Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice.

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don't have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6-8 months, 15 patients were able to return to life and work after 12-18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients' lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.

[An online dynamic knowledge base in multiple languages on general medicine and primary care]. / Une base de connaissance multilingue et dynamique en ligne pour la médecine générale et les soins primaires.

INTRODUCTION: The International Classification of Primary Care, Second version (ICPC-2) aligned with the 10th Revision of the International Classification of Disease (ICD-10) is a standard for primary care epidemiology compendium. ICPC-2 has been also intended to identify the clinical topics in family medicine. Contextual field-specific knowledge in family medicine and primary care such as health structures, management, categories of patients, research methods, ethical or environmental features are not standardized and reflect, more often, the views of experts. METHODS: A qualitative research method, applied to the analysis of several Family Medicine congresses, has helped identify, in addition to clinical items, a spectrum of contextual concepts addressed by family doctors during their exchanges at the congresses. Assembled in a hierarchical manner, these concepts were given expression, together with ICPC-2, under the name of Q-codes Version 2.5, in the multilingual multi-terminology semantic server of the Department of Information and medical informatics (D2Im) at the University of Rouen, France. The two classifications are edited under the acronym 3 CGP for Core Content classification of General Practice. This free access server allows you to consult the ICPC-2 in 22 languages and the Q-codes in ten languages. RESULTS: The result of the joint use of these two classifications, as descriptors in congress to identify the concepts in texts or index the gray literature for family medicine and primary care is presented here in its various pilot uses. The validity and generalizability of 3CGP appears to be good in the light of the translations already carried out by colleagues around the world and of the applicability of the method in the two sides of the Atlantic. However the reproducibility and the inter-coder variations still remain to be tested for Q-codes. Maintenance remains an issue. CONCLUSION: This method highlights the conceptual extension, the complexity and the dynamics of the role of general practitioner and family doctor as well as of primary care physician.

Vaccination against human papilloma virus in the light of quaternary prevention / Vacunación contra el virus del papiloma humano a la luz de la prevención cuaternaria / Vacinação contra o vírus do papiloma humano à luz da prevenção quaternária

In spite of the demonstrated benefits, the question of HPV massive vaccination is still subject to intense discussions and controversies. The protection against cancer is still unproven and need more time to be accurate about the quantification of the decrease in cervical cancer. The analysis of HPV vaccine relevance is very complex due to several overlapped levels to be considered. The authors analyze many of the ethical, sociological, economic, political and finally scientific issues involved. The population trust in vaccines has been affected owing to dubious practices of many pharmaceutical companies. Faced with this manipulation of information on a worldwide scale, general practitioners have organized themselves to fight this uncertainty. Quaternary prevention, a concept supported by the World Organization of Family doctors, advocates the application of ethically acceptable procedures in health care. This opinion article addresses some of the multiple dimensions involved to encourage reflection on this issue.

A pesar de los beneficios demostrados, la cuestión de la vacunación masiva contra el VPH todavía está sujeta a intensas discusiones y controversias. La protección contra el cáncer aún no está probada y necesita más tiempo para la precisión sobre la cuantificación de la disminución del cáncer cervical. El análisis de la relevancia de la vacuna contra el VPH es muy complejo debido a varios niveles superpuestos que se deben considerar. Los autores analizan muchas de las cuestiones éticas, sociológicas, económicas, políticas y finalmente científicas involucradas en este análisis. La confianza de la población en las vacunas se ha visto afectada debido a prácticas dudosas de muchas compañías farmacéuticas. Ante esta manipulación de información a escala mundial, los médicos generales, de familia y comunidad, se han organizado para luchar contra la incertidumbre. La prevención cuaternaria, un concepto apoyado por la Organización Mundial de Médicos de Familia, aboga por la aplicación de procedimientos éticamente aceptables en la atención médica. Este artículo de opinión aborda algunas de las múltiples dimensiones involucradas para favorecer la reflexión sobre este tema.

