Alimentación y nutrición en atención primaria en Brasil

Objective

To describe food and nutrition actions in primary health care in Brazil.

Hiperfrecuentación en Atención Primaria e hiperfrecuentadores en Urgencias

Objective

To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED).

Manejo del consumo de cannabis en población joven en Atención Primaria

Cannabis is currently the most frequently used illicit drug substance in developed societies, just behind legal alcohol and tobacco. In this article clinical implications concerning cannabis use, particularly in young people, are approached. It also points out ways to make a correct diagnosis in Primary Care, with special emphasis on prevention and treatment. This is the first level of care in most cases.     

Efecto de la educación en neurociencia del dolor en pacientes con fibromialgia: intervención grupal estructurada en atención primaria

ObjectiveTo evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE).DesignPre-post study.LocationUrban Primary Health Centre in Bilbao.ParticipantsPatients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥ 18 years.Intervention5 weekly sessions (2 hours each), and a reminder session one month later.Main measurementsCompliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ: ≥ 20% and ≥ 50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ < 39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up.ResultsAll the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ < 39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%).ConclusionsAn intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM.     

Participación social en la atención primaria en salud: tensiones y contradicciones

ObjectiveTo explore the perspectives of the decision makers and community members in primary health care (PHC) around the conceptualization of social participation (PS).DesignAn exploratory cross-sectional study with qualitative methodology.LocationHealth Centers of the Metropolitan Region (RM), Santiago, Chile.ParticipantsEight informants from the management level (group 1), 13 from execution level in PHC (group 2), 28 community members and four community agents of health (group 3).MethodInterviews and discussion groups were conducted, which were recorded and transcribed. The organization and analysis of the data was done with Atlas.ti 8.1. The narratives were systematized using a thematic analysis. All the documents were codified, and we hold periodic meetings to review the existing codes, as well as discussing the inclusion of new codes.ResultsGroup 1 refers to a more theoretical conception of PS. Group 2 expresses more concrete and operative dimensions. Group 3 indicates that PS is embodied in particular personal experiences. Groups 1 and 3 have more than one notion of social participation in health.ConclusionsAn institutional conception of participation prevails transversally, rooted since the 1990s. At the community level, the narratives take the form of collective practices lived around the improvement of the quality of community life mediated by the level of execution.     

Efectividad del Mini-Mental en la detección del deterioro cognitivo en Atención Primaria

ObjectiveTo evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose.DesignPooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain).SettingThe MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care.ParticipantsSubjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic.Principal measuresThe DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately.ResultsIn the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84 ± 0.02 vs 0.82 ± 0.02, p ≤ .001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52 ± 0.05) and was not improved by any MMSa cut-off point.ConclusionThe DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off.     

Gestión de los recursos humanos y estrategias de vacunación en atención primaria en Europa en la pandemia COVID-19

This article describes the management of human resource and the vaccination strategies in primary care in twelve European countries in relation to the COVID-19 pandemic. All the countries have found solutions to increase their workforce in primary care. Other healthcare professionals were incorporated to support family doctors assuming their tasks, under their supervision and coordination. The European Commission had a crucial role in the production, purchase and distribution of the vaccines. The engagement of primary care in the vaccination campaign has had an unequal participation in the different countries, although the greatest burden has been managed from the government's public health departments.     

Estudio prospectivo para evaluar la precisión diagnóstica en enfermedad anal benigna en atención primaria

ObjectiveTo analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases.DesignCross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery.SettingDepartment of General Surgery and Digestive Diseases. Castellon General Hospital.ParticipantsPatients diagnosed with a benign anal disease in PC and referred to our department.MeasurementsThe sensitivity, specificity and kappa index was calculated for each disease.ResultsA total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results.ConclusionsThe diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results.     

Índice de privación en España por sección censal en 2011

ObjectiveTo present the methodology used in the design and implementation of a deprivation index by enumeration district, and to describe the socioeconomic situation of Spain in 2011.MethodThe unit of analysis was the enumeration district (N = 35,960). Data came from the 2011 Population and Housing Census of Spain. Given both the sampling nature of the Census and the regulatory limitations of data confidentiality, variables were calculated indirectly by using the complement of the available variables. Checks were made to ensure reliability. The selection of the indicators took into account comparability with the MEDEA index. The inclusion of additional information was explored. A deprivation index was built using Principal Component Analysis. Sensitivity analysis of the index was performed for urban areas and the rest of the regions.ResultsUsing the census information, 22 indicators were calculated for 35,917 enumeration districts. The deprivation index was based on six indicators: manual and temporary workers, unemployment, insufficient education overall and in young people (aged 16 to 29 years), and dwellings without access to the internet. The map of Spain shows a gradient of decreasing deprivation from south-west to north-east.ConclusionsThe socioeconomic information of the 2011 census by enumeration district was used systematically. The drafted index, similar to the MEDEA, will facilitate the updated study of health inequalities for Spain overall following the economic recession that began in 2008.     

Efectividad de una intervención educativa breve en pacientes con insomnio en atención primaria

ObjetiveTo evaluate the effectiveness of providing an educational intervention in primary care (PC) alongside a pharmacological treatment for insomnia.DesignSingle blinded non randomised clinical trial.LocationTwo urban primary health centers in Gijón (Asturias, Spain).ParticipantsPatients who consulted for insomnia between July 2012-January 2013 and met the inclusion criteria (n = 50) were assigned systematically to the control group (CG) or intervention group (IG). All patients initiated treatment with lorazepam 1 mg in the evenings and had four weekly 15 min visits plus a follow-up visit after another month.InterventionsThe IG received training for control of stimuli, sleep hygiene and respiration and relaxation techniques in the four visits. The CG had only non invasive measures taken.MeasurementsConsidering as cured those who reached a Pittsburgh Sleep Quality Index PSQI < 6 or a 50% reduction from baseline level. It was also analyzed the change in the PSQI from baseline to final visit and to follow-up visit, and voluntary interruption of lorazepam. Analysis by Bayesian inference.ResultsTwelve out of recoveries after intervention against one out of 24 among control group. Mean change in PSQI to final visit and follow-up visit was: –4.7 (95%CrI:–5.9 to –3.5) and –6,3 (95%ICred: –7.5 to –5.1) in IG; –1.8 (95%ICred: –3 to –0.5) and –1.7 (95%ICred: –2.9 to –0.4) in CG. Interruption of lorazepan: in 4 controls (16,7%) and 9 (34,6%) in IG. Twenty nine patients in GI and 17 in GC completed the trial. Per protocol analysis showed similar results.ConclusionsThe educational intervention in PC improves sleep quality and reduces the need of treatment with benzodiacepines.     

Percepción del riesgo de contraer una enfermedad de transmisión sexual en población joven

ObjectiveTo find out the perception of the risk of adquire a sexually transmitted disease (STD) in young people (15–21 years), and their attitudes and behaviour to adopt protective measures in sexual relationships.DesignSocioconstructive qualitative study performed between the years 2006 and 2008SettingTwo Primary Care Centres in the city of Girona.ParticipantsA total of 34 young people selected from lists provided by doctors and key informers.MethodsTheoretical sample from different designed profiles. The data was obtained and saturated by performing 5 group interviews. A thematic content analysis of the narrative data was made of the categorical subject.ResultsThey had partial knowledge on AIDS and very little on other STD. The risk of pregnancy has the most influence on adopting protective measures. Despite easy access and knowledge of condoms, in some cases they are not used either in stable relationships or in sporadic ones, with different reasons for having this risk behaviour. They have limited contact with the health services, and when they do it is mainly to ask for emergency contraception.ConclusionsHealth strategies should be directed towards adolescents, taking into account what they need from the health services as regards sexual health, in a different context from the health centre. Information should be focused on combating erroneous beliefs, such as AIDS is a disease of “others” and not “ours”, and address these actions, not only to improve knowledge and attitudes but also changes in behaviour.