Objective: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. Methods: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation ” or “reasoned judgment ” qualitative analysis techniques. Results: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas. Conclusions: Establishing a diagnosis improves the patient’s coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established. (c) 2021 Elsevier Espan tilde a, S.L.U. and Sociedad Espan tilde ola de Reumatologi acute accent a y Colegio Mexicano de Reumatologi acute accent a. All rights reserved.

Fibromyalgia syndrome (FMS) is characterized by generalized chronic musculoskeletal pain, fatigue, and sleep disturbance, as well as cognitive, somatic, and other symptoms. Most people affected by FMS are women, and studies analyzing this condition in men are scarce. In this study, we discuss the physical and psychological symptoms of FMS in men, analyze the possible side effects of pharmacological therapies, and explore the impact of the illness comparing these results between the different classification groups according to sociodemographic variables (marital status, level of education, employment situation and number of people living at home). We used a sequential exploratory mixed method (MM). Qualitative information was obtained from two focus groups (n = 10). Structured questionnaires were administered to 23 men affected by FMS. The mean age of the participants was 51.7 years (SD = 9.64). The most common drugs used were antidepressants and anxiolytics (86.9%), followed by non-steroidal anti-inflammatory drugs (82.6%) and opioids (60.9%). Current level of pain was high (8.2; SD = 1.1), while perceived health and satisfaction with pharmacological treatments were low (4.6; SD = 2.6 and 3.5; SD = 3.2, respectively). The impact of FMS measured using the Fibromyalgia Impact Questionnaire (FIQ) was very high at 88.7 (SD = 8.2). Six categories related with symptoms and side effects of the medication were observed in the qualitative data: (1) main physical symptoms, (2) mood disorders, (3) insomnia and non-restorative sleep, (4) cognitive disturbance, (5) hypersensitivity, and (6) symptoms secondary to opioids. Pain and fatigue were the symptoms most often mentioned by the participants (70% and 80%, respectively). Other important symptoms were anxiety, depression, and memory and sleep disorders. The consumption of opioids causes further unwanted symptoms such as drowsiness and dependence, which makes it difficult for patients to perform basic everyday activities. We believe it is vitally important to continue investigating this symptomatology in order to improve diagnosis and treatment for these patients.

Objective To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region.Methods Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI).Results Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17 177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression.Conclusions Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.

BackgroundThis study aims to examine risk of adverse pregnancy outcomes and mothers’ characteristics in patients with chronic hypertension, gestational hypertension and preeclampsia.MethodsThe study included all births born from women aged 15-45 years, in Lleida, Spain from 2012 to 2018. Pregnancy outcomes were retrieved by regional administrative databases. Logistic regression analysis was used to calculate adjusted odds ratios (OR) (OR 95% CI) for maternal characteristics or neonatal outcomes.ResultsAmong 17,177 pregnant women, different types of hypertension present varying risks for both the mother and fetus. There is an increased risk of cesarean section in patients with preeclampsia (OR 2.04, 95% CI: 1.43-2.88). For the newborn, a higher risk of preterm birth is associated with maternal chronic hypertension (OR 3.09, 95% CI: 1.91-4.83) and preeclampsia (OR 5.07, 95% CI: 3.28-7.65). Additionally, there is a higher risk of low birth weight in cases of maternal chronic hypertension (OR 3.2, 95% CI: 2.04-4.88), preeclampsia (OR 5.07, 95% CI: 3.34-7.52), and gestational hypertension (OR 2.72, 95% CI: 1.49-4.68). Furthermore, only newborns of patients with preeclampsia had a higher risk of an Apgar score lower than 7 in the first minute (OR 2.95, 95% CI: 1.45-5.38).ConclusionsIn the study population adjusted for body weight, the different types of hypertension represent different risks in the mother and foetus. These complications were mostly associated with preeclampsia.

Aims: To assess the impact of the COVID-19 pandemic on the health condition of people >= 75 years of age and on their family caregivers in Spain. Design: Multicentric, mixed method concurrent study. Methods: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration: Identifier: NCT05249868 [ClinicalTrials.gov].

Gestational diabetes is characterized by hyperglycaemia diagnosed during pregnancy. Gestational and pregestational diabetes can have deleterious effects during pregnancy and perinatally. The baby’s weight is frequently above average and might reach macrosomia (= 4 kg), which can reduce pregnancy time causing preterm births, and increase foetal-pelvic disproportion which often requires delivery by caesarean section. Foetal-pelvic disproportion due to the baby’s weight can also cause foetal distress resulting in lower Apgar scores. To analyse the association between pregestational and gestational diabetes with maternal and foetal risk. We conducted a retrospective cohort study in women pregnant between 2012 and 2018 in the region of Lleida. Regression coefficients and 95% confidence intervals (CI) were used. The multivariate analysis showed statistically significant associations between pregestational diabetes and: prematurity (OR 2.4); caesarean section (OR 1.4); moderate (OR 1.3), high (OR 3.3) and very high (OR 1.7) risk pregnancies; and birth weight = 4000 g (macrosomia) (OR 1.7). In getational diabetes the multivariate analysis show significant association with: caesarean section (OR 1.5); moderate (OR 1.7), high (OR 1.7) and very high (OR 1.8) risk pregnancies and lower 1-minuto Apgar score (OR 1.5). Pregestational and gestational diabetes increase: pregnancy risk, caesarean sections, prematurity, low Apgar scores, and macrosomia.

Background: Our study aimed to evaluate the performance of primary healthcare physicians (PCPs) in managing glycemia, lipids, and blood pressure in people with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. Methods: We included 3267 PCPs with 367,132 T2DM subjects in a cross-sectional analysis of the SIDIAP (Sistema d’Informaci & oacute; per al Desenvolupament de la Investigaci & oacute; en Atenci & oacute; Prim & agrave;ria) database for the year 2017. Results: 63.1% of PCPs were female, with an average practice size of 1512 subjects. T2DM individuals had a mean (standard deviation) age of 70 (+/- 12.2) years old, a mean body mass index (BMI) of 30.2 (+/- 5.21) kg/m(2), and a median diabetes duration of 8.8 years. Overall, 42.6% of subjects achieved target glycemic control (glycated hemoglobin < 7%). Notably, 59.2% maintained blood pressure < 140/90 mmHg during the 12-month study period. The multivariable analysis identified positive associations between glycemic control and female PCPs, practice sizes (1000-1500 people), a higher proportion of patients aged >= 65 years, and rural practices. Combined glycemic, lipid, and blood pressure target attainment was associated with medium-sized practices and those with a higher proportion of patients aged >= 65 years. Conclusions: Practice size, patient age distribution, and rurality are factors associated with the performance of PCPs in the control of glycemia, lipids, and blood pressure in T2DM subjects in primary health care centers in our region.

The prevalence of overweight and obesity has risen dramatically in the last few years. This has led to an increase in both conditions in pregnant women. Obesity and overweight are associated with complications for both the mother and the newborn. The aim of this study is to determine the prevalence of obesity and its association with the risk of complications during pregnancy. Materials and Methods: We conducted a retrospective cohort study of pregnant women who delivered from 1 January 2012 to 31 December 2018. Results: A higher prevalence of obesity is observed in the group of women aged 35 or older. Women with a BMI > 25 present a higher risk of cesarean section (aOR 1.49, 95% CI: 1.37-1.61), preeclampsia (aOR 1.64, 95% CI: 1.19-2.26), high-risk pregnancy (aOR 2.34, 95% CI: 1.68-2.6), Apgar < 7 at one minute (aOR 1.53, 95% CI: 1.25-1.89) and macrosomia (aOR 2.08, 95% CI: 1.83-2.37). Maternal overweight and obesity are important determinants of the risk of complications for both the mother and the newborn.

Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact.

Background Primary maternal hypothyroidism is defined as the increase of TSH levels in serum during pregnancy. Hypothyroidism in pregnancy is the second most common endocrine disease, after diabetes mellitus, with a prevalence ranging between 3.2 and 5.5%. Its variability depends on ethnical differences. Hypothyroidism in pregnancy is associated with other chronic diseases and fetal and maternal outcomes.
Objective To analyze the prevalence of hypothyroidism among multiethnic pregnant women, and to evaluate the comorbidity with chronic diseases and outcomes leaded during pregnancy and newborn.
Methods Retrospective observational cohort study in pregnant women during the years 2012-2018 in the health region of Lleida. The relationship of hypothyroidism with different variables was analyzed by calculating the adjusted odds ratio (aOR) and the 95% confidence intervals (CI) with multivariate logistic regression models.
Results We analyzed a sample of 17177 pregnant women, which represents more than 92% of the total of pregnant women in the health region of Lleida. The annual prevalence of hypothyroidism was 5.7-7.1%. According to the region of origin, the lowest prevalence was found in the population from Sub Saharian Africa (2.1%), while the highest was from Asia and the Middle East (8.6%). Other factors associated with hypothyroidism were age, hypertension, diabetes mellitus, and dyslipidemia. In addition, we did not observe an effect of hypothyroidism on the course of pregnancy, childbirth, and on the newborn. Finally, there was a good control of the disease during pregnancy.
Conclusions The prevalence of hypothyroidism in pregnancy was 6,5% in this study which depends on the country of origin, lower values were found in Sub Saharian African women and higher in those from Asia and the Middle East. Hypothyroidism was associated with age, diabetes mellitus, arterial hypertension, or dyslipidemia, and was not related to the Apgar score or the weight of the newborn.