Apesar dos benefícios demonstrados, a questão da vacinação massiva contra o HPV ainda está sujeita a intensas discussões e controvérsias. A proteção contra o câncer ainda não está comprovada e precisa de mais tempo para ser precisa sobre a quantificação da redução do câncer do colo do útero. A análise da relevância da vacina contra o HPV é muito complexa devido a vários níveis sobrepostos que devem ser considerados. Os autores analisam muitas das questões éticas, sociológicas, econômicas, políticas e, finalmente, científicas envolvidas nesta análise. A confiança da população nas vacinas foi afetada devido às práticas duvidosas de muitas empresas farmacêuticas. Diante dessa manipulação de informações em escala global, clínicos gerais, família e comunidade se organizaram para lutar contra a incerteza. A prevenção quaternária, conceito apoiado pela Organização Mundial de Médicos de Família, defende a aplicação de procedimentos eticamente aceitáveis nos cuidados médicos. Este artigo de opinião aborda algumas das múltiplas dimensões envolvidas para incentivar a reflexão sobre esta questão.

"M@dNotes Project". Giving colour to Grey Literature / "Projeto NotasL@cas". Dando cor à Literatura Gris / Proyecto NotasL@cas". Dando color a la Literatura Gris

Sharing the results of research and scientific production is crucial for the survival and development of all disciplines. Health information is becoming uncertain and powerful economic interests disrupting medical information has triggered a loss of credibility. M@dNotes project (in Spanish NotasL@cas), is the by-product of nonprofit collaborative international knowledge network with participation of students, general practitioners, family physicians, and healthcare workers. One of the aims of this network is to discuss the validity of the information available on sensitive subjects and build a knowledge exchange network inside a community of practice. It has been created to share different materials excluded from traditional academic publishing and commercial distribution channels: monographic reports, commented articles, files with references searches. These materials product of learning process are qualified with an appropriate level because there were submitted to a peer review or judged by a scientific committee to get an approval. Includes an indexing method (Q Codes and ICPC) to manage and retrieve the materials received. The project provides a particular folder to upload and share the documents. A web blog is the dissemination friendly tool or interface to share and retrieve the documents available in the network. Through a facility in the cloud, it is possible to access an excel file with all the materials shared, codes assigned and the hyperlink to get a pdf file of each material.

Compartilhar os resultados da pesquisa e da produção científica é crucial para a sobrevivência e o desenvolvimento de todas as disciplinas. A informação de saúde está se tornando incerta e poderosos interesses econômicos que alteram informações médicas causaram uma perda de credibilidade. O projeto M@dNotes (em espanhol NotasL@cas) é o resultado de uma rede de conhecimento internacional colaborativa sem fins lucrativos de estudantes, médicos de família e comunidade e trabalhadores de saúde. Um dos objetivos dessa rede é discutir a validade das informações disponíveis sobre questões sensíveis e construir uma rede de troca de conhecimento dentro de uma comunidade de prática. O objetivo do projeto é compartilhar diferentes materiais excluídos da publicação acadêmica tradicional e dos canais de distribuição comercial: artigos monográficos, comentários sobre artigos, pesquisas de referências. Muitos desses materiais resultantes do processo de aprendizagem atingem um nível adequado de qualidade, porque foram submetidos à revisão por pares ou foram julgados por um comitê científico para obter aprovação. A plataforma inclui um método de indexação (Q-Codes e CIAP-2) para gerenciar e permitir a recuperação de materiais recebidos. O projeto fornece uma ferramenta específica para carregar e compartilhar os documentos. Um web blog é a interfase de difusão amigável e para compartilhar e recuperar os documentos disponíveis nesta rede. Através de uma instalação na nuvem, é possível acessar um arquivo Excel com todos os materiais compartilhados, os códigos atribuídos e o hiperlink para obter o arquivo pdf correspondente para cada material.

Compartir los resultados de investigación y producción científica es crucial para la supervivencia y el desarrollo de todas las disciplinas. La información sanitaria se está volviendo incierta y poderosos intereses económicos que alteran la información médica han provocado una pérdida de credibilidad en ella. El proyecto M@dNotes (en español NotasL@cas) es el resultado de una red de conocimiento internacional colaborativa sin fines de lucro de estudiantes, médicos generales y familiares y trabajadores de la salud. Uno de los objetivos de esta red es discutir la validez de la información disponible sobre temas delicados y construir una red de intercambio de conocimiento dentro de una comunidad de práctica. El propósito del proyecto es compartir diferentes materiales excluidos de la publicación académica tradicional y de los canales de distribución comercial: artículos monográficos, comentarios sobre artículos, archivos con búsquedas de referencias. Muchos de estos materiales producto del proceso de aprendizaje alcanzan un nivel adecuado de calidad, porque fueron sometidos a revisión de pares o han sido juzgados por un comité científico para obtener una aprobación. La plataforma incluye un método de indexación (Códigos-Q e CIAP-2) para administrar y permitir la recuperación de los materiales recibidos. El proyecto proporciona una carpeta particular para cargar y compartir los documentos. Un web blog es la herramienta o interfaz de difusión amigable para compartir y recuperar los documentos disponibles en esta red. A través de una instalación en la nube, es posible acceder a un archivo Excel con todos los materiales compartidos, los códigos asignados y el hipervínculo para obtener el archivo pdf correspondiente a cada material.

Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention / Implicações éticas, pedagógicas, sócio-políticas e antropológicas da prevenção quaternária / Implicaciones éticas, pedagógicas, sociopolíticas y antropológicas de la prevención cuaternaria

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with: the bioethics of prevention, the importance of teaching Quaternary prevention and factual medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

Development, dissemination, and applications of a new terminological resource, the Q-Code taxonomy for professional aspects of general practice/family medicine.

BACKGROUND: While documentation of clinical aspects of General Practice/Family Medicine (GP/FM) is assured by the International Classification of Primary Care (ICPC), there is no taxonomy for the professional aspects (context and management) of GP/FM. OBJECTIVES: To present the development, dissemination, applications, and resulting face validity of the Q-Codes taxonomy specifically designed to describe contextual features of GP/FM, proposed as an extension to the ICPC. DEVELOPMENT: The Q-Codes taxonomy was developed from Lamberts' seminal idea for indexing contextual content (1987) by a multi-disciplinary team of knowledge engineers, linguists and general practitioners, through a qualitative and iterative analysis of 1702 abstracts from six GP/FM conferences using Atlas.ti software. A total of 182 concepts, called Q-Codes, representing professional aspects of GP/FM were identified and organized in a taxonomy. Dissemination: The taxonomy is published as an online terminological resource, using semantic web techniques and web ontology language (OWL) ( http://www.hetop.eu/Q ). Each Q-Code is identified with a unique resource identifier (URI), and provided with preferred terms, and scope notes in ten languages (Portuguese, Spanish, English, French, Dutch, Korean, Vietnamese, Turkish, Georgian, German) and search filters for MEDLINE and web searches. APPLICATIONS: This taxonomy has already been used to support queries in bibliographic databases (e.g., MEDLINE), to facilitate indexing of grey literature in GP/FM as congress abstracts, master theses, websites and as an educational tool in vocational teaching, Conclusions: The rapidly growing list of practical applications provides face-validity for the usefulness of this freely available new terminological resource.

A Terminology in General Practice/Family Medicine to Represent Non-Clinical Aspects for Various Usages: The Q-Codes.

The hereby proposed terminology called "Q-Codes" can be defined as an extension of the International Classification of Primary Care (ICPC-2). It deals with non-clinical concepts that are relevant in General Practice/Family Medicine (GP/FM). This terminology is a good way to put an emphasis on underestimated topics such as Teaching, Patient issues or Ethics. It aims at indexing GP/FM documents such as congress abstracts and theses to get a more comprehensive view about the GP/FM domain. The 182 identified Q-Codes have been very precisely defined by a college of experts (physicians and terminologists) from twelve countries. The result is available on the Health Terminology/Ontology Portal (http://www.hetop.org/Q) and formatted in OWL-2 for further semantic considerations and will be used to index the 2016 WONCA World congress communications.

Analysis of definitions of general practice, family medicine, and primary health care: a terminological analysis.

