Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid / Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid

Objetivo Diversos estudios han identificado factores asociados con el riesgo de muerte en pacientes infectados por SARS-CoV-2. Sin embargo, su tamaño muestral ha sido muchas veces limitado, y sus resultados parcialmente contradictorios. Este estudio ha evaluado los factores asociados con la mortalidad por COVID-19 en la población madrileña mayor de 75 años, en los pacientes infectados y en los hospitalizados hasta enero de 2021. Pacientes y métodos Estudio de cohortes de base poblacional con todos los residentes de la Comunidad de Madrid nacidos antes del 1 de enero de 1945 y vivos a 31 de diciembre de 2019. Se obtuvieron variables demográficas y clínicas de la historia clínica electrónica de atención primaria (AP-Madrid), de los ingresos hospitalarios a través del Conjunto Mínimo Básico de Datos (CMBD) y de la mortalidad a través del Índice Nacional de Defunciones (INDEF). Se recogieron los datos de infección, hospitalización y muerte por SARS-CoV-2 entre el 1 de marzo e 2020 y el 31 de enero de 2021. Resultados De los 587.603 sujetos incluidos en la cohorte, 41.603 (7,1%) desarrollaron una infección confirmada por SARS-CoV-2. De ellos, 22.362 (53,7% de los infectados) se hospitalizaron y 11.251 (27%) murieron. El sexo masculino y la edad fueron los factores más asociados con la mortalidad, si bien también contribuyeron numerosas comorbilidades. La asociación fue de mayor magnitud en los análisis poblacionales que en los análisis con pacientes infectados u hospitalizados. La mortalidad en los hospitalizados fue menor en la segunda ola (33,4%) que en la primera ola (41,2%) de la pandemia Conclusión La edad, el sexo y las numerosas comorbilidades se asocian con el riesgo de muerte por COVID-19. La mortalidad en los pacientes hospitalizados se redujo apreciablemente después de la primera ola de la pandemia (AU)

Objective Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and Methods This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic (AU)

Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid.

OBJECTIVE: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. PATIENTS AND METHODS: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. RESULTS: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. CONCLUSION: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

[Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid]. / Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid.

Objective: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and methods: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

Detección de las dudas y necesidades formativas de los médicos de familia en un centro de salud / Detecting doubts and training needs of family doctors of a health centre

OBJETIVO: Detectar las dudas y las necesidades formativas de los médicos de familia de un centro de salud urbano y docente durante la práctica clínica habitual. MATERIAL Y MÉTODOS: Estudio descriptivo transversal de un mes de duración en un centro de salud urbano de Madrid. Los médicos de familia del equipo fueron entrevistados tras la consulta sobre las dudas que habían tenido, eligiendo dos de ellas. Las dudas no resueltas en las dos semanas siguientes se agruparon por materias y según las taxonomías vigentes. Posteriormente se elaboró un programa docente para resolverlas. RESULTADOS: Participaron 19 de los 21 médicos del centro, y en el periodo de estudio atendieron a 10.678 pacientes. Se detectaron 0,44 dudas por cada 10 pacientes atendidos. De las 384 dudas elegidas, el 83,34% fueron clínicas y el 16,66%, no clínicas. El 51,2% de estas quedaron sin resolver en los 15días tras la consulta. Los métodos para su resolución fueron las bases científicas de internet (PubMed, UpToDate y guías de práctica clínica, principalmente; 38%), seguido de la consulta a otros colegas (34,9%). CONCLUSIONES: La mayoría de las dudas generadas durante la consulta son clínicas, aunque existe una carga importante de preguntas burocráticas. Más de la mitad de las dudas no se resuelven durante la consulta ni en los 15días posteriores. Las bases de datos científicas en internet son la principal fuente de información, seguida de la consulta a otros colegas. Deberían mejorar los tiempos por paciente y el acceso a fuentes de información fiables y ágiles, para mejorar estos aspectos

OBJECTIVE: To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS: Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS: Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate

[Detecting doubts and training needs of family doctors of a health centre]. / Detección de las dudas y necesidades formativas de los médicos de familia en un centro de salud.

OBJECTIVE: To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS: Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS: Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate.

Diabetes mellitus tipo LADA y cetoacidosis: reflexiones a partir de un caso clínico / Latent autoimmune diabetes in adults and ketoacidosis: a clinical case

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Infarto agudo de miocardio en un paciente sin factores de riesgo cardiovascular. Una mirada hacia atrás / Acute myocardial infarction in a patient with no cardiovascular risk factors. A look backwards

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Cáncer de intervalo, cribado y marcadores de riesgo en neoplasias mamarias / Interval cancer, screening, and risk markers in breast tumours

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Síndrome constitucional atípico / Atypical constitutional syndrome

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Homeostasis / Homeostasis

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Actualización del cáncer de mama en Atención Primaria (III/V) / Update of breast cancer in Primary Care (III/V)

El cáncer de mama es una enfermedad prevalente con implicaciones en todas las esferas de la vida de las pacientes, por lo que el médico de familia debe conocer en profundidad esta patología, para optimizar la atención con los mejores recursos disponibles. Los cinco artículos que componen esta revisión ofrecen un resumen de la literatura sobre el cáncer de mama publicada en los últimos diez años. En esta tercera parte, se recordarán el contexto clínico, estadiaje y los factores pronósticos de la enfermedad. Esta revisión pretende ofrecer una visión global, actualizada y práctica sobre la enfermedad que permita resolver los interrogantes que se presentan en la consulta de Atención Primaria, facilitar respuestas a las mujeres que lo soliciten y, en definitiva, permanecer al lado de las pacientes a lo largo de su enfermedad con la tranquilidad del conocimiento (AU)

Breast cancer is a prevalent disease with implications in all aspects of patientś life, therefore, family doctors must know this pathology in depth, in order to optimize the health care provided to these patients with the best available resources. This series of five articles on breast cancer is based on a review of the scientific literature of the last ten years. This third article will review the clinical context and the staging and prognostic factors of the disease. This summary report aims to provide a global, current and practical review about this problem, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness (AU)

[Update of breast cancer in Primary Care (III/V)]. / Actualización del cáncer de mama en Atención Primaria (III/V).

Breast cancer is a prevalent disease with implications in all aspects of patients life, therefore, family doctors must know this pathology in depth, in order to optimize the health care provided to these patients with the best available resources. This series of five articles on breast cancer is based on a review of the scientific literature of the last ten years. This third article will review the clinical context and the staging and prognostic factors of the disease. This summary report aims to provide a global, current and practical review about this problem, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness.

Razones para investigar en Atención Primaria / Reasons to investigate in primary care

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Reflexión: nuestra casa, la casa de todos / Reflection: our home, home to all

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Posible efecto inductor de lupus eritematoso diseminado por el virus de la rubéola: un caso clínico / Possible inductor effect of disseminated lupus erythematosus by rubella virus: a clinical case

El lupus eritematoso diseminado (LED) es una entidad que se manifiesta con gran variabilidad clínica y formas de presentación. Al igual que otras enfermedades del tejido conectivo, su etiología y patogenia no se conocen con exactitud, aunque se asume una base genética y unos factores precipitantes o favorecedores. La asociación con determinados virus aparece descrita en la literatura científica como agentes desencadenantes, inductores o simuladores de la enfermedad. Se describe en este artículo un caso clínico de LED en asociación temporal con una infección aguda por el virus de la rubéola, lo cual no ha sido publicado con anterioridad. El papel etiopatogénico del virus en este caso concreto de LED quedaría por determinar

Lupus erythematosus (SLE) is a disease that is seen with a wide range of clinical signs and presentation forms. As other connective tissue diseases, its etiology and pathogeny are not known exactly, although it is assumed that there is a genetic base and some precipitating or favoring factors. Association of certain viruses has been described in the scientific literature, such as precipitating, inductor or simulator agents of the disease. A case of SLE is described in this article in temporal association with an acute infection by the rubella virus, which has not been previously published. The etiopathogenic role of the virus in this specific case of SLE must still be determined