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de la Cruz Herrera M, Fuster-Casanovas A, Miró Catalina Q, Cigarrán Mensa M, Alcántara Pinillos P, Vilanova Guitart I, Grau Carrión S, Vidal-Alaball J. Use of virtual reality in the reduction of pain after the administration of vaccines in children in primary care centers: a randomized clinical trial (Preprint). JMIR Res Protoc 2021; 11:e35910. [PMID: 35388793 PMCID: PMC9030982 DOI: 10.2196/35910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pain and anxiety caused by vaccination and other medical procedures in childhood can result in discomfort for both patients and their parents. Virtual reality (VR) is a technology that is capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions. Objective We aim to publish the protocol of a clinical trial for the reduction of pain and anxiety after the administration of 2 vaccines in children aged 3 to 6 years. Methods We will conduct a randomized, parallel, controlled clinical trial with 2 assigned groups. The intervention group will wear VR goggles during the administration of 2 vaccines, while the control group will receive standard care from a primary care center for the procedure. Randomization will be carried out by using the RandomizedR computer system—a randomization tool of the R Studio program. This trial will be an open or unblinded trial; both the subjects and the investigators will know the assigned treatment groups. Due to the nature of the VR intervention, it will be impossible to blind the patients, caregivers, or observers. However, a blind third-party assessment will be carried out. The study population will include children aged 3 to 6 years who are included in the patient registry and cared for in a primary care center of the region of Central Catalonia. They will receive the following vaccines during the Well-Child checkup: the triple viral+varicella vaccine at 3 years of age and the hepatitis A+diphtheria-tetanus-pertussis vaccine at 6 years of age. Results The study is scheduled to begin in January 2022 and is scheduled to end in January 2023, which is when the statistical analysis will begin. As of March 2022, a total of 23 children have been recruited, of which 13 have used VR during the vaccination process. In addition, all of the guardians have found that VR helps to reduce pain during vaccination. Conclusions VR can be a useful tool in pediatric procedures that generate pain and anxiety. International Registered Report Identifier (IRRID) PRR1-10.2196/35910
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Affiliation(s)
- Mercedes de la Cruz Herrera
- Centre d'Atenció Primària Súria, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Aïna Fuster-Casanovas
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | | | - Pablo Alcántara Pinillos
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Isabel Vilanova Guitart
- Centre d'Atenció Primària Súria, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Sergi Grau Carrión
- Digital Care Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Vic, Spain
| | - Josep Vidal-Alaball
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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Bonet-Esteve AM, Font-Ribera L, Dorca-Vila J, Retamal-Cañiz A, Roura-Poch P, Vidal-Alaball J. [Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?]. Aten Primaria 2021; 53:102102. [PMID: 34507074 PMCID: PMC8433117 DOI: 10.1016/j.aprim.2021.102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/12/2021] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence. DESIGN Randomized community clinical trial with two study groups. LOCATION Primary Care Centers in Central Catalonia. PARTICIPANTS Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated. INTERVENTION The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment. MAIN MEASUREMENTS Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey. RESULTS Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found. CONCLUSION Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.
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Affiliation(s)
- Anna Maria Bonet-Esteve
- Unitat de Farmàcia Atenció Primària. Gerència Territorial Catalunya Central. Institut Català de la Salut, Sant Fruitós de Bages, España; Grupo de Investigación PROSAARU (Promoción de la Salud en el Ámbito Rural), Gerència Territorial Catalunya Central. Institut Català de la Salut, Sant Fruitós de Bages, España
| | | | - Judit Dorca-Vila
- Xarxa Assistencial Universitària de Manresa, Calle Dr. Joan Soler, 1-3, Manresa 08243, España
| | - Antonia Retamal-Cañiz
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, España
| | - Pere Roura-Poch
- Servei d'Atenció Primària d'Osona. Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, España
| | - Josep Vidal-Alaball
- Grupo de Investigación PROSAARU (Promoción de la Salud en el Ámbito Rural), Gerència Territorial Catalunya Central. Institut Català de la Salut, Sant Fruitós de Bages, España; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, España; Facultat de Medicina. Universitat de Vic-Universitat Central de Catalunya, Vic, España.
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53
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Coma E, Miró Q, Medina M, Marin-Gomez FX, Cos X, Benítez M, Mas A, Fàbregas M, Fina F, Lejardi Y, Vidal-Alaball J. Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia. Diabetes Res Clin Pract 2021; 182:109127. [PMID: 34752800 PMCID: PMC8592525 DOI: 10.1016/j.diabres.2021.109127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
AIM To analyse the relation between face-to-face appointments and management of patients with type 2 diabetes mellitus (T2DM) visited in primary care practices (PCP). METHODS Retrospective study in 287 primary care practices (PCPs) attending>300,000 patients with T2DM. We analysed the results of 9 diabetes-related indicators of the Healthcare quality standard, comprising foot and retinopathy screening, blood pressure (BP) and glycemic control; and the incidence of T2DM. We calculated each indicator's percentage of change in 2020 with respect to the results of 2019. RESULTS Indicators' results were reduced in 2020 compared to 2019, highlighting the indicators of foot and retinopathy screening (-51.6% and -25.7%, respectively); the glycemic control indicator (-21.2%); the BP control indicator (-33.7%) and the incidence of T2DM (-25.6%). Conversely, the percentage of type 2 diabetes patients with HbA1c > 10% increased by 34%. PCPs with<11 weekly face-to-face appointments offered per professional had greater reductions than those PCPs with more than 40. For instance, a reduction of -60.7% vs -38.2% (p-value < 0.001) in the foot screening's indicator; -27.5% vs -12.5% (p-value < 0.001) in glycemic control and -40.2 vs -24.3% (p-value < 0.001) in BP control. CONCLUSIONS Reducing face-to-face visits offered may impact T2DM patients' follow-up and thus worsen their control.
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Affiliation(s)
- Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.
| | - Queralt Miró
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain
| | - Manuel Medina
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Francesc X Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Spain; Faculty of Medicine. University of Vic - Central University of Catalonia, Vic, Spain
| | - Xavier Cos
- DAP_Cat Research Group, Gerencia Territorial Barcelona Ciutat, Institut Català de la Salut, Spain; Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autonoma de Barcelona, Spain; Institut Català de la Salut, Spain
| | - Mència Benítez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain; Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | | | - Mireia Fàbregas
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Spain; Faculty of Medicine. University of Vic - Central University of Catalonia, Vic, Spain
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Dobaño C, Ramírez-Morros A, Alonso S, Vidal-Alaball J, Ruiz-Olalla G, Vidal M, Rubio R, Cascant E, Parras D, Rodrigo Melero N, Serra P, Carolis C, Santamaria P, Forcada A, Mendioroz J, Aguilar R, Moncunill G, Ruiz-Comellas A. Persistence and baseline determinants of seropositivity and reinfection rates in health care workers up to 12.5 months after COVID-19. BMC Med 2021; 19:155. [PMID: 34183003 PMCID: PMC8237770 DOI: 10.1186/s12916-021-02032-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
We assessed the duration and baseline determinants of antibody responses to SARS-CoV-2 spike antigens and the occurrence of reinfections in a prospective cohort of 173 Spanish primary health care worker patients followed initially for 9 months and subsequently up to 12.5 months after COVID-19 symptoms onset. Seropositivity to SARS-CoV-2 spike and receptor-binding domain antigens up to 149-270 days was 92.49% (90.17% IgG, 76.3% IgA, 60.69% IgM). In a subset of 64 health care workers who had not yet been vaccinated by April 2021, seropositivity was 96.88% (95.31% IgG, 82.81% IgA) up to 322-379 days post symptoms onset. Four suspected reinfections were detected by passive case detection, two among seronegative individuals (5 and 7 months after the first episode), and one low antibody responder. Antibody levels significantly correlated with fever, hospitalization, anosmia/hypogeusia, allergies, smoking, and occupation. Stable sustainment of IgG responses raises hope for long-lasting COVID-19 vaccine immunity.
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Affiliation(s)
- Carlota Dobaño
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain.
| | - Anna Ramírez-Morros
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain.
| | - Selena Alonso
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Gemma Ruiz-Olalla
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Rocío Rubio
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Emma Cascant
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Daniel Parras
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Natalia Rodrigo Melero
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Pau Serra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Carlo Carolis
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Pere Santamaria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Julia McFarlane Diabetes Research Centre (JMDRC) and Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Anna Forcada
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Jacobo Mendioroz
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Anna Ruiz-Comellas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Centre d'Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
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Lopez Segui F, Hernandez Guillamet G, Pifarré Arolas H, Marin Gomez X, Ruiz Comellas A, Ramirez Morros AM, Adroher Mas C, Vidal-Alaball J. Big data-based analysis to characterise and identify variations in the type of Primary Care visits before and during COVID in Catalonia. J Med Internet Res 2021; 23:e29622. [PMID: 34313600 PMCID: PMC8767991 DOI: 10.2196/29622] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems—the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. Objective The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. Methods We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. Results The increase in non–face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental health–related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-10 codes J00-J06: –40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. Conclusions The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non–face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic.
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Affiliation(s)
- Francesc Lopez Segui
- CRES - Pompeu Fabra University, Carrer de Ramon Trias Fargas, 25, 27, Barcelona, ES
| | | | | | - Xavier Marin Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, ES.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, ES
| | - Anna Ruiz Comellas
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, ES.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, ES
| | - Anna Maria Ramirez Morros
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, ES.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, ES
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, Barcelona, ES.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, ES
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Ruiz-Comellas A, Sauch Valmaña G, Mendioroz Peña J, Roura Poch P, Sabata Carrera A, Cornet Pujol I, Gómez Baena I, Casaldàliga Solà À, Saldaña Vila C, Fusté Gamisans M, Boix De la Casa C, Rodoreda Pallàs B, Ramirez-Morros A, Vazquez Abanades L, Vidal-Alaball J. Physical activity, emotional state and socialization in the elderly: study protocol for a clinical multicentre randomized trial. J Int Med Res 2021; 49:3000605211016735. [PMID: 34154431 PMCID: PMC8236794 DOI: 10.1177/03000605211016735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/20/2021] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate whether a 4-month physical activity (PA) group program and visits to sociocultural organizations improve emotional state, social support levels and health-related quality of life in elderly individuals with depression and/or anxiety and/or loneliness. METHODS This will be a multicentre, randomized, two-group clinical trial with a 1-year follow-up. Participants will be 150 primary care patients aged >64 years allocated equally to a control group and an intervention group. Inclusion criteria are Beck Depression Inventory (BDI-II) score ≥14 and/or General Anxiety Disorder (GAD-7) scale score ≥10 and/or Duke-UNC-11 scale score ≥32. The intervention group will participate in a 4-month group PA program. The program will comprise two walks per week and a monthly visit to a sociocultural facility. RESULTS Measured outcomes are clinical remission of depression (BDI-II score <14) and anxiety (GAD-7 scale score <10), improved social support (reduction in DUKE-UNC-11 score), improved quality of life and/or response to the intervention at 4 and 12 months post-intervention. Intervention satisfaction and adherence and post-intervention links with sociocultural organizations will also be assessed. CONCLUSION The findings could encourage the provision of activity-based community interventions for older individuals.
