Atencion Primaria最新文献

英文中文

Del dicho al hecho: descripción y desafíos en la implantación de la recomendación de activos en la atención primaria española [从言语到行动：西班牙初级保健社会处方实施的描述与挑战]。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-22 DOI: 10.1016/j.aprim.2025.103340

A.M. Carrera Noguero , M. Gilabert Mora , M.P. Astier Peña , J.J. Mira , V. Pérez-Jover , E. Melús Palazón

Objective

To analyze the evolution of the health policy framework regarding the deployment of community care services in primary care across different comunidades autónomas (CC. AA.) in Spain.

Design

A qualitative study.

Location

Comunidades autónomas, Spain.

Participants

Regional representatives of the Programa de Actividades Comunitarias en Atención Primaria (PACAP).

Methods

A qualitative study was conducted in three phases: The first phase, document review of community health plans and strategies from the 17 Spain‘s CC. AA.. The second phase, semi-structured interviews with regional representatives of the PACAP. The third phase, focus group with community health experts.

Content analysis was used to identify key patterns and implementation challenges.

Results

The 77.7% of CC. AA. Include community care in their health plans, but only 64.7% have formal PS. Aragon, Catalonia, and the Balearic Islands have integrated ABCD into electronic health records, while in other regions, recommendation and recording depend on individual professional interest. Barriers include lack of training, coordination with asset providers, and absence of impact evaluation indicators.

Conclusions

Effective implementation of PS requires institutional support, standardization of indicators, and strengthening of intersectoral coordination spaces. Reducing regional inequalities in its application is key to ensuring a positive impact on community health at the national level.

目的：分析西班牙不同社区在初级保健中部署社区护理服务的卫生政策框架的演变autónomas （CC. AA.）。设计：定性研究。地点：Comunidades autónomas，西班牙。参加者：Atención初级社会主义活动方案的区域代表。方法：分三个阶段进行定性研究：第一阶段，对西班牙17个社区卫生计划和战略进行文件审查。第二阶段，与亚太经社会区域代表进行半结构化的面谈。第三阶段，与社区卫生专家进行焦点小组讨论。内容分析用于识别关键模式和实现挑战。结果：77.7%的CC. AA。将社区护理纳入其健康计划，但只有64.7%的人有正式的PS。阿拉贡、加泰罗尼亚和巴利阿里群岛已将ABCD纳入电子健康记录，而在其他地区，推荐和记录取决于个人的专业兴趣。障碍包括缺乏培训、与资产提供者的协调以及缺乏影响评估指标。结论：PS的有效实施需要机构支持、指标标准化和加强部门间协调空间。减少在实施方面的区域不平等是确保在国家一级对社区保健产生积极影响的关键。

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引用次数: 0

Primary healthcare nurse managers’ perceptions in relation to evidence-based practice and their role in further extension: A qualitative study 初级保健护士管理者对循证实践的看法及其在进一步扩展中的作用：一项定性研究

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-10 DOI: 10.1016/j.aprim.2025.103365

Óscar Román , Itziar Estalella , Cristina Vaamonde-García , Beatriz Cubeiro-López , Amaia Maquibar

Objective

To explore the perceptions of primary healthcare nurse managers in relation to evidence based practice (EBP) and their role for further EBP extension.

Design

Bradshaw's qualitative descriptive approach.

Site

Primary Healthcare Centres in the Basque Country, Spain.

Participants

12 nurse managers in Primary Healthcare Centres.

Methods

Data were collected through semi-structured interviews in 2024, transcribed and analysed following qualitative content analysis.

Results

Three categories were elaborated during the analysis. The first one, ‘Somehow contradictory perceptions around EBP’ describes how participants considered EBP at the core of nursing while at the same time perceived it to be something abstract, difficult to achieve and to implement. The second category, ‘The tortuous pathway to EBP competence’ reflects how participants understood that acquiring EBP competence was not a straightforward process, but dependent on individual willingness and motivation of each nurse. Finally, the third category ‘EBP implementation: whose responsibility?’ covers participants’ reflections on their role in further EBP expansion as nursing supervisors along with reflections on institutional barriers and responsibility and action in this regard.

Conclusions

There was a great consensus among participants in this study about EBP being essential to provide quality healthcare but, at the same time, they perceived EBP as something abstract and difficult to implement and dependent on individual nurses’ willingness and motivation. Although participants extensively described organisational barriers for further EBP implementation, their role in EBP implementation was never described as advocating for an organisational change in favour of EBP but down the hierarchy towards the nurses under their management.

