Atencion Primaria最新文献

英文中文

The impact of chronic diseases on all-cause mortality in Spain: A population-based cohort study 西班牙慢性病对全因死亡率的影响：一项基于人口的队列研究。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-11 DOI: 10.1016/j.aprim.2024.103112

Elena Caride-Miana , Domingo Orozco-Beltrán , Jose Antonio Quesada-Rico , Jose Joaquin Mira-Solves

Objective

Our study aimed to assess the association between all-cause mortality and the most prevalent chronic diseases in Spain, including diabetes mellitus.

Design

Population-based retrospective cohort study.

Site

Spanish population (Spanish National Health Survey).

Participants

A population numbering 14,584 respondents of both sexes aged 40 years or older was selected.

Main measurements

The outcome variable was all-cause mortality over 6-year follow-up, measured by probabilistic cross-matching with the national death registry. Socioeconomic variables, health indicators, service use, and behavioral factors were collected. The main data source was the National Statistics Institute.

Results

Of the 14584 people included, 1346 (9.2%) died over 6-year follow-up. Regarding the most prevalent chronic diseases, those showing the strongest association with mortality were cancer (HR 1.74, 95% CI 1.40–2.16); chronic lung diseases (chronic obstructive pulmonary disease, bronchitis, or emphysema; HR 1.44, 95% CI 1.19–1.70); acute myocardial infarction (HR 1.33, 95% CI 1.08–1.65); and diabetes (HR 1.23, 95% CI 1.06–1.42). Less prevalent chronic diseases also increased mortality risk, including cirrhosis/liver disease (prevalence 1.5%; HR 1.67, 95% CI 1.22–2.29) and cerebrovascular diseases, including embolism and stroke (prevalence 2%; HR 1.39, 95% CI 1.07–1.81).

Conclusions

Chronic diseases affect over half the population aged 40 years and older in Spain. Some of the most prevalent conditions are closely associated with all-cause mortality. These include chronic lung diseases, acute myocardial infarction, and diabetes. Given their impact on mortality in the population, more efforts are needed in chronic disease prevention and management.

研究目的我们的研究旨在评估全因死亡率与西班牙最常见的慢性疾病（包括糖尿病）之间的关系：设计：基于人群的回顾性队列研究。地点：西班牙人口（西班牙全国健康调查）：主要测量指标：主要测量指标：结果变量为随访 6 年的全因死亡率，通过与国家死亡登记处的概率交叉匹配进行测量。此外，还收集了社会经济变量、健康指标、服务使用情况和行为因素。主要数据来源是国家统计局：在纳入的 14584 人中，有 1346 人（9.2%）在 6 年的跟踪调查中死亡。就最常见的慢性病而言，与死亡率关系最密切的是癌症（HR 1.74，95% CI 1.40-2.16）、慢性肺部疾病（慢性阻塞性肺病、支气管炎或肺气肿；HR 1.44，95% CI 1.19-1.70）、急性心肌梗死（HR 1.33，95% CI 1.08-1.65）和糖尿病（HR 1.23，95% CI 1.06-1.42）。发病率较低的慢性病也会增加死亡风险，包括肝硬化/肝病（发病率 1.5%；HR 1.67，95% CI 1.22-2.29）和脑血管疾病，包括栓塞和中风（发病率 2%；HR 1.39，95% CI 1.07-1.81）：慢性疾病影响着西班牙一半以上 40 岁及以上的人口。一些最常见的疾病与全因死亡率密切相关。这些疾病包括慢性肺病、急性心肌梗塞和糖尿病。鉴于这些疾病对人口死亡率的影响，需要在慢性病预防和管理方面做出更多努力。

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引用次数: 0

Relationship between physical activity and the sense of coherence in healthy adults 健康成年人的体育锻炼与协调感之间的关系。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-11 DOI: 10.1016/j.aprim.2024.103106

Miguel Jose Soares-Santeugini , Indira Enith Rodriguez-Prieto , Margareth Lorena Alfonso-Mora , Carolina Sandoval-Cuellar

Objective

This study seeks to stablish a relation between the level of physical activity and the sense of coherence in young adults.

Design

Cross sectional and analytical study in healthy young participants.

Site

Web form application.

Participants

191 active or inactive adult men or women between the ages of 18 and 45 without cognitive alterations. Professional or amateur athletes were excluded.

Main measurements

Correlation between the sense of coherence instrument (SOC-13) and Inventory of Physical Activity Questionnaire (IPAQ) were applied.

Results

The physical activity levels in the sample were distributed as: high level 34%, medium level 52%, and low level 13%. The mean of SOC-13 was 52.4. No difference was found when comparing between SOC-13 for each group of physical activity (high: 55, medium: 54, low: 58, p > 0.05), no correlation between SOC-13, age, and MET's reported by participants was found.

Conclusions

In healthy individuals, the IPAQ measure of physical activity levels showed no correlation with the sense of coherence in healthy young adults. Apparently, a sedentary lifestyle does not correlate with an individual's self-directed pursuit of health. It is possible that being physically active or sedentary is related to extrinsic variables associated with culture or family environment.

研究目的本研究旨在确定年轻人的体育锻炼水平与协调感之间的关系：设计：对健康青年参与者进行横断面分析研究。网站：网络表格应用：191名年龄在18至45岁之间、无认知障碍的成年男性或女性。职业或业余运动员除外：主要测量指标：连贯感工具（SOC-13）与体力活动调查表（IPAQ）之间的相关性：结果：样本的体力活动水平分布为：高水平 34%，中等水平 52%，低水平 13%。SOC-13 的平均值为 52.4。比较各组体力活动的 SOC-13 没有发现差异（高：55，中：54，低：58，P>0.05），也没有发现 SOC-13、年龄和参与者报告的 MET 之间的相关性：结论：在健康人中，IPAQ 测量的体力活动水平与健康年轻人的协调感没有相关性。显然，久坐不动的生活方式与个人对健康的自我追求并不相关。体力活动或久坐不动可能与文化或家庭环境相关的外在变量有关。

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引用次数: 0

Los ahogamientos y la gestión de espacios acuáticos: un problema de salud pública [溺水与水生空间管理：一个公共卫生问题]。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-09 DOI: 10.1016/j.aprim.2024.103137

Javier Fagundo-Rivera , Juan Gómez-Salgado

引用次数: 0

Prevalence and factors associated with female genital mutilation among daughters using Somalia Demographic Health Survey Data, SDHS 2020 利用索马里 2020 年人口与健康调查数据，研究切割女性生殖器在女儿中的流行率和相关因素

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-05 DOI: 10.1016/j.aprim.2024.103113

Omer Adam Farih , Abdirahman Omer Ali , Abdirizak Hassan Abokor , Mustafe Abdillahi Ali , Abdisalam Hassan Muse , Ahmed Abdi Aw Egge

Objective

To determine the prevalence and associated factors of female genital mutilation (FGM) among daughters of women aged 15–49 in Somalia using data from the 2020 Somaliland Demographic and Health Survey (SDHS).

Design

A cross-sectional study utilizing data from the 2020 SDHS.

Setting

Data was collected across Somalia, including urban, rural, and nomadic areas.

Main measurements

FGM prevalence was presented as percentages. Logistic regression analysis was used to identify associated factors, presented as odds ratios with 95% confidence intervals.

Results

The prevalence of FGM among daughters was 24%. Factors significantly associated with FGM included age, region, residence, education, and wealth index. Younger daughters were more likely to be circumcised (p = 0.000, 95% CI: 0.066–0.274). Rural residence increased the likelihood of FGM (OR = 1.436, CI = 1.257–1.64). Primary education increased the odds of FGM (OR = 1.334, CI = 1.127–1.58). Mothers who believed FGM should continue were more likely to have circumcised daughters (OR = 1.464, CI = 1.305–1.642).

Conclusions

FGM prevalence among daughters in Somalia is influenced by age, region, rural residency, and education. The findings highlight the need for targeted educational and intervention programs, particularly in rural areas, to effectively reduce FGM practices.