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Affiliation(s)
- Anna Ruiz-Comellas
- Centre d’Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Glòria Sauch Valmaña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Pere Roura Poch
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
- Consorci Sanitari de Vic, Hospital de Vic, Vic, Spain
| | - Anna Sabata Carrera
- CAP Navàs, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Irene Cornet Pujol
- CAP Súria, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Isabel Gómez Baena
- Centre d’Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Àngels Casaldàliga Solà
- Centre d’Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Carme Saldaña Vila
- Centre d’Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Montserrat Fusté Gamisans
- Centre d’Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Carme Boix De la Casa
- Centre d’Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Berta Rodoreda Pallàs
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- CAP Santpedor, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Anna Ramirez-Morros
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Lorena Vazquez Abanades
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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Saigí-Rubió F, Vidal-Alaball J, Torrent-Sellens J, Jiménez-Zarco A, López Segui F, Carrasco Hernandez M, Alzaga Reig X, Bonet Simó JM, Abizanda González M, Piera-Jimenez J, Solans O. Determinants of Catalan public primary care professionals' intention to use digital clinical consultations (eConsulta) in the post-COVID-19 context: optical illusion or permanent transformation? J Med Internet Res 2021; 23:e28944. [PMID: 34097638 PMCID: PMC8386368 DOI: 10.2196/28944] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND During lockdown due to the COVID-19 pandemic, telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care, and it has been used to support the healthcare needs of COVID-19 patients and routine primary care patients alike. However, this change has not been fully consolidated. OBJECTIVE The objective of this study was to analyse the determinants of healthcare professionals' intention to use the eConsulta digital clinical consultations tool in the post-COVID-19 context. METHODS A literature review of the Technology Acceptance Model (TAM) allowed us to construct a theoretical model and establish a set of hypotheses derived from it about the influence that a variety of different factors relating to both healthcare professionals and the institutions where they work had on those professionals' intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data collection instrument. The data were analysed using univariate and bivariate analysis techniques. To confirm the theoretical model, exploratory factor analysis and binary logistic regression were applied. RESULTS The most important variables were those referring to perceived benefits (B=2.408) and the type of use that individuals habitually made of eConsulta (B=0.715). Environmental pressure (B=0.678), experience of technology (B=0.542), gender (B=0.639) and the degree of eConsulta implementation (B=0.266) were other variables influencing the intention to use the tool in the post-COVID-19 context. When replicating the previous analysis by professional group, experience of technology and gender in the physician group, and experience of the tool's use and the centre where a professional works in the nurse group, were found to be of considerable importance. CONCLUSIONS The implementation and use of eConsulta had increased significantly as a consequence of the COVID-19 pandemic, and the majority of the healthcare professionals were satisfied with its use in practice and planned to incorporate it into their practices in the post-COVID-19 context. Perceived benefits and environmental pressure were determining factors in the attitude towards and intention to use eConsulta. CLINICALTRIAL
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Affiliation(s)
- Francesc Saigí-Rubió
- Universitat Oberta de Catalunya, Faculty of Health Sciences, Barcelona, ES
- Interdisciplinary Research Group on ICTs, Barcelona,, ES
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Catala de la Salut, Carrer Pica d'Estats, 36,, Sant Fruitos de Bages, ES
- Unitat de Suport a la Recerca de la Catalunya Central, Fundacio Institut Universitari per a la Recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Sant Fruitos de Bages, ES
- Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, ES
| | - Joan Torrent-Sellens
- Interdisciplinary Research Group on ICTs, Barcelona,, ES
- Universitat Oberta de Catalunya, Faculty of Economics and Business, Barcelona, ES
| | - Ana Jiménez-Zarco
- Interdisciplinary Research Group on ICTs, Barcelona,, ES
- Universitat Oberta de Catalunya, Faculty of Economics and Business, Barcelona, ES
| | - Francesc López Segui
- Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, ES
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, ES
| | | | | | - Josep Maria Bonet Simó
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, ES
| | - Mercedes Abizanda González
- Health Department, eHealth Unit, Barcelona, ES
- Pere Virgili Health Park, Primary Care Management Control, Barcelona, ES
| | - Jordi Piera-Jimenez
- Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, ES
- Servei Català de la Salut, Barcelona, ES
- Universitat Oberta de Catalunya, Open Evidence Research Group, Barcelona, ES
| | - Oscar Solans
- Health Department, eHealth Unit, Barcelona, ES
- Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, ES
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Solans O, Vidal-Alaball J, Roig Cabo P, Mora N, Coma E, Bonet Simó JM, Hermosilla Pérez E, Saigí-Rubió F, Olmos Domínguez C, Piera-Jiménez J, Abizanda González M, López Seguí F. Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res 2021; 23:e28629. [PMID: 33970867 PMCID: PMC8163495 DOI: 10.2196/28629] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.
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Affiliation(s)
- Oscar Solans
- Health Department, Catalan Ministry of Health, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain.,Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Pasqual Roig Cabo
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Núria Mora
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Josep Maria Bonet Simó
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Eduardo Hermosilla Pérez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.,Jordi Gol i Gurina Primary Health Care Research Institute Foundation, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | | | - Jordi Piera-Jiménez
- Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Mercè Abizanda González
- Health Department, eHealth Unit, Barcelona, Spain.,Pere Virgili Health Park, Primary Care Management Control, Barcelona, Spain
| | - Francesc López Seguí
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain.,Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain
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Pifarré i Arolas H, Vidal-Alaball J, Gil J, López F, Nicodemo C, Saez M. Missing Diagnoses during the COVID-19 Pandemic: A Year in Review. Int J Environ Res Public Health 2021; 18:5335. [PMID: 34067807 PMCID: PMC8156815 DOI: 10.3390/ijerph18105335] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has had major impacts on population health not only through COVID-positive cases, but also via the disruption of healthcare services, which in turn has impacted the diagnosis and treatment of all other diseases during this time. We study changes in all new registered diagnoses in ICD-10 groups during 2020 with respect to a 2019 baseline. We compare new diagnoses in 2019 and 2020 based on administrative records of the public primary health system in Central Catalonia, Spain, which cover over 400,000 patients and 3 million patient visits. We study the ratio of new diagnoses between 2019 and 2020 and find an average decline of 31.1% in new diagnoses, with substantial drops in April (61.1%), May (55.6%), and November (52%). Neoplasms experience the largest decline (49.7%), with heterogeneity in the magnitudes of the declines across different types of cancer diagnoses. While we find evidence of temporal variation in new diagnoses, reductions in diagnoses early in the year are not recouped by the year end. The observed decline in new diagnoses across all diagnosis groups suggest a large number of untreated and undetected cases across conditions. Our findings provide a year-end summary of the impact of the pandemic on healthcare activities and can help guide health authorities to design evidence-based plans to target under-diagnosed conditions in 2021.
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Affiliation(s)
- Héctor Pifarré i Arolas
- Centre for Research in Health Economics, Universitat Pompeu Fabra, 08002 Barcelona, Spain; (H.P.iA.); (F.L.)
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
| | - Joan Gil
- Barcelona Economic Analysis Team, Department of Economics, Universitat de Barcelona, 08007 Barcelona, Spain;
| | - Francesc López
- Centre for Research in Health Economics, Universitat Pompeu Fabra, 08002 Barcelona, Spain; (H.P.iA.); (F.L.)
| | - Catia Nicodemo
- Centre of Organisation, Department of Primary Economics, University of Oxford, Oxford OX1 3UQ, UK;
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health, Department of Economics, Universitat de Girona, 17004 Girona, Spain;
- Epidemiology and Public Health Networking Biomedical Research Centre, 28029 Madrid, Spain
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60
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Bonet-Esteve A, Muñoz-Miralles R, Gonzalez-Claramunt C, Rufas AM, Cruz XP, Vidal-Alaball J. Influenza vaccination during the coronavirus pandemic: intention to vaccinate among the at-risk population in the Central Catalonia Health Region (VAGCOVID). BMC Fam Pract 2021; 22:84. [PMID: 33931039 PMCID: PMC8087502 DOI: 10.1186/s12875-021-01434-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Influenza is a major public health issue, with the primary preventive measure being an annual influenza vaccination. Nevertheless, vaccination coverage among the at-risk population is low. Our understanding of the behaviour of the influenza virus during the SARS-CoV-2 coronavirus pandemic is limited, meaning influenza vaccination is still recommended for individuals at risk for severe complications due to influenza infection. The aim of the study is to determine the intention to vaccinate against seasonal influenza among the at-risk population in the 2020-21 campaign during the SARS-CoV-2 pandemic and to analyse the factors which influence such intention. METHODS Cross-sectional telephone survey of adults (aged over 18) with risk factors in central Catalonia where the need for the Seasonal Influenza Vaccine (SIV) was recommended. RESULTS A total of 434 participants responded to the survey, 43.3% of whom intended to be vaccinated against influenza for the 2020-2021 influenza season, 40.8% had no intention to be vaccinated and 15.9% were uncertain or did not express their opinion. The intention to get vaccinated against influenza is associated with having dependents, the individual's perception of the risk of being infected with influenza and the perceived risk of transmission to dependents. It is also associated with age, whether the individual had received influenza vaccine the previous season or any other season before. The best predictors of the intention to vaccinate are the individual's perception of the risk of catching influenza and whether the individual had been vaccinated in the previous season. CONCLUSIONS Intention to vaccinate can be a good predictor of individual behaviour in relation to vaccination. During the current SARS-CoV-2 pandemic many individuals are hesitant to influenza vaccination. In order to improve influenza vaccination coverage in people included in risk groups, it is necessary to promote educational actions, especially among those who express doubts.
