Search

The article presents a Community Intervention Plan (CIP) for the management of chronic obstructive pulmonary disease (COPD) in Spain. The CIP aims to improve the diagnosis, treatment, and monitoring of COPD through collaboration between community pharmacies and health centers. The plan includes a standardized work procedure that describes the actions to be taken by community pharmacists, such as population screening for COPD and disease evaluation. It also proposes to evaluate the effectiveness of the intervention and establish a training plan on COPD. The implementation of the CIP could reduce underdiagnosis of COPD and improve patient management in Spain. [Extracted from the article]

Diabetic foot is one of the most frequent and important complications worldwide. In Mexico, it is estimated that 15-25% of diabetic patients will develop ulcers in the lower extremities. One of the diabetic foot complications is the amputation of the affected lower limb, in our country it is the main cause of non-traumatic amputation. In this context, it is important to establish a medical conduct based on the prevention and timely diagnosis of possible micro and macrovascular complications associated with diabetes mellitus, coupled with multidisciplinary management, the corresponding screening of all diabetic patients at the time of diagnosis and on an annual basis, where the extremities are valued in an integral way. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Analyze the notifications made by Primary Care (PC) professionals of Galicia, in the Notification and Learning system for Patient Safety (SiNASP), of the Ministry of Health of Spain, its variables and the factors that contribute to its appearance for thus characterize security incidents in this healthcare field., Materials and Methods: This is a retrospective descriptive study of notifications made in PC, between October 2010 and December 2019, in the SiNASP, in the Autonomous Community of Galicia. The data are presented using absolute and relative frequencies. Incidents are determined on the total number of personnel of different professional categories. To contrast the relationship between different variables, the Chi-square test was used., Results: 1863 notifications corresponded to PC (10% of the total). There were no differences in terms of sex, but it was observed that the incidence increases with age. The largest number of notifications was made by doctors, although, in percentage terms, pharmacists are the professionals who report the most incidents. The largest number of safety events occurred in consultations, with the most frequent being those due to a problem related to medication. Approximately 1 in every 200 incidents that reached the patient were classified as catastrophic., Conclusions: Even though there are fewer notifications and possibly having a lower incidence than in hospitals, security incidents in PC are frequent and, sometimes, serious. Therefore, measures that influence the promotion of safety culture and raise awareness, in this sense, among managers and professionals in this healthcare field are essential., Competing Interests: Conflicto de intereses Los autores no declaran conflictos de intereses., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

The 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension (ESH Guidelines 2024) have recently been published, a brief document but with a very elaborate infographic that summarizes as much as possible the previous guidelines for the management of arterial hypertension (HTN), aimed at serving as a quick reference tool to make decisions in daily clinical practice. The main objective of this work is to analyze the recommendations and innovations of these guidelines from the perspective of their applicability and taking into account all the scientific societies in the specialty of Family and Community Medicine, Internal Medicine and the Spanish Society of Hypertension (SEHLELHA) in order to achieve more homogeneous and evidence-based care for HTN in Spain. The most important results include the maintenance of the thresholds to define HTN and the therapeutic objectives, as well as the recommendation to initiate pharmacological treatment based on both the blood pressure values and the cardiovascular risk estimated by SCORE2 and the presence of organic damage. New are the introduction of practical tables to estimate the fragility of hypertensive subjects based on their age and autonomy, as well as precise recommendations for monitoring HTN. In summary, the ESH 2024 Guidelines represent a useful, reasoned and concise instrument that can serve as a tool to improve the control of HTN in our environment., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Introduction: Primary health care is essential in a well-designed health system. A way of approaching the quality of an institution or service is evaluating different aspects like accessibility, treatment, satisfaction, and efficiency. The COVID-19 pandemic caused substantial disruptions in health systems. The present work focused on assessing the evolution of the experience of patients. It analyzed its relationship with various factors of the centers and the professionals' quality of life., Methods: Retrospective quantitative study through a survey carried out in Catalonia evaluating the experience of users in relation to primary health care services. Results from years 2015, 2018, 2021 and 2022 are included in the study., Results: Users from 370 centers were included in the study. The highest scores were registered in dimensions as environment and information (more than 90%), while accessibility was the worst scored dimension (mean 65.19). Global satisfaction scores were significantly higher in 2015 and 2018 and dropped the following years showing the impact of the COVID-19 pandemics., Conclusion: The evolution of the patient experience in Catalonia shows a progressive decrease from the first edition in 2015 to the most recent edition in 2022, aggravated by the COVID-19 pandemic. During the pandemic, all the characteristics of primary care were affected, and they are beginning to recover. The