BACKGROUND: There are numerous definitions of general practice/family medicine (GP/FM) and primary health care (PHC), but the distinction between the two concepts is unclear. AIM: To conduct a terminological analysis of a set of definitions of GP/FM and of PHC, to clarify the commonalities and differences between these two concepts. DESIGN: Sets of 20 definitions were collected in two 'bags of words' (one for GP/FM and one for PHC terms). A terminological analysis of these two collections was performed to prioritise the terms and analyse their universe of discourse. METHOD: The two collections were extracted with VocabGrabber, configured in two 'term clouds' using Wordle, and further explored for similarities using Tropes. The main terms were analysed using the Aristotelian approach to the categorisation of things. RESULTS: Although continuity of care (characterised by a person-centred approach and shared decision making) is common to both sets, the two sets of definitions differ greatly in content. The main terms specific to GP/FM (community, medicine, responsibility, individual, problem, and needs) are different from those specific to PHC (home, team, promotion, collaborator, engagement, neighbourhood, and medical centre). CONCLUSION: Terminological analysis of the definitions for GP/FM and PHC shows two overlapping but distinct entities, necessitating a different taxonomic approach and different bibliographic search strategies.

Primary Care Physicians' Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention.

Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.

The words of prevention, part I: changing the model / As palavras da prevenção, parte I: mudando o modelo / Las palabras de la prevención, parte I: cambiando el modelo

Objective: this part I article explores the different meanings of relevant keywords for General Practice/Family Medicine (GP/FM) in the prevention domain. The aim is to contribute to information process in GP/FM by keeping in line with the main terms used in health care organization. Methods: important keywords for GP/FM in the prevention domain were selected. Then, a search was carried out on the main sources in GP/FM databases, as well as in Medical Subject Heading and major terminological databases available online. Results and Discussion: there is discrepancy between the conceptual contents of major prevention models amongst the usual bibliographic sources of knowledge in GP/FM in particular and medicine in general. Conclusion: For GP/FM, distribution of preventive activities is now firmly established on a new constructivist model, privileging the doctor-patient relationships and introducing a cybernetic thinking on the health care activities with a special commitment to ethics and the positive duty of beneficence.

Objetivo: este artigo, parte I, explora os diferentes significados de palavras-chave relevantes para a Medicina Geral/Medicina de Família (MG/MF) no campo da prevenção. O objetivo é contribuir para o processo de informação para a MG/MF, mantendo-se alinhado com os principais termos utilizados na organização dos cuidados em saúde. Métodos: foram selecionadas palavras-chave importantes para a MG/MF no campo da prevenção. Em seguida, foi realizada uma busca nas principais fontes no âmbito da MG/MF, bem como no Medical Subject Heading e nas principais bases de dados terminológicas disponíveis online. Resultados e Discussão: há discrepância entre os conteúdos conceituais dos principais modelos de prevenção entre as fontes bibliográficas usuais na área do conhecimento em MG/MF, em particular, e da medicina em geral. Conclusão: para a MG/MF a distribuição de atividades preventivas está firmemente estabelecida em um novo modelo construtivista, privilegiando a relação médico-paciente ao introduzir um pensamento cibernético sobre as atividades de cuidados de saúde, com um especial compromisso com a ética e o dever positivo da beneficência.

Objetivo: este artículo, parte I, explora los diferentes significados de palabras clave relevantes para la Medicina General/Medicina Familiar (MG/MF) en el campo de la prevención. El objetivo es contribuir al proceso de información en MG/MF, manteniendo en línea con los principales términos utilizados en la organización sanitaria. Métodos: palabras clave importantes para la MG/MF fueron seleccionados en el campo de la prevención. A continuación, se realizó una búsqueda en las principales fuentes en el ámbito de la MG/MF, así como en el Medical Subject Heading y en las principales bases de datos terminológicas disponibles online. Resultados y Discusión: existe discrepancia entre los contenidos conceptuales de los principales modelos de prevención entre las fuentes bibliográficas habituales de conocimiento en MG/MF, en particular, y la medicina en general. Conclusión: para la MG/MF la distribución de las actividades preventivas se ha establecido firmemente en un nuevo modelo constructivista, que privilegia la relación médico-paciente y la introducción de un pensamiento cibernético en las actividades de atención de la salud, con un especial compromiso con la ética y el deber positivo de beneficencia.