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Affiliation(s)
- Anna Bonet-Esteve
- Unitat de Farmàcia, Gerència Territorial Catalunya Central Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Raquel Muñoz-Miralles
- Centre d’Atenció Primària Plaça Catalunya, SAP Bages-Berguedà-Solsonès, Gerència Territorial Catalunya Central Institut Català de la Salut, CAP Plaça Catalunya. C/ Soler i March 6, 08242 Manresa, Spain
| | - Carla Gonzalez-Claramunt
- Centre d’Atenció Primària Vilanova del Camí, SAP Anoia, Gerència Territorial Catalunya Central, Institut Català de la Salut, Vilanova del Camí, Spain
| | - Ana M Rufas
- Centre d’Atenció Primària Manlleu, SAP Osona, Gerència Territorial Catalunya Central, Institut Català de la Salut, Manlleu, Spain
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
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Marin-Gomez FX, Fàbregas-Escurriola M, Seguí FL, Pérez EH, Camps MB, Peña JM, Comellas AR, Vidal-Alaball J. Assessing the likelihood of contracting COVID-19 disease based on a predictive tree model: A retrospective cohort study. PLoS One 2021; 16:e0247995. [PMID: 33657164 PMCID: PMC7928490 DOI: 10.1371/journal.pone.0247995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Primary care is the major point of access in most health systems in developed countries and therefore for the detection of coronavirus disease 2019 (COVID-19) cases. The quality of its IT systems, together with access to the results of mass screening with Polymerase chain reaction (PCR) tests, makes it possible to analyse the impact of various concurrent factors on the likelihood of contracting the disease. METHODS AND FINDINGS Through data mining techniques with the sociodemographic and clinical variables recorded in patient's medical histories, a decision tree-based logistic regression model has been proposed which analyses the significance of demographic and clinical variables in the probability of having a positive PCR in a sample of 7,314 individuals treated in the Primary Care service of the public health system of Catalonia. The statistical approach to decision tree modelling allows 66.2% of diagnoses of infection by COVID-19 to be classified with a sensitivity of 64.3% and a specificity of 62.5%, with prior contact with a positive case being the primary predictor variable. CONCLUSIONS The use of a classification tree model may be useful in screening for COVID-19 infection. Contact detection is the most reliable variable for detecting Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases. The model would support that, beyond a symptomatic diagnosis, the best way to detect cases would be to engage in contact tracing.
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Affiliation(s)
- Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | - Francesc López Seguí
- Departament de Ciències Experimentals, Grup d’Investigació Economía i Salut, Pompeu Fabra University, Barcelona, Spain
| | - Eduardo Hermosilla Pérez
- Sistema de Informació pel Desenvolupament d’Investigació en Atenció Primària, Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Mència Benítez Camps
- Sistemes d’Informació dels Serveis d’Atenció Primària, Institut Català de la Salut, Barcelona, Spain
- Equip d’atenció Primària Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Departament de Salut, Direcció i Coordinació de la Resposta a la COVID19, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Ruiz Comellas
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Equip d’atenció Primaria Sant Joan de Vilatorrada, Institut Català de la Salut, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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Mayer MA, Vidal-Alaball J, Puigdellívol-Sánchez A, Marín Gomez FX, Leis A, Mendioroz Peña J. Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study. JMIR Public Health Surveill 2021; 7:e25452. [PMID: 33496668 PMCID: PMC7871981 DOI: 10.2196/25452] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background The country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic. Objective The objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19. Methods An observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain. Results The study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ≥60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15). Conclusions We observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2.
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Affiliation(s)
- Miguel Angel Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Anna Puigdellívol-Sánchez
- Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain.,CAP Anton de Borja, Consorci Sanitari de Terrassa, Terrassa, Spain.,Unitat d'Anatomia Humana Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Francesc X Marín Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Angela Leis
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, Barcelona, Spain
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Sauch Valmaña G, Vidal-Alaball J, Garcia Furió V, Testoni G, Espelt A, Exposito K, Saigí-Rubió F, Carré N, Sanz I, Vicens V. An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study. JMIR Res Protoc 2021; 10:e25062. [PMID: 33533729 PMCID: PMC7889420 DOI: 10.2196/25062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 12/04/2022] Open
Abstract
Background Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients’ safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID) PRR1-10.2196/25062
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Affiliation(s)
- Glòria Sauch Valmaña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Victoria Garcia Furió
- Primary Care Center Igualada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Igualada, Spain
| | | | - Albert Espelt
- Faculty of Health Science, Universitat de Vic Universitat Central de Catalunya, Manresa, Spain.,Centro de Investigación Biomédica en Red, Epidemiologia y Salud Pública, Madrid, Spain
| | - Katarin Exposito
- Santa Coloma de Queralt Primary Care Center, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Santa Coloma de Queralt, Spain
| | | | - Núria Carré
- Primary Care Regional Service Anoia, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Igualada, Spain
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Flors-Sidro JJ, Househ M, Abd-Alrazaq A, Vidal-Alaball J, Fernandez-Luque L, Sanchez-Bocanegra CL. Analysis of Diabetes Apps to Assess Privacy-Related Permissions: Systematic Search of Apps. JMIR Diabetes 2021; 6:e16146. [PMID: 33439129 PMCID: PMC7840294 DOI: 10.2196/16146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/03/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mobile health has become a major vehicle of support for people living with diabetes. Accordingly, the availability of mobile apps for diabetes has been steadily increasing. Most of the previous reviews of diabetes apps have focused on the apps’ features and their alignment with clinical guidelines. However, there is a lack of knowledge on the actual compliance of diabetes apps with privacy and data security guidelines. Objective The aim of this study was to assess the levels of privacy of mobile apps for diabetes to contribute to the raising of awareness of privacy issues for app users, developers, and governmental data protection regulators. Methods We developed a semiautomatic app search module capable of retrieving Android apps’ privacy-related information, particularly the dangerous permissions required by apps, with the aim of analyzing privacy aspects related to diabetes apps. Following the research selection criteria, the original 882 apps were narrowed down to 497 apps that were included in the analysis. Results Approximately 60% of the analyzed diabetes apps requested potentially dangerous permissions, which pose a significant risk to users’ data privacy. In addition, 28.4% (141/497) of the apps did not provide a website for their privacy policy. Moreover, it was found that 40.0% (199/497) of the apps contained advertising, and some apps that claimed not to contain advertisements actually did. Ninety-five percent of the apps were free, and those belonging to the “medical” and “health and fitness” categories were the most popular. However, app users do not always realize that the free apps’ business model is largely based on advertising and, consequently, on sharing or selling their private data, either directly or indirectly, to unknown third parties. Conclusions The aforementioned findings confirm the necessity of educating patients and health care providers and raising their awareness regarding the privacy aspects of diabetes apps. Therefore, this research recommends properly and comprehensively training users, ensuring that governments and regulatory bodies enforce strict data protection laws, devising much tougher security policies and protocols in Android and in the Google Play Store, and implicating and supervising all stakeholders in the apps’ development process.
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Affiliation(s)
- José Javier Flors-Sidro
- Information Systems Department, Consorci Hospitalari Provincial de Castelló, Castelló de la Plana, Spain
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
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Vidal-Alaball J, Camps-Vilà L. [Guidelines for a good and safe telephone service in COVID-19]. Aten Primaria 2020; 53:101965. [PMID: 33530018 PMCID: PMC7762836 DOI: 10.1016/j.aprim.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Josep Vidal-Alaball
- Grup de Recerca Promoció de la Salut en l'Àmbit Rural, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Barcelona, España
| | - Laura Camps-Vilà
- Centre de Atenció Primària Plaça Catalunya, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Manresa, Barcelona, España.
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Ahmed W, Vidal-Alaball J, Lopez Segui F, Moreno-Sánchez PA. A Social Network Analysis of Tweets Related to Masks during the COVID-19 Pandemic. Int J Environ Res Public Health 2020; 17:E8235. [PMID: 33171843 PMCID: PMC7664625 DOI: 10.3390/ijerph17218235] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND High compliance in wearing a mask is a crucial factor for stopping the transmission of COVID-19. Since the beginning of the pandemic, social media has been a key communication channel for citizens. This study focused on analyzing content from Twitter related to masks during the COVID-19 pandemic. METHODS Twitter data were collected using the keyword "mask" from 27 June 2020 to 4 July 2020. The total number of tweets gathered were n = 452,430. A systematic random sample of 1% (n = 4525) of tweets was analyzed using social network analysis. NodeXL (Social Media Research Foundation, California, CA, USA) was used to identify users ranked influential by betweenness centrality and was used to identify key hashtags and content. RESULTS The overall shape of the network resembled a community network because there was a range of users conversing amongst each other in different clusters. It was found that a range of accounts were influential and/or mentioned within the network. These ranged from ordinary citizens, politicians, and popular culture figures. The most common theme and popular hashtags to emerge from the data encouraged the public to wear masks. CONCLUSION Towards the end of June 2020, Twitter was utilized by the public to encourage others to wear masks and discussions around masks included a wide range of users.
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Affiliation(s)
- Wasim Ahmed
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne NE1 4SE, UK
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
| | - Francesc Lopez Segui
- TIC Salut Social, Generalitat de Catalunya, 08005 Barcelona, Spain;
- Center for Research in Health and Economics (CRES-UPF), Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Pedro A. Moreno-Sánchez
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, 60100 Seinäjoki, Finland;
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Ahmed W, López Seguí F, Vidal-Alaball J, Katz MS. COVID-19 and the "Film Your Hospital" Conspiracy Theory: Social Network Analysis of Twitter Data. J Med Internet Res 2020; 22:e22374. [PMID: 32936771 PMCID: PMC7537721 DOI: 10.2196/22374] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, a number of conspiracy theories have emerged. A popular theory posits that the pandemic is a hoax and suggests that certain hospitals are "empty." Research has shown that accepting conspiracy theories increases the likelihood that an individual may ignore government advice about social distancing and other public health interventions. Due to the possibility of a second wave and future pandemics, it is important to gain an understanding of the drivers of misinformation and strategies to mitigate it. OBJECTIVE This study set out to evaluate the #FilmYourHospital conspiracy theory on Twitter, attempting to understand the drivers behind it. More specifically, the objectives were to determine which online sources of information were used as evidence to support the theory, the ratio of automated to organic accounts in the network, and what lessons can be learned to mitigate the spread of such a conspiracy theory in the future. METHODS Twitter data related to the #FilmYourHospital hashtag were retrieved and analyzed using social network analysis across a 7-day period from April 13-20, 2020. The data set consisted of 22,785 tweets and 11,333 Twitter users. The Botometer tool was used to identify accounts with a higher probability of being bots. RESULTS The most important drivers of the conspiracy theory are ordinary citizens; one of the most influential accounts is a Brexit supporter. We found that YouTube was the information source most linked to by users. The most retweeted post belonged to a verified Twitter user, indicating that the user may have had more influence on the platform. There was a small number of automated accounts (bots) and deleted accounts within the network. CONCLUSIONS Hashtags using and sharing conspiracy theories can be targeted in an effort to delegitimize content containing misinformation. Social media organizations need to bolster their efforts to label or remove content that contains misinformation. Public health authorities could enlist the assistance of influencers in spreading antinarrative content.
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Affiliation(s)
- Wasim Ahmed
- Department of Marketing, Operations and Systems, Newcastle University Business School, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, United States
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López Seguí F, Walsh S, Solans O, Adroher Mas C, Ferraro G, García-Altés A, García Cuyàs F, Salvador Carulla L, Sagarra Castro M, Vidal-Alaball J. Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study. J Med Internet Res 2020; 22:e19149. [PMID: 32687477 PMCID: PMC7530682 DOI: 10.2196/19149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation service between primary care professionals and citizens in the public health care system, has already reached 1 million cases. Before the COVID-19 pandemic, the use of eConsulta was growing at a monthly rate of 7%, and the growth has been exponential from March 15, 2020 to the present day. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. OBJECTIVE The aim of this study was to annotate a random sample of teleconsultations from eConsulta, and to evaluate the level of agreement between health care professionals with respect to the annotation. METHODS Twenty general practitioners retrospectively annotated a random sample of 5382 cases managed by eConsulta according to three aspects: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. A total of 1217 cases were classified three times by three different professionals to assess the degree of consensus among them. RESULTS The general practitioners considered that 79.60% (4284/5382) of the teleconsultations resulted in avoiding a face-to-face visit, and considered that 64.96% (3496/5382) of the time, the patient would have made a face-to-face visit in the absence of a service like eConsulta. The most frequent uses were for management of test results (26.77%, 1433/5354), management of repeat prescriptions (24.30%, 1301/5354), and medical enquiries (14.23%, 762/5354). The degree of agreement among professionals as to the annotations was mixed, with the highest consensus demonstrated for the question "Has the online consultation avoided a face-to-face visit?" (3/3 professionals agreed 67.95% of the time, 827/1217), and the lowest consensus for the type of use of the teleconsultation (3/3 professionals agreed 57.60% of the time, 701/1217). CONCLUSIONS This study shows the ability of eConsulta to reduce the number of face-to-face visits for 55% (79% × 65%) to 79% of cases. In comparison to previous research, these results are slightly more pessimistic, although the rates are still high and in line with administrative data proxies, showing that 84% of patients using teleconsultations do not make an in-person appointment in the following 3 months. With respect to the type of consultation performed, our results are similar to the existing literature, thus providing robust support for eConsulta's usage. The mixed degree of consensus among professionals implies that results derived from artificial intelligence tools such as message classification algorithms should be interpreted in light of these shortcomings.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Spain.,Centre de Recerca en Economía de la Salut, Pompeu Fabra University, Barcelona, Spain
| | - Sandra Walsh
- Institut de Biologia Evolutiva (CSIC), Pompeu Fabra University, Barcelona, Spain
| | - Oscar Solans
- Health Department, Catalan Ministry of Health, Barcelona, Spain
| | | | | | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia, Catalan Ministry of Health, Barcelona, Spain
| | | | - Luis Salvador Carulla
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Marta Sagarra Castro
- Centre d'Atenció Primària Capellades, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
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69
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Marin-Gomez FX, Vidal-Alaball J, Poch PR, Sariola CJ, Ferrer RT, Peña JM. Diagnosis of Skin Lesions Using Photographs Taken With a Mobile Phone: An Online Survey of Primary Care Physicians. J Prim Care Community Health 2020; 11:2150132720937831. [PMID: 32590923 PMCID: PMC7328057 DOI: 10.1177/2150132720937831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Skin conditions are one of the most frequent reasons for visiting a primary
health care facility, making it of vital importance that general practitioners
(GPs) have the right knowledge and tools to diagnose the most frequent
dermatological conditions. Methods: This study evaluates the
accuracy of dermatological diagnoses made by 120 GPs based on photographs taken
with a smartphone by an anonymous online cross-sectional survey.
Results: The study was carried out between August and October
2018. The results show that the majority of the participants are in favor of
using mobile phones to communicate with other professionals and use them to
consult medical images. The majority (69%) took dermatological photographs and
the preferred device was a smartphone (70%). From 22 different images evaluated,
in 69% of responses, participants expressed a high degree of confidence in their
ability to diagnose the lesion shown and in 72% of the cases, the diagnosis
chosen was correct. Conclusions: The study confirms that the use of
smartphone to send medical images is growing rapidly and its potential for
taking medical images is an opportunity to help primary care teams deal with
dermatological problems. The results suggest that GPs need further training in
interpreting dermatological images, to increase their diagnostic confidence and
to avoid the need for referrals to face-to-face visits.
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Affiliation(s)
- Francesc X Marin-Gomez
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Josep Vidal-Alaball
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Pere Roura Poch
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | | | - Jacobo Mendioroz Peña
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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70
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Vidal-Alaball J, Acosta-Roja R, Pastor Hernández N, Sanchez Luque U, Morrison D, Narejos Pérez S, Perez-Llano J, Salvador Vèrges A, López Seguí F. Telemedicine in the face of the COVID-19 pandemic. Aten Primaria 2020; 52:418-422. [PMID: 32402477 PMCID: PMC7164871 DOI: 10.1016/j.aprim.2020.04.003] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 is a positive single-stranded RNA virus that can be immediately translated and integrated into the host cell with its own RNA messenger, facilitating replication inside the cell and infectivity. The rapid progression of the disease presents a real challenge for the whole world. As the usual capacity for citizen care is exceeded, health professionals and governments struggle. One of the most important strategies to reduce and mitigate the advance of the epidemic are social distance measures; this is where telemedicine can help, and provide support to the healthcare systems, especially in the areas of public health, prevention and clinical practices, just as it is doing in others sectors. Telemedicine connects the convenience, low cost, and ready accessibility of health-related information and communication using the Internet and associated technologies. Telemedicine during the coronavirus epidemic has been the doctors' first line of defense to slow the spread of the coronavirus, keeping social distancing and providing services by phone or videoconferencing for mild to focus personal care and limited supplies to the most urgent cases.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Foundation for Research in Primary Health Care Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Ruthy Acosta-Roja
- EBA Centelles, Barcelona, Spain; Digital Care Research Group, University of Vic-UCC, Barcelona, Spain
| | | | | | - Danielle Morrison
- HumanITcare, SME Technology Company, Barcelona, Spain; North Carolina State University, USA
| | - Silvia Narejos Pérez
- EBA Centelles, Barcelona, Spain; Digital Care Research Group, University of Vic-UCC, Barcelona, Spain; Grup Innovació ACEBA, Barcelona, Spain
| | | | - Angels Salvador Vèrges
- Digital Care Research Group, University of Vic-UCC, Barcelona, Spain; Iberian Society of Telehealth and Telemedicine.
| | - Francesc López Seguí
- TIC Salut Social - Ministry of Health, CRES&CEXS - Pompeu Fabra University, Barcelona, Spain
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Floss M, Hoedebecke K, Vidal-Alaball J. Where is the patient's chair? Differences in general practitioner consultation room layouts - an exploratory questionnaire. F1000Res 2020; 8:1439. [PMID: 32399181 PMCID: PMC7194339 DOI: 10.12688/f1000research.19565.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Consultation room design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences. Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups. Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback. Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men. The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Pacific and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other. Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.
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Affiliation(s)
- Mayara Floss
- Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Kyle Hoedebecke
- Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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Marín-Gomez FX, Mendioroz Peña J, Canal Casals V, Romero Mendez M, Darnés Surroca A, Nieto Maclino A, Vidal-Alaball J. Environmental and Patient Impact of Applying a Point-of-Care Ultrasound Model in Primary Care: Rural vs. Urban Centres. Int J Environ Res Public Health 2020; 17:E3333. [PMID: 32403439 PMCID: PMC7246434 DOI: 10.3390/ijerph17093333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
Motor vehicles are a major contributor to air pollution, and the exposure to this human-caused air pollution can lead to harmful health effects. This study evaluates the impact of the provision of point-of-care ultrasounds (POCUS) by primary care (PC) to avoid the patient's need to travel to a specialized service. The study estimates the costs and air pollution avoided during 2019. The results confirm that performing this ultrasound at the point of care reduces the emission of 61.4 gr of carbon monoxide, 14.8 gr of nitric oxide and 2.7 gr of sulfur dioxide on each trip. During the study, an average of 17.8 km, 21.4 min per trip and almost 2000 L of fuel consumed in a year were avoided. Performing POCUS from PC reduces fuel consumption and the emission of air pollutants and also saves time and money. Furthermore, only 0.3% of the scans had to be repeated by radiologists. However, more studies with more participants need to be done to calculate the exact impact that these pollution reductions will have on human health.
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Affiliation(s)
- Francesc X Marín-Gomez
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Servei d’Atenció Primària Osona, Gerència Territorial de Barcelona, Institut Català de la Salut, 08500 Vic, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Vicenç Canal Casals
- Centre d’Atenció Primària Vic Nord, Gerència Territorial de Barcelona, Institut Català de la Salut, 08500 Vic, Barcelona, Spain;
| | - Marcos Romero Mendez
- Centre d’Atenció Primària St. Quirze de Besora, Gerència Territorial de Barcelona, Institut Català de la Salut, 08580 Sant Quirze de Besora, Barcelona, Spain;
| | - Ana Darnés Surroca
- Centre d’Atenció Primària Manlleu, Gerència Territorial de Barcelona, Institut Català de la Salut, 08560 Manlleu, Barcelona, Spain;
| | - Antoni Nieto Maclino
- Centre d’Atenció Primària Sta. Eugènia de Berga, Gerència Territorial de Barcelona, Institut Català de la Salut, 08507 Santa Eugènia de Berga, Barcelona, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Ahmed W, Vidal-Alaball J, Downing J, López Seguí F. COVID-19 and the 5G Conspiracy Theory: Social Network Analysis of Twitter Data. J Med Internet Res 2020; 22:e19458. [PMID: 32352383 PMCID: PMC7205032 DOI: 10.2196/19458] [Citation(s) in RCA: 278] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 01/22/2023] Open
Abstract
Background Since the beginning of December 2019, the coronavirus disease (COVID-19) has spread rapidly around the world, which has led to increased discussions across online platforms. These conversations have also included various conspiracies shared by social media users. Amongst them, a popular theory has linked 5G to the spread of COVID-19, leading to misinformation and the burning of 5G towers in the United Kingdom. The understanding of the drivers of fake news and quick policies oriented to isolate and rebate misinformation are keys to combating it. Objective The aim of this study is to develop an understanding of the drivers of the 5G COVID-19 conspiracy theory and strategies to deal with such misinformation. Methods This paper performs a social network analysis and content analysis of Twitter data from a 7-day period (Friday, March 27, 2020, to Saturday, April 4, 2020) in which the #5GCoronavirus hashtag was trending on Twitter in the United Kingdom. Influential users were analyzed through social network graph clusters. The size of the nodes were ranked by their betweenness centrality score, and the graph’s vertices were grouped by cluster using the Clauset-Newman-Moore algorithm. The topics and web sources used were also examined. Results Social network analysis identified that the two largest network structures consisted of an isolates group and a broadcast group. The analysis also revealed that there was a lack of an authority figure who was actively combating such misinformation. Content analysis revealed that, of 233 sample tweets, 34.8% (n=81) contained views that 5G and COVID-19 were linked, 32.2% (n=75) denounced the conspiracy theory, and 33.0% (n=77) were general tweets not expressing any personal views or opinions. Thus, 65.2% (n=152) of tweets derived from nonconspiracy theory supporters, which suggests that, although the topic attracted high volume, only a handful of users genuinely believed the conspiracy.
This paper also shows that fake news websites were the most popular web source shared by users; although, YouTube videos were also shared. The study also identified an account whose sole aim was to spread the conspiracy theory on Twitter. Conclusions The combination of quick and targeted interventions oriented to delegitimize the sources of fake information is key to reducing their impact. Those users voicing their views against the conspiracy theory, link baiting, or sharing humorous tweets inadvertently raised the profile of the topic, suggesting that policymakers should insist in the efforts of isolating opinions that are based on fake news. Many social media platforms provide users with the ability to report inappropriate content, which should be used. This study is the first to analyze the 5G conspiracy theory in the context of COVID-19 on Twitter offering practical guidance to health authorities in how, in the context of a pandemic, rumors may be combated in the future.
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Affiliation(s)
- Wasim Ahmed
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Joseph Downing
- London School of Economics, European Institute, London, United Kingdom
| | - Francesc López Seguí
- TIC Salut Social, Generalitat de Catalunya, Barcelona, Spain.,CRES & CEXS, Universitat Pompeu Fabra, Barcelona, Spain
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Ahmed W, Marin-Gomez X, Vidal-Alaball J. Contextualising the 2019 E-Cigarette Health Scare: Insights from Twitter. Int J Environ Res Public Health 2020; 17:ijerph17072236. [PMID: 32225020 PMCID: PMC7177596 DOI: 10.3390/ijerph17072236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
A health scare can be described as a campaign that attempts to alert the public of a particular substance or activity that can lead to a negative effect on health. A recent health scare to emerge relates to the health hazards associated with the use of e-cigarettes, which has caused widespread debate, which peaked towards the end of 2019. Health scares need to be studied in the context in which they occur, and one method of studying them is through social media. This paper identifies two key topics of discussion on Twitter, which consisted of pro-vaping and anti-vaping views. The paper then identifies influential users, frequently occurring words, hashtags, and websites related to this time period in order to gain insight into e-cigarette perceptions. The paper then reviews current scientific evidence and develops a flowchart for the general public, which can be used to for public reassurance and guidance.
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Affiliation(s)
- Wasim Ahmed
- Newcastle University Business School, Newcastle University, 5 Barrack Rd, Newcastle upon Tyne NE1 4SE, UK
- Correspondence:
| | - Xavier Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (X.M.-G.); (J.V.-A.)
- Servei d’Atenció Primària d’Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08500 Vic, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (X.M.-G.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
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75
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López Seguí F, Franch Parella J, Gironès García X, Mendioroz Peña J, García Cuyàs F, Adroher Mas C, García-Altés A, Vidal-Alaball J. A Cost-Minimization Analysis of a Medical Record-based, Store and Forward and Provider-to-provider Telemedicine Compared to Usual Care in Catalonia: More Agile and Efficient, Especially for Users. Int J Environ Res Public Health 2020; 17:ijerph17062008. [PMID: 32197434 PMCID: PMC7143363 DOI: 10.3390/ijerph17062008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011, specializing in teledermatology, teleulcers, teleophthalmology and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits were recorded. Objective: To analyze the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user’s costs, was carried out over a three-month period. Results: Telemedicine saved € 780,397 over the period analyzed. A differential cost favorable to telemedicine of about € 15 per visit was observed, with the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Allowing users to save time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favorable for the healthcare system, enabling it to provide a more agile service, which also benefits healthcare professionals.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Catalan Ministry of Health, 08005 Barcelona, Spain;
- CRES&CEXS, Pompeu Fabra University, 08003 Barcelona, Spain
| | - Jordi Franch Parella
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain; (J.F.P.); (X.G.G.)
| | - Xavier Gironès García
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain; (J.F.P.); (X.G.G.)
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
| | - Francesc García Cuyàs
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain; (F.G.C.); (C.A.M.)
| | - Cristina Adroher Mas
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain; (F.G.C.); (C.A.M.)
| | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, 08003 Barcelona, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
- Correspondence:
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López Seguí F, Vidal-Alaball J, Sagarra Castro M, García-Altés A, García Cuyàs F. General Practitioners' Perceptions of Whether Teleconsultations Reduce the Number of Face-to-face Visits in the Catalan Public Primary Care System: Retrospective Cross-Sectional Study. J Med Internet Res 2020; 22:e14478. [PMID: 32175914 PMCID: PMC7105927 DOI: 10.2196/14478] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/09/2019] [Accepted: 02/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND eConsulta is a teleconsultation service involving general practitioners (GPs) and patients. It is part of the information system belonging to Catalonia's primary care service. It has been in operation since the end of 2015 in conjunction with face-to-face consultations with Primary Care Teams as one of the services offered in the patient's Personal Health Folder. OBJECTIVE This study aimed to assess the ability of using eConsulta to reduce the number of face-to-face visits to Primary Care Teams. METHODS Using 13 categories proposed by the researchers, 18 GPs from the Central Catalonia Health Region retrospectively classified 2268 cases managed with eConsulta and indicated whether, in their opinion, the teleconsultations reduced the number of face-to-face visits. RESULTS There was broad consensus among the GPs that eConsulta has the potential to resolve patient queries for every type of consultation. eConsulta avoided the need for a face-to-face visit in 87.9% of cases. In addition, the GPs reported that the ease of access increased the demand for health care support in 27.7% of cases; otherwise, the patient would not have initiated the queries. Therefore, based on the equation (88% x [1-28%]), eConsulta could replace 63%-88% of conventional appointments. The most frequent uses of the teleconsultation service were for management of test results (35.2%), medical enquiries (16.0%), and the management of repeat prescriptions (12.2%). On average, the teleconsultations consisted of a mean 1.57 messages (SD 0.54 messages); 45.9% (1040/2268) of the teleconsultations consisted of 1 message, and the majority of the remaining teleconsultations consisted of 2-5 interactions. The patient initiated 60.0% (1361/2268) of the teleconsultations. CONCLUSIONS Based on the GPs' perceptions, eConsulta could replace 63%-88% of conventional appointments. Therefore, asynchronous teleconsultations between practitioners and patients in primary care could avoid interactions that have limited added clinical value.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Spain.,Centre for Research in Health and Economics, Pompeu Fabra University, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Marta Sagarra Castro
- Centre d'Atenció Primària Capellades, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Anna García-Altés
- Centre for Research in Health and Economics, Pompeu Fabra University, Barcelona, Spain.,Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, Barcelona, Spain
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López Seguí F, Ander Egg Aguilar R, de Maeztu G, García-Altés A, García Cuyàs F, Walsh S, Sagarra Castro M, Vidal-Alaball J. Teleconsultations between Patients and Healthcare Professionals in Primary Care in Catalonia: The Evaluation of Text Classification Algorithms Using Supervised Machine Learning. Int J Environ Res Public Health 2020; 17:E1093. [PMID: 32050435 PMCID: PMC7036927 DOI: 10.3390/ijerph17031093] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 11/16/2022]
Abstract
Background: The primary care service in Catalonia has operated an asynchronous teleconsulting service between GPs and patients since 2015 (eConsulta), which has generated some 500,000 messages. New developments in big data analysis tools, particularly those involving natural language, can be used to accurately and systematically evaluate the impact of the service. Objective: The study was intended to assess the predictive potential of eConsulta messages through different combinations of vector representation of text and machine learning algorithms and to evaluate their performance. Methodology: Twenty machine learning algorithms (based on five types of algorithms and four text representation techniques) were trained using a sample of 3559 messages (169,102 words) corresponding to 2268 teleconsultations (1.57 messages per teleconsultation) in order to predict the three variables of interest (avoiding the need for a face-to-face visit, increased demand and type of use of the teleconsultation). The performance of the various combinations was measured in terms of precision, sensitivity, F-value and the ROC curve. Results: The best-trained algorithms are generally effective, proving themselves to be more robust when approximating the two binary variables "avoiding the need of a face-to-face visit" and "increased demand" (precision = 0.98 and 0.97, respectively) rather than the variable "type of query" (precision = 0.48). Conclusion: To the best of our knowledge, this study is the first to investigate a machine learning strategy for text classification using primary care teleconsultation datasets. The study illustrates the possible capacities of text analysis using artificial intelligence. The development of a robust text classification tool could be feasible by validating it with more data, making it potentially more useful for decision support for health professionals.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social—Ministry of Health, 08028 Barcelona, Spain;
- CRES&CEXS—Pompeu Fabra University, 08003 Barcelona, Spain
| | | | | | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, 08005 Barcelona, Spain;
| | | | - Sandra Walsh
- Institut de Biologia Evolutiva (UPF-CSIC), Pompeu Fabra University, 08003 Barcelona, Spain;
| | - Marta Sagarra Castro
- Centre d’Atenció Primària Capellades, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08786 Sant Fruitós de Bages, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
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Fernández OS, Seguí FL, Vidal-Alaball J, Bonet Simo JM, Vian OH, Cabo PR, Hernandez MC, Dominguez CO, Reig XA, Rodríguez YD, Peralta MM, Hermosilla E, León NM, Guimferrer N, González MA, Cuyàs FG, Sust PP. Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study. JMIR Med Inform 2020; 8:e16484. [PMID: 32012061 PMCID: PMC7055836 DOI: 10.2196/16484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND eConsulta is a tele-consultation service involving doctors and patients, and is part of Catalonia's public health information technology system. The service has been in operation since the end of 2015 as an adjunct to face-to-face consultations. A key factor in understanding the barriers and facilitators to the acceptance of the tool is understanding the sociodemographic characteristics of general practitioners who determine its use. OBJECTIVE This study aimed to analyze the sociodemographic factors that affect the likelihood of doctors using eConsulta. METHODS A retrospective cross-sectional analysis of administrative data was used to perform a multivariate logistic regression analysis on the use of eConsulta in relation to sociodemographic variables. RESULTS The model shows that the doctors who use eConsulta are 45-54 years of age, score higher than the 80th percentile on the quality of care index, have a high degree of accessibility, are involved in teaching, and work on a health team in a high socioeconomic urban setting. CONCLUSIONS The results suggest that certain sociodemographic characteristics associated with general practitioners determine whether they use eConsulta. These results must be taken into account if its deployment is to be encouraged in the context of a public health system.
