Atencion Primaria最新文献_第5页

Disparidades en salud y determinantes legislativos en América Latina: análisis comparativo multivariado de la esperanza de vida, la mortalidad infantil y la inmunización en Chile, Colombia y Honduras (2011-2019) 拉丁美洲的健康差距和政策决定因素：智利、哥伦比亚和洪都拉斯的预期寿命、婴儿死亡率和免疫接种的多变量比较分析（2011-2019年）

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103428

Camilo Andrés Estupiñan Ruiz , Cristian Correa-Arrieta , Jeisson Andrés Hincapié-Carvajal

Objective

To compare the evolution of health indicators and their relationship with legal frameworks and health policies in Chile, Colombia, and Honduras between 2011 and 2019.

Design

Retrospective ecological study of time series, with multivariate and comparative analysis.

Setting

Secondary national-level data from PAHO and WHO.

Participants

General population, represented through indicators of life expectancy, infant mortality, and vaccination coverage.

Interventions

Review of laws, plans, and public health policies in force, including financing regulations and vaccination programs.

Main measurements

Life expectancy at birth (years), infant mortality rate (per 1,000 live births), coverage of three doses of pneumococcal conjugate vaccine (PCV3, %), legal framework and health policies.

Analysis

MANOVA for multivariate differences, multiple linear regression adjusted by country and year, Pearson correlation, and assumption diagnostics.

Results

Significant heterogeneity was found among countries (Pillai's trace = 1.0653; p < 0.001). In 2019, Chile showed the highest life expectancy (79.9 years) and the lowest infant mortality (7.04/1,000), while Honduras recorded the worst indicators (71.3 years; 18.8/1,000). PCV3 coverage was high and homogeneous (>90%) in all three countries. The correlation between life expectancy and infant mortality was very strong and inverse (r = –0.943; p < 0.001).

Conclusions

Health disparities are explained by interactions among economic, institutional, and legislative factors. Reducing them requires strengthening the legal framework, increasing public health expenditure, and promoting international cooperation.

目的比较2011年至2019年智利、哥伦比亚和洪都拉斯健康指标的演变及其与法律框架和卫生政策的关系。设计回顾性生态学时间序列研究，采用多变量分析和比较分析。设置来自泛美卫生组织和世卫组织的二级国家级数据。参与者：一般人群，通过预期寿命、婴儿死亡率和疫苗接种覆盖率指标表示。干预措施审查现行法律、计划和公共卫生政策，包括融资条例和疫苗接种规划。主要衡量指标：出生时预期寿命（岁）、婴儿死亡率（每1,000名活产婴儿）、三剂肺炎球菌结合疫苗（PCV3, %）的覆盖率、法律框架和卫生政策。多元方差分析，国家和年份调整的多元线性回归，Pearson相关性和假设诊断。结果不同国家间存在显著的异质性（Pillai's trace = 1.0653; p < 0.001）。2019年，智利的预期寿命最高（79.9岁），婴儿死亡率最低（7.04/ 1000），而洪都拉斯的指标最差（71.3岁；18.8/ 1000）。在所有三个国家，PCV3的覆盖率都很高且均匀（90%）。预期寿命与婴儿死亡率之间的相关性非常强，呈负相关（r = -0.943; p < 0.001）。结论健康差异是经济、制度、立法等因素相互作用的结果。减少这些疾病需要加强法律框架、增加公共卫生支出和促进国际合作。

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引用次数: 0

Communicating effectively with women experiencing socioeconomic vulnerability during the perinatal period: A systematic review 与围产期处于社会经济弱势的妇女有效沟通：一项系统综述

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103400

Ayse Akalin , Florence D’haenens , Joeri Vermeulen , Sandra Tricas-Sauras

Objective

To assess the evidence on communication interventions designed to support women experiencing socioeconomic vulnerability in the context of perinatal care.

Design

Systematic review based on narrative synthesis.

Data sources

Web of Science Core Collection, MEDLINE (PubMed), CINAHL (Ebsco), and The Cochrane Library.

Study selection

Following PRISMA guidelines, peer-reviewed qualitative, quantitative, and mixed-method studies published between 2013 and 2023 in English, Spanish, Dutch, French, or Turkish were included. Research from all care settings was eligible, except for studies conducted in low-income countries according to the Human Development Index.

Data extraction

Data extraction was performed at least two team members. Studies were analyzed through narrative synthesis. Methodological quality was assessed using the Critical Appraisal Tools developed by the Centre for Evidence-Based Management (CEBMa).