目的探讨基层卫生保健护理管理者对循证实践（EBP）的看法及其在进一步推广EBP中的作用。DesignBradshaw的定性描述方法。西班牙巴斯克地区的初级保健中心。参与者为初级保健中心的12名护士管理人员。方法采用半结构化访谈法收集2024年的调查数据，采用定性内容分析进行转录和分析。结果在分析过程中细化了三类。第一个，“围绕EBP的矛盾看法”描述了参与者如何将EBP视为护理的核心，同时又将其视为抽象的，难以实现和实施的东西。第二类，“通往EBP能力的曲折之路”反映了参与者如何理解获得EBP能力不是一个简单的过程，而是取决于每个护士的个人意愿和动机。最后，第三类“EBP实施：谁的责任？”'涵盖了参与者对他们作为护理主管在进一步扩展EBP中的作用的思考，以及对这方面的制度障碍和责任和行动的思考。结论本研究的参与者一致认为EBP是提供高质量医疗服务的必要条件，但同时，他们认为EBP是一种抽象的、难以实施的东西，并且依赖于护士个人的意愿和动机。尽管参与者广泛地描述了进一步实施EBP的组织障碍，但他们在EBP实施中的作用从未被描述为倡导有利于EBP的组织变革，而是在其管理下的护士的层次结构。

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引用次数: 0

Torus palatino: a propósito de un caso 腭环面：针对一个案例

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-09 DOI: 10.1016/j.aprim.2025.103387

Sara de Antonio Feu , María de Altabas de Vicente Martínez , Ana Peral Martín

引用次数: 0

Utilidad del score H2FPEF en el diagnóstico y pronóstico de las insuficiencia cardiaca con fracción de eyección preservada en atención primaria [H2FPEF评分在初级保健中保留射血分数的心力衰竭诊断和预后中的价值]。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-07 DOI: 10.1016/j.aprim.2025.103335

Victoria Cendrós , José María Verdú-Rotellar , Jaume Parra , Miguel Ángel Muñoz , Mar Domingo , Josep Franch

Objective

To determine, in a group of patients with a diagnosis of heart failure (HF) in primary care, the probability of presenting heart failure with preserved ejection fraction (HFpEF) according to the H₂FPEF score and its association with one-year morbidity and mortality.

Design

Cross-sectional descriptive study.

Setting

Seven primary care centres in Barcelona.

Participants

Patients with HF (ICD-10: I.50) and left ventricular ejection fraction ≥ 50%.

Interventions

analysis of electronic health record data from primary care and clinical interview with patients.

Main measurements

Clinical, laboratory and echocardiographic variables were collected. The H₂FPEF score was calculated and patients were classified accordingly. The association between the score and the composite outcome (all-cause mortality or HF hospitalisation) at one year was analysed.

Results

A total of 628 patients were included, of whom 169 had complete data for score calculation. Of these, 47.9% had a high probability of HFpEF. These patients were older, with more comorbidities and worse functional class. The incidence of the composite event was higher in the high-probability group (64.4%) compared to the low/intermediate group (35.6%; P=.011). In multivariate analysis, high probability showed a trend towards association with the composite outcome (OR: 2.06; 95% CI: 0.96-4.54; P=.066).

Conclusions

The H₂FPEF score is a useful and feasible tool in primary care for improving the diagnosis and risk stratification of morbidity and mortality in patients with suspected HF.

目的：在一组在初级保健中诊断为心力衰竭（HF）的患者中，根据H2FPEF评分确定心力衰竭伴保留射血分数（HFpEF）的概率及其与一年发病率和死亡率的关系。设计：横断面描述性研究。环境：巴塞罗那的七个初级保健中心。参与者：HF （ICD-10: I.50）和左心室射血分数≥50%的患者。干预措施：分析来自初级保健和患者临床访谈的电子健康记录数据。主要测量指标：收集临床、实验室和超声心动图变量。计算H2FPEF评分并对患者进行分类。分析了评分与一年内的综合结果（全因死亡率或HF住院）之间的关系。结果：共纳入628例患者，其中169例患者资料完整。其中47.9%为高概率HFpEF。这些患者年龄较大，合并症较多，功能分级较差。综合事件的发生率在高概率组（64.4%）高于低/中级组（35.6%，P= 0.011）。在多变量分析中，高概率与综合结果呈相关趋势（OR: 2.06; 95% CI: 0.96-4.54； P= 0.066）。结论：在初级保健中，H2FPEF评分是一种有用且可行的工具，可改善疑似心衰患者的诊断和发病率和死亡率的风险分层。

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引用次数: 0

Dolor crónico y dolor persistente: diferencias conceptuales y clínicas en la terminología del dolor 慢性疼痛和持续性疼痛：疼痛术语的概念和临床差异。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-07 DOI: 10.1016/j.aprim.2025.103368

Luz de Myotanh Vázquez Canales , Aina Perelló-Bratescu , Marta Domínguez-García , Antoni Morral Fernández

Since 2009, there has been a growing trend in English-language scientific literature toward replacing the term chronic pain with persistent pain. This semantic shift is a clear statement of reversibility and indicates the possibility of pain change.

In 2022, the Tradop working group (Grup d’Abordatge Transdisciplinar del Dolor Persistent) was created within the CAMFIC Scientific Society (Catalan Society of Family and Community Medicine). Various associations of patients and family members affected by chronic pain felt challenged to learn that our group used persistent pain instead of chronic pain in courses, conferences, and publications. Given their discomfort, we initiated a collective reflection and an etymological, historical, and scientific investigation of the terms «chronic» and «persistent». This search led to the conclusion that the two terms are not equivalent and that the translation from English to Spanish has a different contextualization and applicability.

自2009年以来，英语科学文献中越来越多的趋势是用持续性疼痛取代慢性疼痛。这种语义转变是可逆性的明确表述，表明疼痛改变的可能性。2022年，在CAMFIC科学协会（加泰罗尼亚家庭和社区医学协会）内创建了Tradop工作组（小组d'Abordatge跨学科del Dolor Persistent）。受慢性疼痛影响的患者和家庭成员的各种协会感到挑战，因为我们的小组在课程，会议和出版物中使用了持续性疼痛而不是慢性疼痛。鉴于他们的不适，我们发起了集体反思，并对“慢性”和“持久”这两个术语进行了词源学、历史和科学调查。通过对这两个术语的研究，得出了这两个术语不等同的结论，并且从英语到西班牙语的翻译具有不同的语境化和适用性。

引用次数: 0

Diabetes mitocondrial: de la sospecha en atención primaria al abordaje multidisciplinar familiar [线粒体糖尿病：从初级保健的怀疑到多学科家庭方法]。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-06 DOI: 10.1016/j.aprim.2025.103370

Blanca Adriana Macías Martínez , Alba Dalmau Vila , Marta Hernández García , Maria Antonia Lafarga Giribets

引用次数: 0

Salud percibida en adultos mayores mexicanos: su asociación con la participación social formal e informal 墨西哥老年人的健康状况：与正式和非正式社会参与的关联

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-03 DOI: 10.1016/j.aprim.2025.103366

Elva Dolores Arias-Merino , Beatriz Adriana Corona-Figueroa , Martha Elena Vázquez-Arias , Jose Carlos Suarez-Herrera

引用次数: 0

[A particular case of a Schwannoma in the foot]. [脚部神经鞘瘤的特殊病例]。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-10-01 Epub Date: 2025-08-08 DOI: 10.1016/j.aprim.2025.103351

Carlos Jiménez Martínez

引用次数: 0

Efectos de los cambios de temperatura secundarios al cambio climático en la salud humana [气候变化引起的温度变化对人类健康的影响]。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-09-30 DOI: 10.1016/j.aprim.2025.103369

María Cristina Almécija Pérez , Marta Gómez Morillo , Carlos Llano Gómez , Nima Peyman-Fard Shafi-Tabatabaei

Climate change is intensifying extreme heat with serious health consequences. Heatwaves increase both mortality and morbidity, particularly affecting vulnerable groups. Heat exacerbates cardiovascular, renal, mental, and respiratory diseases, and its impact is greater in contexts of energy poverty and inadequate housing. Moreover, there are significant geographical and social inequalities: those who contribute the least to climate change are often the most affected. Adaptation can reduce heat-related mortality by up to 80% and includes physiological, cultural, technological, and policy-based measures. From Primary Health Care, strategies are proposed at individual, group, community, and political levels, focusing on identifying vulnerabilities, raising awareness, promoting healthy environments, and demanding climate justice. The approach must be comprehensive, equitable, and transformative in order to address this global health crisis effectively.

气候变化加剧了极端高温，造成严重的健康后果。热浪会增加死亡率和发病率，尤其会影响弱势群体。高温会加剧心血管、肾脏、精神和呼吸系统疾病，在能源贫困和住房不足的情况下，其影响更大。此外，还存在显著的地理和社会不平等：对气候变化贡献最小的人往往受影响最大。适应措施包括生理、文化、技术和基于政策的措施，可将与热有关的死亡率降低高达80%。从初级卫生保健来看，在个人、群体、社区和政治层面提出了战略，重点是确定脆弱性、提高认识、促进健康环境和要求气候正义。这种做法必须是全面、公平和变革性的，以便有效地应对这一全球卫生危机。

引用次数: 0

Ansiedad y estrés en la paternidad: desafíos y oportunidades para los hombres [父亲的焦虑和压力：男性的挑战和机遇]。

IF 1.6 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria

Pub Date : 2025-09-30 DOI: 10.1016/j.aprim.2025.103382

Aldo Medina Gamero

引用次数: 0

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