Institut d'Assistència Sanitària

ABSTRACTBackground and AimsChildren with cerebral palsy (CP) are vulnerable to respiratory infections and chronic airway inflammation, which leads to diminished respiratory function. This decline is exacerbated by muscle tone abnormalities and reduced strength, worsening as CP progresses. Traditional lung function tests are often impractical for those with severe cognitive and motor impairments. Diaphragm evaluation through ultrasound imaging emerges as a non‐invasive, easy‐to‐apply technique for assessing respiratory function in CP children. This study aimed to evaluate diaphragm function in CP and typically developing (TD) children using ultrasound, focusing on diaphragm thickness and excursion parameters. The study also explored factors influencing respiratory function, particularly the number of lower respiratory tract infections (LRTI).MethodsThe study included 10 CP (11.2; range 4–17 years) and 12 TD children (8.9 years; range 4–13 years). M‐mode ultrasound assessed diaphragm thickness, thickening fraction (TF), and inspiratory slope (IS). Additionally, data on demographics, anthropometrics, medical history, and physical examination were collected.ResultsThe intra‐operator reliability for diaphragm ultrasound measurements showed good to excellent consistency (over 0.86). Significant differences were found between CP and TD children; CP children exhibited lower excursion and IS, with a non‐significant trend towards reduced diaphragm thickness. LTRI were associated to decreased excursion and IS, and increased TF in CP children.ConclusionsDiaphragmatic ultrasound is a non‐invasive, reproducible tool for assessing respiratory function in both CP and TD children, even in cases of severe cognitive and motor impairment. It effectively identifies diaphragm dysfunction associated with LRTI.

BackgroundThis study aimed to develop, refine, and assess content validity of the PromoACTIVA-CE questionnaire, designed to assess health promotion activities in primary and secondary education. The tool addresses the need for a culturally and contextually relevant instrument to systematically evaluate and support health promotion initiatives in schools.MethodsQuestionnaire development followed a five-phase process that included the following phases: (1) conceptualization; (2) item generation, structure and format; (3) content validation; (4) comprehensibility and semantic fit testing; and (5) pilot testing.ResultsThe PromoACTIVA-CE questionnaire was successfully developed and validated, resulting in a reliable tool with 37 items classified into eight health promotion action areas. Minor floor effects were observed, but no ceiling effects were detected.ConclusionsThe PromoACTIVA-CE questionnaire is a valid and reliable tool for assessing health promotion activities in primary and secondary schools. Its development leveraged existing evidence-based practices while ensuring cultural and contextual relevance. The tool facilitates systematic assessment and operationalization of health promotion activities, contributing to the sustainability and effectiveness of health promotion initiatives in educational settings. Future research should explore the questionnaire’s sensitivity to changes over time and its applicability in diverse school contexts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25925-w.

Personal stigma in psychosis, encompassing perceived and internalised stigma, poses a significant barrier to recovery and well-being. This study investigates the effectiveness of Individualised Metacognitive Training (MCT+) in reducing personal stigma among individuals with recent-onset psychosis, with a focus on sex-specific outcomes and the predictive roles of self-certainty, self-esteem and quality of life (QoL). A randomised controlled trial was conducted across multiple Spanish clinical sites, comparing MCT+ with treatment as usual. Participants were assessed at baseline, post-treatment and 6-month follow-up using validated measures of stigma, cognitive insight, QoL and self-esteem. Robust linear mixed models revealed that MCT+ significantly reduced perceived stigma over time, with QoL emerging as a strong predictor of perceived stigma levels. However, no significant effects were observed for internalised stigma, although self-certainty was positively associated with its severity. Exploratory analyses suggested potential sex differences in stigma trajectories, with males showing greater improvements in internalised stigma. These findings highlight the nuanced impact of metacognitive interventions on stigma and underscore the importance of tailoring treatments to individual psychosocial and cognitive profiles. Future research should explore gender-sensitive adaptations of MCT+ and the inclusion of targeted self-stigma modules to enhance intervention efficacy.

The assessment of psychological variables in older adults is often conducted using instruments that are not specifically designed for this population. Moreover, there are few screening tools that are effective for healthcare professionals in detecting emotional difficulties in older individuals. Therefore, the objective of this study was to design a questionnaire that can be used as a screening instrument to measure emotional distress in older individuals. A 12-item instrument (CADIS-G) with a 4-point Likert-type response scale was developed and tested for validity. 186 older adults from eight residences and/or centers for older individuals in Spain. The participants completed, in addition to the 12-item CADIS-G, different instruments considered gold standards: Yesavage Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI), State-Trait Anger Expression Inventory (STAXI-2) and UCLA Loneliness Scale. Exploratory factor analysis (EFA) was performed to study the dimensionality of the CADIS-G items. The results showed that 10 of the 12 items of the CADIS-G grouped well with the theoretically proposed gold standard scales. The CADIS-G is a screening instrument that shows adequate psychometric properties to measure anxiety, depression, anger and loneliness in older people.

In 2015, Catalonia introduced sickle cell disease (SCD) screening in its newborn screening (NBS) program along with standard-of-care treatments like penicillin, hydroxyurea, and anti-pneumococcal vaccination. Few studies have assessed the clinical impact of introducing NBS programs on SCD patients. We analyzed the incidence of SCD and related hemoglobinopathies in Catalonia and the change in clinical events occurring after introducing NBS. Screening 506,996 newborns from 2015 to 2022, we conducted a retrospective multicenter study including 100 screened (SG) and 95 unscreened (UG) SCD patients and analyzed SCD-related clinical events over the first six years of life. We diagnosed 160 cases of SCD, with an incidence of 1 in 3169 newborns. The SG had a significantly lower median age at diagnosis (0.1 y vs. 1.68 y, p < 0.0001), and initiated penicillin prophylaxis (0.12 y vs. 1.86 y, p < 0.0001) and hydroxyurea treatment earlier (1.42 y vs. 4.5 y, p < 0.0001). The SG experienced fewer median SCD-related clinical events (vaso-occlusive crisis, acute chest syndrome, infections of probable bacterial origin, acute anemia requiring transfusion, acute splenic sequestration, and pathological transcranial Doppler echography) per year of follow-up (0.19 vs. 0.77, p < 0.0001), a reduced number of annual emergency department visits (0.37 vs. 0.76, p < 0.0001), and fewer hospitalizations (0.33 vs. 0.72, p < 0.0001). SCD screening in Catalonia’s NBS program has effectively reduced morbidity and improved affected children’s quality of life.

Recently, we demonstrated that staging Parkinson's disease (PD) with a novel simple classification called MNCD, based on four axes (motor, non-motor, cognition, and dependency) and five stages, correlated with disease severity and patients' quality of life. Here, we analyzed the correlation of MNCD staging with PD caregiver's status. Data from the baseline visit of PD patients and their principal caregiver recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD total score (from 0 to 12) and MNCD stages (from 1 to 5) in this cross-sectional analysis. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), PQ-10, and EUROHIS-QOL 8-item index (EUROHIS-QOL8). Two hundred and twenty-four PD patients (63±9.6 years old; 61.2% males) and their caregivers (58.5±12.1 years old; 67.9% females) were included. The frequency of MNCD stages was 1, 7.6%; 2, 58.9%; 3, 31.3%; and 4-5, 2.2%. A more advanced MNCD stage was associated with a higher score on the ZCBI (p<.0001) and CSI (p<.0001), and a lower score on the PQ-10 (p=.001), but no significant differences were observed in the BDI-II (p=.310) and EUROHIS-QOL8 (p=.133). Moderate correlations were observed between the MNCD total score and the ZCBI (r=.496; p<.0001), CSI (r=.433; p<.0001), and BDI-II (r=.306; p<.0001) in caregivers. Staging PD according to the MNCD classification is correlated with caregivers' strain and burden.

Patients with young-onset Parkinson's disease (YOPD) have a slower progression. Our aim was to analyze the change in cognitive function in YOPD compared to patients with a later onset and controls. Patients with Parkinson's disease (PD) and controls from the COPPADIS cohort were included. Cognitive function was assessed with the Parkinson's Disease Cognitive Rating Scale (PD-CRS) at baseline (V0), 2-year ± 1month (V2y), and 4-year ± 3months follow-up (V4y). Regarding age from symptoms onset, patients were classified as YOPD (< 50years) or non-YOPD (≥ 50). A score in the PD-CRS < 81 was defined as cognitive impairment (CI): ≤ 64 dementia; 65-80 mild cognitive impairment (MCI). One-hundred and twenty-four YOPD (50.7 ± 7.9years; 66.1% males), 234 non-YOPD (67.8 ± 7.8years; 59.3% males) patients, and 205 controls (61 ± 8.3years; 49.5% males) were included. The score on the PD-CRS and its subscore domains was higher at all visits in YOPD compared to non-YOPD patients and to controls (p < 0.0001 in all analysis), but no differences were detected between YOPD patients and controls. Only non-YOPD patients had significant impairment in their cognitive function from V0 to V4y (p < 0.0001). At V4y, the frequency of dementia and MCI was 5% and 10% in YOPD compared to 25.2% and 22.3% in non-YOPD patients (p < 0.0001). A lower score on the Parkinson's Disease Sleep Scale at baseline was a predictor of CI at V4y in YOPD patients (Adjusted R2 = 0.61; OR = 0.965; p = 0.029). Cognitive dysfunction progressed more slowly in YOPD than in non-YOPD patients.

The aim of this study is to adapt and validate the global deterioration scale (GDS) for the systematic tracking of Alzheimer’s disease (AD) progression in a population with Down syndrome (DS). A retrospective dual-center cohort study was conducted with 83 participants with DS (46.65 ± 5.08 years) who formed the primary diagnosis (PD) group: cognitive stability (n = 48), mild cognitive impairment (n = 24), and Alzheimer’s disease (n = 11). The proposed scale for adults with DS (GDS-DS) comprises six stages, from cognitive and/or behavioral stability to advanced AD. Two neuropsychologists placed the participants of the PD group in each stage of the GDS-DS according to cognitive, behavioral and daily living skills data. Inter-rater reliability in staging with the GDS-DS was excellent (ICC = 0.86; CI: 0.80–0.93), and the agreement with the diagnosis categories of the PD group ranged from substantial to excellent with κ values of 0.82 (95% CI: 0.73–0.92) and 0.85 (95% CI: 0.72, 0.99). Performance with regard to the CAMCOG-DS total score and orientation subtest of the Barcelona test for intellectual disability showed a slight progressive decline across all the GDS-DS stages. The GDS-DS scale is a sensitive tool for staging the progression of AD in the DS population, with special relevance in daily clinical practice.