[Recommendations for Primary Health Care for transgender people]. / Recomendaciones para la atención de la salud en Atención Primaria de las personas transgénero.

The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination. With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.

[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]. / Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos.

Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists.

BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.

Real-life effect on the control of risk factors associated with initiation of the cardiovascular polypill created from equipotent drugs.

OBJECTIVE: This work aims to analyze the impact of Spain's National Center for Cardiovascular Research (CNIC-Ferrer)'s cardiovascular (CV)-polypill on blood pressure (BP) and low-density lipoprotein cholesterol (cLDL) levels in patients in our healthcare area who previously took equipotent doses of statins and antihypertensives. MATERIAL AND METHODS: All patients in our healthcare area (Santiago de Compostela, Spain) who, as of December 31, 2019, had an active prescription for the CV-polypill (CNIC-Ferrer) since January 16, 2015 were registered. The index date was the start date of the CV-polypill prescription. The drugs the patient had previously received for dyslipidemia and hypertension were analyzed, classifying them by their equivalent potency to atorvastatin and ramipril. Changes in cLDL and BP were analyzed by means of Student's t-test for paired samples. RESULTS: We analyzed 547 patients with a mean age of 71.5 ± 11.5 years. The majority were men (60.6%). We observed a decrease in cLDL (-10.6 [95% CI: -7.0, -14.3], p < 0.001) in patients who started taking the CV-polypill who had previously taken equally potent doses of atorvastatin (n = 471). We documented a reduction in systolic BP (-3.7 [95% CI: -0.4, -6.9], p = 0.029) in patients who had previously taken equally potent doses of ramipril (n = 360). In 88 patients, the CV-polypill was started via equally potent doses of atorvastatin and ramipril, with a decrease in cLDL (-8.7 [95% CI: -3.8, -13.6], p = 0.001) and systolic BP (-3.6 [95% CI: -7.8, 0.5], p = 0.085). CONCLUSIONS: The initiation of treatment with the CV-polypill in patients who previously received equally potent treatment with atorvastatin and ramipril was associated with a greater reduction in cLDL and systolic BP.

[Analysis on the impact of the introduction of a quality management plan of the diabetes care process in a Health Area of Galicia (Spain)]. / Análisis del impacto de la implantación del plan de gestión de calidad del proceso asistencial de diabetes en un Área Sanitaria de Galicia.

OBJECTIVE: To analyse the impact of a management plan for the diabetes process on the level of control of HbA1c and the rate of hypoglycaemia. MATERIAL AND METHODS: The Health Area had a catchment population of 446,603. An anti-diabetic drug prescription (29,705 patients) was used to select diabetic patients. The variables recorded were: percentage of patients with HbA1c <8% and the hypoglycaemia rate before and after implementation of the quality program. RESULTS: The prevalence of diabetes was 11.8%, with 71.3% of them receiving some pharmacological treatment. In the year 2016, in the Integrated Health Area of Santiago de Compostela (Spain), 59.6% (95% CI: 57.9% -61.2%) of the patients had an HbA1c of less than 8%. After the implementation of the quality program, there was an increase in the number of controlled patients, reaching 63.6% (IRQ: 16.0%) in 2017, and 63.8% (95% CI: 62.5% - 65.2%) in 2018. The annual rate of hypoglycaemia increased non-significantly from 2.8 (95% CI: 2.22-3.35) in 2016, to 2.94 (95% CI: 2.35-2.35) in 2017 (P=.083), and 3.0 (95% CI: 2.44-3.56) in 2018 (P=.399). CONCLUSIONS: The implementation of the diabetes process management program enabled the level of control of HbA1c to be improved, as well as increase the percentage of patients who undergo regular check-ups, without increasing hypoglycaemia.

[Knowledge And Experience In Gender Violence Of Tutors And Trainees Of Galicia Family Medicine]. / Conocimiento y experiencia en violencia de género de las/os tutoras/es médicas/os y residentes de medicina de familia de Galicia.

OBJECTIVE: To analyse the level of preparation, knowledge and experience of gender violence of medical tutors and family medicine trainees of the Teaching Units of Family and Community Care of Galicia. METHODS: Descriptive cross-sectional study conducted in the 7 Teaching Units of Family and Community Care in Galicia. The Physician Readiness Manage Intimate Violence Survey (PREMIS), in its validated version in Spanish was used. This survey allows the collection of information from primary health care professionals about their attitudes, knowledge, and practices as regards gender violence. A descriptive and comparative statistical analysis was performed on the data. RESULTS: Out of a total of 159 questionnaires received, 72.32% came from women, and 59.1% of the responses were from doctors / tutors. It was noted that there were statistically significant differences in the detection / diagnosis of violence by those professionals who were aware of the gender violence protocol or who had received training in this area (P<.01). In the self-perception of gender violence training, statistically significant worse results were observed in those professionals with greater care burden (P<.05). CONCLUSIONS: Having received training or knowing the health care protocol on gender violence is associated with greater detection of cases of gender violence. There has been a deficit in training in gender-based violence both in tutors and in family medicine residents, especially in those with greater care burden, so it is a priority to develop medical training strategies in this field.

[Strategies to improve the quality of care in the chronic patient on multiple medications]. / Líneas estratégicas para mejorar la calidad de la atención al paciente crónico polimedicado.