Quaternary prevention: first, do not harm / Prevenção quaternária: primeiro não causar dano / Prevención cuaternaria: primero no hacer daño

Clinical prevention, under the influence of public health, has been organised in a chronological manner since the middle of the 20th century. A paradigm shift from a chronological to a constructivist relationship-based preventive pattern of care1 offers new insights into the practice of doctors. This paradigm shift brings to light the concept of quaternary prevention, a critical look at medical activities with an emphasis on the need not to harm. Quaternary prevention addresses the fundamental question of what constitutes too much or too little medicine. It is the fourth form of disease prevention, but also the fourth frame of action for family doctors (Figure 1). The shift from time-based prevention towards a relationship-based organisation offers new perspectives into physicians' work. The physicians observe themselves and question the ethical limits of their activities. In this sense, quaternary prevention is aimed more at the doctor than the patient. Moreover, the four definitions of prevention, published in the Wonca Dictionary of Family Medicine,2 offer a structured way to discuss the activities of family doctors, including ethical considerations on the patient-doctor encounter. Quaternary prevention, also known as P4, is a new term for an old concept: first, do not harm. This concept enforces disciplines and attitudes such as evidence-based medicine, quality assurance, defensive medicine, avoiding abusive nosographic diagnoses and ethical issues including those linked to overinformation, and overmedicalisation.3

The words of prevention, part II: ten terms in the realm of quaternary prevention / As palavras da prevenção, parte II: dez termos no âmbito da prevenção quaternária / Las palabras de la prevención, parte II: diez términos en el ámbito de la prevención cuaternaria

Objective: this part II article about the 'words of prevention' presents in a terminological way the content of ten current concepts used in the prevention domain which are closely linked to quaternary prevention: (1) overinformation; (2) overdiagnosis; (3) medically unexplained symptoms; (4) overmedicalization; (5) incidentaloma; (6) overscreening; (7) overtreatment; (8) shared decision making; (9) deprescribing; and (10) disease mongering. Methods: with the support of the laboratory team of the University of Rouen, France, which is dedicated to medical terminology and semantic relationships, it was possible to utilize a graphic user interface (called DBGUI) allowing the construction of links for each of chosen terms, and making automatic links to MeSH, if any. Those concepts are analyzed in their environment in current literature, as well as in their MeSH counterparts, if any, and related semantic online terminologies. Results and Discussion: the rules in terminological development aspire to cover the whole field of a concept and in the meantime, they can help to avoid the noise due to proxy and not exactly related issues. This refers to exhaustivity and specificity in information retrieval. Our finds show that referring to MeSH only in information retrieval in General Practice/Family medicine can induce much noise and poor adequacy to the subject investigated. Conclusion: gathering concepts in specially prepared terminologies for further development of ontologies is a necessity to enter in the semantic web area and the era of disseminated data in family medicine.

Objetivo: este artigo parte II sobre as 'palavras da prevenção' apresenta de uma forma terminológica o conteúdo de dez conceitos atuais utilizados no domínio da prevenção, que estão intimamente ligados à prevenção quaternária: (1) sobrecarga de informação; (2) sobrediagnóstico; (3) sintomas sem explicação médica; (4) sobremedicalização; (5) incidentaloma; (6) sobrerrastreamento; (7) sobretratamento; (8) tomada de decisão compartilhada; (9) desprescrição; e (10) comercialização de doenças. Métodos: com o apoio da equipe do laboratório da Universidade de Rouen, França, que se dedica à terminologia médica e às relações semânticas, foi possível utilizar uma interface gráfica de usuário (chamado DBGUI) permitindo a construção de links para cada um dos termos escolhidos, fazendo ligações automáticas para o MeSH, caso houvesse. Estes conceitos foram analisados no seu ambiente na literatura corrente, bem como os seus homólogos no MeSH, caso houvesse, e terminologias semânticas online a eles relacionadas. Resultados e Discussão: as regras em desenvolvimento terminológico aspiram cobrir todo o campo de um conceito, ao mesmo tempo em que podem auxiliar a evitar ruídos devido a aproximações e questões não exatamente relacionadas. Isto se refere à exaustividade e especificidade na recuperação da informação. Nossos achados mostram que referir-se somente ao MeSH na recuperação de informação em medicina de família pode induzir muito ruídos e uma pobre adequação em relação ao tema investigado. Conclusão: reunir conceitos em terminologias especialmente preparadas para um maior desenvolvimento de ontologias é uma necessidade para se adentrar na área da rede semântica e da era de dados disseminados em medicina de família.

