Objectives: We aimed to evaluate the accuracy of the Panbio TM Ag-RDT at primary health care (PHC) centers and test sites in symptomatic patients and close contacts, using the Reverse-Transcription Polymerase Chain Reaction (RT-PCR) test as the gold standard. Methods: The study was conducted in four PHC centers and two test sites in Mallorca, Spain. Consecutive patients older than 18 years, attending the sites for RT-PCR testing were included. Two nasopharyngeal samples were collected, one for RT-PCR and the other was processed on-site using the Panbio TM rapid antigen test kit for SARS-CoV-2. The sensitivity and specificity were calculated using RT-PCR as the reference, and the predictive values using the pretest probability results for each analyzed group. Findings: A total of 1369 participants were included; mean age 42.5 ± 14.9 years and 54.3% women. The overall prevalence was 10.2%. Most participants (70.6%) presented within 5 days of the onset of symptoms. The overall sensitivity was of 71.4% (95% CI: 63.1%, 78.7%), the specificity of 99.8% (95% CI: 99.4%, 99.9%), the positive predictive value of 98.0% (95% CI: 93.0%, 99.7%) and a negative predictive value of 96.8% (95% CI: 95.7%, 97.7%). The sensitivity was higher in symptomatic patients, in those arriving within 5 days since symptom onset and in those with high viral load. ✩ COVID-19 Primary Care Research Group members (alphabetical order) Layla Aoukhiyad-pharmacist,

Introduction: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. Methods/Design: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). Discussion: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).

BackgroundPostherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition.Methods/designPatients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions).DiscussionGabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons.Trial registrationISRCTN Registry identifier: ISRCTN79871784. Registered on 2 May 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1729-y) contains supplementary material, which is available to authorized users.

ResumenObjetivosConocer la prevalencia de insomnio y los hábitos, comorbilidades, calidad del sueño y tratamiento de los pacientes insomnes.DiseñoEstudio descriptivo transversal.EmplazamientoCentro de Atención Primaria de Calviá (Mallorca).ParticipantesSujetos entre 18-80 años con >2 años de adscripción al Centro de Salud.MétodosSe realizó una primera entrevista telefónica para cribado de insomnes mediante el Insomnia Severity Index. Los sujetos insomnes fueron entrevistados personalmente en el centro de salud para registrar el resto de variables.ResultadosDe la muestra de 1.563 personas, contactamos con 591 y participaron 467. La prevalencia de insomnio fue del 21,1% (IC 95% 17,38-25,01) y de insomnio clínico del 6,9% (IC 95% 4,45-9,25).Fue más común en mujeres, viudos y divorciados, jubilados y desempleados. Dos tercios tenían sobrepeso-obesidad; un 37% dolor crónico, un 21,1% depresión y un 37,9% ansiedad. La mitad refería dificultades para realizar las actividades de la vida diaria y mantener un buen estado de ánimo. Asimismo, el 41,1% refería que habitualmente tomaba fármacos para dormir. Las medidas terapéuticas más utilizadas fueron la higiene del sueño y las benzodiacepinas; mientras que las terapias cognitivo-conductuales eran poco habituales.ConclusionesLa prevalencia de insomnes en nuestra zona es semejante a la esperada en estudios realizados en población general. La presencia de algunos hábitos perjudiciales para el sueño y las comorbilidades pueden favorecer la cronificación del insomnio, por lo que se debe considerar el manejo de esta patología en un contexto más amplio. Predomina el tratamiento farmacológico mientras que las terapias no farmacológicas de demostrada efectividad son muy ocasionales.

Most FPs consider insomnia as a major health problem, in which they usually get involved. The most commonly used treatments are sleep hygiene advice, followed by benzodiazepines and Z drugs. The CBT is considered effective but not widely used.