Results

Twelve studies met the inclusion criteria. Interventions included telehealth, home visits, peer-led initiatives, and tailored approaches such as Brief Interpersonal Psychotherapy and Motivational Interviewing. These interventions showed positive effects on breastfeeding, psychosocial well-being, maternal and neonatal health, and satisfaction with care, although outcomes varied in significance. Study quality ranged from moderate to high.

Conclusions

Although the evidence is limited, the findings suggest that communication interventions may improve perinatal care for women facing socioeconomic vulnerability. Further robust research is recommended.

Systematic review registration

The protocol for this review was registered in PROSPERO (registration number: CRD42023406466).

目的评估围产期护理中社会经济弱势妇女沟通干预的证据。基于叙事综合的系统评价。数据来源：web of Science Core Collection， MEDLINE (PubMed), CINAHL （Ebsco）和Cochrane Library。研究选择遵循PRISMA指南，纳入了2013年至2023年间以英语、西班牙语、荷兰语、法语或土耳其语发表的同行评议的定性、定量和混合方法研究。除了在低收入国家根据人类发展指数进行的研究外，所有护理机构的研究都符合条件。数据提取数据提取至少由两名团队成员执行。研究通过叙事综合进行分析。采用循证管理中心（CEBMa）开发的关键评估工具评估方法学质量。结果12项研究符合纳入标准。干预措施包括远程医疗、家访、同伴领导的倡议，以及量身定制的方法，如简短的人际心理治疗和动机性访谈。这些干预措施对母乳喂养、社会心理健康、孕产妇和新生儿健康以及对护理的满意度产生了积极影响，尽管结果的显著性有所不同。研究质量从中等到高不等。结论虽然证据有限，但研究结果表明，沟通干预可以改善面临社会经济弱势妇女的围产期护理。建议进行进一步有力的研究。系统综述注册本综述的方案已在PROSPERO注册（注册号：CRD42023406466）。

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引用次数: 0

Salud pública y cáncer cervicouterino en América Latina: impacto del gasto y legislación en la prevención en tres países 拉丁美洲的公共卫生和宫颈癌：支出和立法对三个国家预防工作的影响

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103427

Camilo Andrés Estupiñan Ruiz , Rubén Darío Morales Doncel , Jeisson Andrés Hincapié-Carvajal

Objective

To assess the association between public health expenditure, legal frameworks, and indicators of cervical cancer incidence, mortality, and female life expectancy in Chile, Colombia, and Nicaragua from 2012 to 2022.

Design

Descriptive and correlational ecological study based on nationally aggregated data.

Setting

Three Latin American countries with information from the Pan American Health Organization (PAHO).

Participants

General female population.

Interventions

Review of national health legislation and policies, including screening, vaccination, and financing mechanisms.

Main measurements

Public health expenditure (% GDP), female life expectancy at birth, and cervical cancer incidence and mortality rates per 100,000 women. Ten-year averages and Pearson correlation coefficients were calculated.

Results

In 2022, Chile showed the highest life expectancy (82.0 years) and the lowest mortality (11.3/100,000) with spending of 8.9% of GDP. Colombia reached 79.6 years of life expectancy, mortality of 12.7/100,000, and spending of 6.4%, while Nicaragua had the lowest investment (5.8%), lowest life expectancy (74.8 years), and highest incidence (20.6) and mortality (11.5). Strong negative correlations were found between life expectancy and incidence (r = −0.97) and mortality (r = −0.81), but weak correlation with public spending (r ≈ −0.13).

Conclusions

The effectiveness of cervical cancer prevention programs depends less on investment volume than on legal strength and strategic direction. Strengthening legislation, prioritizing primary care, and expanding screening and vaccination are key to eliminating this preventable disease in Latin America.

目的评估2012年至2022年智利、哥伦比亚和尼加拉瓜的公共卫生支出、法律框架、宫颈癌发病率、死亡率和女性预期寿命指标之间的关系。设计基于全国汇总数据的描述性和相关性生态学研究。设置三个拉丁美洲国家，提供来自泛美卫生组织的信息。参与者：一般女性人群。干预措施审查国家卫生立法和政策，包括筛查、疫苗接种和筹资机制。主要衡量指标：公共卫生支出（国内生产总值百分比）、女性出生时预期寿命、每10万名妇女的宫颈癌发病率和死亡率。计算十年平均值和Pearson相关系数。结果2022年，智利人均预期寿命最高（82.0岁），死亡率最低（11.3/10万），支出占GDP的8.9%。哥伦比亚的预期寿命为79.6岁，死亡率为12.7/10万，支出为6.4%，而尼加拉瓜的投资最低（5.8%），预期寿命最低（74.8岁），发病率最高（20.6岁），死亡率最高（11.5岁）。预期寿命与发病率（r = - 0.97）和死亡率（r = - 0.81）呈显著负相关，但与公共支出呈弱相关（r≈- 0.13）。结论宫颈癌预防项目的有效性主要取决于法律力量和战略方向，而不是投资规模。加强立法、优先考虑初级保健以及扩大筛查和疫苗接种是在拉丁美洲消除这一可预防疾病的关键。

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引用次数: 0

Características sociodemográficas e indicadores de preferencia de la población demandante de Manifestaciones Anticipadas de Voluntad 要求提前表示意愿的人口的社会人口特征和偏好指标

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103431

María Victoria Castañeyra Góngora, Xenia Cabrera Rodríguez

Objective

To analyze the sociodemographic characteristics, preferences, and satisfaction levels of individuals who registered their Advance Directive (Manifestación Anticipada de Voluntad, MAV) in Lanzarote.

Design

Observational, descriptive, prospective, and cross-sectional study.Setting. Advance Directive Office of Lanzarote, University Hospital Doctor José Molina Orosa (Canary Health Service).

Participants

Individuals aged 18 years or older who registered their MAV between January and December 2024.

Main measurements

Sociodemographic variables, motivations for completing the MAV, stated preferences, and level of satisfaction.

Results

A total of 527 users were analyzed (67.2% women; mean age 59.5 ± 14.3 years). Most had secondary or higher education (65.7%) and reported no religious affiliation (78.7%). The main motivation was the desire to exercise personal autonomy (38.5%), followed by the wish not to be a burden (33.2%). Organ donation was indicated by 73.2% of participants, and 86.7% accepted euthanasia in the context of moderate dementia. Significant associations were found between educational level and acceptance of euthanasia (χ²(6) = 39.27; p< 0.001), and between the motivation for completing the MAV and both sex (χ²(4) = 11.70; p = 0.020) and religion (χ²(20) = 463.49; p< 0.001). Overall, 99.1% reported being satisfied with the care received.

Conclusions

The predominant profile was that of a Spanish woman, middle-aged or older, with higher education. Autonomy at the end of life emerged as the main motivation, with differences observed according to sex and religious beliefs. The findings highlight the need to strengthen professional training and communication strategies to promote the use of Advance Directives.

目的分析兰萨罗特州登记了预先指示（Manifestación predicada de Voluntad， MAV）的个人的社会人口学特征、偏好和满意度。设计：观察性、描述性、前瞻性和横断面研究。兰萨罗特预先指示办公室，大学医院jossore Molina Orosa医生（加那利卫生服务）。参与者：在2024年1月至12月期间注册了MAV的18岁或以上的个人。主要测量指标：社会人口学变量、完成MAV的动机、陈述的偏好和满意度。结果共分析527例患者，其中女性67.2%，平均年龄59.5±14.3岁。大多数人受过中等或高等教育（65.7%），没有宗教信仰（78.7%）。主要动机是希望行使个人自主权（38.5%），其次是希望不成为负担（33.2%）。73.2%的参与者表示器官捐赠，86.7%的参与者在中度痴呆的情况下接受安乐死。受教育程度与接受安乐死有显著相关性(χ2(6) = 39.27；p< 0.001)，完成MAV的动机与两性之间的差异(χ2(4) = 11.70；P = 0.020)、宗教信仰(χ2(20) = 463.49；术中,0.001)。总体而言，99.1%的人对所接受的护理感到满意。结论以西班牙女性为主，中老年，受过高等教育。在生命结束时的自主成为主要动机，根据性别和宗教信仰的不同，可以观察到差异。研究结果强调需要加强专业培训和沟通策略，以促进预先指示的使用。

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引用次数: 0

Revisión de la autoexploración mamaria y autoconciencia mamaria 乳房自我检查和乳房自我意识审查

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103435

Cruz Bartolome-Moreno , Jorge Navarro-Soriano , Elena Melus-Palazón

引用次数: 0

La salud podológica como estrategia de equidad y prevención desde la atención primaria 足部健康作为初级保健中的公平和预防战略

