Del lado de allá y del lado de acá. ¿Qué pueden aprender mutuamente los países emergentes latinoamericanos y España para mejorar sus perfiles del médico de familia? / From one side of the ocean to the other. What can emerging latinamerican countries and Spain learn from each other to improve their family physician profile?

Objetivo: Se realizó un estudio cualitativo con el objetivo de encontrar factores estratégicos en medicina de familia que impliquen oportunidades de aprendizaje que los países del Norte desarrollado puedan utilizar de los países del Sur emergentes, y viceversa. Diseño, emplazamiento y participantes: A partir de un muestreo no aleatorio, intencionado, seguido de muestra en bola de nieve, hasta la saturación de los datos, se realizaron por parte médicos de familia de atención primaria de Toledo y Tenerife en España, y Paraguay, México, y Perú, diarios de campo de un día habitual y su contexto socio-sanitario, y se evaluaron mediante análisis del contenido y un estudio DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades). Mediciones principales y resultados: Se obtuvieron 24 diarios de un día normal (9 médicos en España, 7 en México, 4 en Paraguay, y 4 en Perú). Se encontraron "fortalezas" del Sur en la coexistencia de trabajo ambulatorio y hospitalario, en el amplio rango de tareas asistenciales, en el mayor peso de actividades de promoción y educación para la salud dirigidas a la población, en la presencia de actividades comunitarias de campo, en la integración de la medicina tradicional, en la mejor relación médico-paciente, y percepción más positiva de la carga de trabajo. Y "fortalezas" del Norte en las actividades de prevención, promoción y educación para la salud integradas en la asistencia por enfermedades en el centro de salud, y en la mayor existencia de recursos materiales. Conclusiones: Hay áreas donde podría aprender el médico de familia español del latinoamericano y viceversa (AU)

Objective: A qualitative study was carried out with the aim to find strategic factors involving learning opportunities that northern developed countries could use from emerging countries in the South and vice versa. Design, setting and participants: A non-random intentional sampling, followed by a snowball sampling until data saturation were carried out by a group of primary health care family physicians in Toledo and Tenerife in Spain and Paraguay, Mexico and Peru. Field diaries of a normal day and its health and social care context were kept and analyzed, and a SWOT study (strengths weaknesses, opportunities and threats) was performed. Main measures and results: Twenty-four diaries of a normal day were obtained (9 physicians in Spain, 7 in Mexico, 4 in Paraguay and 4 in Peru). Some strengths were found in the South in the coexistence of ambulatory care and hospital work, in the wide range of care tasks, in the greater weight of health promotion and educational activities targeted to the population, in the presence of community field activities, in the integration of traditional medicine, in the better patient-doctor relationship and a more positive perception of the workload. And the strengths in northern countries were: more prevention, health promotion and educational actions integrated in visits to the family physician in primary care settings and more material resources available. Conclusions: There are some areas in which the Spanish family physician could learn from the latinamerican physician and vice versa (AU)

Las odiseas de los Ulises. Estudio de los relatos de un día normal de trabajo del médico de familia en Paraguay, México, Perú y España / The odysseys of Ulysses. A study of tales in a normal working day of the family doctor in Paraguay, Mexico, Peru, and Spain

OBJETIVO: Examinar en diferentes países el perfil profesional del médico de familia y el contexto socio-sanitario donde aplica su trabajo. DISEÑO: Metodología cualitativa de elaboración de diarios de campo de un día habitual. Emplazamiento: Atención primaria de Toledo y Tenerife en España, y Paraguay, México y Perú. Participantes y contextos: Muestreo no aleatorio, intencionado, seguido de muestra en bola de nieve, hasta la saturación de los datos. MÉTODO: Los participantes escribieron un diario de un día habitual trabajo, sus circunstancias y contexto sociosanitario, y se estudiaron mediante análisis del contenido. Como técnicas para controlar los sesgos se usaron la verificación de los participantes y la triangulación entre los resultados obtenidos y la bibliografía existente, y los datos de diarios encontrados en Internet. Se realizó un mapa mental para transcribir de forma gráfica e integral los resultados. RESULTADOS: Se obtuvieron 24 diarios de un día normal (9 médicos en España, 7 en México, 4 en Paraguay y 4 en Perú). Se encontraron algunas similitudes, pero numerosas diferencias entre países. En los contextos humildes pero animosos, rurales, con raíces tradicionales y poco demandantes, se encontraban un mayor rango de tareas del médico de familia, la coexistencia de trabajo público y privado, y de medicina moderna y tradicional, con mayor presencia de asistencia familiar y comunitaria, más satisfacción del médico y mejor relación médico-paciente. CONCLUSIONES: El perfil profesional del médico de familia es diverso y dependiente del contexto variable, y no se deriva directamente de la teoría externa de la medicina de familia