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Affiliation(s)
| | - Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Catalonia, Spain
- Center for Research in Health and Economics, Pompeu Fabra University, Barcelona, Catalonia, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Catalonia, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Catalonia, Spain
| | | | | | - Pascual Roig Cabo
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
| | - Marta Carrasco Hernandez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | | | - Xavier Alzaga Reig
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
| | - Yesika Díaz Rodríguez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | - Manuel Medina Peralta
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | - Eduardo Hermosilla
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | | | - Nuria Guimferrer
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
| | | | | | - Pol Pérez Sust
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
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Sauch Valmaña G, Vidal-Alaball J, Poch PR, Peña JM, Panadés Zafra R, Cantero Gómez FX, Ruíz Comellas A, Barranco Reixachs D. Effects of a Physical Exercise Program on Patients Affected with Fibromyalgia. J Prim Care Community Health 2020; 11:2150132720965071. [PMID: 33084477 PMCID: PMC7786411 DOI: 10.1177/2150132720965071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND physical activity has been used for a number of years in the treatment of fibromyalgia (FM). The main objective of this study is to compare the effects of physical activity on 2 groups of women diagnosed with FM in terms of pain, quality of life and the impact of the condition on their daily lives. METHODS this was a randomized clinical trial to assess the effects of physical activity performed by subjects assigned to one of 2 groups on the scores of 3 questionnaires, the pain Visual Analog Scale (EVA), the Fibromyalgia Impact Questionnaire (FIQ) and the SF-36 health questionnaire administered before and after the intervention. RESULTS A total of 24 subjects were randomly assigned to each of the 2 study groups. No significant differences were found after the program of 3 months of physical activity ended. CONCLUSIONS Our study shows that a physical activity program with duration of less than 3 months does not significantly improve any of the factors studied.
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Affiliation(s)
- Glòria Sauch Valmaña
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Barcelona, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages (Barcelona), Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Barcelona, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages (Barcelona), Spain
| | | | - Jacobo Mendiroz Peña
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Barcelona, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages (Barcelona), Spain
| | - Robert Panadés Zafra
- Centre d’Atenció Primària Anoia Rural. Institut Català de la Salut, Catalunya Central, Igualada, (Barcelona), Spain
| | - Francesc Xavier Cantero Gómez
- Centre d’Atenció Primària Igualada Urbà. Institut Català de la Salut, Catalunya Central, Igualada (Barcelona), Spain
| | - Anna Ruíz Comellas
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages (Barcelona), Spain
- Centre d’Atenció Primària Sant Joan de Vilatorrada. Institut Català de Salut, Catalunya Central (Barcelona), Spain
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Vidal-Alaball J, Franch-Parella J, Lopez Seguí F, Garcia Cuyàs F, Mendioroz Peña J. Impact of a Telemedicine Program on the Reduction in the Emission of Atmospheric Pollutants and Journeys by Road. Int J Environ Res Public Health 2019; 16:ijerph16224366. [PMID: 31717386 PMCID: PMC6888368 DOI: 10.3390/ijerph16224366] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/27/2019] [Accepted: 11/06/2019] [Indexed: 01/18/2023]
Abstract
This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants, thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019, a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time saving of 3779 h and a total fuel reduction of 11,754 L with an associated cost of €15,664. This represents an average reduction of 3248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles by reducing the number of journeys made for face-to-face visits, and thus contributing to environmental sustainability.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Correspondence: (J.V.-A.); (J.F.-P.)
| | - Jordi Franch-Parella
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain
- Correspondence: (J.V.-A.); (J.F.-P.)
| | - Francesc Lopez Seguí
- TIC Salut Social-Ministry of Health, 08005 Barcelona, Spain
- CRES&CEXS-Pompeu Fabra University, 08005 Barcelona, Spain
| | | | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Flors-sidro JJ, Househ M, Abd-alrazaq A, Vidal-alaball J, Fernandez-luque L, Sanchez-bocanegra CL. Analysis of Diabetes Apps to Assess Privacy-Related Permissions: Systematic Search of Apps (Preprint).. [DOI: 10.2196/preprints.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Mobile health has become a major vehicle of support for people living with diabetes. Accordingly, the availability of mobile apps for diabetes has been steadily increasing. Most of the previous reviews of diabetes apps have focused on the apps’ features and their alignment with clinical guidelines. However, there is a lack of knowledge on the actual compliance of diabetes apps with privacy and data security guidelines.
OBJECTIVE
The aim of this study was to assess the levels of privacy of mobile apps for diabetes to contribute to the raising of awareness of privacy issues for app users, developers, and governmental data protection regulators.
METHODS
We developed a semiautomatic app search module capable of retrieving Android apps’ privacy-related information, particularly the dangerous permissions required by apps, with the aim of analyzing privacy aspects related to diabetes apps. Following the research selection criteria, the original 882 apps were narrowed down to 497 apps that were included in the analysis.
RESULTS
Approximately 60% of the analyzed diabetes apps requested potentially dangerous permissions, which pose a significant risk to users’ data privacy. In addition, 28.4% (141/497) of the apps did not provide a website for their privacy policy. Moreover, it was found that 40.0% (199/497) of the apps contained advertising, and some apps that claimed not to contain advertisements actually did. Ninety-five percent of the apps were free, and those belonging to the “medical” and “health and fitness” categories were the most popular. However, app users do not always realize that the free apps’ business model is largely based on advertising and, consequently, on sharing or selling their private data, either directly or indirectly, to unknown third parties.
CONCLUSIONS
The aforementioned findings confirm the necessity of educating patients and health care providers and raising their awareness regarding the privacy aspects of diabetes apps. Therefore, this research recommends properly and comprehensively training users, ensuring that governments and regulatory bodies enforce strict data protection laws, devising much tougher security policies and protocols in Android and in the Google Play Store, and implicating and supervising all stakeholders in the apps’ development process.
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Vidal-Alaball J, Fernandez-Luque L, Marin-Gomez FX, Ahmed W. A New Tool for Public Health Opinion to Give Insight Into Telemedicine: Twitter Poll Analysis. JMIR Form Res 2019; 3:e13870. [PMID: 31140442 PMCID: PMC6658260 DOI: 10.2196/13870] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background Telemedicine draws on information technologies in order to enable the delivery of clinical health care from a distance. Twitter is a social networking platform that has 316 million monthly active users with 500 million tweets per day; its potential for real-time monitoring of public health has been well documented. There is a lack of empirical research that has critically examined the potential of Twitter polls for providing insight into public health. One of the benefits of utilizing Twitter polls is that it is possible to gain access to a large audience that can provide instant and real-time feedback. Moreover, Twitter polls are completely anonymized. Objective The overall aim of this study was to develop and disseminate Twitter polls based on existing surveys to gain real-time feedback on public views and opinions toward telemedicine. Methods Two Twitter polls were developed utilizing questions from previously used questionnaires to explore acceptance of telemedicine among Twitter users. The polls were placed on the Twitter timeline of one of the authors, which had more than 9300 followers, and the account followers were asked to answer the poll and retweet it to reach a larger audience. Results In a population where telemedicine was expected to enjoy big support, a significant number of Twitter users responding to the poll felt that telemedicine was not as good as traditional care. Conclusions Our results show the potential of Twitter polls for gaining insight into public health topics on a range of health issues not just limited to telemedicine. Our study also sheds light on how Twitter polls can be used to validate and test survey questions.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | | | - Francesc X Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Wasim Ahmed
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
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Vidal-Alaball J, Royo Fibla D, Zapata MA, Marin-Gomez FX, Solans Fernandez O. Artificial Intelligence for the Detection of Diabetic Retinopathy in Primary Care: Protocol for Algorithm Development. JMIR Res Protoc 2019; 8:e12539. [PMID: 30707105 PMCID: PMC6376335 DOI: 10.2196/12539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background Diabetic retinopathy (DR) is one of the most important causes of blindness worldwide, especially in developed countries. In diabetic patients, periodic examination of the back of the eye using a nonmydriatic camera has been widely demonstrated to be an effective system to control and prevent the onset of DR. Convolutional neural networks have been used to detect DR, achieving very high sensitivities and specificities. Objective The objective of this is paper was to develop an artificial intelligence (AI) algorithm for the detection of signs of DR in diabetic patients and to scientifically validate the algorithm to be used as a screening tool in primary care. Methods Under this project, 2 studies will be conducted in a concomitant way: (1) Development of an algorithm with AI to detect signs of DR in patients with diabetes and (2) A prospective study comparing the diagnostic capacity of the AI algorithm with respect to the actual system of family physicians evaluating the images. The standard reference to compare with will be a blinded double reading conducted by retina specialists. For the development of the AI algorithm, different iterations and workouts will be performed on the same set of data. Before starting each new workout, the strategy of dividing the set date into 2 groups will be used randomly. A group with 80% of the images will be used during the training (training dataset), and the remaining 20% images will be used to validate the results (validation dataset) of each cycle (epoch). During the prospective study, true-positive, true-negative, false-positive, and false-negative values will be calculated again. From here, we will obtain the resulting confusion matrix and other indicators to measure the performance of the algorithm. Results Cession of the images began at the end of 2018. The development of the AI algorithm is calculated to last about 3 to 4 months. Inclusion of patients in the cohort will start in early 2019 and is expected to last 3 to 4 months. Preliminary results are expected to be published by the end of 2019. Conclusions The study will allow the development of an algorithm based on AI that can demonstrate an equal or superior performance, and that constitutes a complement or an alternative, to the current screening of DR in diabetic patients. International Registered Report Identifier (IRRID) PRR1-10.2196/12539
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain
| | | | | | - Francesc X Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Spain
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Marin-Gomez FX, Garcia Cuyas F, Reig-Bolano R, Mendioroz J, Roura-Poch P, Pico-Nicolau M, Vidal-Alaball J. Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey. JMIR Mhealth Uhealth 2018; 6:e11147. [PMID: 30578175 PMCID: PMC6320407 DOI: 10.2196/11147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 01/16/2023] Open
Abstract
Background Several studies have been conducted to analyze the role social networks play in communication between patients and health professionals. However, there is a shortage of studies in relation to communication among primary health professionals, in a professional context, using the various mobile phone apps available. Objective The objective of our study was to explore mobile phone social networking app use among primary health care professionals for work-related purposes, by comparing the most widely used apps in the market. Methods We undertook a cross-sectional study using an anonymous Web survey among a convenience sample of 1635 primary health care professionals during August and September 2017. Results Of 483 participants in the survey, 474 (98.1%, 95% CI 97.1%-99.4%) were health professionals who commonly accessed social networking sites and 362 (74.9%, 95% CI 71.1%-78.8%) accessed the sites in a work-related context. Of those 362 respondents, 219 (96.7%, 95% CI 94.8%-98.5%) preferred WhatsApp for both personal and professional uses. Of the 362 respondents who used social networking sites in a work-related context, 276 (76.2%, 95% CI 71.9%-80.6%) rated social networking sites as useful or very useful to solve clinical problems, 261 (72.1%, 95% CI 67.5%-76.7%) to improve their professional knowledge, and 254 (70.2%, 95% CI 65.5%-74.9%) to speed up the transmission of clinical information. Most of them (338/362, 94.8%, 95% CI 92.5%-97.0%) used social networking sites for interprofessional communications, and 204 of 362 (56.4%, 95% CI 51.2%-61.5%) used them for pharmacological-related consultations. Conclusions Health professionals frequently accessed social networking sites using their mobile phones and often for work-related issues. This trend suggests that social networking sites may be useful tools in primary care settings, but we need to ensure the security of the data transfer process to make sure that social networking sites are used appropriately. Health institutions need to increase information and training activities to ensure the correct use of these tools.
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Affiliation(s)
- Francesc X Marin-Gomez
- Servei d'Atenció Primària d'Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Vic, Spain.,Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Digital Care Research Group, Centre for Health and Social Care Research, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Francesc Garcia Cuyas
- Digital Care Research Group, Centre for Health and Social Care Research, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain.,Department of Information and Communications Technology in Health, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Ramon Reig-Bolano
- Digital Care Research Group, Centre for Health and Social Care Research, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain.,Department of Engineering, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Jacobo Mendioroz
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Pere Roura-Poch
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain
| | - Margalida Pico-Nicolau
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Centre d'Atenció Primària Sant Quirze de Besora, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Quirze de Besora, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
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85
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Vidal-Alaball J, Garcia Domingo JL, Garcia Cuyàs F, Mendioroz Peña J, Flores Mateo G, Deniel Rosanas J, Sauch Valmaña G. A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia. BMC Health Serv Res 2018; 18:650. [PMID: 30134891 PMCID: PMC6103877 DOI: 10.1186/s12913-018-3464-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A teledermatology pilot scheme was first conducted in the town of Manresa (Barcelona) in the summer of 2010. The clinical success of the scheme prompted its expansion to the whole county of Bages in 2011 and to the adjacent county of Berguedà in 2012. In the teledermatology service, primary care physicians take a photograph of the lesion and attach it to the electronic medical records of the patient together with a brief clinical account. In the referral hospital, the consultant dermatologists access the electronic medical records, review the images and suggest a treatment or action plan. Next, the primary care physicians review these recommendations and call the patient to report the results. This whole process is usually completed in less than 5 working days. METHODS A cost saving analysis comparing teledermatology with dermatology face-to-face visits was performed in the county of Bages measuring the cost difference attributable to visits saved. RESULTS The estimated added costs of the teledermatology service during 2016 amounted to 61,870 €. For the same period, the estimated costs of traditional outpatient dermatology services were of 113,034 €. This represents savings of 51,164 € per year. After subtraction of societal costs, the savings equal 10,350 € per year. CONCLUSIONS Using a teledermatology service instead of face-to-face dermatology consultations could save 51,164 € per year (11.4 € per patient visited) in the county of Bages. Societal savings are the most significant.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain.
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
- Department of Economics and Business, University of Vic- Central University of Catalonia, Vic, Barcelona, Spain.
| | - Josep Lluís Garcia Domingo
- Department of Economics and Business, University of Vic- Central University of Catalonia, Vic, Barcelona, Spain
| | - Francesc Garcia Cuyàs
- General Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
- Chair in ICT and Healthcare, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Joan Deniel Rosanas
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Glòria Sauch Valmaña
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
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Vidal-Alaball J, Mendioroz Peña J, Sauch Valmaña G. Rural-urban differences in the pattern of referrals to an asynchronous teledermatology service. Int Arch Med 2018. [DOI: 10.3823/2571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background
Telemedicine is particularly useful in rural areas where can facilitate access to specialised care in regions far from urban hospitals and can prevent unnecessary travel. The purpose of this research was to evaluate the degree of resolution of an asynchronous teledermatology service in the Bages County, comparing urban and rural primary care centres.
Methods and findings
A longitudinal descriptive study of referrals from 14 Primary Care Teams to a hospital dermatology service as a result of a previous referral to a teledermatology program was performed, comparing years 2015 and 2016 and urban with rural practices.
Both in urban and rural areas there was an increase in referrals to the teledermatology service in 2016 compared to the previous year (12.9% and 0.3% respectively). In the two years analysed, referral rates to the teledermatology service per thousand inhabitants from rural centres was statistically much higher than that of urban centres (p<0.001). The number of referrals to the face-to-face dermatology service after a teledermatology consultation decreased significantly in both urban [OR=0,81 (0,70-0,93) p=0,001] and rural centres [OR=0,64 (0,57-0,72) p<0,001].
Conclusions
The asynchronous teledermatology service established in the Bages County increases the resolution of primary care teams as reduces referrals to the face-to-face dermatology service. This effect is more pronounced in rural than in urban areas. Such finding may indicate the need to prioritize telemedicine services in rural primary care practices.
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Marin-Gomez FX, Vidal-Alaball J, Garcia Cuyàs F, Reig-Bolano R. Attending home care patients in primary care using a smartphone application (WhatsICS): A feasibility study. Int Arch Med 2017. [DOI: 10.3823/2531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Provision of care to patients with chronic diseases at their homes remains a great challenge for modern health care systems. Smartphone applications are indicated as one of the strategies that could improve care delivery to this group of patients. The aim of this study is to investigate the feasibility and usability of a proprietary application with a messaging service used by a primary care team attending chronic patients mainly at their homes.
Methods: A Cross-sectional pilot study of a smartphone application to communicate amongst clinicians. Primary care practices in Tona, Spain, were recruited during a period from January to December 2016. Clinicians used WhatsICS to communicate during their home visits for 12 months. We studied the patterns of use, response time and types of communication. To explore barriers and enablers, semi-structured interviews were conducted with selected nurses, social worker and general practitioners.
Results: Two nurses, two practitioners and a social worker were recruited and more than 1,000 hours of communication were recorded on 163 patients, generating 5820 communication events. Nurses initiated the majority of communications (59.79%); these communications were mainly for the purpose of receiving instructions from practitioners and for coordination (66.6%). The communications were made on weekdays, from Monday to Friday, and between 7:30 a.m. and 9:30 p.m. (99.73%). Participants felt that WhatsICS helped streamline and improve home-based care.
Conclusions: WhatsICS is safe technologically and accepted as a communication tool for professionals. This study establishes the basis for future implementations of this tool to improve the care of chronic patients at home through smartphones.
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Vidal-Alaball J, Álamo-Junquera D, López-Aguilá S, García-Altés A. [Evaluation of the impact of teledermatology in decreasing the waiting list in the Bages region (2009-2012)]. Aten Primaria 2014; 47:320-1. [PMID: 25443766 PMCID: PMC6983780 DOI: 10.1016/j.aprim.2014.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/22/2014] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | - Sílvia López-Aguilá
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, España; CIBER Epidemiología y Salud Pública (CIBERESP), España
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, España; CIBER Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España.
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90
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Vidal-Alaball J, Butler CC, Potter CC. Comparing costs of intramuscular and oral vitamin B12administration in primary care: A cost-minimization analysis. Eur J Gen Pract 2009; 12:169-73. [PMID: 17127603 DOI: 10.1080/14017430601049449] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To establish whether savings could be made by changing patients from intramuscular to high doses of oral vitamin B12 in primary care without compromising their wellbeing. METHODS Cost-minimization analysis from a UK perspective, using secondary data obtained from the literature available and expert opinion. RESULTS The cost of the resources used to treat patients with vitamin B12 deficiency with intramuscular vitamin B12 was calculated as between 55.99 pounds (83.1 Euro) and 99.99 pounds (148.5 Euro) per year. The cost of treating patients with high doses of oral vitamin B12 during the first year was between 125.55 pounds (186.5 Euro) and 248.55 pounds (369.1 Euro). However, once patients receiving intramuscular treatment had been converted to oral treatment, or in new patients treated orally from the outset, the cost was 35.55 pounds per year (52.8 Euro). One variable, home visits, had a high impact on the calculations. CONCLUSION Switching patients with vitamin B12 deficiency from intramuscular to high-dose oral therapy and treating patients newly diagnosed with vitamin B12 deficiency with oral vitamin B12 from the outset could save resources in the medium and long term, and in newly diagnosed patients. Savings would come particularly in the form of nursing time.