resilience that primary care has shown during the pandemic contrasts with a downward valuation of the experience of patients who have used it., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyse the implementation and identify and describe the community activities (CA) developed during 2018-2022, in the Primary Health Care (PHC) of the health area of Santiago de Compostela y Barbanza. In addition, the barriers and facilitators for its development will be determined., Design: Observational, cross-sectional study., Setting: The study was conducted in Galicia, an autonomous community located in northwestern Spain, covering the 74 health centres in the health area, which are part of the public network of the Spanish health system., Participants: All nursing coordinators were invited to participate, as well as heads of service and those PHC professionals with greater knowledge of the CA developed., Main Measurements: A hetero-administered questionnaire on the characteristics, barriers and facilitators of CA was completed by means of a telephone interview., Results: A total of 95 CA were identified. Most were one-time activities (72.6%), single-session (67.4%), with passive participation of the attendees (100%) and little cross-sectoral collaboration (9.5%). 76.8% of the CA were not evaluated and arose on the initiative of PHC professionals. The flexibility of PHC professionals' agendas was identified as a key factor in achieving the implementation of CA in PHC., Conclusions: In order to achieve an effective implementation of CA, greater institutional involvement is crucial to facilitate the flexibility of PHC agendas, the evaluation of CA, the incorporation of professionals with specific training in community care, as well as greater collaboration with community agents., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Purpose: To determine the prevalence and incidence of electrocardiographic abnormalities (EKG-abn)., Material and Methods: Design. 2 stage study: 1st: descriptive cross-sectional, 2nd: prospective cohort., Location: 28 urban primary health centers in Barcelona city area., Participants: The study population was composed by patients who had participated in the population based ARTPER multicentric study. This study has two phases where each patient had one EKG, physical examination and blood test to obtain the secondary variables. The available EKG from both phases were reviewed, achieving a total of 2,727 patients with EKG. 601 (22%) individuals with CV disease were excluded. A total of 2.126 patients were studied of whom 392 (18%) had 2 EKG, one at each phase. Mean measurements. The association between the presence of EKG-abn and explanatory variables was performed using multivariate logistic regression, obtaining odds ratios (OR) and their 95% confidence intervals (95%CI)., Results: 58% women and average age 66years. 32% (95%CI: 30%-34%) (n=671) presented EKG-abn of whom 60% (n=402) were minor and 40% (n=269) major disorders. The most common EKG-abn were the conduction disturbances. EKG-abn were associated with males (OR: 1.7; 95%CI: 1.4-2.1) and patients older than 65 (OR: 1.6; 95%CI: 1.4-2.0). Among the 345 people without EKG-abn at baseline and with 2 available EKG, 71 showed an EKG-abn at the second EKG (incidence in 4.7years of 21% (95%CI: 16%-25%)., Conclusion: EKG abnormalities are common in healthy general population. EKG-abn are more common in male and elderly patients., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The foundation of virtual consultation is to improve the cooperation and the coordination between Primary Care and other specialties. However, in its use inequities related to socioeconomic determinants have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource., Material and Methods: Descriptive study of virtual and non-virtual consultations requested by Primary Care doctors from other specialists doctors in Aragon between 1 January 2020 and 31 December 2022. Characteristics of the interconsultations and variables specific to the patient treated were recorded and analyzed; and the request rate for virtual consultations by specialty and the standardized rates by age by Basic Health Zone and stratified by sex were calculated., Results: Progressive increase in the number of virtual consultations for the study period, being Traumatology, Neurology, Urology, General Surgery and Dermatology the specialties that received the most. The standardized rates by age and stratified by sex were higher in women and the Health Areas of Huesca, Calatayud and Alcañiz. The request was higher in 2022 and the specialized referral was the main type of response. Regarding variables of the patients treated, virtual consultations were requested more in urban and less dispersed areas, women, patients with lower adjusted morbidity and with free pharmacy, pensioners and active users with income less than €18,000/year., Conclusions: Despite the rise of telemedicine and its potential advantages, it is necessary to adapt it to the needs of the local population, to mitigate inequalities in access, and to integrate it with face-to-face care., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

The prevalence of obesity has increased in recent years worldwide. In this context, strategies for management obesity in primary care are essential. The first step in the treatment of obesity are lifestyle intervention programs. The three pillars of these programs, ideally of high intensity (high frequency of visits), are dietary intervention, exercise and behavioral therapy. There is no universal model of care for patients with obesity, but it must take into account key aspects, such as facilitating the access and adherence of the patient and a multidisciplinary and coordinated care among professionals at different levels of healthcare. The components of the model of care and its format should be defined according to the resources available and the characteristics of the population to be treated., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

This article addresses the diagnostic challenges of palmoplantar dermatoses (PPD) within the scope of Primary Health Care (PHC). These common skin conditions, encountered in daily practice, exhibit a diverse range of symptoms and morphologies, complicating their diagnosis. They are etiologically classified into infectious inflammatory, non-infectious inflammatory, and hereditary keratodermas. While various dermatoses may affect the palms and soles, few are specific to this area. Notable examples include palmoplantar pustulosis, dyshidrosis, erythema pernio, and Bazex syndrome. Given the high prevalence of dermatological consultations in PHC, this article underscores the significance of PHC professionals' knowledge regarding these conditions. It proposes a diagnostic algorithm to facilitate their management and timely referral., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Professionals who work with women victims of gender violence face difficult emotional situations, and it is important to be aware of the emotions and feelings that the attitudes and behaviour of victims and aggressors generate in them. These emotions can become barriers to communication and seriously affect the professional's relationship with victims. Furthermore, they can generate situations of sustained stress, lead to emotional exhaustion, and affect their health, life, and work performance. We describe the consequences, risk factors and warning signs, as well as protective or resilience factors, that are important to know, and we list the current challenges and some recommendations for professionals and management in order to help prevent such effects and improve professional performance without health risks., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: This study aimed to assess the cause of acute pharyngitis and determine the duration of severe and moderate symptoms based on the aetiology., Design: Prospective observational study. SITE: One urban health care centre., Participants: Patients aged 15 or older with acute pharyngitis were included., Interventions: Bacterial identification was carried out in the microbiology lab using MALDI-TOF in two throat samples. Patients received a symptom diary to return after one week., Main Measurements: Number of days with severe symptoms, scoring 5 or more in any of the symptoms included in the symptom diary, and moderate symptoms, scoring 3 or more., Results: Among the 149 patients recruited, beta-haemolytic streptococcus group A (GABHS) was the most common aetiology. Symptoms and signs alone as well as the mean Centor score cannot distinguish between GABHS and other bacterial causes in patients with acute pharyngitis. However, there was a trend indicating that infections caused by Streptococcus dysgalactiae and Streptococcus agalactiae presented more severe symptoms, whereas infections attributed to the Streptococcus anginosus group, Fusobacterium spp., and those where oropharyngeal microbiota was isolated tended to have milder symptoms. S. dysgalactiae infections showed a trend towards longer severe and moderate symptom duration., Conclusion: GABHS was the most prevalent, but group C streptococcus caused more severe and prolonged symptoms., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Mental Health (MH) and Female Genital Mutilation (FGM) are two aspects of migrant health that should be addressed and screened in primary care. These topics are inherently sensitive, often challenging and difficult to approach in routine consultations. Providing comprehensive care and management needs both knowledge and a careful approach, yet these factors may sometimes result in low screening of both health issues. Migration itself does not inherently lead to MH disorders. However, the various experiences encountered throughout the migration process can contribute to MH challenges. Migrants face the same issues as the rest of the population, but their expressions may differ. Therefore, it is important to understand the cultural contexts and create a supportive environment within healthcare to effectively address both MH and FGM. FGM is a serious health issue for girls and women that should be assessed in primary care. This includes prevention for at-risk girls, support and care for affected women and community initiatives. To engage with individuals from high-risk countries, both men and women is essential to facilitate change and help to end this harmful practice., (Copyright © 2024. Publicado por Elsevier España S.L.U.)

In chronic non-oncological pain, there is a gap between the recommendations and the usual clinical practice. To improve this situation, it is essential to address unhelpful beliefs about pain in patients and health professionals. We address cultural beliefs such as thinking that pain means damage to the tissue where it is felt, that pain originates in the area where it is perceived, that it is important to rest for the tissues to heal, or that drugs and surgery are the best treatments for pain. First, professionals need to reflect on their own beliefs and question their own clinical practice: what do I believe about pain? Are these beliefs in line with current evidence? Do I follow the recommendations of clinical practice guidelines? In this way, by aligning their beliefs with the evidence, professionals will be able to begin to give appropriate educational advice to patients., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Background and Aim: To use a risk scale or predictive model outside the population of origin, it is necessary to evaluate the predictive indicators through external validation. The aim was to validate the FAscore, originally constructed in hypertensive patients in primary care in the Valencian Region, in an external cohort with hypertension in primary care in the Basque Country., Methods: A retrospective cohort study was designed to perform an external validation of the FAscore app in patients affiliated with 26 health centers in the municipality of Bilbao. The area under the ROC curve and predictive indicators were calculated with their 95% confidence intervals., Results: Thirty-six thousand eight hundred nine patients were included: 53.6% (n=19,719) were women, the mean age was 75.1 years, 41.8% (n=15,381). Over the four-year follow-up period, 1420 patients were diagnosed with AF (cumulative incidence 3.9%). The median risk estimated by FAscore was 4.5%, and the 5th, 25th, 75th, and 95th percentiles were 1.0%, 2.5%, 6.1%, and 14.8%, respectively. The ROC curve for the risk estimated by FAscore and the cases of atrial fibrillation observed was AUC 0.715 (95% CI 0.703-0.727). The 5% risk cutoff provides a sensitivity of 70.8%, specificity of 61.0%, positive predictive value of 6.8%, negative predictive value of 98.1%, and positive and negative likelihood ratios of 1.82 and 0.48, respectively., Conclusion: This study reports on the external validation of the atrial fibrillation risk scale in hypertensive patients, which shows an acceptable predictive capacity. The best-performing risk cutoff, providing good predictive indicators, can be set at 5%., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To validate the efficacy of brief CPR training with dual feedback to maintain the ability to perform quality chest compressions., Materials and Methods: Quasi-experimental study with two groups to evaluate a brief theoretical training followed by a practice with manikin with feedback; Participants: 155 health and non-health professionals from 5 primary care health centers of urban area (43 losses); Main measurements: Characteristics of compressions that were measured before and after the brief training and their maintenance at 3 and 6 months according to the study group. The effect of training and maintenance of skills were analyzed using multiple linear regression models., Results: 155 participants were included, mean age 39.7 years (SD=12.0) with 82.7% female. The training effect had an improvement in mean compression depth (pre-post difference: 3.5, P<.001), total compressions with adequate depth (pre-post difference: 0.2, P<.001) and Total Compressions with Adequate Rhythm (pre-post difference: 0.4, P<.001). The second phase was completed by 112 participants (72.2%). Compression skills declined at 3 months and were lower at 6 months, although the loss of skills was not statistically significant between the two groups., Conclusions: An individualized, brief training action with feedback immediately improves the quality of compressions. The progressive loss of skills from 3 to 6 months is not relevant., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care., Method: During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care», «Diabetes Mellitus, Type2». Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023., Results: The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes., Conclusions: The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: There are few data about the optimal use of natriuretic peptides (NP) in the Primary Care (PC) setting. The aim to assess how, through a common coordinated PC-hospital care pathway, the use of NPs in patients with suspected heart failure (HF) is improved., Material and Methods: Analytical, experimental, prospective, non-randomized study. An intervention group composed of 22 PC physicians from 2 health centers is provided with face-to-face training and a consensual protocol is attached with a cut-off point of NT-proBNP> 300 pg/mL as pathological. The control group is made up of the rest of PC physicians in the healthcare area. The aim is to compare the use and results of PN in both groups. Propensity analysis is performed so thar the patient populations with requested PN are comparable., Results: From June 2021 to March 2022, NP was requested in 103 and 105 patients in the intervention/control groups. Both populations were similar, with equal HF risk. Symptomatology was present in 100% of intervention vs 41% of asymptomatic patients in the control group (p <0.001). ECG was performed in 100% vs 33.3%, p <0.001. Optimal NP indication in 76.7% vs 29.5%, p <0.001. In the intervention group more patients with NT-proBNP> 300 pg/mL are referred to cardiology consultations (76.6% vs 27.2%, p 0.001)., Conclusion: The optimal indication for NP and its interpretation as a diagnostic tool for HF, in the PC setting seems not to be appropriate, but improvable with a coordinated and multidisciplinary intervention approach., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To quantify the incremental impact that population dispersion has on the number of health personnel in Primary Care in Alto Aragón, using a reproducible method., Method: Descriptive observational study that compares health the number of health personnel (family medicine, pediatrics and nursing) in EAP and PA emergencies in 2019 in an unpopulated and dispersed territory such as Huesca, with the number that would correspond to it by applying population ratios per professional of hypothetical constructs with different population densities., Results: Huesca, with respect to the national average, has 39% more PA health personnel. There are 239 additional professionals (112 in family medicine, 2 in pediatrics and 115 in nursing), 130 in emergencies and 109 in EAP. With the average of the five most densely populated provinces, it would reduce this staff by 49%, and with the average of the five least densely populated provinces, it would increase it by 12%., Conclusions: There is a relationship between low population density and a greater number of family medicine and PC nurses, but not with pediatrics. The powerful incremental effect that dispersion has on health care spending gives it a relevant role in the regional financing system. Comparing PC health personnel in scenarios with different population density is a useful method for quantifying the impact of dispersion., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To characterize the profile of the informal primary caregiver (IPC) of adult patients with type2 diabetes (T2D) and the possible factors associated with caregiver collapse (CC)., Design: Observational, descriptive, cross-sectional and analytical study. SITE: Ambulatory Care Medical Unit., Participants: Mexican CPIs of adult patients with T2D., Main Measurements: Data were collected through a prolective design using the Zarit scale and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed., Results: The CPI profile is assumed by: women, people aged 36-58, daughters, people with a secondary and high school educational level, married, Catholic, with income <8,900 Mexican pesos, own home, inhabited by a maximum of 5 inhabitants, with support networks, who have dedicated >5years to the care of their patient, without training and with chronic diseases. The risk factors that increase the risk of CC are: being a woman (OR=11.03; 95%CI: 1.49-81.95), having a history of more than 5years of having assumed the role of caregiver (OR=2, 65; 95%CI: 1.07-6.55), living in one's own house (OR=3.03; 95%CI: 1.04-8.82), with 6 or more inhabitants (OR=2.41; 95%CI: 1.08-5.38). The support of other family members and/or friends was associated as a protective factor (OR=0.15; 95%CI: 0.07-0.33)., Conclusions: Prevention programs are required to avoid CC and complications, as well as interventions to improve the quality of life of the CPI and patients in care, incorporating strategies to generate and/or increase their family and social support networks., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands' advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: The postpartum period represents a vulnerable time for women's mental health, especially for those with complications and prematurity. This study aims to explore the evolution of depression and anxiety levels during the 12 weeks postpartum in mothers of premature babies., Design: Prospective study of two parallel cohorts., Setting: Hospital Clínic of Barcelona., Participants: Women with obstetric complications [premature rupture of membranes or preeclampsia] requiring hospitalization and preterm delivery (< 37 weeks of gestation); 2) Women without complications with term delivery., Main Measures: Validated questionnaires were administered to measure anxiety (State-Trait Anxiety Inventory, STAI) and depression (Edinburgh Postnatal Depression Scale, EPDS) during the first week, and at 6 and 12 weeks postpartum., Results: 182 women were analyzed: 90 with uncomplicated pregnancies and term deliveries, and 92 with complications requiring preterm delivery. During the follow-up, women with premature newborns showed a significantly unfavorable progression in depression (p <0.001) and anxiety (p <0.001) scores, as well as a higher proportion of abnormal scores on both scales (p <0.001 and p=0.004, respectively) CONCLUSIONS: Women with preterm delivery show higher anxiety and depression levels than those with term delivery during the 12 weeks postpartum. It is essential to ensure a seamless transition between care levels to effectively address postpartum mental health., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Main Aim: In July 2022, an extensive outbreak of Mpox (monkeypox) was considered by WHO as a Public Health Emergency. The objective of this study is to describe the obtained results from a Mpox case detection program in a semi-urban healthcare area where approximately 420 Primary Care physicians work., Design: An observational prospective study performed between June 01, 2022 and December 31, 2023., Setting: The Northern Metropolitan area of Barcelona, with 1400.000hab (Catalonia, Spain)., Methods: An unified Mpox management procedure was agreed, including a prior online training of Primary Care professionals, to individually assess all Mpox suspected cases from a clinical and epidemiological perspective., Participants: All patients who met clinical and/or epidemiological criteria of Mpox., Data Collection: Age, gender, risk classification (suspected/probable), cluster-linked (yes/no), high-risk sexual contact (yes/no), general symptoms, genital lesion and final diagnostic., Results: A total of 68 suspected Mpox cases were included, from which 16 (26.6%) were Mpox confirmed by PCR. Up to 13 (81.2%) were male and, among them, 12 (75%) men who have sex with men (MSM). The series, however, included two minors and three women. Among MSM, 3 (18.7%) were HIV positive and 3 had no regular access to the Public Healthcare system. Among discarded patients, any infectious disease was diagnosed in 55% of cases., Conclusions: In spite of the short series, this Primary Care community-based study identified a sub-population group showing a different profile of Mpox cases compared to other published series (lower HIV prevalence, higher representativeness of heterosexual transmission and hard to reach population)., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Routinely obtaining a sexual history is a necessary first step to identify which patients have specific sexual behaviours that may put them at risk and use appropriate protective measures, especially in vulnerable populations. However, late diagnosis of HIV infection remains very high. Combination prevention strategies based on condom promotion, harm reduction programs for people who inject drugs plus PrEP and HIV PEP are the best options to prevent new infections. Screening for STIs (including hepatotropic viruses) and early diagnosis and treatment are essential for the person since it improves the prognosis and complications and also for the community because it breaks the chain of transmission. People living with HIV who have an undetectable viral load do not transmit the virus sexually (undetectable=untransmittable)., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Objectives: To describe the proportion of patients with liver fibrosis in at-risk populations in primary care (PC). To know the agreement between FIB-4 and transitional elastography (TE), interobserver agreement between PC and hospital care (HC) in TE, and associated risk Factors (RF)., Methods: Observational, descriptive, cross-sectional study in ≥16 years of age with RF for chronic liver disease. Sex and age, RF (alteration of liver tests [LT], metabolic syndrome, diabetes, obesity, alcohol consumption, hepatic steatosis), and FIB-4, controlled attenuation parameter and TE in PC and in HC, were collected. According to a consensus algorithm, vibration-controlled TE was performed in PC in patients with FIB-4≥1,3, and those with measurement ≥8kPa were referred to HC., Results: 326 patients were studied. 71% were not referred to HC, due to liver stiffness <8kPa. 83 of the 95 derivations did TE in HC. 45 (54%) had TE ≥8, and 25 (30%) ≥12. The proportion of patients with stiffness ≥8kPa was 13,8% (45/326) and ≥12kPa, 7,6% (25/326). The predictive values of the FIB-4 were low. The interobserver correlation coefficient between TE in PC and HC was 0,433. Variables associated with TE ≥8 in PC: LT alteration, diabetes and steatosis. With TE ≥12: LT alteration, diabetes and obesity., Predictor Variables: LT alteration and obesity., Conclusions: The study supports the sequential performance of serum indices and TE as a screening for fibrosis in the at-risk population in PC, which allows a reduction in the percentage of patients referred to AH, and a better stratification of risk patients., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the impact of a pharmaceutical intervention on treatment optimization in patients with type 2 diabetes mellitus., Design: Before-after intervention study. SITE: Health centers of the Primary Care Department of Camp de Tarragona., Participants: Patients aged ≥ 18 years, diagnosed with type 2 diabetes mellitus and under treatment with antidiabetic drugs., Interventions: Review of pharmacological treatment for type 2 diabetes mellitus and issuance of proposals for its adequacy., Main Measurements: Demographic and clinical variables were collected to assess the adequacy of antidiabetic treatment. A consensus meeting was arranged with the patients' primary care physician to evaluate the proposals for improvement. The implementation of the proposals and the variation in postintervention glycemic control were assessed., Results: A total of 907 patients (59% men) were included. A total of 782 proposals for intervention were made in 65.8% of the patients reviewed. Of the proposals, 43.5% corresponded to drug discontinuation, 16% to intensification of dosing and 12.6% to exchange for a therapeutic equivalent. Of the consensual proposals, 54.7% were implemented. HbA1c was reduced by 0.2% after the intervention (7.4 vs 7.2%)., Conclusions: Review of the pharmacological treatment of patients with type 2 diabetes mellitus by a pharmacist or pharmacologist facilitates its optimization., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Objectives: To know the needs and lack of information on health issues of Maghrebi women., Subjects, Material and Method: Design: Qualitative study technique nominal group (TGN)., Subjects: 14 North African women from Association for Solidarity and Rapprochement of Cultures (ASAC) from the rural clinic of La Aljorra who knew and understood Spanish, older age, and lived in the town for more than 3 years. Material and method TGN asks: «What daily health issues for you and your family worry you the most and do you need answers?» Individual reflection and list that were discussed among them, joining the group consensus. Subsequently, they were prioritized individually and a definitive list of their prioritized health needs was made., Results: Thirty-six percent of the ASAC associates attended. At first, 17 topics were written on health needs for which they wanted a response. The final topics chosen and grouped by them were 6: 1) Contraceptive methods; 2) Relationship problems; 3) Thyroid; 4) How to cure the sciatic nerve?; 5) Anemia and 6) Stress. 70% related to the area of sexuality., Conclusions: 1) Qualitative research is an adequate consensus method to obtain information on little-known topics and directly from the person involved; 2) The Moroccan migrant woman considers information about sexuality and couple relationships very important; 3) Another pathology unknown to them and emerging in the area is thyroid; 4) Stress and its repercussions; 5) Sciatica and its consequences are also important when being agricultural workers., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Most physicians in general, and family physicians in particular, are familiar with certain parameters when ordering a hematological study, such as hemoglobin (including hematocrit and its features), leukocytes (including lymphocytes) and platelets. Nevertheless, there are two values that we use to overlook which are eosinophils and basophils. Specifically, eosinophils have a tendency to increase with allergic pathology. This article focuses on this type of cells, helping to interpret the values obtained and highlighting their importance in two of the most frequent respiratory pathologies in primary care: asthma and COPD. In addition to observing how the increase or normality of these parameters condition the diagnosis, phenotype and even the treatment., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine the prevalence of suspected abuse of non-institutionalised elderly people and the associated variables., Patients and Method: Observational, descriptive, cross-sectional, multicentre study in patients aged 65 years or older, non-institutionalised, consecutively selected in primary care (PC). The EASI questionnaires (Suspected Elderly Abuse Index), the EAI questionnaire (Suspected Abuse Index in patients with cognitive impairment), the Barthel index, and the EUROQOL-5D questionnaire were used with patients, and the CASE questionnaire and the Zarit test were used with caregivers. Socio-demographic, health, and quality of life variables were analysed in all patients., Results: Eight hundred four patients were included, mean age 78.9±7.9 years, 58.3% women. The prevalence of suspected abuse was 11.3% (95% CI: 9.1%-13.9%). Suspected abuse was more frequent in women than in men (14.4% vs. 7.1%; odds ratio (OR)=1.97; 95% CI=1.1-3.4; p=0.016) and in those who lived with two or more people compared to those who lived alone (18.4% vs. 7.3%; OR=2.42; 95% CI=1.1-5.0; p=0.017). Among older patients, the lower their dependency, the lower the prevalence of suspected abuse (30.0% in highly dependent vs. 8.7% in non-dependent: p-trend=0.006); and the better the perceived health status, the lower the prevalence of suspected abuse (29.6% in poor health status vs. 6.9% in optimal health status; p-trend=<0.001). Among caregivers, the prevalence of suspected abuse was 20.4% (95% CI=12.8%-28.0%). A trend of higher prevalence of suspected abuse could be observed with higher scores on the CASE questionnaire (56.3% at high risk and 9.6% with no risk of abuse; p-trend=0.007). In the case of the ZARIT questionnaire with scores below 47, the prevalence of suspected abuse was 9.1%, and for scores above 55, it was 52.6% (p-trend<0.001)., Conclusions: The results of the PRESENCIA study show that approximately 1 in 10 patients aged ≥65 meet the criteria for suspected abuse. The probability of abuse increases in women, in patients with greater dependency and in patients with poorer perceived health status. Caregivers with greater overload and greater risk presented a greater suspicion of elder abuse., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Headache is a frequent reason for consultation with primary care (PC) physicians. However, the condition is underdiagnosed and undertreated. One reason for this may be the lack of specific training on headache in PC. Methods: We conducted a descriptive cross-sectional study of data gathered with a self-administered survey that was completed by PC physicians from our health district. We collected sociodemographic data and information on previous training in neurology and headache, and training needs. Results: The survey was completed by 104 PC physicians, 53% of whom were women; mean age was 49 years. Most respondents worked in urban settings (42.3%) and had been trained via residency (77.9%). Although 65.4% spent more time with patients with headache than with other patients, only 32.7% used the International Classification of Headache Disorders. In our sample, 68.3% of respondents reported a high or very high interest in headache, and 75.9% wished to receive further training on the condition; theoretical and practical courses and update lectures were regarded as the most useful tools. In clinical practice, 90% used triptans and 78% used preventive treatments. The most frequently used drug was amitriptyline; only 22.1% choose topiramate. Conclusions: PC physicians are in frequent contact with patients with headache and show interest in receiving training on this condition. This could be helpful in designing training programmes aimed at improving quality of care in this area. Resumen: Introducción: La cefalea es un motivo de consulta frecuente en atención primaria (AP), sin embargo, se trata de una patología infradiagnosticada e infratratada. Uno de los posibles factores es la falta de formación de los profesionales de AP en cefaleas. Métodos: Estudio descriptivo transversal mediante encuesta auto-administrada a los médicos de AP de nuestro sector sanitario. Se recogieron variables sociodemográficas, variables relacionadas con la formación previa en neurología y cefaleas y variables en relación con sus necesidades formativas. Resultados: Completaron la encuesta 104 médicos de atención primaria, de los cuales el 53% fueron mujeres y la edad media fue 49 años. La mayoría de los encuestados trabajan en un centro de salud urbano (42,3%) y se han formado vía MIR (77,9%). El 65,4% dedican más tiempo a una consulta de cefaleas que a otras consultas y sólo un 32,7% utilizan la Clasificación Internacional de Cefaleas. El 68,3% declaran tener un interés alto o muy alto en cefaleas y al 75,9% les gustaría mejorar su formación, eligiendo cursos teórico-prácticos y ponencias de actualización como la herramienta más útil. Un 90% utiliza triptanes en su práctica clínica diaria y el 78% emplea tratamientos preventivos. El fármaco más utilizado es amitriptilina y sólo un 22,1% elige topiramato. Conclusiones: Los profesionales de AP están en contacto constante con pacientes con cefaleas y muestran interés en la formación en esta patología, lo que podría ayudarnos a diseñar programas docentes dirigidos a mejorar la calidad asistencial en este ámbito.

RESUMEN Objetivo: Estudiar en pacientes mayores de 65 años las prescripciones potencialmente inapropiadas y omisiones de prescripción en patología cardiovascular en atención primaria. Metodología: Estudio descriptivo transversal en un centro de salud urbano utilizando la versión 2 de los criterios STOPP-START. Resultados: En los 170 pacientes incluidos (62,4% mujeres; mediana de edad, 79 años) hubo un 15,3% de prescripciones potencialmente inapropiadas y un 8,8% de omisiones de prescripción. El 72,9% tenía más de 4 enfermedades y el 57,1% tomaba más de 4 fármacos. A mayor pluripatología, mayor consumo de fármacos, sin relación entre las prescripciones potencialmente inapropiadas y las características epidemiológicas y clínicas de los pacientes. Conclusiones: Los criterios STOPP-START son útiles para revisar la prescripción en personas mayores de 65 años con enfermedades cardiovasculares entre su pluripatología.

La inserción de la salud mental en una atención primaria (APS) integradora ha sido una política exitosa para reducir la brecha en el tratamiento de personas que padecen trastornos mentales (TMs). Sin embargo, las consecuencias de este progreso pudiesen estar yendo más allá de las deseables. Este despliegue sustancioso de la atención de salud mental podría estar también estimulando la medicalización la vida cotidiana de las personas de manera más activa y en consecuencia coadyuvar a desactivar la potencia socializadora y trasformadora del malestar en la sociedad. En este trabajo me propongo comprender cómo los programas de salud mental en APS pudiesen estar contribuyendo a trasformar en problemas médicos expresiones del diario vivir que no lo son. Luego de examinar algunos aspectos de las políticas relacionadas con la salud mental, informes e investigaciones, sugiero que el diseño del plan de Garantías Explícitas en Salud, las tecnologías utilizadas para integrar y desarrollar la atención de salud mental, y ciertas circunstancias derivadas de este proceso, podrían estar estimulando la sobrevivencia de un modelo biomédico reduccionista y patologizador que respaldaría prácticas medicalizadores. Algunas sugerencias son esbozadas para el desarrollo de una política y práctica en salud que reconozca e integre la posibilidad para mitigar los potenciales efectos negativos de este fenómeno.

Introduction: Obesity in the child population and its effect in the development of metabolic diseases are a public health issue. One of the aims of the European Project in a health system, is the evaluation of the effectiveness of a multidisciplinary health promotion program directed at adolescents with risk factors associated with the development of type 2 Diabetes Mellitus (T2DM). Patients and methods: Randomised clinical trial with two groups of 12–14 year-old overweight adolescents. The intervention group took part in a multidisciplinary program for 24 months. This program was based on 11 group sessions (8 main sessions and 3 additional support ones) for adolescents and their guardians. The control group received usual care at primary care level. Longitudinal regression models were adjusted to assess the evolution of anthropometric measures and living habits at baseline, 3, 6, 12, and 24 months in both groups. Results: There were 92 participants, equally distributed by group. Statistically significant differences were observed between intervention and control groups in several results: evolution of the body mass index; increase in the consumption of fruits and vegetables; decrease in the consumption of snacks and sweetened drinks; and increase in the number of days per week with more than one hour of physical activity. Conclusions: The results confirm the effectiveness of this multidisciplinary program, both in the evolution of the body mass index, and in the improvement of the eating and physical activity habits, all of them risk factors for the future development of metabolic diseases, such as T2DM. Resumen: Introducción: La obesidad en la población pediátrica y su efecto en la génesis de enfermedades metabólicas, constituye un gran problema de salud pública. Uno de los objetivos del estudio de ámbito europeo en un sistema de salud es evaluar la efectividad de un programa de promoción de la salud dirigido a adolescentes con factores de riesgo asociados al desarrollo de Diabetes Mellitus tipo 2 (DMT2). Pacientes y métodos: Ensayo clínico con doble grupo aleatorizado de adolescentes de 12 a 14 años con exceso ponderal. El grupo intervención recibió un programa multidisciplinar durante 24 meses, de 11 sesiones grupales (8 al inicio, 3 de refuerzo) junto a sus tutores. El grupo control continuó el seguimiento habitual por los equipos de pediatría de Atención Primaria. Se plantean modelos longitudinales para estudiar la evolución de medidas antropométricas y hábitos de vida desde el momento basal, a los 3, 6, 12 y 24 meses. Resultados: Participaron 92 personas en el estudio, igualmente distribuidas por grupo. Se observaron mejoras estadísticamente significativas en varios resultados: evolución del índice de masa corporal; aumento del consumo de frutas y verduras; disminución del consumo de snacks y de bebidas azucaradas; y aumento del número de días por semana en los que realizan más de 1 hora de ejercicio físico. Conclusiones: Los resultados confirman la efectividad del programa multidisciplinar tanto en la evolución del índice de masa corporal como en la mejora de los hábitos alimentarios y de actividad física, todos ellos factores de riesgo en la génesis de enfermedades metabólicas futuras, como la DMT2.

Introduction: Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem. Objective: To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care. Participants and method: Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n = 57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done. Results: Three themes emerged from the data: “Parents’ attitude in childhood obesity” (sub-themes “The conscience of parents”, “The parents ask for help”), “Paediatric staff and childhood obesity” (sub-themes “Approaching to the problem: The interview with parents”, “Looking together for the solution”), and “System barriers” (sub-themes “Improving teamwork and health policy”, “Family participation in addressing childhood obesity”). Conclusions: Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel. Resumen: Introducción: Comprender los factores que influyen en el tratamiento del sobrepeso y la obesidad infantil es crucial para ofrecer el mejor apoyo a las familias y solucionar este grave problema de salud pública. Objetivo: Describir las actitudes y sentimientos del personal de pediatría al tratar con los padres el sobrepeso y la obesidad de sus hijos, explorando los facilitadores y las barreras percibidas, a fin de realizar una atención efectiva. Sujetos y método: Estudio cualitativo por cuestionarios individuales semiestructurados de personal pediátrico (pediatras y enfermeras pediatras; n = 57; 68% mujeres) de centros de atención primaria y hospitales de la isla de Mallorca, sobre las que se aplicó un análisis temático. Resultados: Se identificaron 3 temas: “La actitud de los padres en la obesidad infantil” (subtemas “La conciencia de los padres”, “Los padres piden ayuda”), “El personal pediátrico y la obesidad infantil” (subtemas “Aproximación al problema: La entrevista con los padres”, “Buscando juntos la solución”) y “Barreras del Sistema” (subtemas “Mejorar el trabajo en equipo y la política de salud”, “Participación familiar al abordar y estudiar la obesidad infantile”). Conclusiones: El personal pediátrico sabe tratar la obesidad infantil, pero demanda entrenamiento en motivación. La terapia de la obesidad infantil será efectiva cuando los padres/cuidadores reconocen el problema y establecen confianza con los equipos pediátricos. El sistema de salud aún es una barrera a la actividad del personal pediátrico.