OBJECTIVE: To examine the professional profile of the family doctor in different countries and the social welfare context where their work is carried out. DESIGN: Qualitative Methodology of production of field diaries of a normal day. Location: Primary Heath Care of Toledo and Tenerife in Spain, and Paraguay, Mexico, and Peru. Participants and contexts: Non-random sampling, intentional, followed by snowball sample until data saturation. METHOD: Participants wrote a diary of a typical day's work, their circumstances and socio-health context, and were studied by content analysis. Techniques to control the biases were used the check the participants and the triangulation between the obtained results and the existing bibliography, and data found on the Internet daily. We performed a mental map to transcribe the results graphically and in a comprehensive form. RESULTS: A total of 24 diaries of a normal day were obtained (9 doctors in Spain, 7 in Mexico, 4 in Paraguay, and 4 in Peru). We found some similarities, but many differences between countries. In contexts of humble but spirited, rural, with traditional roots and undemanding, there was a wider range of tasks of the family doctor, the coexistence of public and private work, and modern and traditional medicine, with greater presence of family and community care, more physician satisfaction and better patient-physician relationship. CONCLUSIONS: The professional profile of the family doctor is diverse and a context-dependent variable, and is not derived directly from external theory of family medicine

[The odysseys of Ulysses. A study of tales in a normal working day of the family doctor in Paraguay, Mexico, Peru, and Spain]. / Las odiseas de los Ulises. Estudio de los relatos de un día normal de trabajo del médico de familia en Paraguay, México, Perú y España.

OBJECTIVE: To examine the professional profile of the family doctor in different countries and the social welfare context where their work is carried out. DESIGN: Qualitative Methodology of production of field diaries of a normal day. LOCATION: Primary Heath Care of Toledo and Tenerife in Spain, and Paraguay, Mexico, and Peru. PARTICIPANTS AND CONTEXTS: Non-random sampling, intentional, followed by snowball sample until data saturation. METHOD: Participants wrote a diary of a typical day's work, their circumstances and socio-health context, and were studied by content analysis. Techniques to control the biases were used the check the participants and the triangulation between the obtained results and the existing bibliography, and data found on the Internet daily. We performed a mental map to transcribe the results graphically and in a comprehensive form. RESULTS: A total of 24 diaries of a normal day were obtained (9 doctors in Spain, 7 in Mexico, 4 in Paraguay, and 4 in Peru). We found some similarities, but many differences between countries. In contexts of humble but spirited, rural, with traditional roots and undemanding, there was a wider range of tasks of the family doctor, the coexistence of public and private work, and modern and traditional medicine, with greater presence of family and community care, more physician satisfaction and better patient-physician relationship. CONCLUSIONS: The professional profile of the family doctor is diverse and a context-dependent variable, and is not derived directly from external theory of family medicine.

Iluminar y deslumbrar. Un caso de prescripción inadecuada de prasugrel con reacción adversa urticante / To enlighten and to dazzle: a case of an inadequate prescription of Prasugrel with an adverse reaction of urticaria

No disponible

Los pacientes con reacciones adversas a medicamentos presentan una mayor prevalencia de alteraciones emocionales / Patients with adverse drug reactions have a higher prevalence of emotional disorders

Objetivo: Examinar la frecuencia de alteraciones emocionales (ansiedad y depresión) en pacientes con reacciones adversas (RA) a medicamentos, y compararla con la que se da en pacientes sin las mismas. Diseño del estudio: Casos y controles. Emplazamiento: Centro de Salud de Santa María de Benquerencia (Toledo). Participantes: Pacientes mayores de 14 años de ambos sexos de una consulta de medicina de familia. Mediciones y resultados: El total de pacientes fue de 311 (108 casos y 203 controles), siendo el 53,7% varones. La edad de los casos fue de 54,1 años y la de los controles 46,0 (t=4,254; p<0,001). El 45,5% de los casos presentaba antecedentes de ansiedad y el 41,7% de depresión, frente al 19,7 y 15,3%, respectivamente, de los controles (p<0,001). El promedio de enfermedades crónicas en casos fue de 5,8 y en controles 3,5 (p<0,001). El número de medicamentos tomados para los casos fue de 3,7 y para los controles de 1,7 (p<0,001). En la regresión logística, la probabilidad de haber presentado ansiedad está aumentada 2,5 veces en los pacientes con RA a medicamentos (IC 95%: 1,12-4,51) y la de haber presentado depresión 2 veces (IC 95%: 1,06-3,66). Los grupos de medicamentos que más RA presentaron fueron los del sistema nervioso central, los antibióticos y los antiinflamatorios. Conclusiones: 1) La comunicación de RA a medicamentos se asocia con la presencia de ansiedad o depresión, lo cual podría usarse como marcador de problemática psicosocial. 2) Debemos prestar atención a los pacientes con ansiedad o depresión a la hora de realizar prescripciones. 3) Los antibióticos, antiinflamatorios y fármacos que actúan en el sistema nervioso central son los más proclives a producir RA(AU)

Aim: To examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders. Study design: Case-control. Setting: Santa María de Benquerencia Health Centre (Toledo).ParticipantsPatients over 14 years old of both sexes managed in a Primary Care Clinic. Measurements and results: A total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t=4.254; P<0.001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P<0.001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P<0.001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P<0.001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely (1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories. Conclusions: 1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR(AU)

[Patients with adverse drug reactions have a higher prevalence of emotional disorders]. / Los pacientes con reacciones adversas a medicamentos presentan una mayor prevalencia de alteraciones emocionales.

AIM: To examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders. STUDY DESIGN: Case-control. SETTING: Santa María de Benquerencia Health Centre (Toledo). PARTICIPANTS: Patients over 14 years old of both sexes managed in a Primary Care Clinic. MEASUREMENTS AND RESULTS: A total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t=4.254; P<.001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P<.001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P<.001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P<.001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely(1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories. CONCLUSIONS: 1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR.