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Introduction: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain., Objectives: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors., Material and Methods: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care., Subjects: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA., Measurements: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE)., Results: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01., Conclusions: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area., Design and Site: A descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care., Participants and Methods: All patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves., Results and Conclusions: The adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring., (Copyright © 2023. Publicado por Elsevier España S.L.U.)

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment., (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This study aimed to characterize the prevalence as well as clinical and epidemiological features of persistent symptoms after acute COVID-19, focusing on gender-specific differences in a primary care setting., Methods: A total of 1542 individuals with confirmed SARS-CoV-2 infection were enrolled. The study population comprised 55.77% females (mean age: 45.04 years). Risk factors for persistent COVID-19 were analyzed, revealing disparities between men and women. Symptom clusters and their prevalence were assessed over time, along with functional status using the post-COVID-19 functional status scale., Results: The prevalence of persistent COVID-19 was 12.38%, with females exhibiting a 1.5 times higher risk. Females displayed a higher number of visits and persistent symptoms at 90 days, decreasing after one year. Symptom clusters varied between genders, with females experiencing more dermatological issues. Functional status analysis revealed that females had a better pre-infection status, similar status to males at 90 days, and improved status at 180-, 270-, and 365-days post-infection. Logistic regression analysis showed significant associations between persistence, gender, hospitalization, radiological abnormalities, age, and immunosuppression., Conclusion: This study provides insights into the prevalence and clinical characteristics of persistent COVID-19 in a primary care population. Females exhibited a higher risk of persistent symptoms and displayed distinct patterns in symptom clusters and functional status compared to males. These findings contribute to a better understanding of the long-term effects of COVID-19 and highlight the importance of gender-specific considerations in post-acute care., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity. Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin. It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis. We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: The objective was to describe the characteristics of the use of clinical ultrasound in two health centers (SC) of Health Area VII of the Region of Murcia (CS Murcia-Sur and CS Floridablanca)., Design: Observational, descriptive, longitudinal, prospective and multicenter study. SITE: CS Murcia-Sur and CS Floridablanca (Health Area VII of the Region of Murcia)., Participants: One hundred and thirty-five patients were included., Interventions: Performance of clinical ultrasound in the primary care (PC) consultation., Main Measurements: Demographic variables (age, sex), as well as clinical variables (reason for consultation, type of ultrasound, results, referrals to the second hospital level, degree of diagnostic agreement) were collected., Results: One hundred and thirty-five patients were included, more than 50% were female. The main reason for consultation was musculoskeletal and soft tissue symptoms (44.4%), followed by digestive symptoms (21.5%). 44.4% of the ultrasounds were classified as normal, while pathological findings were found in 55.6%. Confirmatory tests were requested in 43.7% and the findings were confirmed in 67% of the patients., Conclusions: The use of ultrasound in PC allows to show the high prevalence of pathological findings in the examination of patients. In a technique that helps the clinician in his diagnostic-therapeutic process. The integration of clinical ultrasound in the PC consultation can save complementary studies and referrals to a second level of care. Its implementation in PC requires proper training of professionals., (Copyright © 2023 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Bariatric surgery (BS) has been shown to be effective and efficient, but only 1% of selected patients will ever receive it. Compared to medical treatment of obesity, BS has demonstrated greater long-term sustained weight loss, a reduction in both total and cardiovascular (CV) mortality, improvement or remission of CV risk factors and other comorbidities associated with obesity, as well as improved mobility and quality of life. BS presents similar risks to other abdominal surgeries, with obesity as an added risk factor. However, mortality after this type of surgery is less than 1%, being in specialised centres even lower than 0.3%, with a morbidity of less than 7%. The most commonly performed surgical procedures at present are vertical gastrectomy and Roux---Y gastric bypass, preferably by laparoscopic approach., (Copyright © 2024. Publicado por Elsevier España S.L.U.)

Introduction and Objectives: A training program was developed to increase general practitioners' engagement in the optimal management of Benign Prostatic Hyperplasia (BPH). The goal of this study was to evaluate changes in BPH management after the implementation of a training program., Material and Methods: This observational retrospective cohort study was conducted between 2019 and 2020. Aggregated data were analyzed in three evaluation periods (2010, 2012 and 2015), addressing quality indicators for diagnosis, treatment, and treatment outcomes., Results: Overall, 118 795 patients who presented any data points were included. All quality indicators (number of IPSS and PSA determinations) increased between the first period and the last. Combination (α-blocker + 5-ARI) therapy was increasingly prescribed during the study periods whereas the proportion of prescriptions for single-agent α-blocker showed no significant differences among the periods analyzed. However, the total number of patients eligible for combination therapy who actually received this treatment was low in all periods (7.5%, 17.9%, and 20.1%, in 2010, 2012, and 2015, respectively). The outcome indicators revealed a decrease in referrals to the urology unit mostly among newly diagnosed patients. Even though the proportion of patients who underwent BPH-related surgeries increased significantly from the first to the second period, the number of surgeries remained stable between the second and third periods., Conclusions: The training program had a generally positive impact on the management of BPH patients in PC, but the overall study period may be insufficient to show an effect on some outcome indicators such as the number of surgeries., (Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow., Design: Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative)., Location: All the primary care teams of the Central Catalonia Management (32 teams)., Participants and Setting: All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023., Methods: A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective., Results: The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline., Conclusions: The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: To evaluate the effectiveness of the incorporation of the clinical assistant in improving the control of type 2 diabetes mellitus and hypertension in a primary care center., Design: Quasi-experimental study (pre-post), with a control group, with a 1-year follow-up., Setting: Primary care center., Participants: Patients between the ages of 18 and 85 with a diagnosis of diabetes type 2 and/or hypertension were selected., Intervention: Incorporation of the figure of the clinical assistant, previously trained. The latter contacted the patient to explain their role and obtain informed consent, assessed compliance with the protocols, and when they were incomplete and/or detected warning signs, referred the patient directly to medicine and/or nursing., Results: Three thousand and sixty-four patients participated, 30.74% assigned to the intervention group. Fifty percent were women. The mean age was 68.5 years (SD 11.07). 93.59% of diabetic patients in the intervention group had at least one determination of glycosylated hemoglobin compared to 86.83% in the control group (p=0.003). Fundus and diabetic foot screening was significantly higher in the intervention group (94.31% and 85.41% vs. 83.49% and 72.38%). 88.43% of the patients in the intervention group had registered blood pressure figures compared to 62.06% of the patients in the control group (p<0.05). There were not statistically significant differences in the control of blood pressure between the patients with recorded measures (p=0.478)., Conclusions: Clinical assistants can facilitate the implementation and compliance with chronic diseases protocols, and in the long run improve the degree of control of these patients and the quality of care., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: To evaluate the effect of an occupational therapy intervention in users recently diagnosed with the decline syndrome, who have experienced a decrease in the Barthel and/or Lawton index in the last month and susceptible to improvement based on medical opinion., Design: Non-controlled, quasi-experimental longitudinal study. A pre-post intervention., Location: Sant Hipòlit de Voltregà health centre. Osona, Barcelona., Participants: Patients referred by the centre's primary care nursing, social work or medical staff with a recent diagnosis of decline syndrome who may benefit from the intervention of an occupational therapy professional., Intervention: Following the initial assessment visit, four training sessions were conducted to improve functional independence, mobility and adaptation of the home environment, providing training to primary caregivers., Main Measurements: Patient autonomy was assessed using the Barthel and Lawton scales, quality of life using the EuroQol questionnaire (EQ-5D) and home suitability using the home suitability assessment questionnaire., Results: Improvements were observed in autonomy in activities of daily living (p=0.003), mobility (p=0.001) and housing adaptation (p<0.001). The level of anxiety/depression was reduced (p=0.028), and the mean health status score increased markedly (p<0.001)., Conclusions: This study highlights the improvement in the quality of life and autonomy in the basic activities of daily living for individuals receiving occupational therapy, emphasizing the need for home adaptation and family support., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

This paper addresses the public-private mix in the Spanish National Health System (SNS) presenting six case studies dealing with both insurance and provision: 1. The special health insurance of civil servants.' 2. The construction of public hospitals with a PFI scheme; 3. The total healthcare concessions of the 'Alzira model' in the Valencian Community and Madrid, which subcontract public insurance; 4. The contract between a large private teaching hospital and the Madrid Health Service; 5. The provision of primary health care in Catalonia through cooperative-like companies of health professionals; 6. A Children s Dental Care Program using public and private dentists. The great complexity, opacity, cost overruns and difficulty of public control of the PFI contracts, the concessions as well as the activity-based contract for hospital services, point out to the outright rejection of theses systems. The comparative nature of the public-private debate in healthcare should emphasize that the problems of 'the public' in the SNS are not due to its public nature but stem from its governance and management arrangements, clearly in need of deep reforms, many of which are included in the Conclusion-Dictamen on health of the Reconstruction Commission of the Congress. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao 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.)

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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.)

