Atencion Primaria最新文献

Objective

To identify the structural and intermediate determinants associated with avoidable hospitalizations (AH) of patients with type 2 diabetes mellitus (T2DM).

Design

Literature review based on narrative synthesis.

Data sources

Databases: PubMed, Science Direct, and Latin American and Caribbean Literature in Health Sciences (LILACS).

Study selection

Documents were selected and analyzed under a critical literature review, considering inclusion and exclusion criteria.

Data extraction

Information extracted from each selected article was synthesized based on the countries’ income levels and the social determinants of health framework.

Results

A total of 4,166 articles were relevant, 36 were selected for review. From this selection, 21 were publications conducted in high-income countries, 14 in upper-middle-income countries, and one in lower-middle-income countries. The review identified that the coverage of health services —mainly primary health care— and health insurance contribute to reducing the risk of AH for T2DM, while social inequalities tend to increase the risk.

Conclusions

The AH due to T2DM are susceptible to reduction through policies that contribute to increasing effective access to health services (availability, insurance), since they express social inequality, occurring to a greater extent in socioeconomically vulnerable populations. This review also provides evidence of the need to expand research on this topic in middle and low-income countries.

Objective

To analyze the experiences regarding the implementation of COVID-19 vaccination strategies, emphasizing the opportunities and challenges identified during its implementation.

Design

A systematic review of the literature published between 2020 and 2022.

Data sources

The study was conducted across four databases: PubMed, ScienceDirect, Scielo, and Lilacs.

Selection of studies

Publications selection followed the PRISMA methodology (Preferred Reporting Items for Systematic Review and Meta-Analysis).

Data extraction

A database was created where key elements of the selected study were identified and recorded, such as results, discussion, and conclusions. In addition, analysis categories were created such as: stages of the implementation plan, challenges identified and opportunity areas.

Results and conclusions

292 publications were found, of which 25 were selected for analysis. Of these, 64% came from high-income countries and 32% from upper-middle-income countries. According to the stages of the implementation plan, 20% of the studies focused on regulations, planning and coordination; 28% in prioritization of the population to be vaccinated; 16% in acceptance, demand, and risk communication; and 16% in administration and information systems. Reflection on the response to the pandemic invites us to consider various aspects, such as the organization and function of health systems, the importance of collaborative work, efforts to achieve equity, communication strategies, as well as ethical dilemmas when seeking preserve health.

Objectives

To develop a decalogue of self-care competencies to manage educational intervention during Cardiac Rehabilitation (CR) programs in Heart Failure with preserved Ejection Fraction (HFpEF) patients through multidisciplinary consensus.

Design

3-round e-Delphi study using an initial questionnaire of 23 competencies based on the main recommendations of the CR and self-care guidelines.

Site

It was framed under the ethics of a randomised clinical trial developed at the Regional Hospital of Malaga. The survey was designed and disseminated as an online questionnaire.

Participants

The expert panel comprised two patients with HFpEF and 13 healthcare professionals from Internal Medicine (n = 3), Cardiology (n = 2), Physiotherapy (n = 3), Nursing (n = 3) and Occupational Therapy (n = 2).

Method

The analysis of results included the content validity index, the percentage of agreement, and the concordance using Fleiss Kappa and Krippendorff's alpha.

Results

After the third round, 20 self-care competencies were identified, grouped into 12 domains, with sufficient consensus for their inclusion in the decalogue.

Conclusions

The decalogue of self-care competencies generated from the multidisciplinary consensus guides education in patients with HFpEF, systematically addressing educational content tailored to patients for clinical practice in CR programs.

Objective

There are numerous instruments in the scientific literature for the evaluation of the quality of Primary Care (PC) and to know which of them are the most used and in which countries provides more information to make a well-founded decision. The aim is to determine which, between 2013 and 2023, have been the instruments used to assess the international quality of PC, its evolution and geographical distribution.

Design

Systematic review.

Data sources

PubMed and Embase. From March to December 2023.

Inclusion criteria

1) Validation studies of specific assessment instruments to measure the quality of PC and/or the satisfaction of patients, providers or managers. 2) carried out in the field of PC and 3) published between 1/01/2013 and 01/02/2023. 83 full-text articles were included.

Data extraction

From each publication, an instrument used to evaluate the quality of the PC, attributes of the PC it evaluates, recipient of the evaluation, user, provider or manager, year, and country.

Results

Fifteen PC assessment instruments were found. The most widely used is the Primary Care Assessing Tool (PCAT), with wide geographical distribution, versions in several languages, is more limited in Europe, except in Spain, and is mostly used in the Primary Care Assessing Tool (PCAT).

Conclusions

The PCAT, due to its cultural adaptability, availability in several languages, its ability to evaluate the fundamental principles of PC enunciated by the World Health Organization and to contemplate the perspectives of all health agents, is a complete, versatile, and consistent questionnaire for the evaluation of the quality of PC.

Obesity and type 2 diabetes mellitus (T2D) significantly increase the risk of cardiovascular diseases such as coronary artery disease, atrial fibrillation, heart failure, and sudden cardiac death. This risk is proportional to body mass index (BMI), is exacerbated by comorbidities such as hypertension and dyslipidemia, and includes emerging risk factors like insulin resistance, low-grade chronic inflammation, and thrombosis tendency. The distribution of adipose tissue, especially visceral fat and ectopic deposition in the heart, is another key factor in the development of cardiovascular diseases in these patients, along with atrial and ventricular remodeling. Bariatric surgery has been shown to be effective in reducing these risks. The prevention and treatment of cardiovascular diseases in obesity and T2D include lifestyle changes, specific pharmacological treatment and management of comorbidities, and attention to cardiovascular risk factors.