Institut Universitari d'Investigació en Atenció Primària Jordi Gol

ObjectiveTo evaluate the feasibility and potential effectiveness of a structured psychoeducational group program aimed at enhancing resilience and reducing burnout among primary healthcare workers.DesignA single-arm pre–post implementation study conducted between September 2022 and February 2024. Trial registration at ClinicalTrials.gov: NCT05720429.Site81 primary care centers of the Catalan Health Institute.ParticipantsPrimary care professionals from all occupational profiles were eligible.InterventionsA 11-session program, delivered by community psychologists, combined psychoeducational content, interactive activities, and relaxation techniques.Main measurementsOutcomes were measured before and immediately after the intervention using the Connor–Davidson Resilience Scale and the burnout subscale of the Professional Quality of Life Scale. Analyses included effect sizes and multivariate models to identify predictors of change.ResultsOf 1419 baseline participants, 387 (87.1% women; median age 47 years) completed both assessments. Resilience increased significantly post-intervention (p = 0.001; effect size = 0.21), with larger gains in men and younger participants. Burnout decreased significantly (p = 0.001; effect size = 0.21), particularly among physicians. Higher baseline secondary traumatic stress predicted greater burnout reduction. Program overall assessment, feasibility and satisfaction were high.ConclusionsThis psychoeducational group intervention was feasible, well-received, and associated with modest but significant improvements in resilience and burnout. Targeted benefits were observed for specific subgroups, suggesting value in tailoring content to professional role and baseline emotional burden.

<h2>Abstract</h2> Steatotic liver disease (SLD) is a spectrum of highly prevalent liver disease that is encountered at many different healthcare levels. Awareness about metabolic dysfunction-associated SLD (MASLD), MetALD (MASLD and increased alcohol intake) and ALD (alcohol-related liver disease) is increasing beyond hepatology, as highlighted by the various SLD guidelines that have been issued by scientific societies from different disciplines, such as endocrinology. The guidance presented here aims to improve cross-disciplinary knowledge and know-how by providing guidance to healthcare professionals from a global, holistic, multi-society and -stakeholder perspective. The patient trajectory was used as an overarching anchor point to ensure uniform guidance at all points along the SLD spectrum, with the ultimate goal of improving patient identification and optimising their care. This consensus guidance covers patient identification and risk stratification, relevant cross-disciplinary primary and secondary care approaches, referral to and from tertiary care and strategies for disease management and monitoring. Strategies at each point of the patient trajectory are recommended and stratified as optimal (i.e., "nice-to-have") or minimal (i.e., "must-have"), per expert-opinion, making them adaptable to differences in healthcare settings, levels of resource availability and policies.

PurposeApplying standardized Brighton Collaboration (BC) case definitions retrospectively to heterogeneous real-world data (RWD) is challenging due to inconsistent clinical detail and data structures across settings. To address this, the Vaccine Monitoring Collaboration for Europe (VAC4EU) developed a structured validation pipeline that operationalizes BC case definitions for vaccine safety outcomes in RWD in a harmonized, scalable, and reusable manner.MethodsVAC4EU developed a systematic, stepwise approach to validate vaccine safety outcomes. BC case definitions were utilized when available, adapted for RWD as needed, and newly developed for outcomes without an existing BC definition. The approach involves: 1) Critical review and adaptation of BC definition by clinical and RWD experts; 2) Creation of dummy cases based on published reports; 3) Creation of REDCap electronic data collection forms (eDCF) incorporating decision logic to assigned levels of certainty (LOC); 4) Iterative testing of decision logic; and 5) comprehensive training of abstractors with real-time feedback. A dedicated task force assigned reference LOCs for dummy cases. Inter-rater reliability was measured using Fleiss’ kappa (κ) by comparing abstractor LOCs to the reference standard.ResultsThe pipeline was applied to 16 COVID-19 vaccine safety outcomes, of which 13 had existing BC definition. In total, 78 dummy case descriptions were developed across the outcomes for training of abstractors, and 15 REDCap eDCFs were created. Myocarditis and pericarditis shared an eDCF. Across 33 abstractors, 747 dummy case abstractions were completed. Agreement analysis showed 93 discrepancies (12.4%) and moderate overall concordance (κ = 0.55, across all outcomes), with the lowest for thrombosis with thrombocytopenia syndrome (κ = –0.05).ConclusionThe VAC4EU validation pipeline provides a standardized framework for training and validating vaccine safety outcome in RWD. By adapting BC case definitions and dedicated training of abstractors, we will reduce variability in outcome validation in post-authorization safety studies.

BackgroundIn Catalonia, Spain, pediatric primary care is undergoing restructuring, including greater integration of information and communication technologies. The adoption of digital health solutions has increased notably since the COVID-19 pandemic. In areas with limited availability of health care professionals, digital tools are a key strategy for facilitating access to services and ensuring continuity of care.ObjectiveThis study aimed to evaluate the feasibility, diagnostic agreement, and satisfaction of users and professionals of an acute pediatric video consultation model, referred to as video interconsultation, that includes a synchronous remote physical examination and takes place between health care professionals.MethodsThis was a 20-month prospective within-patient diagnostic accuracy study including 200 children (aged 0‐14 y) with acute conditions in rural primary care in Catalonia. A secure, closed, real-time, web-based, clinician-assisted video consultation platform enabled remote pediatric assessment—visual examination, audio auscultation via a digital stethoscope, and caregiver-reported symptoms—with a pediatrician remotely guiding a nurse physically present with the child. The intervention was compared, in all cases, with a standard in-person pediatric assessment as the reference standard. Outcomes were feasibility, diagnostic accuracy, and user and professional satisfaction. The platform was developed based on telemedicine usability and clinical safety principles.ResultsOf the 200 children enrolled, remote video consultations were successfully completed in 64.5% (129/200) of cases. Diagnostic agreement with in-person assessment was 78.2% (129/165). Overall mean diagnostic accuracy across all diagnoses was 0.99 (95% CI 0.98‐1.00), with a mean specificity of 0.99 (95% CI 0.98‐1.00) and a mean sensitivity of 0.90 (95% CI 0.84‐0.95), varying by condition, with lower performance for pathologies requiring detailed physical examination. Overall, 95% (190/200) of users and 74% (148/200) of professionals reported a positive experience.ConclusionsThe proposed pediatric video consultation model was feasible, accurate, and well accepted for managing a substantial proportion of acute pediatric conditions in primary care. Its implementation could improve access to medical care in rural areas and help reduce health care disparities. Further research is needed to support scalability and implementation in routine clinical practice.

Background/Objectives: Urinary incontinence (UI) is a prevalent health condition with a negative impact on quality of life (QoL). Exercise therapy (ET), specifically, pelvic floor muscle training (PFMT), is recommended as a first-line conservative treatment for UI during pregnancy, childbirth, and the postpartum period. This study evaluated the effects of ET on the management of postpartum UI. Methods: A systematic search was conducted to identify clinical trials and randomized controlled trials including women over 18 years with postpartum UI. All included studies used ET as the main intervention. Studies were excluded if UI symptoms were attributable to factors outside the urinary tract or if participants had concomitant pathologies. Results: From 298 records screened, four trials were included. Three trials reported statistically significant improvements in UI outcomes, while findings for pelvic floor function and QoL showed greater heterogeneity. One trial found that supervised PFMT was associated with greater improvements in urinary symptoms (BFLUTS), vaginal pressure (18.96 mmHg (SD: 9.08)), and endurance (11.32 s (SD: 3.17)) compared to unsupervised training. Another trial using electromyographic biofeedback with electrical stimulation reported a continence rate exceeding 70% on the 20 min pad test, with improvements in perceived burden (VAS), symptoms (UDI), and QoL (IIQ). A third trial combining PFMT with infrared physiotherapy showed improvements in pelvic floor function (PFIQ-7, PFDI-20), urodynamic parameters, urine loss, and QoL (GQOLI-74). In the remaining trial, within-group improvements were observed, with no statistically significant between-group differences. Conclusions: ET appears to be beneficial for postpartum UI, with a moderate certainty of evidence. While the greatest benefits are observed with supervised PFMT, the diversity of comparators, and the risk of performance bias limit definitive conclusions regarding its superiority. Given the short-term follow-up, it remains unclear whether the results are influenced by the spontaneous recovery trajectory in the postpartum period and if these effects are sustained in the long term.

Advanced glycation end-products (AGEs) activate specific receptors (RAGE) promoting inflammation and oxidative stress. The lungs, with high RAGE expression, may be particularly susceptible to AGE-related injury. This study assessed whether baseline skin AGE levels, measured by skin autofluorescence (SAF), predict pulmonary function decline in middle-aged adults with cardiovascular risk factors. This ancillary analysis of the ILERVAS cohort included adults aged 45–70 years with cardiovascular risk factors but without diabetes or chronic kidney disease. Baseline data included demographics, lifestyle, and fasting blood tests. SAF was measured using AGE Reader™, and spirometry performed at baseline and after a median follow-up of 4 years. Associations between baseline SAF and annual declines in FEV1, FVC, and FEV1/FVC were analysed using adjusted models and generalized additive models, stratified by smoking status. Among 658 participants (median age 56 years, 48% female), median baseline SAF was 1.90 AU [1.60; 2.20]. Baseline lung function was preserved, with median FEV1, FVC and FEV1/FVC of 2795 mL [2270; 3,341], 3,525 mL [2870; 4300], and 78.6% [74.4; 82.8]. Annual declines were − 81.9 mL [− 120.6; − 43.3] for FEV1, − 99.6 mL [− 159.3; − 37.9] for FVC, and − 0.04% [− 0.85; 0.70] for FEV1/FVC. No significant associations were found between SAF and spirometry changes. Results were consistent across smoking subgroups. Baseline skin AGE levels did not predict pulmonary function decline over four years in middle-aged adults with cardiovascular risk factors. While SAF reflects cumulative AGE exposure, it has limited prognostic value for lung function in this population.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-33414-8.

Despite growing recognition of social determinants of health (SDH), quantitative evidence comparing healthcare costs between individuals with and without adverse SDH remains limited. This study addresses this gap by providing a comprehensive cost analysis comparing resource utilization and direct healthcare expenditures between populations with social determinants and those without social determinants. A prospective cohort study was conducted to evaluate costs by comparing individuals with unfavorable social determinants of health against those without such determinants. The study adopted a societal perspective, monitoring 638 participants over a 12-month period. A cost analysis was performed comparing basic resource utilization indicators and their associated direct costs between two groups: one comprising individuals with adverse social determinants of health (ySDH, n = 290) and another comprising those without such determinants (nSDH, n = 348). Resource utilization indicators examined included primary care visits by professional discipline, hospital-level diagnostic tests, specialist consultations, and pharmaceutical costs. Subgroup analyses examined heterogeneity by number of Z-codes, geographic location (urban/rural), and area-level socioeconomic index. Significant differences in direct costs were observed between groups. Participants with adverse social determinants incurred 23.3% higher primary care costs (€1,015 vs €823 per person annually, p = 0.001) and higher total healthcare utilization (22.86 vs 18.34 visits per person). Pharmaceutical expenditure was significantly higher (€432 vs €268 per person), with notable differences in psycholeptics (46.2% vs 33.0%, p < 0.001), psychoanaleptics (30.1% vs 16.5%, p < 0.001), analgesics, antacids, anti-anemia preparations, and antiepileptic. Subgroup analyses revealed substantial heterogeneity within the ySDH population. Patients with multiple Z-codes demonstrated 39.4% higher costs than those with single Z-codes (€1,217 vs € 873, p = 0.001, Cohen’s d = 0.42). The highest-risk subgroup consisted of urban patients with multiple Z-codes (€1,337, n = 22), representing 62.7% higher costs than urban patients with single Z-codes. Healthcare utilization patterns differed by professional discipline: nursing visits were significantly higher among ySDH patients (11.88 vs 9.17 visits, p = 0.003), while physician visits showed no significant difference (8.81 vs 8.09, p = 0.186). Geographic analysis revealed no overall urban-rural cost differences (€1,031 vs €1,014, p = 0.776), suggesting equitable primary care access across Catalonia. Individuals with social determinants of health incur substantially higher healthcare costs, with greatest burden among those with multiple social vulnerabilities in urban settings. Healthcare utilization patterns highlight nursing’s critical role in identifying and addressing social needs. Healthcare systems should implement systematic screening for social determinants, proactive case management for high-risk subgroups (particularly patients with multiple Z-codes in urban areas), integration of the biopsychosocial model into primary care workflows, and partnerships with community organizations to address underlying social conditions.