Medicina de Familia-SEMERGEN最新文献

英文中文

Nationwide real-world assessment of the economic impact of obesity in Spanish healthcare settings (ECC-OS) 西班牙卫生保健机构肥胖经济影响的全国实际评估（ECC-OS）

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.semerg.2025.102662

J. Redondo-Antón , P. Pérez-Martínez , G. Cuatrecasas , M. Rubio-de Santos , S. Díaz-Cerezo

Objective

This study aimed to estimate the direct healthcare costs associated with obesity in primary care and hospital settings in the adult population in Spain, and to describe the sociodemographic and clinical characteristics of individuals diagnosed with obesity.

Methods

Observational, retrospective study using two unlinked nationwide public databases in Spain: the Primary Care Clinical Database (BDCAP) and the Specialized Care Activity Registry-Minimum Basic Data Set (RAE-CMBD), which collects data for hospitalizations. Adults aged ≥20 with obesity were identified based on diagnosis codes in medical records or discharge reports. Data included demographic and clinical characteristics, healthcare resource utilization, and characteristics of hospitalizations. Data for the year 2022 were analyzed independently for each database, using descriptive statistics.

Results

Of 34,338,405 adults aged ≥20 identified in 2022 in the BDCAP, 10.3% had body mass index (BMI) records and, of these, 37.1% presented a BMI ≥30 kg/m². 3,285,946 (9.6%) had a diagnosis code for obesity. These had more visits to primary care in 2022 (22.2 versus 11.6), diagnostic or therapeutic procedures (20.5 versus 12.4 per person), or prescriptions for chronic medication than those without a diagnosis code. Annual cost in primary care for 2022 were €1656 per person diagnosed with obesity, versus €851 per person without a diagnosis. A total of 15,969 admissions to hospitals due to obesity were registered in the RAE-CMBD, with a cost of €79.8 million.

Conclusions

Obesity is under-recorded in public databases in Spain. Individuals diagnosed with obesity have higher estimated per-person costs than those without an obesity diagnosis.

目的本研究旨在估计西班牙成人初级保健和医院环境中与肥胖相关的直接医疗保健成本，并描述被诊断为肥胖的个体的社会人口学和临床特征。方法观察性、回顾性研究，使用西班牙两个未关联的全国性公共数据库：初级保健临床数据库（BDCAP）和专门护理活动登记-最低基本数据集（RAE-CMBD），该数据库收集住院数据。根据病历或出院报告中的诊断代码确定年龄≥20岁的肥胖成年人。数据包括人口统计学和临床特征、医疗资源利用和住院特征。使用描述性统计，对每个数据库独立分析2022年的数据。结果在2022年BDCAP中确定的34,338,405名年龄≥20岁的成年人中，10.3%的人有身体质量指数（BMI）记录，其中37.1%的人BMI≥30 kg/m2。3285946人（9.6%）有肥胖诊断代码。与没有诊断代码的人相比，这些人在2022年有更多的初级保健（22.2次对11.6次）、诊断或治疗程序（20.5次对12.4次）或慢性病药物处方。2022年，诊断为肥胖的人均初级保健费用为1656欧元，而未诊断为肥胖的人均初级保健费用为851欧元。由于肥胖而入院的15 969人在医疗保健和医疗保健中心登记，费用为7 980万欧元。结论西班牙公共数据库中肥胖记录不足。被诊断为肥胖的人比没有被诊断为肥胖的人估计的人均成本更高。

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引用次数: 0

Redefiniendo el papel de los betabloqueantes tras un infarto de miocardio 重新定义心肌梗死后β受体阻滞剂的作用

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.semerg.2025.102647

V. Pallarés-Carratalá , V. Martín-Sánchez

引用次数: 0

SGLT2i compared to other non-insulin antidiabetics in Primary Care patients with earlier diabetes. Cohort profile and sample characteristics of DIAB-CV-AP study 早期糖尿病初级保健患者中SGLT2i与其他非胰岛素抗糖尿病药物的比较diabb - cv - ap研究的队列概况和样本特征

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.semerg.2025.102667

J. Pablo-Ortega , D. Rey-Aldana , A. Segura-Fragoso , P. Mazón-Ramos , M. Portela-Romero , J.R. González-Juanatey , S. Cinza-Sanjurjo

Aim

To describe the methodology and baseline characteristics of the sample of the DIAB-CV-AP study which, as a general objective of the cohort, aims to analyse the possible protective effect of iSGLT2 associated with metformin in patients with T2DM.