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Andrès E, Vidal-Alaball J, Federici L, Loukili NH, Zimmer J, Kaltenbach G. Clinical aspects of cobalamin deficiency in elderly patients. Epidemiology, causes, clinical manifestations, and treatment with special focus on oral cobalamin therapy. Eur J Intern Med 2007; 18:456-62. [PMID: 17822656 DOI: 10.1016/j.ejim.2007.02.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 11/03/2006] [Accepted: 02/22/2007] [Indexed: 11/19/2022]
Abstract
The aim of this work was to review the literature concerning cobalamin deficiency in elderly patients. Articles were identified through searches of PubMed-MEDLINE (January 1990 to June 2006), restricted to: English and French language, human subjects, elderly patients (>65 years), clinical trial, review and guidelines. Additional unpublished data from our cohort with cobalamin deficiency at the University Hospital of Strasbourg, France, were also considered. All of the papers and abstracts were reviewed by at least two senior researchers who selected the data used in the study. In elderly people, the main causes of cobalamin deficiency are pernicious anemia and food-cobalamin malabsorption. The recently identified food-cobalamin malabsorption syndrome is a disorder characterized by the inability to release cobalamin from food or from its binding proteins. This syndrome is usually the consequence of atrophic gastritis, related or not to Helicobacter pylori infection, and of the long-term ingestion of antacids and biguanides (in around 60% of the patients). Management of cobalamin deficiency has been well established with the use of cobalamin injections. However, new routes of cobalamin administration (oral and nasal) are currently being developed, especially the use of oral cobalamin therapy to treat food-cobalamin malabsorption.
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Affiliation(s)
- Emmanuel Andrès
- Department of Internal Medicine, Diabetes and Metabolic Diseases, Hôpitaux Universitaires de Strasbourg, France
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Andrès E, Federici L, Affenberger S, Vidal-Alaball J, Loukili NH, Zimmer J, Kaltenbach G. B12 deficiency: a look beyond pernicious anemia. J Fam Pract 2007; 56:537-42. [PMID: 17605945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Emmanuel Andrès
- Department of Internal Medicine, Diabetes and Metabolic Diseases, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
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Vidal-Alaball J, Hayes S, Jones R. Tuberculosis outbreak linked to pubs in south Wales. Euro Surveill 2006; 11:E060907.5. [PMID: 17075144 DOI: 10.2807/esw.11.36.03042-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
On 10 February 2004, the specialist respiratory nurse for a hospital in a city in South Wales alerted the local health authorities that Mycobacterium tuberculosis infections
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Affiliation(s)
- J Vidal-Alaball
- National Public Health Service for Wales, Health Protection Team, Mid and West Wales Region, Swansea, United Kingdom.
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Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Papaioannou A, Mcdowell I, Goringe A. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Fam Pract 2006; 23:279-85. [PMID: 16585128 DOI: 10.1093/fampra/cml008] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vitamin B(12) deficiency is common, increasing with age. Most people are treated in primary care with intramuscular vitamin B(12). Several studies have reported equal efficacy of oral administration of vitamin B(12). OBJECTIVES We set out to identify randomized controlled trial (RCT) evidence for the effectiveness of oral versus intramuscular vitamin B(12) to treat vitamin B(12) deficiency. METHODS We conducted a systematic review searching databases for relevant RCTs. Outcomes included levels of serum vitamin B(12), total serum homocysteine and methylmalonic acid, haemoglobin and signs and symptoms of vitamin B(12) deficiency. RESULTS Two RCTs comparing oral with intramuscular administration of vitamin B(12) met our inclusion criteria. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to 4 months. In one of the studies, mean serum vitamin B(12) levels were significantly higher in the oral (643 +/- 328 pg/ml; n = 18) compared with the intramuscular group (306 +/- 118 pg/ml; n = 15) at 2 months (P < 0.001) and 4 months (1005 +/- 595 versus 325 +/- 165 pg/ml; P < 0.0005) and both groups had neurological responses. In the other study, serum vitamin B(12) levels increased significantly in those receiving oral vitamin B(12) and intramuscular vitamin B(12) (P < 0.001). CONCLUSIONS The evidence derived from these limited studies suggests that 2000 microg doses of oral vitamin B(12) daily and 1000 microg doses initially daily and thereafter weekly and then monthly may be as effective as intramuscular administration in obtaining short-term haematological and neurological responses in vitamin B(12)-deficient patients.
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Goringe A, Ellis R, McDowell I, Vidal-Alaball J, Jenkins C, Butler C, Worwood M. The limited value of methylmalonic acid, homocysteine and holotranscobalamin in the diagnosis of early B12 deficiency. Haematologica 2006; 91:231-4. [PMID: 16461308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Treatment of B12 deficiency is important to prevent progressive neurological and/or hematologic disease but requires a secure diagnosis. The aim of this study was to evaluate second line tests of B12 status as prognostic indicators of a hematologic response to vitamin B12 therapy. Forty-nine patients referred with low, serum vitamin B12 concentrations were treated with intramuscular B12 and re-assessed after 3 months. Methylmalonic acid, homocysteine, holotranscobalamin and neutrophil hypersegmentation index were measured before and after treatment. Before treatment 27/49 patients were anemic or macrocytic of whom 15 had a clear hematologic response. All the tests had a similar prognostic accuracy. Symptomatic improvement did not correlate with hematologic response. Supplementary tests of vitamin B12 status were not significantly better than total serum B12 concentration as predictors of a hematologic response to vitamin B12 therapy.
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Affiliation(s)
- Andrew Goringe
- Department of Haematology, University Hospital of Wales, Cardiff CF14 4XN, UK
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Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A, McDowell I, Papaioannou A. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev 2005:CD004655. [PMID: 16034940 PMCID: PMC5112015 DOI: 10.1002/14651858.cd004655.pub2] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vitamin B12 deficiency is common and rises with age. Most people with vitamin B12 deficiency are treated in primary care with intramuscular vitamin B12 which is a considerable source of work for health care professionals. Several case control and case series studies have reported equal efficacy of oral administration of vitamin B12 but it is rarely prescribed in this form, other than in Sweden and Canada. Doctors may not be prescribing oral formulations because they are unaware of this option or have concerns regarding effectiveness. OBJECTIVES To assess the effectiveness of oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. SEARCH STRATEGY Searches were undertaken of The Cochrane Library, MEDLINE, EMBASE and Lilacs in early 2005. The bibliographies of all relevant papers identified using this strategy were searched. In addition we contacted authors of relevant identified studies and Vitamin B12 research and pharmaceutical companies to enquire about other published or unpublished studies and ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) examining the use of oral or intramuscular vitamin B12 to treat vitamin B12 deficiency. DATA COLLECTION AND ANALYSIS All abstracts or titles identified by the electronic searches were independently scrutinised by two reviewers. When a difference between reviewers arose, we obtained and reviewed a hard copy of the papers and made decisions by consensus. We obtained a copy of all pre-selected papers and two researchers independently extracted the data from these studies using piloted data extraction forms. The whole group checked whether inclusion and exclusion criteria were met, and disagreement was decided by consensus. The methodological quality of the included studies was independently assessed by two researchers and disagreements were brought back to the whole group and resolved by consensus. MAIN RESULTS Two RCT's comparing oral with intramuscular administration of vitamin B12 met our inclusion criteria. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to four months. High oral doses of B12 (1000 mcg and 2000 mcg) were as effective as intramuscular administration in achieving haematological and neurological responses. AUTHORS' CONCLUSIONS The evidence derived from these limited studies suggests that 2000 mcg doses of oral vitamin B12 daily and 1000 mcg doses initially daily and thereafter weekly and then monthly may be as effective as intramuscular administration in obtaining short term haematological and neurological responses in vitamin B12 deficient patients.
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Affiliation(s)
- J Vidal-Alaball
- National Public Health Service for Wales, 36 Orchard Street, Swansea, Wales, UK, SA1 5AQ.
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Owen D, Vidal-Alaball J, Mansour M, Bordeaux K, Jones KV, Edwards A. Parent's opinions on the diagnosis of children under 2 years of age with urinary tract infection. Fam Pract 2003; 20:531-7. [PMID: 14507794 DOI: 10.1093/fampra/cmg507] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) in childhood can be diagnosed in 5% of febrile infants. Renal scarring is associated with increasing numbers of UTI episodes, and the incidence of renal scarring rises with each urinary infection. High levels of awareness of childhood UTI are important among both professionals and parents. Whilst problems for professionals in making the diagnosis have been explored, few data exist concerning parental understanding and perspectives. OBJECTIVES The purpose of this study was to assess parental understanding of UTI in their child and identify any delay perceived in the diagnosis, along with identifying how helpful parents had found any information that they had been given. METHODS Subjects were the parents of children aged <2 years being investigated in one out-patient department following proven UTI. A semi-structured questionnaire was given to parents at first attendance (quantitative data) and content analysis of qualitative data was carried out. RESULTS Fifty-two out of 84 parents responded (response rate 64%), of whom 45 (86.5%) felt that they had been given a full explanation of the significance of UTI in childhood. Forty percent felt that clean catch was the easiest method of obtaining a urine sample from their child. Although the quantitative data were positive, several themes were identified in the qualitative data, relating to lack of awareness, delay in investigation by health professionals and issues regarding the information that had been imparted to parents. Parents would like more information about the illness that affects their child, and many would like this in leaflet form. CONCLUSIONS Parents perceive low awareness levels and delays in investigation of UTI in childhood amongst health professionals. Increasing awareness about the importance of UTI in childhood, its incidence and management should be generated amongst health professionals who deal with young children. Parents need and would like more information about the disease and how to identify it, with guidance on urine collection. Further research is needed into whether educational strategies for either parents or health professionals are effective in identifying UTI earlier, and what the best methods of implementing these would be.
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Affiliation(s)
- Diane Owen
- Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Llanedeyrn, Cardiff CF23 9PN, UK.
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