Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey.

Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

Depressive symptom severity is a major risk factor for frailty in community-dwelling older adults with depression. A prospective study.

BACKGROUND: Depression and frailty are closely related, but the mechanisms by which depressed older adults are at an increased risk of becoming frail are still not well understood. AIM: To assess socioeconomic and depression-related risk factors for frailty in older adults with depression. METHODS: Observational and prospective cohort study, with 12-month follow-up, of nonfrail community-dwelling subjects aged ≥70 years old with depression. The main study factors were clinical characteristics of depression, including symptom severity (Hamilton Depression Rating Scale), accompanying anxiety and cognitive symptoms, pharmacological treatment, and social factors including educational level, income, housing conditions and living circumstances, and social network. Frailty status was established according to Fried criteria. RESULTS: We recruited and analysed 216 subjects (mean age 76.5 years; 74% women), 65 (30%) of whom were lost to follow-up. Annual incidence of frailty was 23.2 new cases/100 persons. Age, female gender, osteoarthritis, pain, number of medications, major depression, first-degree family history of depression, depressive symptom severity, low educational level, and low-income level were risk factors for frailty. The multivariate analysis showed that age (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 1.04-1.29), visual analogue scale (VAS)-pain (OR = 1.25; 95% CI: 1.01-1.55), and severe or very severe depressive symptoms (OR = 37.36; 95% CI: 2.68-518.53) were significantly associated with incident frailty at 12 months of follow-up. CONCLUSIONS: Both clinical and social characteristics are risk factors for frailty, but severity of depressive symptoms had the highest independent effect on frailty in depressed aged subjects. Frailty requires a multidisciplinary approach that pays special attention to pain and depressed mood.

Primary Care Professionals' Self-Efficacy Surrounding Advance Care Planning and Its Link to Sociodemographics, Background and Perceptions: A Cross-Sectional Study.

Primary care (PC) professionals have been considered the most appropriate practitioners for leading Advance care planning (ACP) processes with advanced chronic patients. AIM: To explore how PC doctors' and nurses' self-efficacy surrounding ACP is linked to their sociodemographic characteristics, background and perceptions of ACP practices. METHODS: A cross-sectional study was performed. Sociodemographics, background and perceptions about ACP in practice were collected using an online survey. The Advance Care Planning Self-Efficacy Spanish (ACP-SEs) scale was used for the self-efficacy measurement. STATISTICAL ANALYSIS: Bivariate, multivariate and backward stepwise logistic regression analyses were performed to identify variables independently related to a higher score on the ACP-SEs. RESULTS: N = 465 participants, 70.04% doctors, 81.47% female. The participants had a mean age of 46.45 years and 66.16% had spent >15 years in their current practice. The logistic regression model showed that scoring ≤ 75 on the ACP-SEs was related to a higher score on feeling sufficiently trained, having participated in ACP processes, perceiving that ACP facilitates knowledge of preferences and values, and perceiving that ACP improves patients' quality of life. CONCLUSION: Professionals with previous background and those who have a positive perception of ACP are more likely to feel able to carry out ACP processes with patients.

Psychosocial factors associated with frailty in the community-dwelling aged population with depression. A cross-sectional study / Factores psicosociales asociados a fragilidad en ancianos de la comunidad con depresión: estudio observacional transversal

Objective: There is a two-way relationship between frailty and depression, but the mechanisms by which one may influence the other are not well understood. The objective of this study was to evaluate the relationship between psychosocial factors and frailty in community-dwelling aged populations with depression. Design:Observational cross-sectional study. Site: 5 primary care centres. Participants: Community-dwelling subjects with depression aged ≥70 years. Main measurements: Frailty status was established according to Fried criteria, depression and depression severity were evaluated by DSM-IV criteria and the Hamilton Depression Rating Scale, respectively, and psychosocial factors were assessed using the Gijón Social-Familial Evaluation Scale and ad hoc questionnaires. Results: Recruited were 338 subjects (mean age 77.2 years), 82% women and 36.1% rated as frail. A dose–response relationship was observed between depression severity and frailty risk. Widowhood was a risk factor for frailty, while a higher educational level, home internet, stairs in the home, and an active social life had a protective effect. A multivariate analysis showed that age, number of drugs, and depression severity were independent risk factors for frailty, while an active social life was a protective factor. The severity of depressive symptoms showed higher association with frailty than other clinical and socio-demographic characteristics. Conclusions: In depressed elderly subjects, frailty is associated with psychologiocal factors such as the intensity of depressive symptoms and with social factors such as education level, widowhood, loneliness, and limited social life. More research is required to better understand the modifiable psychological risk factors for frailty.(AU)

Objetivo: Existe una relación bidireccional entre la fragilidad y la depresión en la población anciana. El objetivo de este estudio fue evaluar la relación entre los factores psicosociales y la fragilidad en ancianos de la comunidad con depresión. Diseño: Estudio observacional transversal. Sitio: Cinco centros de atención primaria. Participantes: Ancianos ≥70años de la comunidad con depresión. Principales mediciones: La fragilidad se estableció de acuerdo con los criterios de Fried, la depresión y la gravedad de la depresión se evaluaron mediante los criterios DSM-IV y la Escala de Hamilton, respectivamente, y los factores psicosociales se evaluaron utilizando la Escala de Evaluación Social-Familiar de Gijón y cuestionarios ad hoc. Resultados: Se reclutaron 338 sujetos (edad media 77años), 82% mujeres y 36,1% frágiles. Se observó una relación dosis-respuesta entre la gravedad de la depresión y el riesgo de fragilidad. La viudez era un factor de riesgo para la fragilidad, mientras que un nivel educativo más alto, internet en el hogar, escaleras en el hogar y una vida social activa tenían un efecto protector. El análisis multivariado mostró que la edad, el número de medicamentos y la gravedad de la depresión eran factores de riesgo independientes para la fragilidad, mientras que una vida social activa era un factor protector. Conclusiones: En ancianos con depresión la fragilidad se asocia con factores psicológicos como la intensidad de los síntomas depresivos y con factores sociales como el nivel de estudios, la viudez, la soledad o la escasa vida social. Se requiere más investigación para comprender mejor los factores de riesgo psicológicos modificables de fragilidad.(AU)

Psychosocial factors associated with frailty in the community-dwelling aged population with depression. A cross-sectional study.

OBJECTIVE: There is a two-way relationship between frailty and depression, but the mechanisms by which one may influence the other are not well understood. The objective of this study was to evaluate the relationship between psychosocial factors and frailty in community-dwelling aged populations with depression. DESIGN: Observational cross-sectional study. SITE: 5 primary care centres. PARTICIPANTS: Community-dwelling subjects with depression aged ≥70 years. MAIN MEASUREMENTS: Frailty status was established according to Fried criteria, depression and depression severity were evaluated by DSM-IV criteria and the Hamilton Depression Rating Scale, respectively, and psychosocial factors were assessed using the Gijón Social-Familial Evaluation Scale and ad hoc questionnaires. RESULTS: Recruited were 338 subjects (mean age 77.2 years), 82% women and 36.1% rated as frail. A dose-response relationship was observed between depression severity and frailty risk. Widowhood was a risk factor for frailty, while a higher educational level, home internet, stairs in the home, and an active social life had a protective effect. A multivariate analysis showed that age, number of drugs, and depression severity were independent risk factors for frailty, while an active social life was a protective factor. The severity of depressive symptoms showed higher association with frailty than other clinical and socio-demographic characteristics. CONCLUSIONS: In depressed elderly subjects, frailty is associated with psychologiocal factors such as the intensity of depressive symptoms and with social factors such as education level, widowhood, loneliness, and limited social life. More research is required to better understand the modifiable psychological risk factors for frailty.

Cada semana cuenta: uso de dispositivos sanitarios y costes relacionados de una cohorte comunitaria de personas con enfermedades crónicas avanzadas / Every week counts: Use of health services and related costs of a community-based cohort of people with advanced chronic diseases

Objetivo: Describir el uso de dispositivos sanitarios de las personas con cronicidad avanzada, cuantificando y caracterizando el coste de dicho consumo para sugerir mejoras en los modelos de atención. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con cronicidad avanzada. Emplazamiento: Tres equipos de atención primaria (EAP) de Osona, Cataluña. Participantes: Un total de 224 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática. Mediciones principales: Edad, sexo, tipo de domicilio, trayectoria final de vida; uso, tipo y coste de los recursos en atención primaria, urgencias, por equipos de paliativos o de hospitalización (en agudos o atención intermedia). Resultados: Se realizaron una media de 1,1 ingresos al año (estancia media = 6 días), el 74% en hospitales de atención intermedia. El 93,4% del tiempo los pacientes vivieron en la comunidad, realizando un contacto semanal con el EAP (45,1% en domicilio). El coste medio diario fue 19,4euros, siendo los principales capítulos la hospitalización de atención intermedia (36,5%), la actividad EAP (29,4%) y los ingresos en agudos (28,6%). Los determinantes de menor coste serían la trayectoria fragilidad/demencia (p < 0,001), vivir en una residencia (p < 0,001) y el sobreenvejecimiento (p < 0,001). Hay ciertas diferencias en el comportamiento de los EAP en el coste global y en recursos comunitarios (p < 0,05). Conclusiones: Los consumos en hospitalización intermedia y atención primaria son más relevantes que las estancias en centros de agudos. Los contextos residencial y domiciliario son importantes para atender con efectividad y eficiencia, especialmente cuando los EAP se preparan para ello

