Medicina de Familia-SEMERGEN最新文献

英文中文

La formación en Medicina Familiar y Comunitaria en el grado de Medicina en las universidades españolas: análisis de la situación actual

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-22 DOI: 10.1016/j.semerg.2024.102437

E. Jiménez-Martínez , A. Fernández-Ramos , S. Cinza-Sanjurjo , V. Martín-Sánchez , A. Barquilla-García , R. Micó-Pérez

Objective

To analyse the specific training in Family and Community Medicine (FCM) that is taught in the medical degrees in Spain.

Method

Descriptive and cross-sectional study based on the content analysis of the study programs and teaching guides based on the official information that universities offer on their study programs and teaching guides for the 2023-2024 academic year. The specific FCM subjects, the number of credits, their theoretical-practical nature and the clinical rotations were identified. The universities were classified according to their training offer in FCM, both theoretical and practical, and as a whole.

Results

There are 49 Spanish universities with a degree in Medicine, 35 public and 14 private. Of these, 40 degrees include some theoretical-practical subject with content on FCM, 27 of which with some specific subject on FCM and 13 degrees with more general subjects in which other specialties are also addressed. On the other hand, 44 degrees have clinical rotations or supervised internships that include MF&C, 21 of which are specific to MF&C and 23 general courses that include several specialties. In the overall classification, 7 universities would be at the level corresponding to the degrees in which there is sufficient training in theory and practice of MF&C; 33 would be at an intermediate level, with some training in MF&C in one of the two types of subjects considered, and 9 universities would be at the bottom level, with deficiencies both at the level of theoretical-practical subjects and clinical rotations.

Conclusions

The presence of MF&C in the degrees of Medicine of Spanish universities has been increasing in recent years, but it is still insufficient. There is a great variability between universities, but at a general level there is a significant lack of theoretical-practical subjects specific to MF&C and specific clinical rotations in Primary Care or with sufficient credits.

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引用次数: 0

Triple inhaled therapy of formoterol/glycopyrrolate/budesonide reduces the use of oral corticosteroids and antibiotics during COPD exacerbations in real-world conditions 福莫特罗/甘罗酸酯/布地奈德三重吸入治疗减少了在现实条件下COPD加重期间口服皮质类固醇和抗生素的使用。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-18 DOI: 10.1016/j.semerg.2024.102418

A. Calderón-Montero , J. de Miguel Diez , R. de Simón Gutiérrez , S. Campos Téllez , A.D. Chacón Moreno , R. Alonso Avilés , N. González Alonso , A. Montero Solís , D. Escribano Pardo

Introduction

Triple inhaled therapy (TT) in one device has been shown in clinical trials to reduce exacerbations and in some cases mortality compared to dual inhaled therapy (DT) in one device in the population of moderate to very severe COPD patients and previous exacerbations. This evidence must be contrasted in real-world conditions.

Patients and methods

Non-intervention retrospective cohort study comparing the incidence of moderate and severe exacerbations in COPD patients treated with TT (formoterol, glycopyrrolate and budesonide, 5 mcg/72 mcg/320 mcg, n = 112) and DT (LAMA/LABA/ or LABA/inhaled glucocorticoid, n = 107) for 26 weeks under clinical practice conditions. Moderate exacerbations were evaluated by the use of oral corticosteroids and/or courses of oral antibiotics and/or attendance at the emergency room (<24 h) without hospitalization. Severe exacerbations were analyzed for hospitalizations for all causes, respiratory causes, cardiovascular causes, and pneumonia. Descriptive statistics for qualitative and quantitative variables, Chi square, Student's t-test and multivariate analysis were performed.

Results

Both cohorts were homogeneous except for age (71.46 vs 66.65 TT vs DT, p < 0.01). TT reduced the use of oral corticosteroids by 42% (HR 0.58; 95%CI 0.41–0.82, p < 0.01) and the use of antibiotics by 25% (HR 0.75; 95%CI 0.60–0.94, p < 0.01). Hospitalizations due to respiratory causes were 11% lower in the TT cohort (HR 0.89; 95%CI 0.79–0.99, p = 0.044) with no difference in the incidence of pneumonia.

Conclusions

Triple inhaled therapy in one device reduces the use of oral corticosteroids and antibiotics during COPD period of exacerbations and reduces respiratory hospitalizations without increasing the incidence of pneumonia in comparision with dual inhaled therapy.

临床试验显示，在中度至极重度COPD患者和既往加重的人群中，与单设备双重吸入治疗（DT）相比，单设备三重吸入治疗（TT）可减少加重和某些情况下的死亡率。这些证据必须在现实世界的条件下进行对比。患者和方法：无干预回顾性队列研究，比较临床条件下TT（福莫特罗、甘罗酸酯和布地奈德，5mcg/72mcg/320mcg, n=112）和DT （LAMA/LABA/或LABA/吸入糖皮质激素，n=107）治疗26周COPD患者中重度加重发生率。通过使用口服皮质类固醇和/或口服抗生素疗程和/或到急诊室就诊来评估中度加重(结果：两个队列除年龄外均相同（TT vs DT 71.46 vs 66.65）。结论：与双重吸入治疗相比，使用一种装置的三联吸入治疗减少了COPD加重期口服皮质类固醇和抗生素的使用，减少了呼吸系统住院，而不增加肺炎的发病率。

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引用次数: 0

[Position statement of the Spanish Society of Primary Care Physicians (SEMERGEN) and Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the management of inflammatory bowel disease in Primary Care]. [西班牙初级保健医师协会（SEMERGEN）和西班牙克罗恩病和溃疡性结肠炎工作组（GETECCU）关于初级保健中炎症性肠病管理的立场声明]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-17 DOI: 10.1016/j.semerg.2024.102334

Daniel Ginard, Noelia Fontanillas, Iria Bastón-Rey, M Elena Pejenaute, Marta Piqueras, Silvia Alcalde, Pilar Nos, Mercedes Ricote, Lucía Expósito, Míriam Mañosa, Manuel Barreiro-de Acosta, Francisco Rodríguez-Moranta, Yamile Zabana, José Polo, Ana Gutiérrez

Primary Care is the first point of contact for most patients after the onset of symptoms of inflammatory bowel disease (IBD). Establishing an initial diagnostic process based on compatible symptoms and agreed criteria and referral pathways, depending on the degree of suspicion and the patient's situation, can reduce diagnostic delays. Once the patient is referred to the Digestive specialist and the diagnosis of IBD is established, a treatment and follow-up plan is structured. The management of the patient must be shared with the participation of the family practitioners in the diagnosis and treatment of concomitant or intercurrent pathologies, the recognition of flare-ups or complications (of IBD or treatments), education tasks or adherence control. With the purpose of developing a comprehensive guide on the management of IBD aimed at Primary Care doctors, we have developed this positioning document collaboratively between the Spanish Society of Primary Care Physicians (SEMERGEN) and the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU).

初级保健是大多数炎症性肠病（IBD）患者出现症状后的第一个接触点。根据怀疑程度和病人的情况，根据相容的症状和商定的标准和转诊途径建立初步诊断程序，可减少诊断延误。一旦患者被转介到消化专家，并确定了IBD的诊断，就会制定治疗和随访计划。患者的管理必须与家庭医生共同参与诊断和治疗伴随或并发的病理，识别突发或并发症（IBD或治疗），教育任务或依从性控制。为了制定针对初级保健医生的IBD管理综合指南，我们与西班牙初级保健医生协会（SEMERGEN）和西班牙克罗恩病和溃疡性结肠炎工作组（GETECCU）合作制定了这一定位文件。

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引用次数: 0

Evaluación de las propiedades psicométricas de la escala Morisky de adherencia terapéutica de 8 ítems (MMAS-8) para anticoagulantes orales en población española [8项Morisky药物依从性量表（MMAS-8）对西班牙人群口服抗凝剂的心理测量特性的评估]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-16 DOI: 10.1016/j.semerg.2024.102439

A. Borrás-Gallén , D. Orozco-Beltrán , J.A. Quesada , C. Carratalá-Munuera , A. López-Pineda , R. Nouni-García , V. Pérez-Jover

Aim

The use of oral anticoagulants has increased due to the rising prevalence of auricular fibrillation, a condition that raises the risk of thromboembolic events. These drugs are effective in preventing such events, but their success depends on therapeutic adherence, which requires validated tools for assessment. The aim of this study is to evaluate the suitability of the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire in its adapted version for the Spanish population.

Materials and methods

An observational, descriptive, cross-sectional study was conducted in health centres in Jávea and Pego between 2017 and 2022. A total of 211 patients treated with oral anticoagulants for at least 6 months participated. To assess adherence, the Spanish version of the MMAS-8 questionnaire was used. Reliability was determined using McDonald's Omega coefficient and the test-retest method, while validity was assessed through factor analysis.

Results

The Omega coefficient of 0.69 indicated moderate internal consistency. Items 1 and 8 showed moderate agreement, while the other items demonstrated weak agreement, resulting in overall moderate concordance. Construct validity analysis showed little variability, suggesting that the scale does not clearly reflect a unidimensional structure.

Conclusions

The MMAS-8 scale demonstrated moderate internal consistency and low temporal stability. Furthermore, the results suggest that the scale is not suitable for measuring adherence in patients treated with oral anticoagulants due to its lack of robustness in the studied population.

目的：口服抗凝剂的使用已经增加，由于耳廓纤颤的患病率上升，这种情况增加了血栓栓塞事件的风险。这些药物在预防此类事件方面是有效的，但它们的成功取决于治疗的依从性，这需要经过验证的评估工具。本研究的目的是评估Morisky药物依从性量表-8 （MMAS-8）问卷在西班牙人口中的适用性。材料和方法：2017年至2022年在Jávea和Pego的卫生中心进行了一项观察性、描述性、横断面研究。接受口服抗凝剂治疗至少6个月的患者共211例。为了评估依从性，使用西班牙语版MMAS-8问卷。信度采用麦当劳ω系数法和重测法确定，效度采用因子分析评估。结果：欧米茄系数为0.69，内部一致性中等。第1项和第8项为中等一致性，其余项为弱一致性，整体为中等一致性。构念效度分析显示，量表变化不大，说明量表并没有清晰地反映出一个单维结构。结论：MMAS-8量表具有中等的内部一致性和较低的时间稳定性。此外，结果表明，该量表不适合测量口服抗凝治疗患者的依从性，因为它在研究人群中缺乏稳健性。

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引用次数: 0

Actualización del diagnóstico y tratamiento de dismenorrea [痛经诊断和治疗的最新进展]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-01 DOI: 10.1016/j.semerg.2024.102331

G. Rubio Pérez , A. Quevedo Córdoba , L. Varela Silva , E. Álvarez Silvares

Dysmenorrhea is defined as pain of uterine origin during menstruation. It's one of the most frequent symptoms in women of childbearing age and an important cause of school or work absenteeism as well as a frequent reason for scheduled or urgent consultation.

In the diagnosis, it's of great importance to take an adequate anamnesis that includes personal and gynecological-obstetric history, detailed description of the pain and chronology regarding the beginning of menstrual bleeding and previous treatments. Ultrasound is not routinely indicated and is the test of choice in those cases in which pelvic pathology is suspected as the cause of dysmenorrhea.

Both Paracetamol and NSAIDs have demonstrated superior efficacy in relieving pain compared to placebo. Hormonal treatment with either

combined hormonal contraceptives or progestin-only contraceptives is considered an effective treatment for primary and secondary dysmenorrhea.

The recent Organic Law 1/2023 provides for disabling dysmenorrhea to be covered by the temporary incapacity benefit through the creation of a new special type of this contingency «in order to reconcile the right to health with employment».

痛经是指月经期间子宫疼痛。痛经是育龄妇女最常见的症状之一，也是造成旷课或旷工的重要原因，同时也是预约或紧急就诊的常见原因。在诊断时，最重要的是充分了解病史，包括个人和妇产科病史、疼痛的详细描述、月经开始出血的时间顺序以及之前的治疗情况。超声波检查并非常规检查方法，但在怀疑盆腔病变是痛经原因的情况下，超声波检查是首选检查方法。扑热息痛和非甾体抗炎药在缓解疼痛方面的疗效优于安慰剂。使用联合荷尔蒙避孕药或纯孕激素避孕药进行荷尔蒙治疗被认为是治疗原发性和继发性痛经的有效方法。最近颁布的第 1/2023 号组织法规定，"为了协调健康权和就业权"，临时丧失工作能力补助金应包括致残性痛经，为此设立了一种新的特殊类型的应急措施。

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引用次数: 0

Prueba de Chi cuadrado de homogeneidad en estudios clínicos: una herramienta para analizar diferencias entre tratamientos [临床研究中的同质性卡方检验：分析不同疗法之间差异的工具]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-01 DOI: 10.1016/j.semerg.2024.102332

R.M. Montaña , Á. Roco-Videla , A.R. Nieves , S.V. Flores

This article explores the application of the chi-squared test of homogeneity in the context of clinical studies, using a previous study on the efficacy of two analgesics for treating headache as an example. The sample included 215 patients, whose responses to treatment were assessed and recorded across four pain intensity categories. The test allowed for the identification of significant differences between the treatments evaluated, proving to be a valuable statistical tool for comparing groups in clinical research. This approach provides clarity and precision in the interpretation of categorical data, essential for informed decision-making in medical practice.

本文以之前一项关于两种镇痛药治疗头痛疗效的研究为例，探讨了同质性卡方检验在临床研究中的应用。样本包括 215 名患者，评估并记录了他们对四种疼痛强度类别的治疗反应。通过该测试，可以确定所评估的治疗方法之间存在显著差异，证明它是在临床研究中进行组间比较的重要统计工具。这种方法可以清晰、准确地解释分类数据，对于医疗实践中的知情决策至关重要。

引用次数: 0

Anticoagulantes orales directos: un nuevo escenario clínico en el manejo del tromboembolismo venoso [直接口服抗凝剂：静脉血栓栓塞治疗的新临床方案]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-01 DOI: 10.1016/j.semerg.2024.102305

E. Martín Riobóo , M. Turégano-Yedro , J.F. Peiró Morant , V. Pallarés-Carratalá

引用次数: 0

Prevalencia de la disfunción tiroidea en pacientes con diabetes mellitus tipo 2: una revisión sistemática [2型糖尿病患者甲状腺功能障碍的患病率：系统综述]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-01 DOI: 10.1016/j.semerg.2024.102336

F.M. Escandell Rico , L. Pérez Fernández

Thyroid diseases and type 2 diabetes mellitus are the two most common metabolic disorders that tend to coexist in patients. The objective of the present study is to have the most current evidence in relation to evaluating the prevalence of thyroid dysfunction in type 2 diabetic patients. During the review process, we followed recommendations to improve the publication of PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: “Patients”, “dysfunction”, “Thyroid”, “Diabetes Mellitus, Type 2”. Eight selected articles were analyzed. The articles were selected based on their relevance and published between 2020 and 2024.The most important discussion topics extracted in the analyzed articles refer to the high prevalence of thyroid disorders in patients with DM2, periodic monitoring of thyroid function and adequate management and control of diabetes. The implications of these results for medical practice refer to the need to improve health care through periodic monitoring of thyroid function and adequate management and control of diabetes. Thus, the high prevalence of thyroid dysfunction in patients with DM2 and specifically associated with female sex and age should be considered.

甲状腺疾病和2型糖尿病是两种最常见的代谢性疾病，往往同时存在于患者体内。本研究的目的是掌握与评估 2 型糖尿病患者甲状腺功能障碍患病率相关的最新证据。在综述过程中，我们遵循了改进PRISMA系统综述发布的建议。文献检索是在Cumulative Index to Nursing and Allied Health Literature (CINAHL)、SCOPUS、Scielo、MedLine/PubMed、Cochrane等数据库以及Google Scholar搜索引擎中进行的，采用自由和受控语言，使用MeSh检索词："患者"、"功能障碍"、"甲状腺"、"2 型糖尿病"。对所选的八篇文章进行了分析。分析文章中提取的最重要的讨论主题涉及甲状腺疾病在 DM2 患者中的高发病率、定期监测甲状腺功能以及充分管理和控制糖尿病。这些结果对医疗实践的影响是，有必要通过定期监测甲状腺功能以及充分管理和控制糖尿病来改善医疗服务。因此，应考虑到甲状腺功能障碍在DM2患者中的高发病率，特别是与女性性别和年龄相关的甲状腺功能障碍。

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引用次数: 0

Uso de la capsaicina tópica en enfermedad dolorosa: revisión de indicaciones basadas en la evidencia [使用局部辣椒素治疗疼痛：回顾与循证适应症]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-01 DOI: 10.1016/j.semerg.2024.102312

R. Mora-Boga

Topical capsaicin is a medication that has been used for years in the treatment of pain, whose effectiveness is based on its ability to cause permanent partial denervation of the superficial terminal nerve fibers, in spite of the fact that it must be used at high doses and for a period of time to perform this effect.

The use of capsaicin in the treatment of neuropathic pain currently has a high level of evidence, and the use of casaicin 8% can be recommended as a second choice medication in the treatment of these pathologies. Capsaicin has actually a good level of evidence in knee osteoarthritis and rheumatoid arthritis. However, although its use is spreading in the treatment of painful osteotendinous syndromes, there are currently no studies that analyze its effect, so we must be cautious when we indicate capsaicin in these pathologies.

外用辣椒素是一种多年来一直用于治疗疼痛的药物，其有效性在于它能够使浅表末端神经纤维永久性地部分去神经化，尽管它必须以高剂量并持续一段时间才能发挥这种作用。目前，使用辣椒素治疗神经病理性疼痛的证据水平很高，可以建议将 8%的辣椒素作为治疗这些病症的第二选择药物。实际上，辣椒素在治疗膝关节骨关节炎和类风湿性关节炎方面也有很好的证据。不过，虽然辣椒素在治疗骨腱疼痛综合征方面的应用正在不断扩大，但目前还没有对其效果进行分析的研究，因此我们在推荐辣椒素用于这些病症时必须谨慎。

引用次数: 0

Primer caso descrito en la literatura mundial de paciente con trombastenia de Glanzmann intervenido de catarata subcapsular posterior en el ojo izquierdo [世界文献中描述的首例格兰兹曼血栓性白内障患者接受左眼后囊下白内障手术的病例]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2025-01-01 DOI: 10.1016/j.semerg.2024.102315

F.J. Suárez-Guzmán

引用次数: 0

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