Objetivo: este artículo parte II de las 'palabras de prevención' presenta en una forma terminológica el contenido de diez conceptos actuales utilizados en el dominio de la prevención que están estrechamente vinculados a la prevención cuaternaria: (1) sobreinformación; (2) sobrediagnóstico; (3) síntomas sin explicación médica; (4) sobremedicalización; (5) incidentaloma; (6) sobretamizaje; (7) sobretratamiento; (8) toma de decisiones compartida; (9) deprescripción; y (10) tráfico de enfermedades. Métodos: con el apoyo del equipo de laboratorio de la Universidad de Rouen, Francia, que se dedica a la terminología médica y las relaciones semánticas, fue posible utilizar la interfaz gráfica de usuario (llamado DBGUI) permitiendo la construcción de enlaces para cada uno de los términos elegidos, y estableciendo vínculos automáticos al MeSH, en su caso. Esos conceptos fueran analizados en el contexto de la literatura actual, así como en sus homólogos MeSH, en su caso, y terminologías semánticos relacionados online. Resultados y Discusión: las reglas en el desarrollo terminológico aspiran a cubrir la totalidad del ámbito del concepto y, mientras tanto, ayudan a evitar el ruido debido al proxy y temas no relacionados con exactitud. Esto se refiere a la exhaustividad y especificidad en la recuperación de informaciones. Nuestros hallazgos muestran que al referir-se solamente al MeSH la recuperación de información en Medicina General/Medicina Familiar puede inducir a mucho ruidos y mala adecuación al tema investigado. Conclusión: la recopilación de conceptos en terminologías especialmente preparados para un mayor desarrollo de ontologías es una necesidad para entrar en el área de la web semántica y en la era de los datos diseminados en medicina familiar.

Teaching and learning quaternary prevention / O ensino e a aprendizagem da prevenção quaternária / La enseñanza y el aprendizaje de la prevención cuaternaria

This article presents an overview of different techniques and skills necessary for teaching and learning quaternary prevention (P4). It adopts the Expertise Model that defines the competences required in P4 for each level: novice, competent, proficient, and expert. This framework should be used as a step-wise roadmap for teachers in order to achieve high levels of performance. This proposal is complemented by a list of methods applied in teaching and assessment of learners' performance and competence. By covering a range of learning and teaching issues, those who aim to teach quaternary prevention can explore the proposed framework. Quaternary prevention is a research and teaching fertile medical field that entails the integration of different areas such as health service organisation, epidemiology, communication skills, and andragogy either at the macro or the micro levels of health related activities.

Este artigo apresenta uma visão geral das diferentes técnicas e habilidades necessárias para o ensino e a aprendizagem da prevenção quaternária (P4). Ele adota o Expertise Model que define as competências exigidas na P4 para cada nível: iniciante, competente, proficiente e expert. Essa estrutura pode ser utilizada como um roteiro passo a passo para os professores, a fim de alcançar elevados níveis de desempenho. Esta proposta é complementada por uma lista de métodos usados no ensino e na avaliação de desempenho e competências dos alunos. Ao cobrir uma série de questões de ensino e aprendizagem, aqueles que visam ensinar prevenção quaternária podem explorar a grade proposta. A prevenção quaternária é um campo fértil para a investigação e o ensino da medicina que envolve a integração de diferentes áreas, como a organização de serviços de saúde, epidemiologia, habilidades de comunicação e andragogia, tanto no nível macro como no micro das atividades relacionadas à saúde.

Este artículo presenta una visión general de las diferentes técnicas y habilidades necesarias para la enseñanza y el aprendizaje de la prevención cuaternaria (P4). El adopta el Expertise Model que define las competencias requeridas en P4 para cada nivel: principiante, competente, proficiente y experto. Esta estructura puede ser utilizada como un guía paso a paso para los profesores con el fin de alcanzar altos niveles de rendimiento. Esta propuesta se complementa con una lista de métodos utilizados en la enseñanza y la evaluación del desempeño y competencia de los educandos. Al hacer referencia a una serie de cuestiones de enseñanza y aprendizaje, los que tienen como objetivo enseñar prevención cuaternaria pueden explorar el marco propuesto. La prevención cuaternaria es un campo fértil de investigación y enseñanza de la medicina que requiere la integración de diferentes áreas como la organización de servicios de salud, epidemiología, habilidades de comunicación, y la andragogía, ya sea en el nivel macro como micro de las actividades relacionadas con la salud.

Quaternary prevention, an answer of family doctors to overmedicalization.

In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare.