Atencion Primaria最新文献

Routinely obtaining a sexual history is a necessary first step to identify which patients have specific sexual behaviours that may put them at risk and use appropriate protective measures, especially in vulnerable populations. However, late diagnosis of HIV infection remains very high. Combination prevention strategies based on condom promotion, harm reduction programs for people who inject drugs plus PrEP and HIV PEP are the best options to prevent new infections. Screening for STIs (including hepatotropic viruses) and early diagnosis and treatment are essential for the person since it improves the prognosis and complications and also for the community because it breaks the chain of transmission. People living with HIV who have an undetectable viral load do not transmit the virus sexually (undetectable=untransmittable).

Objective

To analyze the concordance between a hemoglobinometer with capillary blood sample and the clinical laboratory with a venous blood sample.

Design

Cross-sectional concordance study.

Location

Care Centre Primary Bufalà-Canyet Primary and Care Centre Primary Dalt la Vila Primary Care Center, Badalona, Barcelona.

Participants

Random selection of participants who attended routine blood tests. Over 18 years old. No abandonment or loss was obtained.

Main interventions and measurements

Sex, age, and reason for the blood test were collected from the medical history. Venous blood is drawn, and simultaneously, capillary blood is collected.

Results

120 individuals are included, with an average age of 58.9 years. The Bland-Almant graph showed differences within the confidence intervals for hemoglobin and hematocrit. The mean differences between the values of the Verio Q Red hemoglobinometer and those of the clinical laboratory were −0.42 mg/dl for hemoglobin and −1.25% for hematocrit. The intraclass correlation coefficient showed excellent correlation for hemoglobin and hematocrit between the Verio Q Red hemoglobinometer and the clinical laboratory. Pearson's correlation for hemoglobin was 0.737 and for hematocrit 0.787.

Conclusions

The Verio Q hemoglobinometer is a valid tool for the early diagnosis of anemias and can be very useful in primary care consultations.

Aim

To determine the proportion of people who undergo discharge follow-up when indicated.

Design

Retrospective longitudinal observational study, with an analytical approach.

Population

persons discharged from the Hospital Universitario de la Princesa of any age and sex, with any reason for admission and with an indication for discharge follow-up in Primary Care. Users who did not have an assigned Autonomous Personal Identification Code (CIPA) were excluded. Random sample (n = 289).

Variables

Discharge follow-up and readmissions (<30 days). Sociodemographic, clinical and discharge follow-up variables were included from the electronic medical records of Primary and Hospital Care. A descriptive analysis of the sociodemographic and clinical characteristics of the study population was conducted. To analyze the association between discharge follow-up and readmissions, a logistic regression model was used.

Results

Age 72.4 years (RIQ 60-87). 55.2% of the population were women. Follow-up was conducted in 61.2% of those indicated. According to the logistic regression model performed between early readmission and discharge follow-up, adjusted for all other factors, the group with discharge follow-up had a 66% lower likelihood of hospital readmission (OR 0.34, 95% CI (0.18-0.67)).

Conclusions

These findings suggest that nursing discharge follow-up conducted in primary care reduces the risk of early readmission.

Objective

To assess the job satisfaction (JS) of physiotherapists in Spain and their relationship with occupational violence, as with other socio-demographic, health, and occupational factors.

Design

A cross-sectional study was conducted.

Setting Primary, community, and hospital attention level at public and private care in Spain.

Participants

Physiotherapists in Spain who have been working for at least 3 months during the last year, and with complete answer to the required variables (n = 2,590).

Main measurements

Information was collected through a questionnaire distributed online. A descriptive quantitative analysis and 3 logistic regression models were performed. In the first model, sociodemographic and violence variables were included as independent variables, in the second, health-related variables, and in the third, occupational variables.

Results

The average JS of physiotherapists is 7.26 points, being 8 or more in 46.8% of the cases, with a higher percentage in men”. Referring not having suffered psychological violence was related to a higher probability of having JS, even controlling for the rest of the variables studied (OR¹ = 0.485; OR² = 0.611; OR³ = 0.697, respectively for each model).

