Atencion Primaria Practica最新文献

In the treatment of anxiety, non-pharmacological measures must be present, both in monotherapy in the case of mild or moderate anxiety and in combination with pharmacological treatments. Some of them have sufficient studies to support a high degree of recommendation and others, although not supported by studies of high level of evidence, are recommended due to the absence of adverse effects in their use. Among these measures are motivational interviewing, psychotherapies, psychoeducational, relaxation techniques, mindfulness, yoga, aromatherapy, therapy through images and use of new technologies, among others. The use of them may be isolated or consist of a combination of several techniques and always adapting it to the intrinsic characteristics of the person suffering from anxiety and their environment.

Anxiety is a natural response that sometimes generates excessive suffering and maladaptation. Anxiety disorders have intensified during the 21st century, leading to increased diagnosis and treatment. The determinants are diverse (biological, psychological, social, and environmental). The text highlights the role of social determinants and how changes in the last century have created an anxiety-inducing environment. Technology and social media contribute to anxiety through dependency, cyberbullying, and overexposure to negative information. Workplace, body image, and lack of privacy also contribute to anxiety. Climate change generates eco-anxiety and concern for the future, particularly affecting young people. Extreme weather events and forced migration increase the risk of mental disorders. In summary, the rise of anxiety in contemporary society appears to be due to a complex interplay of social, technological, occupational, and environmental factors.

The burden on Primary Care professionals to carry out assessments and treatments for mild mental disorders (MMD), with the rigour of clinical practice guidelines and available resources, leads to over-medicalization and the consequent higher health expenditure and the possibility of chronicling the problem. To treat mild mental disorders, specifically anxiety disorders, multiprofessional work is proposed (doctors, psychologists, nurses, pharmacists) where the patient occupies the center of actions. Clinical psychologists incorporated into health centers perform psychological assessment of patients referred by family doctors, to form therapy groups. PC nurses develop some interventions, depending on the level of anxiety experienced by the person and following the systematic nursing care plan. Community pharmacists detect anxiety-related problems early, are actively involved in the dispensing service and, with proper training, provide emotional support and counseling to the anxious patient.

Acute pancreatitis is an inflammatory pathology involving the exocrine pancreas. Biliary stones and alcohol are its most common etiological factors; it is mentioned that around 10% of acute pancreatitis cases are caused by other factors, such as infections by parasites, bacteria, and viruses. We present the case of a patient who started with a febrile condition for three weeks and, in the last week, developed abdominal symptoms, leading to a diagnosis of acute viral pancreatitis based on clinical and laboratory criteria. A literature review on this topic is also provided.

The main objective of the treatment for anxiety disorders is to relieve symptoms, prevent relapse and avoid sequels. An integral therapeutic approach most be considered (psychosocial, biologic and pharmacologic). The antidepressants and anxiolytics are the mainstay pharmacological treatment. When the prescription is made, the patient must be informed of therapeutic objectives, duration and possible side effects. Age, previous treatment, tolerance, pregnancy and side effects most be considered. In Spain there is a high rate of prescription and consume of antidepressants and anxiolytics: the data of “Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)” support that the consume of antidepressants in Spain has passed from 26.5 DHD (Daily doses per 1000 habitants/Dose per day per 1000 habitants) in the year 2000 to 79.5 DHD in the year 2013; translating and increment of 200%. Regarding the anxiolytics the DHD has increased from 50.88 in 2012 to 58.09 in 2022.

Introduction and objectives

Patients with diabetes are prone to cognitive decline, including memory loss, decreased attention, and processing speed. This study aims to evaluate cognitive impairment in patients with diabetes and the factors associated with cognitive decline.

Materials and methods

A cross-sectional study was conducted over 5 months targeting 318 previously diagnosed patients with diabetes from 2 endocrinology clinics. The Arab version of the Mini-Mental State Examination assessed cognitive function through 11 items exploring 6 cognitive domains. Participants' general characteristics, lifestyle, and medical history were collected. They were also asked about the management of their diabetes (type of and adherence to medication and doing regular laboratory tests or glycemic monitoring at home). Other information, such as glycated hemoglobin A1c, cholesterol, and triglycerides level, was retrieved from the patient's files while noting the patient's systolic and diastolic blood pressures.

Results

Patients had a mean age of 59.8 (10.7). Around 68% of patients had a possible cognitive impairment, and 31.8% a normal cognitive function. Significantly lower scores were noted among females (20.0; P < .001), and older patients had lower cognitive functions than others (19.4; P < .001). Illiterate had significantly lower scores (15.0) than those with advanced education (24.9; P < .001). Participants with diabetes for more than 5 years (20.8) and those with uncontrolled glycemia (20.8) had lower cognitive function than patients diagnosed more recently (22.2; P = .021) or those with controlled glycemia (23.1; P < .001). A cognitive decline was found among those with total cholesterol ≥ 200 mg/dL (20.7 vs. 21.9; P = .044), a systolic blood pressure of 140 mmHg or more (20.0 vs. 22.5; P < .001), and hematocrit levels below 40% (20.6 vs. 22.4; P = .002). After adjusting for covariates, a lower cognitive function score was found per increase of 1 year of age (b =−0.120, CI (− 0.13, − 0.03); P = .038) and among females (− 0.186 (− 3.30, − 0.35); P = .016). An increase of a factor of 0.342 was found between the levels of education (CI (0.71–2.04); P < .001), and patients with uncontrolled glycemia had a significantly lower score than others. Moreover, having a systolic blood pressure ≥ 140 mmHg decreased the cognitive function score by a factor of 0.147 (CI (− 2.98, − 0.01); P = .049).

Conclusion

The combined effect of these factors should be considered for treatment management and glycemic control to help early referrals of patients at risk.

The consumption of benzodiazepines in our environment has increased in recent years due to the increase in Mental Health disorders caused by the COVID-19 pandemic. However, the data already showed a previous increase not only in Spain but worldwide. The causes detected are the lack of time, the inertia of the doctor and the patient or the lack of knowledge in the management of its withdrawal. Most prescriptions are made in the Primary Care context. For this reason, it should also be the space in which the deprescriptions should be carried out. This article analyzes the causes of the increase, the moment in which they should be withdrawn, the strategies to be able to carry out a correct withdrawal and community strategies carried out in Spain that have contributed to reducing their consumption.

It is well known that primary care (PC) in Spain is under considerable stress due to the large volume of care it provides. The aging of the population, the increase in chronic pathologies such as diabetes and cardiovascular risk factors (hypertension and hyperlipidemia) and the growing complexity of diagnostic methods and treatments make it necessary for Family Physicians to be constantly updated. For this reason, the ENDMAP project was designed, a practical training program for Family Physicians in Endocrinology. This article presents how the project has evolved over its 5 editions and the results of the evaluation of the project by both attendees and trainers in terms of interest and usefulness.