Methods

The National Health System's BIFAP Primary Care prescription database was used, which includes information on 20,831,855 patients. A total of 52,739 patients were identified who started a second non-insulin-based antidiabetic (NIAD) combined with metformin. After propensity score matching, 11,746 patients were obtained, 5873 in each group.

Results

The most used molecules as SGLT2i were dapagliflozin (51.3%) and empagliflozin (34.9%). The prevalence of CV risk factors was dyslipidemia (63.8%) and hypertension (62.9%), and CV disease was present in 7.7% of the patients. CKD prevalence was 1.8%. Patients in the SGLT2i group was younger (53.9 [10.3] vs 60.6 [13.1], p < 0.001) with had higher body mass index (32.6 [5.6] vs 31.6 [5.9]; p < 0.001), HbA1c (p < 0.001), better kidney function (p < 0.001) and lower albuminuria (p < 0.001). No differences were observed in the cholesterol levels (p = 0.519).

Conclusions

The findings of the DIAB-CV-AP study will expand our knowledge of SGLT2 inhibitors in the early stages of type 2 diabetes mellitus. The recruited cohort, with a lower baseline cardiovascular risk profile than other clinical trials and real-life studies, provides a solid basis for future analyses that will assess whether the protective effect at the cardiovascular and renal levels is reproduced in this clinical context.

目的：描述diab2 - cv - ap研究样本的方法和基线特征，该研究的总体目标是分析iSGLT2联合二甲双胍对T2DM患者可能的保护作用。方法使用国家卫生系统BIFAP初级保健处方数据库，其中包括20,831,855例患者的信息。共有52,739名患者开始了第二种非胰岛素型降糖药（NIAD）联合二甲双胍治疗。倾向评分匹配后，共获得11746例患者，每组5873例。结果SGLT2i使用最多的分子是达格列净（51.3%）和恩格列净（34.9%）。心血管危险因素的患病率为血脂异常（63.8%）和高血压（62.9%），7.7%的患者存在心血管疾病。CKD患病率为1.8%。SGLT2i组患者更年轻（53.9 [10.3]vs 60.6 [13.1], p < 0.001），体重指数更高（32.6 [5.6]vs 31.6 [5.9]; p < 0.001）， HbA1c (p < 0.001)，肾功能更好（p < 0.001），蛋白尿更低（p < 0.001）。胆固醇水平无差异（p = 0.519）。结论diab2 - cv - ap研究的发现将扩大我们对2型糖尿病早期SGLT2抑制剂的认识。与其他临床试验和现实研究相比，招募的队列具有较低的基线心血管风险概况，为未来的分析提供了坚实的基础，这些分析将评估心血管和肾脏水平的保护作用是否在该临床背景下重现。

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引用次数: 0

The effect of obesity on fertility: A systematic review 肥胖对生育的影响：一项系统综述

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.semerg.2025.102670

M. Efstratiou , M. Kantilafti , A. Hadjikou , S. Chrysostomou

Objective

Obesity and female infertility are two rising public health issues. The relationship between them has been partially explored; however, systematic reviews summarizing the impact of obesity on female infertility are limited.

Materials and methods

We investigated the relationships between obesity and infertility outcomes in adult females, through a systematic review using PubMed and Scopus databases.

Results

Findings from 14 studies concluded that obese women (as defined by body mass index – BMI) and centrally obese women (as defined by waist circumference – WC) experienced prolonged time to pregnancy (TTP) and a gradually increased risk of infertility compared to women with normal values for these indicators. Among the three obesity indicators, WC followed by BMI appeared to increase infertility risk when values exceeded normal thresholds. The waist–hip ratio – WHR indicator, though less frequently studied, displayed variability in results regarding TTP. As for linearity, this was investigated only for WC and BMI, revealing non-linear relationships with infertility risk and TTP, respectively. The relationship between obesity and infertility outcome is presented as positive, particularly in the case of central obesity in women of reproductive age. Overweight women experience negative effects on fertility, though not at the extent that appear on obese women.

Conclusions

The present study highlights the need for maintaining a healthy, normal weight for better fertility outcomes. Further research to uncover the deeper mechanisms of obesity that cause reproductive problems in women and their connection with various obesity indicators is encouraged.

肥胖和女性不孕是两个日益突出的公共卫生问题。它们之间的关系已被部分探讨；然而，总结肥胖对女性不孕症影响的系统综述有限。材料和方法通过对PubMed和Scopus数据库的系统综述，研究了成年女性肥胖与不孕结果之间的关系。结果来自14项研究的结果表明，与这些指标正常值的女性相比，肥胖女性（以体重指数（BMI）定义）和中心肥胖女性（以腰围（WC）定义）的怀孕时间延长（TTP），不孕风险逐渐增加。在三个肥胖指标中，当超过正常阈值时，WC紧随BMI似乎会增加不孕风险。腰臀比- WHR指标，虽然研究较少，但在TTP的结果中表现出可变性。在线性方面，我们只研究了WC和BMI，分别揭示了与不孕风险和TTP的非线性关系。肥胖和不孕症结果之间的关系是积极的，特别是在育龄妇女的中心肥胖的情况下。超重女性的生育能力会受到负面影响，尽管程度不及肥胖女性。结论：本研究强调了保持健康、正常体重对提高生育效果的必要性。鼓励进一步研究揭示肥胖导致女性生殖问题的更深层次机制及其与各种肥胖指标的联系。

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引用次数: 0

Miasis cutánea, un desafío diagnóstico en atención primaria 皮肤Miasis——初级保健中的一项诊断挑战

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2025-12-17 DOI: 10.1016/j.semerg.2025.102651

E. Valverde-Valverde, A. Redondo-Sendino, M. Signoret-Sacristán

引用次数: 0

Association between psychoactive substance use and suicidal thoughts in the Colombian population during 2019 2019年哥伦比亚人口中精神活性物质使用与自杀念头之间的关系

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-10 DOI: 10.1016/j.semerg.2025.102668

K.J. Quintero Díaz , J. Martínez Torres , C.V. Martínez Cagua , Y.A. Cagua Ardila , C.M. Barrera Rangel , M. Gallego Granada , E. Barrera Angarita , O.A. Gutierrez Lesmes

Objective

To estimate the association between psychoactive substance use and suicidal thoughts among Colombians who consumed at least one psychoactive substance in the last twelve months of 2019.

Methods

Analytical cross-sectional study. This report corresponds to a subsample of the National Survey on Psychoactive Substance Use (2019), which analyzed 27,252 individuals, habitual residents of Colombia, aged between 12 and 65 years, who reported having used at least one psychoactive substance in the past 12 months. Sociodemographic characteristics (age, sex, ethnicity, marital status), the frequency of suicidal thoughts in the previous 12 months, and the use of 14 psychoactive substances during the same period (including alcohol, cigarettes, among others) were examined. For each of the 14 included substances, an independent question was asked to determine whether the respondent had used that substance in the past 12 months. Generalized linear models (family: binomial; link: log) were used to estimate the association between suicidal thoughts and the use of different psychoactive substances.

Results

All the substances analyzed showed relationships with STs, except for alcohol and ecstasy. Notably, those who consumed coca paste (PR: 16.16, 95% CI: 10.97–23.70) and cocaine (PR: 8.72, 95% CI: 6.52–11.68) evidenced the highest associations. Finally, a directly proportional relationship was found between the number of drugs used and the likelihood of having had suicidal thoughts.

Conclusions

There is a strong association between the consumption of psychoactive substances and suicidal ideation in the Colombian population during 2019.

目的：估计在2019年最后12个月中至少使用一种精神活性物质的哥伦比亚人使用精神活性物质与自杀念头之间的关系。方法：分析性横断面研究。该报告与全国精神活性物质使用调查（2019年）的子样本相对应，该调查分析了27,252名年龄在12至65岁之间的哥伦比亚惯常居民，他们报告在过去12个月内至少使用过一种精神活性物质。检查了社会人口特征（年龄、性别、种族、婚姻状况）、过去12个月内自杀念头的频率以及同期使用14种精神活性物质（包括酒精、香烟等）的情况。对于14种物质中的每一种，都有一个独立的问题来确定被调查者在过去12个月内是否使用过该物质。使用广义线性模型（家族：二项；链接：对数）来估计自杀念头与使用不同精神活性物质之间的关联。结果：除酒精和摇头丸外，所有分析物质均与STs有关。值得注意的是，那些食用古柯膏（PR: 16.16, 95% CI: 10.97-23.70）和可卡因（PR: 8.72, 95% CI: 6.52-11.68）的人证明了最高的相关性。最后，研究人员发现，使用药物的数量与产生自杀念头的可能性之间存在直接的比例关系。结论：2019年，哥伦比亚人口中精神活性物质的消费与自杀意念之间存在很强的关联。

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引用次数: 0

Reconocimiento y manejo de la alodinia en Atención Primaria: una revisión actualizada [初级保健中异常性疼痛的识别和管理：最新综述]。

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-12 DOI: 10.1016/j.semerg.2025.102664

A. Alcántara Montero , P.J. Ibor Vidal

Allodynia is a sensory disturbance that causes pain in response to stimuli that would not normally be painful, such as light touch, gentle pressure, or temperature changes. This phenomenon reflects a dysfunction in pain processing, which may originate in the peripheral or central nervous system, and is observed in various chronic conditions including fibromyalgia, postherpetic neuralgia, diabetic neuropathy, and certain types of postsurgical pain. Diagnosis in Primary Care requires careful clinical examination and assessment of both emotional and functional impact. Treatment should be tailored to each patient, combining drugs that modulate the nervous system with physical, educational, and psychological interventions. Regular clinical follow-up is essential, and referral to specialized units should be considered in complex cases. This article provides an updated narrative review of allodynia, aiming to enhance its recognition and management in everyday clinical practice.

异常性痛觉是一种感觉障碍，通常不会引起疼痛的刺激引起疼痛，如轻触、轻压或温度变化。这种现象反映了疼痛处理的功能障碍，可能起源于外周或中枢神经系统，并在各种慢性疾病中观察到，包括纤维肌痛、带状疱疹后神经痛、糖尿病神经病变和某些类型的术后疼痛。初级保健的诊断需要仔细的临床检查和评估情绪和功能影响。治疗应该针对每个病人，将调节神经系统的药物与身体、教育和心理干预相结合。定期的临床随访是必要的，在复杂的病例中应考虑转诊到专门的单位。本文对异位性疼痛进行了最新的叙述综述，旨在提高其在日常临床实践中的认识和管理。

引用次数: 0

Eccema de manos: abordaje integral y perspectivas terapéuticas en Atención Primaria 手部湿疹：初级保健的综合方法和治疗观点

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.semerg.2025.102673

F.J. Navarro-Triviño

Hand eczema is a common inflammatory dermatosis in primary care, characterized by erythema, pruritus, scaling, fissures, and functional impairment. It encompasses various clinical and etiological forms, either acute or chronic, related to irritant, allergic, or atopic mechanisms.

When the condition persists for more than three months or recurs at least twice within one year, it is defined as chronic hand eczema. This represents one of the most prevalent dermatoses, with substantial clinical, occupational, and psychosocial impact. Its multifactorial pathogenesis involves genetic predisposition, barrier dysfunction, and environmental exposures, particularly to occupational irritants and allergens.

In primary care, the family physician plays a key role in the early recognition of hand eczema, patient education on skin care and preventive measures, and in identifying alarm signs that warrant referral to a dermatologist. A focused history and clinical examination enable diagnostic orientation and allow the initiation, from the first consultation, of appropriate topical treatment, emollient use, and protection against triggering factors. Referral should be considered in severe, refractory cases or those with significant functional or occupational impact, in order to assess advanced therapies such as phototherapy, alitretinoin, dupilumab, oral JAK inhibitors, or topical delgocitinib.