OBJECTIVE: To carry out an evaluation of the impact on the number of patients in the risk situation due to safety problems with the medications after compliance with a program to improve the quality of care of the chronic patient on multiple medications in the Health Area of Santiago de Compostela. METHOD: The intervention program consisted of the design of a computer tool that would allow the detection and stratification of the risk of patients with potential safety problems with medications. The program included sessions and pop-ups on the quality of the prescription and the systematic periodic communication of the results on the use of the prescriptions to the doctors and pharmacists of Primary Care. A one-year time horizon was considered. RESULTS: In January 2018, there were 9,874 patients at risk due to potential safety problems related to medicines in the Health Area of Santiago de Compostela. At the end of December 2018, the patients at risk had fallen to 5,797 patients (41.2% reduction; P<.05). CONCLUSIONS: The design of computer tools that allow the use of the information available from the electronic prescription using standardised protocols, along with the team work of hospital pharmacists and primary care pharmacists, the collaboration between physicians, nurses and pharmacists, as well as the design of information adapted to the computer equipment and the stratification of the risk have all been actions with very positive results in the decrease in exposure of chronic patients to risk situations related to medications.

[Profile of the Family Doctor who gains access to positions with teaching tutorship of Family and Community Medicine by means of relocation examination in Galicia]. / Perfil del médico de familia que accede a plazas con tutoría docente de Medicina Familiar y Comunitaria mediante concurso de traslados en Galicia.

OBJECTIVE: To analyse the profile of Family Doctors who gain access to positions, both to the general quota, as well those reserved for teaching tutors of Family and Community Medicine, by means of a relocation competition. MATERIAL AND METHODS: A descriptive observational study was conducted in which 2 comparison groups were established: A Non-Teaching group that did not include Family Doctors who did not request or gain access to tutor positions, and a Teaching group with those that gained access to positions reserved for tutors. The information was obtained from the marks of the relocation competition carried out in Galicia in 2018. A total of 426 General Practitioners that entered the examination were included, of which 301 were female (70.7%) and 125 (29.3%) males. The variables were the obtaining of a position reserved for tutor, gender, and the merits considered in the competition: professional experience, training, scientific publications, and Galician language. The non-parametric statistics tests of Mann-Whitney and Kruskal-Wallis were used, after checking for non-normal distribution. RESULTS: Statistically significant differences were found in the distribution by gender in favour of males in the Teaching group compared to the Non-Teaching group (P<.01). The Teaching group obtained better results in training and publications. The females obtained statistically significant results in their favour in the training variable, and the males in experience. CONCLUSIONS: For the choice of teaching places in relocation interviews and examinations, publications and training had an important weighting; but, taking the gender perspective into account, a lower percentage of women had gained access to teaching positions due to having lower score in the experience category.

[Regulatory requirements; What steps must be taken before starting a biomedical research study?] / Requerimientos normativos: ¿Qué pasos tengo que seguir antes de iniciar un estudio de investigación biomédica?

Studies of research with human beings, their biological specimens, or their personal data in the field of biomedicine have been subject to regulation since the middle of the last century. Initially a regulation based on recommendations such as the Nuremberg Code, the Belmont Report or the first versions of the Declaration of Helsinki. All of them documents in which the principles (autonomy, beneficence, non-maleficence, and justice) were conceptualized, and that all researchers had to follow in the development of their research. This first phase is known as a period of self-regulation, because it is considered that the researchers themselves could, by following these recommendations, carry out their investigations without further control. Subsequently, it went through a clearly regulatory period in which the premises of these recommendations were progressively incorporated into the legal system of the different countries, and with this, arose the external control of the investigation by the administrations and other bodies, such as the Research Ethics Committees. The purpose of this article is to serve as a guide to professionals whose main activity is care in the field of Primary Care and who, in turn, are interested in initiating research studies to respond to uncertainties in the context of their daily activity that may arise.

[Macrocheilia, granulomatous cheilitis and Crohn's disease]. / Macroquelia, queilitis granulomatosa y enfermedad de Crohn.

Granulomatous cheilitis is a rare disease included among the orofacial granulomatoses. It is characterized by a idiopathic chronic inflammation of the labial mucosa (macrochelia), which takes the form of episodic and progressive outbreaks. In 10% of patients, it is associated with Crohn's disease. We report the presentation, evaluation and treatment of a case of granulomatous cheilitis which appearted two years after the onset of Crohn's disease. We conclude that granulomatous cheilitis is rare in children, with few reported cases, although probably underdiagnosed because of lack of awareness. The diagnosis of granulomatous cheilitis is clinical, although the histological evaluation is a determining factor. After making the diagnosis a comprehensive assessment of the patient is recommended, to rule out the other associated syndromes described in the literature.

[Methylphenidate and secondary Raynaud's phenomenon]. / Metilfenidato y fenómeno de Raynaud secundario.

Raynaud's phenomenon is a clinical disease characterized by episodic attacks of vasoconstriction of the arteries and arterioles of the extremities such as fingers and toes, sometimes the ears and nose, in response to cold or emotional stimuli. A classic attack is the pallor of the distal extremity, followed by cyanosis and redness, accompanied by paresthesia, usually as heat. When it occurs without apparent cause is called primary Raynaud's phenomenon. When associated with other disease, is called secondary Raynaud's phenomenon. The secondary table is associated with increased frequency of rheumatic diseases of collagen. They can also present certain drugs that cause vasoconstriction, such as ergotamine, beta-adrenergic antagonists, contraception and sympathomimetic drugs. Regarding the latter, we present a case of Raynaud's phenomenon secondary to methylphenidate in a 14 years.