目标利用 2020 年索马里兰人口与健康调查 (SDHS) 的数据，确定索马里 15-49 岁妇女的女儿中切割女性生殖器官 (FGM) 的流行率和相关因素。采用逻辑回归分析确定相关因素，以几率和 95% 的置信区间表示。结果女性生殖器切割在女儿中的流行率为 24%。与切割女性生殖器官明显相关的因素包括年龄、地区、居住地、教育程度和财富指数。年龄较小的女儿更有可能接受割礼（p = 0.000，95% CI：0.066-0.274）。居住在农村会增加切割女性生殖器的几率（OR = 1.436，CI = 1.257-1.64）。小学文化程度会增加切割女性生殖器的几率（OR = 1.334，CI = 1.127-1.58）。认为女性生殖器切割应继续下去的母亲更有可能为女儿实施割礼（OR = 1.464，CI = 1.305-1.642）。研究结果表明，有必要开展有针对性的教育和干预计划，尤其是在农村地区，以有效减少切割女性生殖器官的做法。

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引用次数: 0

Violencia de género: situación actual, avances y desafíos pendientes en la respuesta del Sistema Sanitario 基于性别的暴力：卫生系统应对措施的现状、进展和有待应对的挑战

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-01 DOI: 10.1016/j.aprim.2023.102767

引用次数: 0

¿A quién le importa la prevención? 谁在乎预防？

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-01 DOI: 10.1016/j.aprim.2024.103124

Asensio López Santiago

引用次数: 0

Recomendaciones sobre el estilo de vida. Actualización PAPPS 2024 关于生活方式的建议。PAPPS 2024更新

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-01 DOI: 10.1016/j.aprim.2024.103133

Rodrigo Córdoba García , Francisco Camarelles Guillem , Elena Muñoz Seco , Juana M. Gómez Puente , Joaquín San José Arango , Jose Ignacio Ramírez Manent , Carlos Martín Cantera , María del Campo Giménez , Juan Revenga Frauca , Ana Egea Ronda , Raquel Cervigón Portaencasa , Laura Rodriguez Benito

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

我们提出了西班牙家庭和社区医学协会（semFYC）的预防活动和健康促进计划（PAPPS）的建议，通过干预方法，预防吸烟和饮酒，健康饮食，休闲时间的体育活动，预防交通事故和儿童约束系统来促进健康的生活方式。这些建议已经更新，并强调了新的方面，例如低风险饮酒的定义，参考文献也已更新。对于主要建议，我们包括具体的表格，显示证据的质量和建议的强度。

引用次数: 0

Aspectos éticos y legales de la violencia sobre la mujer [暴力侵害妇女行为的伦理与法律问题]。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-01 DOI: 10.1016/j.aprim.2023.102857

Caring for female victims of violence presents health professionals with situations that require careful consideration due to the conflicts raised between the fundamental principles of bioethics. During this process, intermediate courses of action should be adopted in which none of the affected principles is totally compromised, yet always take into account due compliance with legal and deontological regulations.

Within these conflicts, the possible impact on the autonomy of the victim must be taken into consideration, conditioned by the relationship of dominance with respect to their aggressor, a fundamental characteristic of gender violence. However, the fact that there is a legal obligation to issue an injury report or to communicate a well-founded suspicion of abuse is not enough to ignore the fact that the person, in this case the victim, must be a participant in the process. As such, the doctor has the obligation to inform his or her patient about this legal requirement, dedicating all the time and attention necessary to ensure that the victim understands the purpose and benefits of complying with this.

In any case, and beyond the appropriate adaptation of the professional's conduct to current precepts, the ethical principle of care must be adhered to, by which the best thing the professional can do is to provide the victim with the means to avoid the repetition of new attacks, implementing prevention measures that have their origin in the accurate diagnosis of the situation of violence and in the communication of this to the authorities.

由于生命伦理学基本原则之间的冲突，医护人员在照顾女性暴力受害者时需要慎重考虑。在这一过程中，应采取中间行动方案，既不能完全损害任何受影响的原则，又要始终考虑到适当遵守法律和道义上的规定。在这些冲突中，必须考虑到对受害者自主权可能造成的影响，这种影响取决于受害者与施暴者之间的支配关系，这也是性别暴力的一个基本特征。然而，尽管法律规定了发布伤害报告或通报有充分理由怀疑的虐待行为的义务，但这并不足以忽视一个事实，即当事人（此处指受害人）必须是这一过程的参与者。因此，医生有义务将这一法律要求告知其病人，并投入一切必要的时间和精力，确保受害人理解遵守这一要求的目的和好处。在任何情况下，除了使专业人员的行为符合当前的规定之外，还必须遵守关爱的道德原则，根据这一原则，专业人员所能做的最好的事情就是向受害者提供避免再次发生新的攻击的手段，实施预防措施，这些措施源于对暴力情况的准确诊断以及向当局通报这一情况。

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引用次数: 0

Contextos de especial vulnerabilidad para la violencia de género. Interseccionalidad: adaptando la respuesta a la diversidad de contextos y situaciones [基于性别的暴力极易发生。交叉性：适应环境和情况多样性的对策]。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2024-11-01 DOI: 10.1016/j.aprim.2023.102834

Addressing gender violence from the health system effectively, still involves addressing numerous challenges. If gender violence is suffered by women with one or more situations of personal and social vulnerability, intervention is surrounded by formidable difficulties.

In these heterogeneous situations, early detection is urgent, as well as professional support adapted to each woman with her particular context. The intersectional approach to gender violence provides useful tools for actions in these complex scenarios, full of suffering and fragility.

This article mentions the common and specific needs of the most vulnerable women. Recommendations are offered to improve the intervention to be developed from the health system — a privileged space for this — to understand and accompany these women in their diversity, with the most effective services and resources, in coordination with the rest of the social protection systems and entities.

从卫生系统有效解决性别暴力问题，仍然需要应对众多挑战。如果遭受性别暴力的妇女有一种或多种个人和社会脆弱性，那么干预工作就会面临巨大的困难。在这些不同的情况下，当务之急是及早发现，并根据每位妇女的具体情况提供专业支持。应对性别暴力的交叉方法为在这些充满痛苦和脆弱的复杂情况下采取行动提供了有用的工具。本文提到了最弱势妇女的共同需求和特殊需求。本文提出了一些建议，以改进卫生系统（这是一个得天独厚的空间）制定的干预措施，以便与其他社会保护系统和实体协调，利用最有效的服务和资源，了解和陪伴这些妇女的多样性。

引用次数: 0

La violencia sexual y su abordaje en el sistema de salud [解决医疗服务中的性暴力问题]。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

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Pub Date : 2024-11-01 DOI: 10.1016/j.aprim.2023.102837

Sexual violence is a very underdetected public health problem, with important short and long-term consequences on physical, mental, social, sexual and reproductive health, which must be taken into account by health services.

Health systems are part of the set of resources necessary for a comprehensive approach from the ecological model: prevention and promotion of healthy sexuality with equality, adequate and coordinated care in the event of sexual assault and subsequent support to prevent sequelae.

All sexual violence has health consequences, even those that may seem less serious such as sexual harassment or sexual cyberviolence.

We must know the needs of the victim and their possible emotional reactions. A risk assessment will be carried out, the victim will be referred to a hospital if necessary and comprehensive and integrated care will be provided.

Care and follow-up must focus on the survivor and with professionals trained in trauma to understand the consequences of sexual violence, offer a safe and trusting environment and know how to reinforce their qualities and support.

性暴力是一个极少被发现的公共卫生问题，对身体、精神、社会、性和生殖健康都有重要的短期和长期影响，卫生服务部门必须考虑到这一点。卫生系统是生态模式综合方法所需的一系列资源的一部分：预防和促进平等的健康性行为，在发生性侵犯时提供充分和协调的护理，以及为防止后遗症提供后续支持。所有性暴力都会对健康造成影响，即使是那些看起来不太严重的性暴力，如性骚扰或网络性暴力。我们必须了解受害者的需求及其可能的情绪反应。我们将进行风险评估，必要时将受害者转到医院，并提供全面综合的护理。护理和后续工作必须以幸存者为重点，并由受过创伤培训的专业人员进行，以了解性暴力的后果，提供一个安全和信任的环境，并知道如何加强他们的素质和支持。

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