Introduction: Background and objectives: despite long hours of sunlight in Spain, vitamin D deficiency has been rising of late. We aimed to describe vitamin D deficiency and insufficiency in at-risk patients in La Rioja, a region in northern Spain. Methods: a retrospective, cross-sectional study involving 21,490 patients (74.3 % women) aged 14-105 years, who were primary health care (PHC) users in La Rioja, with an available 25-hidroxyvitamin D (25(OH)D) test result corresponding to the first request from January 2013 to October 2015. Vitamin D deficiency, insufficiency, and sufficiency were defined as 25(OH)D levels < 12 ng/mL, 12-20 ng/mL, and ≥ 20 ng/mL, respectively. Hypovitaminosis D was defined considering 2 cut-off points for 25(OH)D: < 20 ng/mL and < 30 ng/mL. Results: mean 25(OH)D levels were 18.3 (SD, 11.6) ng/mL in the whole sample, being lower in men than in women (17.6 vs 18.5 ng/mL, p < 0.001). Significantly higher 25(OH)D levels were found in the groups with 55-59, 60-64, 65-69, and 70-74 years of age (range, 19.4-20.4 ng/mL), and lower levels were found in the groups with 80-85 years and older (16.7 and 14.5 ng/mL), as compared to other groups. Two thirds of the population were vitamin D-deficient (< 12 ng/mL, 30.9 %) or insufficient (12-20 ng/mL, 32.8 %), and only 32.8 % of patients were found to be vitamin D-sufficient (> 20 ng/ml). Hypovitaminosis D rate was higher (89.7 %) when the 25(OH)D cut-off point was set at < 30 ng/mL. A higher hypovitaminosis D rate (< 20 ng/mL) was found in men (67.1 %) vs women (62.6 %) (p < 0.001), and it was more prevalent in patients over 75 years (72.6 %). The prevalence of hypovitaminosis D followed a seasonal pattern ranging from 51.8 % to 76.5 %; the lowest 25(OH)D levels were found in winter, and the highest in summer, with levels above 20 ng/mL in all age groups except for patients over 75 years (17.7 ng/mL). Patients over 75 years exhibited high rates of deficiency or insufficiency across all seasons of the year. Conclusions: in La Rioja, Spain, hypovitaminosis D was highly prevalent among PHC users, and especially in older age groups and during the winter months. [ABSTRACT FROM AUTHOR]

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Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0–10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR = 3.94, p = 0.021) and antihypertensive therapy (OR 3.02, p = 0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p = 0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV. Resumen: A los pacientes que experimentan tanto vértigo como nistagmo en la prueba de Dix-Hallpike (DHT) se les diagnostica vértigo posicional paroxístico benigno objetivo (VPPB). Esta prueba provoca solamente vértigo entre el 11 y el 48% de los pacientes a los que se les diagnostica VPPB subjetivo. La detección de nistagmo tiene importantes implicaciones diagnósticas y pronósticas. Comparar las características de los pacientes diagnosticados de VPPB objetivo y subjetivo en Atención Primaria. Estudio descriptivo transversal. Ubicación: 2 centros urbanos de Atención Primaria. Participantes: adultos (≥18 años) diagnosticados de VPPB objetivo o subjetivo entre noviembre del 2012 y enero del 2015. Resultados de la DHT (vértigo o vértigo más nistagmo; variable dependiente: nistagmo como respuesta a la DHT), edad, sexo, tiempo desde el inicio, episodios de vértigo previos, gravedad del vértigo autoinformada (escala Likert, 0-10), comorbilidades (infección viral reciente, lesión cerebral traumática, dolor de cabeza, ansiedad/depresión, hipertensión, diabetes mellitus, dislipidemia, enfermedad cardiovascular, función tiroidea alterada, osteoporosis, espondilosis cervical, cervicalgia). Se incluyó a 134 pacientes (76,1% mujeres) con una edad media de 52 años. El 59,71% presentaba VPPB subjetivo. El VPPB objetivo se asoció significativamente con hipertensión, tratamiento antihipertensivo y espondilosis cervical en el análisis bivariado y con espondilosis cervical (OR = 3,94, p = 0,021) y tratamiento antihipertensivo (OR = 3,02, p = 0,028) en el análisis multivariado. Los pacientes con VPPB subjetivo tenían más probabilidades de estar tomando benzodiacepinas (OR = 0,24, p = 0,023). La prevalencia de VPPB subjetivo fue superior a la esperada. La espondilosis cervical y la terapia hipertensiva se asociaron con VPPB objetivo, mientras que las benzodiacepinas se asociaron con VPPB subjetivo.

Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment is the Epley manoeuvre (EM). Objective: The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Design: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Participants: Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix–Hallpike test (DHT) were randomised to: Interventions: Intervention (EM) group or a control (sham manoeuvre) group. Main measurements: The main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory – screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P

Introducción: se realizó un análisis de la evidencia disponible sobre intervenciones orientadas a mejorar la adherencia al lavado de manos, para generar recomendaciones para los centros de atención en salud ambulatoria. Materiales y métodos: se realizó una búsqueda en Pubmed, Embase y Epistemonikos, y en las referencias de guías sobre el tema, seleccionando aquellos estudios no observacionales en que se realizaran intervenciones para aumentar la adherencia al lavado de manos en atención en salud. Se clasificaron las estrategias descritas según tipo de intervención, y se evaluaron según su efectividad en mejorar la adherencia al lavado de manos y el seguimiento en el tiempo. Resultados: se seleccionaron 34 estudios experimentales prospectivos, que se clasificaron en 10 grupos según el tipo de intervención realizada, y se evaluaron según efectividad y seguimiento en una escala del I al VII. 24 de 34 estudios mostraron un aumento estadísticamente significativo de la adherencia al lavado de manos mayor al 15% desde el basal o en comparación al grupo control, correspondiendo en su mayoría a estrategias multimodales y de feedback. Discusión: las intervenciones más efectivas para mejorar la adherencia al lavado de manos fueron las que incluían abordajes multimodales y las que incluían feedback. Se hace urgente generar mayor evidencia sobre esta temática en el contexto de atención ambulatoria.

RESUMEN Introducción: La ciencia y la tecnología son importantes para el progreso histórico con sus consecuencias inevitables para el desarrollo social. Uno de los componentes de la ciencia y la tecnología que sigue la misma ley y se desarrolla de manera proporcional al desarrollo de la sociedad son las ciencias médicas. Su función es proteger, cuidar, desarrollar y mejorar los recursos y la calidad de la fuerza laboral, y promover el desarrollo social. Por lo tanto, es una condición necesaria que influye directamente en la reproducción humana y garantiza el desarrollo económico y social. Los servicios médicos socialistas son servicios productivos y de bienestar, que mejoran la fuerza física y la inteligencia, además crean condiciones favorables para el desarrollo social y económico e interactúan con la sociedad. Objetivo: Demostrar la influencia de los avances de la ciencia y la tecnología en la salud humana y la atención primaria y describir la importancia de concebir al hombre como un ser biopsicosocial en la atención primaria de salud y la prevención de obesidad. Métodos: Se realiza un estudio de revisión a través de las referencias bibliográficas actualizadas sobre el tema. Desarrollo: China también ha propuesto pautas específicas para la prevención de la obesidad, pero los resultados son pobres. Por un lado, esto está relacionado con la gran tasa de población del país, y por otro, con el lento desarrollo de la atención médica primaria y la falta de concientización sobre la importancia de prevenir el sobrepeso y la obesidad como estrategia de trabajo. Conclusiones: Los profesionales de la salud deben crear estrategias adaptadas a las condiciones locales, de forma tal que perciban una buena atmósfera para controlar el peso. Esto aumentara la conciencia de la sociedad, respecto al problema de la obesidad.

El objetivo de este estudio es describir los niveles de plomo en sangre, en la población que vive en asentamientos irregulares identificados con niveles de plomo en suelo superiores a 400 mg/kg. Es un estudio descriptivo retrospectivo de las consultas recibidas en la UPA entre 2011 y 2018, de poblaciones provenientes de estos asentamientos irregulares. La población estudiada fue una muestra de conveniencia que incluyó niños de hasta 15 años y mujeres embarazadas que voluntariamente se presentaron en los centros de Atención Primaria. Se les realizó plombemia en equipo Lead Care II®, por voltametría anódica. Los niveles de plombemia mayores de 5 μg/dL fueron confirmados por Espectrometría de Absorción Atómica. En este periodo se recibieron 606 consultas, de siete asentamientos irregulares (6 de Montevideo y 1 de Canelones); 530 (87,4 %) eran menores de 15 años y 76 (12,6 %) mayores de 15 años, 2 de ellas (0,3 %) mujeres embarazadas y 74 (12,3 %) familiares de los niños. El 32 % (n=194) de pacientes presentó plombemia mayor de 5 μg/dL, y de estos, el 54 % (n=106) fueron niños menores de 5 años. De los casos con plombemia mayor de 10 μg/dL (n=55), el 52 % (n=29) eran niños menores de 5 años. El suelo contaminado es una fuente de exposición relevante. Según la Academia Americana de Pediatría (AAP), los niños con valor de plombemia mayor a 5 μg/dL, requieren mayores estudios de exposición y vigilancia, por lo que, la interacción intersectorial con la red de Atención Primaria es una herramienta clave para evaluar comunidades en riesgo y priorizar intervenciones.

Objective: To describe the construction of an educational booklet for family caregivers about home care for dependent elderly in the Amazon context. Methods: This is a methodological study, carried out from September 2019 to August 2021. Technological production followed four stages: Bibliographic survey; Textual construction of the booklet; Research and definition of images and Layout and diagramming of the booklet. Results: The booklet addresses the care related to the difficulties and needs of home caregivers - body hygiene, showering, bathing in bed, intimate hygiene, mouth hygiene, changing diapers, preventing falls, mobilization and transfer, care with food, care with medications, care to prevent falls, care regarding the use of hammocks and care regarding the use of home remedies. Conclusion: The booklet provides guidance on the main care activities that the caregiver performs on a daily basis in caring for the dependent elderly person, being divided into topics. Each activity follows the necessary care guidelines so that the caregiver provides safer care and the difficulties experienced in practice are minimized. [ABSTRACT FROM AUTHOR]

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Introducción: El diagnóstico precoz de la infección por VIH es fundamental para mejorar el pronóstico de la enfermedad y evitar nuevos contagios. Atención Primaria (AP), al ser el primer nivel asistencial al que suele consultar el paciente, brinda la oportunidad de diagnosticar precozmente a muchos de ellos. El objetivo fue potenciar este diagnóstico mediante la identificación de condiciones indicadoras (CI) de seropositividad que permitan al profesional sospechar la infección. Métodos: Estudio observacional transversal descriptivo con participación de 89 centros de AP de Galicia (Septiembre 2013-Junio 2015). Se recogieron variables clínicas, analíticas y sociodemográficas de pacientes a los que se le realizaba el test de VIH, tanto por sospecha del médico como por petición del propio individuo. Resultados: De entre 1061 pacientes incluídos en el estudio DIVAPIS se obtuvieron 19 test positivos, con una prevalencia de nuevos diagnósticos del 1.76%. Las variables que resultaron estadísticamente predictores de seropositividad fueron: ser hombre que tiene sexo con hombres (p=0,02), serología positiva para VHB (p

Objetivo. Describir las características sociodemográficas, necesidades de salud, derivaciones efectivas realizadas y evaluación inmediata de la población migrante internacional que participó en el Programa de Atención Inicial al Migrante durante el primer año de ejecución (entre mayo y diciembre del año 2016), implementado en el Centro de Salud Familiar Ignacio Domeyko, Santiago de Chile. Métodos. Estudio descriptivo. Se diseñó e implementó una intervención para dar bienvenida a migrantes internacionales, que contemplaba la evaluación integral inicial, el diagnóstico de situación y detección de necesidades y derivación a otras atenciones, y la entrega de información. Para el análisis se describen, por medio de medidas de tendencia central y frecuencias absolutas y relativas, las características sociodemográficas, el proceso migratorio, las necesidades de salud, el cumplimento de derivaciones a un año de seguimiento y los resultados de la encuesta de satisfacción usuaria. Resultados. Se inscribieron 436 personas, de las cuales asistieron 270 (61,9%). El 80% eran mujeres, provenientes en su mayoría de Perú y Venezuela. La principal derivación realizada fue a control de embarazo (32,6%), seguido de planificación familiar (30%) y servicios sociales (27,04%). A un año de seguimiento, las derivaciones para controles cardiovasculares alcanzaron 100% de cumplimiento, 97,7% para embarazo y 87,7% para servicios sociales. El menor cumplimiento en las derivaciones fue a salud mental (11,1%). Conclusiones. Esta intervención, pionera en Chile, permitió dar bienvenida y proporcionar información clave a la población migrante internacional, así como también realizar derivaciones basadas en necesidades de salud y promover la inserción de la población inmigrante al sistema de salud chileno.

Introducción: la demanda neurológica ambulatoria ha ido creciendo constantemente. Existen pocos datos estadísticos sobre las patologías neurológicas en nuestra población. Objetivo: caracterizar la morbilidad neurológica del Policlínico Docente “Ramón López Peña” en el periodo comprendido de enero a diciembre de 2018. Método: se realizó un estudio descriptivo transversal de 247 pacientes que asistieron a consulta de Neurología del Policlínico Docente “Ramón López Peña” de Santiago de Cuba, de enero a diciembre de 2018. Las variables estudiadas fueron edad, sexo, enfermedades neurológicas, grupos etiopatogénicos, origen de la remisión y concordancia diagnóstica. Resultados: predominó el sexo femenino con un 63,9 % y el grupo de edad entre los 55 a 64 años representados por 61 pacientes para un 25%, la enfermedad neurológica más frecuente fue la cefalea con 63 pacientes, para 25,5 %, seguidas de la epilepsia con 34 pacientes (13,7%) y las polineuropatías con 31 pacientes (12,5 %), los pacientes fueron remitidos predominantemente por el médico de familia y no hubo concordancia diagnóstica en un tercio de los pacientes, para un 37,44%. Conclusiones: el trastorno neurológico más frecuente fue la cefalea en féminas de 55 a 64 años de edad y las remisiones en su mayoría fueron realizadas por el médico de familia, no existió coincidencia diagnóstica en un por ciento considerable de los casos lo que denota la necesidad de superación a todos los niveles en el conocimiento de la semiología y patología del sistema nervioso.

Introduction and objective: Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. Method: To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged

Objective: Hyper-attendance is a significant problem in paediatric primary care clinics. The aim of our study was to analyse the level of attendance in these clinics and its relationship with certain psychosocial aspects of the families attending them. Patients and methods: Observational descriptive study was conducted using questionnaires collected during a period of 6 months, as well as recording the frequency of attendance in the previous 6 months. A total of 346 questionnaires of children between 6 months and 13 years of age belonging to 2 urban primary care clinics in Madrid were completed. The raw data was analysed, and comparisons between groups and multivariate analysis were performed. Results: The mean number of consultations in the last 6 months, of the total included in the study, was 3.06 in the primary care centre, and 0.77 in the emergency services. It was considered over-frequent for those who had attended the primary care health centre 6 or more times in this period (>P90), of which there were 33 children (9.53%). In the multivariate analysis, the variables related to being frequent users of primary care clinics were: the presence of high level of anxiety in the parents (OR = 5.50; 95% CI: 2.49–12.17, P p90), que fueron 33 niños (9,53%). En el análisis multivariante, las variables relacionadas con ser hiperfrecuentador en las consultas del centro de salud fueron la presencia de elevado nivel de ansiedad en los padres (OR = 5,50; IC 95%: 2,49-12,17; p

RESUMEN Objetivo: analizar el riesgo de aparición y la prevalencia de lesión por presión en personas encamadas asistidas por las unidades de atención primaria en el domicilio, además de describir las características sociodemográficas de los participantes del estudio, así como las condiciones clínicas y de tratamiento de los pacientes con lesiones por presión. Método: se trata de un estudio transversal, con 79 participantes encamados y englobados en el programa Estrategia de Salud Familiar. Los datos fueron recogidos mediante entrevista semiestructurada, y el riesgo de aparición de lesiones por presión se estimó mediante la aplicación de la escala de Braden. Resultados: se verificó que la condición clínica de los usuarios que necesitaron cuidados en el domicilio supone un riesgo significativo para el desarrollo de la úlcera por presión o agravamiento de estas lesiones, especialmente en los ancianos. Se evidenció la presencia de lesión por presión en el 15,1%. Conclusión: el estudio pone de relieve el elevado riesgo para el desarrollo de úlcera por presión en la población del municipio.

RESUMEN Objetivo: Evaluar la efectividad de la EPA-HCC en el cuidado de los pacientes con úlceras por presión. Métodos: Se realiza un estudio de tipo cuasi experimental, multicéntrico, con dos mediciones sin grupo control, en cuanto a las medidas preventivas y tratamientos aplicados a pacientes con úlceras por presión (UPP) en los distritos o áreas de gestión sanitaria donde se está pilotando la EPA-HCC: Distrito Sanitario Poniente, Área de Gestión Sanitaria Jaén Norte-Nordeste y Área de Gestión Sanitaria Serranía de Ronda, entre septiembre 2015 y octubre 2016. Se utilizó un documento autoadministrado ad-hoc para todas las enfermeras que tenían pacientes a su cargo, y se realizó un análisis descriptivo de los mismos. Resultados: Respondieron un total de 335 profesionales en 2015 y 308 en 2016 (tasa de respuesta del 89,1%); los tres distritos atienden a una población total de 707.814 habitantes. En cuanto a las medidas preventivas del uso de sistemas especiales para el manejo de la presión (SEMP), se ha producido un incremento de un 6% en su uso de un año a otro, un descenso de un 4% del total de UPP, un descenso en el consumo de apósitos de hidrofibra con plata casi del 50% y un descenso de la escala RESVECH en un 52% del primer año al segundo. Conclusiones: Se constata una mejora en la optimización de los recursos, en las medidas preventivas puestas en marcha para conseguir los objetivos marcados y se crea la necesidad de seguir formando en tratamientos locales y tipos de desbridamientos a realizar.

Las diferencias educativas entre hombres y mujeres tienen un claro reflejo en la elección de los estudios universitarios. Por otra parte, el campo de la educación física, la actividad física y el deporte es un espacio de socialización de género de amplio alcance. En este marco, el objetivo de este trabajo es analizar la presencia de mujeres durante los últimos 25 años en los estudios de la familia de la actividad física, la educación física y el deporte impartidos en Cataluña. Los resultados muestran el progresivo descenso de la presencia femenina en los diferentes estudios relacionados con la educación física, la actividad física y el deporte. Se constata, pues, un proceso de masculinización de esta área de conocimiento. Esta tendencia a la disminución de mujeres en estas áreas contrasta con el aumento de su porcentaje en la práctica del deporte. Esta paradoja pone en evidencia la necesidad de un cambio en dichos estudios, de modo que incorporen la forma de ver y vivir la actividad física, educación física, y el deporte de las chicas.

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Mexico faces an enormous challenge in attending mental health disorders with depression rising as one of the five main contributors to disability adjusted life years (DALYs) and increasing suicide rates. These challenges are coupled with a dearth of resources and an inefficient allocation of the meager funds. While no magical bullet is available to ameliorate this situation in the short term, here we discuss current concepts and experiences that could be used in Mexico to deliver better primary mental health care. We focus on depression and suicidal behavior and argue that collaborative care is a feasible and replicable model, emphasizing the importance of training non-specialized primary care personnel to become case managers and provide primary mental health care. Mexico is currently undergoing a process of changes, including the emergence of universal health care. The time seems right to make mental health care more transversal, widely available and scientifically proven. [ABSTRACT FROM AUTHOR]

Objective. To identify the existence of gender inequalities in the use of primary care (PA), emergency care and nursing consultation. Materials and methods. Repeated cross-sectional study using Spanish and European health surveys (2006-2017) to Spanish population aged 16 and over (n= 95 929). Results. The use of three care services was higher among women. Pensioners, as well as unpaid household labour women, with low education level and those of manual social class, were the most likely to use PC. In emergency care, the higher age, the lower probability of use, and living in a rural town was associated with a higher probability of use of emergency care. Unpaid household labour women were the most likely to use nursing care. Conclusions. Studies that analyse gender inequalities in different contexts such as the use of health services care are still necessary, as well as, new management strategies are needed to achieve care equity. [ABSTRACT FROM AUTHOR]

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Objetivo: Conocer cómo la población se adapta durante la fase de desescalada, después de la pandemia por SARS-CoV-2 en la demanda del Servicio de Urgencias Pediátricas del Hospital Universitario Valle Hebrón. Métodos: Estudio observacional, descriptivo y transversal realizado en el citado hospital entre mayo y junio de 2020. Se recogieron datos sobre la edad de los pacientes, nivel de prioridad de atención, motivo de consulta, recursos asistenciales alternativos utilizados y opinión sobre medidas de protección adoptadas. La información se recogió mediante una encuesta autoadministrada de elaboración propia. Resultados: Disminuyó la demanda en la asistencia durante los meses de mayo y junio del 2020 respecto a los mismos meses el año anterior (2019). Existe un aumento del 3,5% de pacientes con nivel 3 de prioridad de atención. Los motivos principales de consulta fueron fiebre y problemas digestivos. El 85% de los pacientes encuestados han sido visitados en varias ocasiones durante el último año en el citado hospital. El 80% de los encuestados tuvieron la necesidad de venir a urgencias durante el confinamiento y no lo hicieron por miedo al contagio. El 62% priorizaron otros recursos antes de acudir al hospital. El recurso sanitario más utilizado fue el Centro de Atención Primaria vía telefónica/presencial. Conclusiones: Durante el periodo de desescalada ha habido una disminución de la asistencia a urgencias pediátricas, recurriendo a otros recursos asistenciales. Los cambios organizativos y funcionales adoptados como medidas de protección no han sido percibidos como motivos de deshumanización en la atención. ABSTRACT Objective: To understand how population’s adaptation during de-escalation phase after SARS-CoV-2 pandemic and their demands of pediatric emergency services in Hospital Universitario Valle Hebrón. Methodology: Observational, descriptive and transversal study made at the cited hospital between May and June 2020. Data were obtained through a self-administered ad hoc questionnaire. The age of the children, priority levels in caregiving, visit’s motive, alternative assistance resources and opinions about protective measures established were gathered. Results: The demands of assistance decreased during May and June 2020 compared with the same months of the previous year (2019). There is a 3.5% increase in level 3 priority attention patients. The main causes of visits were fever and digestive problems. 85% of surveyed patients received medical attention on several occasions during the year. 80% of respondents needed to attend emergency services but they did not go because fear of contagion. 62% prioritized other resources before attending to the hospital. The most used sanitary resource were centers of Primary Care. More than 80% of the respondents did not perceive any dehumanization in their attention and 40% adopted all safety measures. Discussion: There has been a decrease in Pediatric Emergency assistance during de-escalation period, what has originated an increase in the use of other healthcare resources. Organizational and functional changes adopted as protective measures have not been perceived as reasons for dehumanization in patient’s care.

Introducción. Las farmacias comunitarias representan un papel clave en la respuesta al COVID-19 y especialmente en el control de enfermedades crónicas más allá de la pandemia. Objetivo. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria para prevenir la fragilidad y promover el autocuidado en personas mayores. Método. Estudio cualitativo de investigación-acción con mapeo de actores, segmentación de perfiles, grupos de discusión, entrevistas en profundidad y sesiones de diseño creativo. Las técnicas utilizadas aseguraron la participación de personas mayores y profesionales en todas las etapas de diseño. Resultados. Se generaron circuitos comunes de comunicación para los nuevos servicios y protocolos de actuación compartidos. Se propusieron nuevos roles profesionales en respuesta a las necesidades, expectativas y preferencias de las personas mayores. Se diseñaron los servicios de detección de fragilidad, adherencia a nuevos medicamentos, toma de constantes y refuerzo terapéutico. El modelo aporta sistemas de comunicación bidireccional entre atención primaria y farmacia comunitaria y reconoce el papel de la farmacia comunitaria en la promoción del autocuidado y gestión de la patología crónica y la medicación. Conclusiones. Se evidencia la importancia de crear un ecosistema más abierto que dé lugar a innovaciones organizativas que aprovechen la proximidad y capilaridad de las oficinas de farmacia, así como la incorporación de la omnicanalidad en la atención, esencial en situaciones de crisis sanitaria como la actual. Asimismo, queda demostrado que las técnicas de diseño cooperativo favorecen la participación de los agentes involucrados, aumentando su contribución e impacto potencial sobre los resultados.

RESUMEN Introducción: La satisfacción es mucho más que una aspiración humana, es un instrumento y una función para lograr la excelencia de la calidad en la atención en salud. Objetivo: Determinar el nivel de satisfacción laboral de médicos de la familia. Métodos: Se realizó un estudio descriptivo de corte transversal en el Policlínico Docente Norte de Placetas en el año 2019. El universo estuvo constituido por los 18 médicos de la familia del policlínico y con un muestreo no probabilístico, deliberado con carácter casuístico a partir de no haber contactado a algunos por difícil acceso quedó conformada la muestra por 15, teniendo como criterio de inclusión la voluntariedad de participar. Resultados: Predominaron como condiciones estructurales no adecuadas los servicios sanitarios (93,3 %) y la privacidad de la consulta (73,3 %); de las condiciones de trabajo propiamente dichas no adecuadas, los muebles de la consulta y sala de espera (86,6 %); de los elementos relacionados con el diagnóstico y tratamiento, todos fueron no adecuados; de los factores subjetivos, el más referido fue el estrés (93,3 %) y como grado de satisfacción, el poco satisfecho (80 %). Conclusiones: Existe poca satisfacción laboral de los médicos del Policlínico Docente Norte de Placetas, determinado esto por un conjunto de factores interrelacionados entre sí.

Background: Major Depressive Disorder (MDD) is highly recurrent. Most patients with MDD are treated in the Primary Care (PC) setting. The purpose of this systematic review was to identify risk factors associated with relapse of MDD in PC. Method: A systematic review of PsycINFO, PubMed, Web of Science and ScienceDirect, from 1978 to 2019, following PRISMA guidelines was conducted. Results: Eight studies fulfilling the eligibility criteria and 12 risk factors associated with relapse of MDD were found. Patients who showed a higher frequency of relapse were: 1) those with higher scores in neuroticism, disability, current MDD episode severity, and childhood abuse; 2) lower scores on extraversion, self-esteem, emotional role, physical functioning; 3) history of MDD relapse; 4) comorbidity; and 5) poorer adherence to antidepressant medication (ADM). In terms of treatment, ADM combined with cognitive behavioural therapy and psychoeducation was reported to produce fewer relapses, as was mindfulness-based cognitive therapy for patients with a higher score in childhood abuse. Conclusions: Despite the very varied nature of the studies, different risk factors associated with relapse were identified. However, more research is needed on this important problem, with randomized controlled trials. [ABSTRACT FROM AUTHOR]

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