Atencion Primaria最新文献

{"title":"[Pharmacological treatment of type 2 diabetes mellitus].","authors":"Francisco Javier García Soidán, Javier Riveiro Villanueva","doi":"10.1016/j.aprim.2024.103143","DOIUrl":"https://doi.org/10.1016/j.aprim.2024.103143","url":null,"abstract":"<p><p>The treatment of type 2 diabetes is based on four fundamental pillars: diet, exercise, therapeutic education, and pharmacological therapy. There are ten groups of antidiabetic drugs that can be classified according to their mechanism of action, effects on body weight, risk of hypoglycemia, and ability to reduce the development of complications. The choice of medication will be individualized based on the preferences and characteristics of the individual, taking into consideration the presence of cardiovascular disease, heart failure, chronic kidney disease, obesity, or non-alcoholic fatty liver disease. The type 2 diabetes mellitus treatment algorithm from the RedGDPS Foundation is an evidence-based tool that can help us select the most appropriate pharmacological therapy depending on the characteristics of each patient.</p>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 4","pages":"103143"},"PeriodicalIF":1.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Suicide prevention in the workplace].","authors":"Israel Macías-Toronjo, Juan Jesús García-Iglesias, Juan Gómez-Salgado","doi":"10.1016/j.aprim.2024.103145","DOIUrl":"https://doi.org/10.1016/j.aprim.2024.103145","url":null,"abstract":"","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 2","pages":"103145"},"PeriodicalIF":1.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of skills and perceptions regarding mHealth in the management of chronic patients by primary care professionals].","authors":"Daniel Monasor Ortola, José Joaquín Mira Solves, Antonio Esteve Ríos","doi":"10.1016/j.aprim.2024.103142","DOIUrl":"https://doi.org/10.1016/j.aprim.2024.103142","url":null,"abstract":"<p><strong>Objective: </strong>To examine the perceptions of primary care professionals regarding the integration and effectiveness of mHealth in managing patients with chronic conditions, as well as their digital skills.</p><p><strong>Design: </strong>Descriptive cross-sectional observational study conducted from April to November 2023.</p><p><strong>Setting: </strong>Primary care services in the Health Department of Denia, Alicante, Spain.</p><p><strong>Participants: </strong>Professionals in nursing, medicine, and physiotherapy.</p><p><strong>Measurements: </strong>Participants completed an anonymized ad hoc questionnaire divided into two sections: sociodemographic data and questions regarding the use of mobile health technologies and the internet.</p><p><strong>Results: </strong>A total of 181 professionals participated, showing high proficiency in managing mobile applications (median score of 8 out of 10; IQR=2), with higher proficiency observed among younger professionals (P<.001). 56.35% had prescribed official or scientifically endorsed digital information. The primary advantage identified for mHealth was the enhancement of patient self-monitoring and self-control (86.74%). However, 88.95% noted the difficulty of using mobile technologies depending on patient type as a disadvantage. 64.64% believed mHealth should be targeted towards patients or caregivers dealing with cardiometabolic or respiratory chronic conditions.</p><p><strong>Conclusions: </strong>The study underscores a generally positive perception of mHealth among primary care professionals, highlighting their technological competence. It also emphasizes the potential of mHealth to improve patient self-management and enhance electronic documentation of patient follow-up. Addressing the digital divide is critical to ensuring equitable access to mHealth and thereby improving health care and outcomes.</p>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 2","pages":"103142"},"PeriodicalIF":1.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tratamiento analgésico y adecuación terapéutica en los pacientes con enfermedad crónica avanzada. Oportunidades de mejora","authors":"Àngels Ballarín Castany ,&nbsp;Jordi Casanovas Font ,&nbsp;Thaïs Serrà Rigol ,&nbsp;Anna Formiguera Macià ,&nbsp;Ramon Oller Piqué ,&nbsp;Xavier Gómez-Batiste","doi":"10.1016/j.aprim.2024.103135","DOIUrl":"10.1016/j.aprim.2024.103135","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the analgesic treatment of patients with advanced chronic disease (ACD), to determine pain management, and to detect opportunities for improvement.</div></div><div><h3>Design</h3><div>Observational, descriptive, cross-sectional, multicentre study.</div></div><div><h3>Location</h3><div>Three primary care teams, one intermediate care hospital and five nursing homes in Catalonia.</div></div><div><h3>Participants</h3><div>Patients with ACD and pain according to the Brief Pain Inventory (Short Form) scale (or Pain Assessment in Advanced Dementia scale, in case of advanced dementia).</div></div><div><h3>Main measurements</h3><div>Place of care (home, nursing home, hospital), end of life (EOL) trajectory (organ failure, cancer, dementia, multimorbidity), type of analgesic treatment and pain management according to the Pain Management Index scale.</div></div><div><h3>Results</h3><div>The study included 183 patients. The most frequent EOL trajectory was dementia, followed by organ failure, multimorbidity and cancer. The most commonly used analgesic was paracetamol, while weak opioids were testimonial. Analgesic use differed according to EOL trajectory and place of care, with the use of strong opioids prevailing in cancer and hospital, respectively. Almost half of patients had negative PMI, and none non-pharmacological intervention for pain control was recorded.</div></div><div><h3>Conclusions</h3><div>In patients with ACD and palliative needs, the use of strong opioids continues to prevail in the hospital setting and oncological disease, although pain is highly prevalent in all EOL trajectories and places of care. The high percentage of negative PMI reveals the opportunity for an individualised analgesic ladder stepping for better pain control. Also, incorporating non-pharmacological approaches could help improve pain in these patients.</div></div>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 5","pages":"Article 103135"},"PeriodicalIF":1.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calidad de la atención en podología universitaria. Análisis del cuestionario de satisfacción del paciente","authors":"Fátima Santalla Borreiros ,&nbsp;Ramón González Cabanach ,&nbsp;Manuel Romero-Soto ,&nbsp;Antonio Souto-Gestal","doi":"10.1016/j.aprim.2024.103138","DOIUrl":"10.1016/j.aprim.2024.103138","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the validity and reliability of a patient satisfaction questionnaire designed to measure the quality of care in university podiatry clinics, and to analyze the perception of care quality in this teaching-assistance setting.</div></div><div><h3>Design</h3><div>Descriptive cross-sectional observational study.</div></div><div><h3>Setting</h3><div>University Podiatry Clinic at the University of A Coruña (CUP-UDC), Spain.</div></div><div><h3>Participants</h3><div>Three hundred and fifteen adult users capable of completing a questionnaire on podiatric care quality, selected through consecutive sampling. The rejection rate was 4.3%.</div></div><div><h3>Interventions</h3><div>The “Quality of care in the clinical area of podiatry questionnaire” was used, specifically designed to measure the quality of care in university podiatry clinics. It evaluated clinical aspects, information, administration, facilities, timing, and accessibility on a 5-point Likert scale. Reliability was assessed using Cronbach's alpha coefficient.</div></div><div><h3>Results</h3><div>The overall mean score was 4.48<!--> <!-->±<!--> <!-->0.34 (“<span>Good</span>”). Factor analysis revealed six dimensions instead of the original five, suggesting a more valid structure. Internal consistency was high (Cronbach's alpha of 0.881). The best-rated factors were “Care”, “Procedures” and “Clinical aspects”.’ Item correlations showed some differences from the original study, highlighting a strong correlation between care received and staff friendliness.</div></div><div><h3>Conclusions</h3><div>The results indicate high satisfaction with care at CUP-UDC. The analyzed instrument proved to be valid and reliable for assessing care quality in the university podiatry setting from the service user's perspective. The new factor structure provides a more detailed view of the factors influencing care quality, offering valuable information to improve clinical practice and podiatry training.</div></div>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 5","pages":"Article 103138"},"PeriodicalIF":1.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El virus del Nilo Occidental en Andalucía: Una zoonosis recurrente sin respuesta","authors":"Pablo Fernández-León ,&nbsp;Juan Gómez-Salgado ,&nbsp;Javier Fagundo-Rivera","doi":"10.1016/j.aprim.2024.103144","DOIUrl":"10.1016/j.aprim.2024.103144","url":null,"abstract":"","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 4","pages":"Article 103144"},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programa educativo para la mejora de conocimientos y del rango terapéutico para pacientes anticoagulados autocontrolados","authors":"Adolfo Romero-Arana ,&nbsp;María José González-Rodríguez ,&nbsp;Patricia Sánchez-Vega ,&nbsp;Juan Jesús García-Iglesias ,&nbsp;Juan Gómez-Salgado ,&nbsp;Adolfo Romero","doi":"10.1016/j.aprim.2024.103139","DOIUrl":"10.1016/j.aprim.2024.103139","url":null,"abstract":"<div><h3>Introduction</h3><div>Oral anticoagulation Self-control programs have demonstrated efficiency over recent years.</div></div><div><h3>Objective</h3><div>The aim of the study was to evaluate the level of knowledge and coagulation level of self-controlled anticoagulated patients after an educational program.</div></div><div><h3>Design</h3><div>A quasi-experimental study, pre-test and post-test.</div></div><div><h3>Site</h3><div>Health area of the Hematology Service of the Virgen de la Victoria University Hospital (Málaga, Spain).</div></div><div><h3>Participants</h3><div>Self-monitored anticoagulated patients.</div></div><div><h3>Interventions</h3><div>Educational intervention about oral anticoagulation knowledge focused on patients that will initiate the self-control program in our consultation.</div></div><div><h3>Main measurements</h3><div>To check the patient's adherence and coagulation level, we evaluated the Rosendaal Time in Therapeutic Rank (TTRr), both before and after the intervention.</div></div><div><h3>Results</h3><div>145 patients have been included from 2016 to 2022 with a mean age of 49.18 years (SD 17.24). The mean score for the first test about knowledge was 14.61 (SD 3.26) and the mean score for the second test was 17.01 (SD 2.14) (p &lt;<!--> <!-->0.001). Values before and after interventions were also statistically significant (67.46 vs 70.53, p&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>The results showed that knowledge improved after the training session and the TTR values are better after the training which appears to be an effective action to improve the knowledge about oral anticoagulation in these patients.</div></div>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 5","pages":"Article 103139"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actividades comunitarias realizadas en Atención Primaria entre 2018 y 2022: un estudio descriptivo","authors":"Diego Gabriel Mosteiro-Miguéns ,&nbsp;Maruxa Zapata-Cachafeiro ,&nbsp;Silvia Novío-Mallón ,&nbsp;Tania Alfonso-González ,&nbsp;Daniel De Bernardo-Roca ,&nbsp;Almudena Rodríguez-Fernández","doi":"10.1016/j.aprim.2024.103134","DOIUrl":"10.1016/j.aprim.2024.103134","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Observational, cross-sectional study.</div></div><div><h3>Setting</h3><div>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.</div></div><div><h3>Participants</h3><div>All nursing coordinators were invited to participate, as well as heads of service and those PHC professionals with greater knowledge of the CA developed.</div></div><div><h3>Main measurements</h3><div>A hetero-administered questionnaire on the characteristics, barriers and facilitators of CA was completed by means of a telephone interview.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 5","pages":"Article 103134"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcoidosis. Una manifestación infrecuente. A propósito de dos casos","authors":"Esperanza Salcedo Lobera,&nbsp;Jessica Martínez Molina,&nbsp;Francisco Espildora Hernández","doi":"10.1016/j.aprim.2024.103141","DOIUrl":"10.1016/j.aprim.2024.103141","url":null,"abstract":"","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 4","pages":"Article 103141"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of chronic diseases on all-cause mortality in Spain: A population-based cohort study","authors":"Elena Caride-Miana ,&nbsp;Domingo Orozco-Beltrán ,&nbsp;Jose Antonio Quesada-Rico ,&nbsp;Jose Joaquin Mira-Solves","doi":"10.1016/j.aprim.2024.103112","DOIUrl":"10.1016/j.aprim.2024.103112","url":null,"abstract":"<div><h3>Objective</h3><div>Our study aimed to assess the association between all-cause mortality and the most prevalent chronic diseases in Spain, including diabetes mellitus.</div></div><div><h3>Design</h3><div>Population-based retrospective cohort study.</div></div><div><h3>Site</h3><div>Spanish population (Spanish National Health Survey).</div></div><div><h3>Participants</h3><div>A population numbering 14,584 respondents of both sexes aged 40 years or older was selected.</div></div><div><h3>Main measurements</h3><div>The outcome variable was all-cause mortality over 6-year follow-up, measured by probabilistic cross-matching with the national death registry. Socioeconomic variables, health indicators, service use, and behavioral factors were collected. The main data source was the National Statistics Institute.</div></div><div><h3>Results</h3><div>Of the 14584 people included, 1346 (9.2%) died over 6-year follow-up. Regarding the most prevalent chronic diseases, those showing the strongest association with mortality were cancer (HR 1.74, 95% CI 1.40–2.16); chronic lung diseases (chronic obstructive pulmonary disease, bronchitis, or emphysema; HR 1.44, 95% CI 1.19–1.70); acute myocardial infarction (HR 1.33, 95% CI 1.08–1.65); and diabetes (HR 1.23, 95% CI 1.06–1.42). Less prevalent chronic diseases also increased mortality risk, including cirrhosis/liver disease (prevalence 1.5%; HR 1.67, 95% CI 1.22–2.29) and cerebrovascular diseases, including embolism and stroke (prevalence 2%; HR 1.39, 95% CI 1.07–1.81).</div></div><div><h3>Conclusions</h3><div>Chronic diseases affect over half the population aged 40 years and older in Spain. Some of the most prevalent conditions are closely associated with all-cause mortality. These include chronic lung diseases, acute myocardial infarction, and diabetes. Given their impact on mortality in the population, more efforts are needed in chronic disease prevention and management.</div></div>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":"57 5","pages":"Article 103112"},"PeriodicalIF":1.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}