Variables related to health (state of health, symptoms, consumption of tobacco/alcohol/other substances) and to the work environment (working day, work area, autonomy, relationship with superiors/colleagues) were statistically significantly related to JS.

Conclusions

Almost 47% of the respondents had very high JS values. Certain areas of work as well as positive health factors have been linked to very high JS. Psychological violence is the form of violence that, independently of the other factors analysed, leads to lower JS.

Objective

To assess strengths and weaknesses of the methodology of health education programs, carried out in the period 2010–2020, in schools in Serbia.

Design

Qualitative study, a thematic analysis approach.

Site

Representatives of Public Health institutions, Serbian biggest nongovernmental organization, Youth organization, Ministry of education and municipality.

Participants

Nine professionals working in the field of Public Health and Health education.

Method

Focus group gathered nine health and non-health professionals in 2022 year. Focus group was recorded, transcribed verbatim, coded and analyzed by three research team members. A coding template evolved through the analysis, providing the expansion of key concepts. Themes were, one by one, extracted, encoded, classified as the smallest units and interpretive, thematic analysis was applied.

Results

Although the Focus group in our study identified among other advantages, support of Health sector to Educational sector as crucial, it emphasized as well following weaknesses: Analyzed health education programs were implemented insufficiently as a separate process in schools, did not have the image of programs shared and integrated into community; Health education needs of schoolchildren, parents, and teachers should be examined prior the education implementation; Well-educated interdisciplinary educators have to be strengthened and supported; Parents participation is necessity; Standards and good practice guidelines are needed, and those developed through Health Promoting Schools program could be practiced.

Conclusion

It is necessary to support cross-curricular competence, where health education should be integrated into all school subjects, and should go far beyond the school, grow into a culture of community life, which will interconnect all stakeholders in strong Public Health network.

Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health.

Objective

To assess the association between electrocardiogram (ECG) patterns according to the MVP ECG risk score (morphology-voltage-P-wave duration) and a diagnosis of Atrial Fibrillation (AF).

Design

Prospective observational cohort study (1/01/2023-31/12/2024).

Site

Primary care.

Participants

Randomized sample of 150 patients aged 65-85 years without prior diagnosis of AF, stroke, or current anticoagulant treatment; high risk of future AF; CHA2DS2-VASc ≥ 2; and ability to use the FibricheckR application (App).

Measurements

At baseline, a standard ECG, MVP risk score assessment, and cardiac rhythm monitoring for 15 days using the Fibricheck^R App were performed. The dependent variables were the presence of P-wave patterns on the electrocardiogram according to MVP risk score and a new diagnosis of AF.

Results

The diagnosis of AF was confirmed in 14 cases (9.3%, 95% CI 5.6-15.1), 3 men and 11 women. In 3 cases, the arrhythmia was diagnosed on the baseline ECG, and in 11 cases by Holter after being reported as possible AF by the Fibricheck^R App. A higher prevalence of atypical advanced interatrial block (A-AIB) (p 0.007) was detected among participants with AF, as well as the prevalence of P-wave < 0.1 mV. (p = 0.006). All new diagnoses of AF were made at scores ≥ 4 in the MVP risk score.

Conclusions

Using scales for identifying ECG patterns in high-risk subjects in primary care can facilitate the diagnosis of unknown AF.

The high incidence of obesity in our environment, the progressive and recurrent nature of this disease makes it necessary to know and use all the possibilities of prevention and treatment.

When a person suffers from obesity we must offer a treatment plan with specific objectives that will include healthy eating, physical activity and, if necessary, treatment with medication or even surgery.

At present in Spain, there are 3 medications available:

• •

  Orlistat, with low efficacy and little use.

• •

  Liraglutide and semaglutide, both based on incretins and capable of improving obesity, diabetes and other obesity-related conditions. The high potency and safety of these drugs has revolutionized the pharmacological treatment of obesity.

New molecules will soon be marketed that will expand the treatment possibilities, which will also be reviewed in this article.