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103422

Natalia Tovaruela-Carrión , Daniel López-López , Juan Gómez-Salgado

引用次数: 0

Validación del cuestionario de calidad relacional y profesional QRP-45: una nueva herramienta conversacional para una nueva cultura de amabilidad integral en el ámbito sanitario QRP-45关系和专业质量问卷的验证：一种新的对话工具，用于在卫生保健中建立全面友好的新文化

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103418

Salvador García-Sánchez , Sara Fernández LLull , Gemma Rodriguez Fuertes , Nuria Prat , Carmen Cabezas , Josep Vidal-Alaball

Objective

The objective of this study is to psychometrically validate the QRP-45 questionnaire to use it in participatory survey-feedback processes in Primary Care Centres.

Design

Cross-sectional psychometric validation study.

Setting

Primary Care Centres in Central Catalonia.

Participants

Healthcare professionals from the primary care centers and professionals from the central support services of the Institut Català de la Salut (ICS), within the Gerència de Atenció Primària i a la Comunitat de la Catalunya Central.

Interventions

Implementation of the QRP-45 questionnaire as part of an intervention aimed at developing organisational culture through four interconnected phases: discover, yearn, act and anchor. The questionnaire was applied in the first and second phases.

Main Measurements

Psychometric evaluation including content analysis (I-CVI and S-CVI-Ave indices), construct validity (exploratory factor analysis), criterion validity (convergent, discriminant, and predictive validity), consistency (Cronbach's alpha and McDonald's omega) and reliability (intraclass correlation coefficient).

Results

The analyses indicate that the QRP-45 has adequate reliability and factorial validity, making it a useful tool for measuring relational and professional quality in healthcare settings. Some limitations and areas for improvement were identified for its interpretation and future development.

Conclusions

The QRP-45 is a suitable and useful questionnaire for use in organisational improvement processes through survey-feedback in Primary Care, contributing to the evaluation of relational and professional quality in this context.

目的本研究的目的是对QRP-45问卷进行心理计量学上的验证，以便在初级保健中心的参与式调查反馈过程中使用。设计横断面心理测量验证研究。在加泰罗尼亚中部设立初级保健中心。参与者：来自初级保健中心的保健专业人员和来自加泰罗尼亚中央政府Atenció Primària内的加泰罗尼亚卫生研究所（ICS）中央支助服务部门的专业人员。干预实施QRP-45问卷，作为干预的一部分，旨在通过四个相互关联的阶段：发现、向往、行动和锚定来发展组织文化。第一阶段和第二阶段采用问卷调查。心理计量学评价包括内容分析（I-CVI和S-CVI-Ave指标）、结构效度（探索性因子分析）、效度（收敛效度、判别效度和预测效度）、一致性（Cronbach’s alpha和McDonald’s omega）和信度（类内相关系数）。结果QRP-45具有足够的信度和析因效度，可作为衡量医疗卫生机构关系质量和专业质量的有效工具。为其解释和未来发展确定了一些限制和需要改进的领域。结论QRP-45是一份适合和有用的问卷，用于通过调查反馈在初级保健组织改进过程中使用，有助于在这种情况下评估关系和专业质量。

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引用次数: 0

Conflicto trabajo-familia y su impacto en la salud de la mujer trabajadora: una revisión sistemática 工作与家庭冲突及其对女工健康的影响：系统审查

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-14 DOI: 10.1016/j.aprim.2025.103391

Isabel García-Rodríguez , Juan Gómez-Salgado , Blanca Prieto-Callejero , Javier Fagundo-Rivera , Luis El Khoury-Moreno , Juan Jesús García-Iglesias

Objective

To evaluate the impact of dual presence (work-family conflict) on the physical and mental health of working women.

Design

Systematic literature review following the PRISMA Declaration (Preferred Reporting Items for Systematic reviews and Meta-Analyses).

Data sources

Searches were conducted in Web of Science, Scopus, and PubMed.

Selection of studies

The search strategy followed the PECO model (Population, Exposure, Comparison, Outcome), using terms such as “Women”, “Working”, “Health”, and “Work-Family Conflict (WFC)”. Studies addressing the relationship between dual presence and women's health were included.

Data extraction

The methodological quality of studies was assessed using the Joanna Briggs Institute critical appraisal tools.

