistent symptoms to carefully matched recovered controls, and to examine the influence of lifestyle and biopsychosocial variables on symptom persistence and functional outcomes over time RALongCOV is a dual-cohort (retrospective and prospective), longitudinal study conducted in Aragón, Spain, including adults (≥18 years) with confirmed SARS-CoV-2 infection. Approximately 400 participants will be recruited through the Long COVID Aragón Patient Association, the Aragón Health Service database, and primary care consultations. Long COVID and recovered participants will be matched by age (±3 years), sex/gender, and date of acute COVID-19 diagnosis (±30 days). Data collection includes standardized questionnaires on quality of life, physical activity, diet, sleep, mental health, functional status, cognitive performance, pain catastrophizing, and fatigue, alongside detailed clinical information and a broad panel of biochemical and immunological markers (including inflammatory and cytokine profiles, SARS-CoV-2 serology, and viral reactivation serologies). Statistical analyses will comprise descriptive and inferential methods, multivariable regression models, and machine-learning approaches (e.g. Random Forest) to identify predictors, derive risk profiles, and explore complex interactions. We expect to identify distinct clinical and immunobiological profiles associated with persistent post-COVID symptoms, reduced quality of life and functional impairment, and to derive risk phenotypes that integrate clinical, biomarker and biopsychosocial variables, thereby informing more targeted follow-up and rehabilitation strategies. This protocol describes a comprehensive, multidimensional cohort study designed to clarify the determinants of Long COVID. By integrating clinical, functional, lifestyle, and immunobiological data in matched cohorts with longitudinal follow-up, ARALongCOV aims to generate robust evidence on risk factors, potential phenotypes, and prognostic markers, informing targeted preventive, diagnostic, and rehabilitative strategies for individuals with persistent post-COVID symptoms. This protocol was registered with the ISRCTN Registry before commencement (ISRCTN27312680).

Introduction: Long COVID syndrome has significant psychological impacts, compounded by feelings of insufficient support. This study aims to analyze individuals' experiences with Long COVID regarding their perceived social support through a qualitative analysis of online discussion forums. Methods: A qualitative substudy was conducted as part of a randomized clinical trial (RCT) evaluating the effectiveness of an online group rehabilitation program. A total of 330 posts from the program’s discussion forums were analyzed using inductive thematic analysis, with data processed via NVivo11 software. Results: Three main themes emerged related to different types of social support: formal, informal, and peer support. Concerning formal support, patients reported insufficient empathy and support from medical professionals, perceiving themselves as neglected. Regarding informal support, many experienced isolation and social judgment from family and friends, who lacked understanding of their condition. In contrast, they deeply appreciated the support and empathy shared with others experiencing similar struggles (peer support), which fostered a sense of collective resilience in their recovery. Discussion and conclusion: The study underscores the need for improved support strategies, both through enhanced healthcare assistance and strengthened personal and peer-based networks for Long COVID patients.

BACKGROUND:Since the emergence of COVID-19, many patients continue to experience symptoms beyond the acute phase, a condition now termed long COVID syndrome (LCS). The complexity of LCS, with its varied symptoms, makes diagnosis and treatment challenging. Recent evidence suggests that dietary approaches, such as fasting and caloric restriction, may help in management of these symptoms. However, research on these interventions remains limited and preliminary. OBJECTIVES:In this review we aimed to explore existing studies on the impacts of fasting and caloric restriction for LCS management, focusing on how these approaches might alleviate symptoms through mechanisms like reduced inflammation, enhanced autophagy, and better metabolic health. Additionally, we examined intervention types, reported outcomes, and gaps in the research to guide future studies of LCS. METHODS:A systematic search was conducted using databases like PubMed, Scopus, and ScienceDirect for studies published from 2019 to 2024, following the Arksey and O'Malley framework and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A range of study types, including case series, narrative reviews, randomized controlled trial protocols, and public guidance documents, were included. Data were descriptively compiled. RESULTS:Eleven studies met inclusion criteria, covering interventions such as intermittent and prolonged fasting, as well as caloric restriction, with durations from days to weeks. Some reported benefits included reductions in fatigue, cognitive impairment, and inflammatory symptoms such as joint pain, muscle pain, or chest tightness. However, the findings reported here are preliminary and limited by small sample sizes, short follow-up, and varied protocols and outcomes, underscoring the need for further standardized research. CONCLUSIONS:Fasting and caloric restriction have shown potential benefits in managing LCS symptoms like fatigue, cognitive decline, and inflammatory symptoms. Nonetheless, the diversity of study designs and outcomes necessitates more rigorous research to confirm the effectiveness and safety of interventions for LCS management. Future studies should focus on long-term effects and biological mechanisms and include broader, more diverse populations to enhance generalizability and support clinical guidance.

Introduction:Loneliness, a multidimensional emotional experience resulting from unmet social needs, affects individuals across demographics and is particularly prevalent among youth. It can be social or emotional and is linked to developmental transitions, reduced social networks, mental health conditions, and excessive social media use. Unlike desired solitude, loneliness is involuntary and associated with significant physical and mental health risks, including depression, suicide, and chronic illnesses. Despite its public health impact, youth loneliness remains underrecognized, necessitating tailored interventions. This study examines its prevalence and relationship with sociodemographic factors, social support, social media use, self-esteem, and health among students in Aragon. Methods:This cross-sectional study investigated loneliness among adolescents and young adults (14-30 years) studying in Zaragoza, Spain, using online surveys conducted in March-April 2024. A sample of 536 participants was selected based on inclusion criteria, including informed consent. Loneliness was assessed using the UCLA Loneliness Scale and the De Jong Gierveld Loneliness Scale, alongside sociodemographic, social, and psychological variables such as self-esteem, health, mental health, and social media use. Descriptive, correlational, and regression analyses were performed to identify predictors of loneliness. Results:The study sample comprised 73.7% women, with an average age of 20 years. Among participants, 45.9% were high school students and 54.1% university students. Higher loneliness levels are associated with spending more time on social media, fewer and lower-quality relationships, lower self-esteem, poorer self-perceived health, and having mental health problems. While no significant gender or age differences were found, the UCLA Loneliness Scale identified 31.2% of participants as lonely, and the De Jong Gierveld Loneliness Scale classified 49.1% with moderate loneliness and 27.1% with severe loneliness. Discussion:This study highlights the high prevalence of loneliness among young individuals, affecting approximately two-thirds of the population aged 14-30. The findings underscore the importance of addressing loneliness as a public health concern, with particular attention to vulnerable groups. Further research is needed to develop effective prevention, detection, and intervention strategies tailored to youth, which could be implemented through Primary Care and educational institutions.

Evaluate nursing staff intervention’s impact on antibiotic use and hygiene for nursing home residents’ infections. A 2-h intervention for nursing staff, involving individual and group feedback, evidence-based infection management, and infection prevention techniques, improved prescription appropriateness for common infections in nursing homes. The intervention was effective, but a more comprehensive educational program is required. The aim of this study was to assess the impact of a multifaceted intervention aimed at nursing home staff on antibiotic use and hygiene elements for nursing home residents with common infections. Before-and-after study carried out in nursing homes in five areas of Spain. Nursing staff registered residents with common infections and documented hygiene practices over three months, before and after a 2-h educational intervention in autumn 2023. The intervention focused on the initial registration results, antibiotic guidelines, infection prevention, and management strategies for nursing homes. Indicators for potentially unnecessary antibiotic use and non-first-line antibiotics were developed, and results from both registration periods (Feb-Apr 2023 and Feb-Apr 2024) were compared to assess impact. Of 34 nursing homes, 23 completed the intervention and the two registrations (67.6

Purpose: This study aims to analyze the medium‐term effectiveness of telerehabilitation in enhancing the quality of life for patients with Long COVID, using a mobile application (APP) called ReCOVery APP. The secondary purpose is to identify significant factors associated with an improvement in the quality of life and other secondary outcomes in this population. Methods: A randomized clinical trial was carried out with two parallel groups involving a total of 100 patients with Long COVID. The first one (control group, n = 48) continued with their usual treatment (TAU), established by their primary care doctor. The second one (intervention group, n = 52), in addition to continuing with their TAU, attended three sessions based on motivational methodology and used the ReCOVery APP for 6 months. The primary outcome was quality of life. Results: After 6 months, ReCOVery APP did not significantly improve the quality of life among Long COVID patients. Poor adherence to the APP was observed among the participants who tried it. Linear regression analyses revealed a significant relationship between the decrease in the number of symptoms and the improvement in mental health–related quality. Conclusions: While this research contributes valuable insights into the potential of telerehabilitation for Long COVID patients, the lack of significant improvement in quality of life underscores the need for future large‐scale studies. Such research should focus on identifying effective strategies to enhance adherence to digital interventions, such as increased professional support and personalized care approaches. Additionally, exploring the long‐term effects of telerehabilitation could provide a more comprehensive understanding of its role in managing Long COVID. Trial Registration: ISRCTN Registry identifier: ISRCTN91104012

Post-coronavirus disease condition (PCC) continues to affect many people globally, yet there remains a lack of diagnostic biomarkers to distinguish PCC from those recovered from acute COVID-19. This study compared biomarkers between two age- and gender-matched groups: PCC individuals and those recovered within three months of acute COVID-19 in 2020 (n n = 85 each). Biomarkers were assessed 12- 24 months after initial diagnosis, examining biochemical profiles, blood cell counts, coagulation status, antibody serology, lymphocyte populations, and cytokine levels. PCC individuals exhibited significant alterations in 49 of 167 markers, including K+ levels, a GAD antibodies, antithrombin III, insulin-like growth factor-binding protein 3 (IGFBP3), and interleukin-10 (IL-10). A panel of a GAD, IL-10, potassium levels, and CD16brightCD56- bright CD56- cell presence distinguished PCC individuals from recovered patients with >88% accuracy and <92% precision.

Digital interventions are expected to facilitate the treatment of patients suffering from Long COVID. This trial assesses the effectiveness of a multimodal rehabilitation program —comprising both online and synchronous components— in managing the characteristic symptoms of Long COVID and, consequently, in improving quality of life. It also aims to identify which changes in measured variables from baseline (T0) to post-intervention (T1) predict an improvement in quality of life. A blind randomized controlled trial was conducted with two parallel groups: (1) the control group, which received usual treatment from the primary care physician and (2) the intervention group, which received usual treatment in addition to an online multimodal rehabilitation program. The data were collected at two time points: prior to the start of the intervention and three months after it. The main outcome variable was quality of life, encompassing both mental health and physical health-related quality of life. Sociodemographic and clinical variables were collected as secondary variables. A total of 134 participants (age 48.97 ± 7.64; 84.33