手部湿疹是一种常见的炎性皮肤病，主要表现为红斑、瘙痒、脱屑、皲裂和功能损害。它包括各种临床和病因形式，无论是急性还是慢性，与刺激，过敏或特应性机制有关。当病情持续三个月以上或一年内至少复发两次时，定义为慢性手湿疹。这是最普遍的皮肤病之一，具有重大的临床、职业和社会心理影响。其多因素发病机制涉及遗传易感性、屏障功能障碍和环境暴露，特别是职业性刺激物和过敏原。在初级保健中，家庭医生在早期识别手部湿疹、对患者进行皮肤护理和预防措施的教育以及识别需要转诊给皮肤科医生的警报信号方面发挥着关键作用。有针对性的病史和临床检查有助于诊断方向，并允许从第一次咨询开始，适当的局部治疗，润肤剂的使用和对触发因素的保护。对于严重、难治性病例或对功能或职业有重大影响的患者，应考虑转诊，以便评估先进的治疗方法，如光疗、阿利维a、杜匹单抗、口服JAK抑制剂或外用德戈西替尼。

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引用次数: 0

Síndrome del escroto rojo: ¿una forma localizada de rosácea? 红阴囊综合征：酒渣鼻的局部形式？

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2025-12-17 DOI: 10.1016/j.semerg.2025.102649

A. Medina-Cobos , A. Cabrerizo-Carvajal , D. Gallego-García , D. Robles-Murcia , R. Ruiz-Villaverde

引用次数: 0

Asociación entre los factores sociodemográficos y los hábitos de salud con el riesgo de enfermedad hepática metabólica (MASLD) valorado mediante los índices FLI, HSI y LAP en los trabajadores españoles del sector comercio e industria 社会人口因素和健康习惯与西班牙商业和工业工人的代谢性肝病风险之间的关联（MASLD），使用FLI、HSI和LAP指数进行评估

IF 0.9 Q4 PRIMARY HEALTH CARE

Medicina de Familia-SEMERGEN

Pub Date : 2026-01-01 Epub Date: 2026-01-08 DOI: 10.1016/j.semerg.2025.102671

M.P. Fernández-Figares Vicioso , M.T. Vicente-Herrero , A. Ramírez Gallegos , J.I. Ramírez-Manent , P.J. Tárraga López , J.L. del Barrio Fernández , Á.A. López-González

Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a growing public health concern. Identifying associated sociodemographic and lifestyle factors is essential for implementing effective preventive strategies.

Objective

To analyze the association between sociodemographic variables (age, sex, educational level, and employment sector), health habits (physical activity, adherence to the Mediterranean diet, and smoking), and the risk of MASLD assessed through three non-invasive indexes: Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and Lipid Accumulation Product (LAP), in a large cohort of Spanish workers from the commerce and industry sectors.

Methods

A cross-sectional study involving 56,856 workers (34,448 men and 22,408 women). FLI, HSI, and LAP were calculated, and their associations with the independent variables were analyzed using descriptive statistics, group comparisons, and multinomial logistic regression.

Results

High MASLD risk was significantly associated with male sex, older age, lower education, employment in the industrial sector, physical inactivity, poor adherence to the Mediterranean diet, and smoking (all p< 0.001). Physical inactivity and a non-Mediterranean diet showed the strongest associations with elevated scores in FLI, HSI, and LAP.

Conclusions

Preventive interventions should prioritize high-risk subgroups. The combined use of FLI, HSI, and LAP allows accurate identification of MASLD risk in occupational settings.

代谢功能障碍相关的脂肪变性肝病（MASLD）已成为一个日益关注的公共卫生问题。确定相关的社会人口和生活方式因素对于实施有效的预防战略至关重要。目的分析社会人口统计学变量（年龄、性别、教育水平和就业部门）、健康习惯（体育活动、坚持地中海饮食和吸烟）与MASLD风险之间的关系，通过三个非侵入性指标：脂肪肝指数（FLI）、肝脂肪变性指数（HSI）和脂质积累产品（LAP），对来自西班牙商业和工业部门的大量工人进行评估。方法一项涉及56,856名工人（34,448名男性和22,408名女性）的横断面研究。计算FLI、HSI和LAP，并使用描述性统计、组间比较和多项逻辑回归分析其与自变量的相关性。结果MASLD高风险与男性、年龄较大、教育程度较低、工业部门就业、缺乏体育锻炼、地中海饮食依从性差和吸烟显著相关（p < 0.001）。缺乏体育活动和非地中海饮食与FLI、HSI和LAP得分升高的相关性最强。结论预防干预应优先考虑高危亚群。结合使用FLI， HSI和LAP可以准确识别职业环境中的MASLD风险。

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