Results

A total of 21 studies were included. Dual presence was associated with both the volume of domestic-family work and paid employment conditions, as well as psychosocial exposures related to work organization. Dual presence may increase the risk of physical and mental health problems in women, particularly when combined with additional occupational risk factors.

Conclusions

Dual presence is a significant determinant of working women's health. Addressing this issue is essential in the development of occupational health and labor policies.

目的评价双重存在（工作-家庭冲突）对职业妇女身心健康的影响。设计遵循PRISMA声明进行系统文献综述（系统综述和荟萃分析的首选报告项目）。数据来源在Web of Science、Scopus和PubMed中进行搜索。研究选择搜索策略遵循PECO模型（人口、暴露、比较、结果），使用诸如“妇女”、“工作”、“健康”和“工作-家庭冲突（WFC）”等术语。其中包括关于双重存在与妇女健康之间关系的研究。数据提取研究的方法学质量使用乔安娜布里格斯研究所的关键评估工具进行评估。结果共纳入21项研究。双重存在与家庭家务工作量和有偿就业条件以及与工作组织相关的社会心理暴露有关。双重存在可能增加妇女身心健康问题的风险，特别是在与其他职业风险因素结合时。结论双重存在是影响职业妇女健康的重要因素。解决这一问题对于制定职业健康和劳工政策至关重要。

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引用次数: 0

Estrategia combinada para cesación tabáquica en un centro de atención primaria de Cataluña. Estudio piloto longitudinal retrospectivo 加泰罗尼亚初级保健中心戒烟综合战略。纵向回顾性试点研究

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-13 DOI: 10.1016/j.aprim.2025.103385

Esther Sotillo Saez

引用次数: 0

Factores predisponentes a sarcopenia en adultos mayores del área rural y urbana 农村和城市地区老年人患骨质疏松症的易感因素

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2026-01-13 DOI: 10.1016/j.aprim.2025.103380

Luz Olivia Bernal Regalado, Carlos Alberto Echeverría Mayorga, Jessica Karina Cruz Gómez

Objective

To analyze the association between physical activity, nutritional status, and the risk of sarcopenia in older adults.

Design

Descriptive cross-sectional study conducted between March and December 2024.

Setting

The study included two populations of older adults: one group residing in a rural area of La Libertad municipality, La Libertad department, and another group living in an urban area of Soyapango municipality, San Salvador department, both located in El Salvador.

Participants

A total of 62 older adults aged from 60 to 93 years old without disabling conditions participated in the study. There were no withdrawals; however, one participant died due to a fall during the study period.

Interventions

General health and demographic data were collected using a structured clinical assessment form, including personal medical history, anthropometric measurements, dietary intake frequency, and routine physical activity.

Measurements

Gait speed, handgrip strength, and chair stand test were assessed. Additionally, the SARC-F questionnaire was applied. Descriptive statistical analysis and variable cross-tabulations were performed using IBM SPSS software.

Results

Findings indicate that 43.5% of participants were classified as having probable sarcopenia. Among them, 56% were from the urban group and 44% from the rural group. In both settings, female participants predominated.

Conclusions

An association was observed between probable sarcopenia, physical inactivity, and malnutrition. These conditions can be identified through low-cost functional tests in primary care settings, contributing to the promotion of healthy aging.

目的分析老年人体力活动、营养状况与肌肉减少症发病风险的关系。设计描述性横断面研究于2024年3月至12月进行。该研究包括两组老年人：一组居住在拉利伯塔德市拉利伯塔德省的农村地区，另一组居住在索亚潘戈市圣萨尔瓦多省的城市地区，均位于萨尔瓦多。共有62名年龄在60岁到93岁之间的老年人参加了这项研究，他们没有残疾。没有人提款；然而，在研究期间，有一名参与者因摔倒而死亡。干预措施：使用结构化的临床评估表格收集一般健康和人口统计数据，包括个人病史、人体测量值、饮食摄入频率和日常体育活动。测量方法：评估步态速度、握力和椅子站立测试。采用SARC-F问卷。采用IBM SPSS软件进行描述性统计分析和变量交叉制表。结果发现43.5%的参与者被归类为可能的肌肉减少症。其中，56%来自城市群体，44%来自农村群体。在这两种情况下，女性参与者占主导地位。结论肌少症与缺乏运动和营养不良之间可能存在关联。这些疾病可以通过初级保健机构的低成本功能测试来确定，有助于促进健康老龄化。

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引用次数: 0