Abstract Background Primary Health Care (PHC) has been key element in detection, monitoring and treatment of COVID-19 cases in Spain. We describe how PHC practices (PCPs) organized healthcare to guarantee quality and safety and, if there were differences among the 17 Spanish regions according to the COVID-19 prevalence. Methods Cross-sectional study through the PRICOV-19 European Online Survey in PCPs in Spain. The questionnaire included structure and process items per PCP. Data collection was due from January to May 2021. A descriptive and comparative analysis and a logistic regression model were performed to identify differences among regions by COVID-19 prevalence (low < 5% or high ≥5%). Results Two hundred sixty-six PCPs answered. 83.8% of PCPs were in high prevalence regions. Over 70% PCPs were multi-professional teams. PCPs attended mainly elderly (60.9%) and chronic patients (53.0%). Regarding structure indicators, no differences by prevalence detected. In 77.1% of PCPs administrative staff were more involved in providing recommendations. Only 53% of PCPs had a phone protocol although 73% of administrative staff participated in phone triage. High prevalence regions offered remote assessment (20.4% vs 2.3%, p 0.004) and online platforms to download administrative documents more frequently than low prevalence (30% vs 4.7%, p < 0.001). More backup staff members were hired by health authorities in high prevalence regions, especially nurses (63.9% vs 37.8%, p < 0.001. OR:4.20 (1.01-8.71)). 63.5% of PCPs provided proactive care for chronic patients. 41.0% of PCPs recognized that patients with serious conditions did not know to get an appointment. Urgent conditions suffered delayed care in 79.1% of PCPs in low prevalence compared to 65.9% in high prevalence regions (p 0.240). A 68% of PCPs agreed on having inadequate support from the government to provide proper functioning. 61% of high prevalence PCPs and 69.5% of low ones (p: 0.036) perceived as positive the role of governmental guidelines for management of COVID-19. Conclusions Spanish PCPs shared a basic standardized PCPs’ structure and common clinical procedures due to the centralization of public health authority in the pandemic. Therefore, no relevant differences in safety and quality of care between regions with high and low prevalence were detected. Nurses and administrative staff were hired efficiently in response to the pandemic. Delay in care happened in patients with serious conditions and little follow-up for mental health and intimate partner violence affected patients was identified. Nevertheless, proactive care was offered for chronic patients in most of the PCPs.

Urinary tract infections (UTIs) are highly prevalent in long-term care facilities, constituting the most common infection in this setting. Our research focuses on analyzing clinical characteristics and antimicrobial prescriptions for UTIs in residents across nursing homes (NH) in Spain. This cross-sectional report is part of a before/after intervention study using a multifaceted approach based on the normalization process theory to improve healthcare quality provided by nursing staff in 34 NHs in Spain. In this study we present the results of the first audit including 719 UTI cases, with an average age of 85.5 years and 74.5% being women. Cystitis and pyelonephritis presented distinct symptom patterns. Notably, 6% of asymptomatic bacteriuria cases were treated. The prevalence of dipstick usage was 83%, raising concerns about overreliance, including in the 46 asymptomatic cases, leading to potential overdiagnosis and antibiotic overtreatment. Improved diagnostic criteria and personalized strategies are crucial for UTI management in NHs, emphasizing the need for personalized guidelines on management of UTIs, to mitigate indiscriminate antibiotic use in asymptomatic cases.

Achieving clinical effectiveness with vitamin K antagonists (VKAs) requires a Time in Therapeutic Range (TTR) above 65%. TTR is influenced by genetics (CYP2C9, VKORC1, CYP4F2), treatment adherence, and knowledge. The SAMe-TT2R2 algorithm is used to assess VKA treatment suitability. In this case report, SAMe-TT2R2 and pharmacogenetic analysis were used to improve oral anticoagulant management in a patient with poor control of INR. An 84-year-old, obese male with atrial fibrillation, undergoing acenocoumarol therapy, had a suboptimal TTR. An assessment with the SAMe-TT2R2 algorithm indicated a favorable profile for VKA use. An educational intervention on vitamin K-rich foods was conducted, and his physician was informed about the interaction between omeprazole and acenocoumarol, recommending its replacement with pantoprazole. This intervention was accepted by the physician and, three months post-intervention, the patient’s TTR improved to 100%. Poor adherence and limited knowledge contributed to treatment failures in patients with a good VKA profile. Pharmaceutical interventions significantly improved TTR management. Patients with favorable genetic and clinical profiles could achieve adequate control of their anticoagulant medication through these interventions. Predictive tools may help select patients who can effectively and safely use VKAs through pharmaceutical interventions.