Objective: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. Design: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. Location: Three primary care teams (EAP) of Osona, Cataluña. Participants: 224 people identified as advanced patients through a systematic population strategy. Main measurements: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). Results: Patients made an average of 1.1 admissions per year (average stay = 6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4 euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p < 0.001), living in a nursing-home facility (p < 0.001) and over-aging (p < 0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p < 0.05). Conclusions: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it

Relative Validity of a Method Based on a Smartphone App (Electronic 12-Hour Dietary Recall) to Estimate Habitual Dietary Intake in Adults.

BACKGROUND: Accurate dietary assessment is key to understanding nutrition-related outcomes and for estimating the dietary change in nutrition-based interventions. When researching the habitual consumption of selected food groups, it is essential to be aware of factors that could possibly affect reporting accuracy. OBJECTIVE: This study aimed to evaluate the relative validity of the current-day dietary recall, a method based on a smartphone app called electronic 12-hour dietary recall (e-12HR), to categorize individuals according to habitual intake, in the whole sample of adults and in different strata thereof. METHODS: University students and employees over 18 years recorded the consumption of 10 selected groups of food using e-12HR during 28 consecutive days. During this period, they also completed 4 dietary records. Once the period was finished, the subjects then completed a food frequency questionnaire (FFQ) and a usability-rating questionnaire for e-12HR. The food group intakes estimated by the e-12HR app, the dietary records, and the FFQ were categorized into sextiles: less than once a week, once or twice a week, 3-4 times a week, 5-6 times a week, once or twice a day, and 3 or more times a day. The 10 selected groups with e-12HR were compared with 4 dietary records and an FFQ reference method, in the whole sample and in different strata thereof: age (years): <25 and ≥25; gender: females and males; occupation: students and employees; smoking: no and yes; physical activity (minutes/week): ≥150 and <150; and body mass index (kg/m2): <25 and ≥25. The association between the different methods was assessed using Spearman correlation coefficient (SCC). Cross-classification and kappa statistic were used as a measure of agreement between the different methods. RESULTS: In total, 203 participants completed the study (56.7% [115/203] women, and 43.3% [88/203] men). For all food groups and all participants, the mean SCC for e-12HR versus FFQ was 0.67 (≥0.62 for all strata). On average, 50.7% of participants were classified into the same category (≥47.0% for all strata) and 90.2% within the nearest category (≥88.6% for all strata). Mean weighted kappa was 0.49 (≥0.44 for all strata). For e-12HR versus RDs, mean SCC was 0.65 (≥0.57 for all strata). On average, 50.0% of participants were classified into the same category (≥47.0% for all strata) and 88.2% within the nearest category (≥86.1% for all strata). Mean weighted kappa was 0.50 (≥0.44 for all strata). CONCLUSIONS: The results indicate that e-12HR generated categories of dietary intake highly comparable with the 2 reference methods in the whole sample and in different strata thereof. The inclusion of photographs to facilitate estimation of the servings consumed generated correlation/agreement data between e-12HR and the FFQ that were similar to a previous study using an older version of the app, which did not include photographs.

Busca tu 1%: prevalencia y mortalidad de una cohorte comunitaria de personas con enfermedad crónica avanzada y necesidades paliativas / Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs

Objetivo: Determinar prevalencias y perfiles de las personas con enfermedades crónicas avanzadas en atención primaria y analizar elementos relacionados con su mortalidad para orientar estrategias de mejora. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con necesidades paliativas. Emplazamiento: Tres equipos de atención primaria del Área de Gestión Asistencial de Osona (Cataluña). Participantes: Un total de 251 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática que incluye el test NECPAL. Mediciones principales: Perfil demográfico y clínico básico (edad, sexo, tipo de domicilio, nivel de estratificación y enfermedad principal); fecha, lugar y causa de los eventuales fallecimientos. Resultados: El 1% de la población adulta analizada presenta enfermedades avanzadas. El 56,6% son mujeres, con una mediana de edad de 85 años. El 49,3% son personas con demencia o fragilidad avanzada, el 13,7% tienen cáncer. El 24,3% viven en residencias. La mortalidad acumulada a los 3 años es del 62,1%, con una mediana de supervivencia de 23 meses. Los factores significativamente relacionados con la probabilidad de morir son tener cáncer, el sexo femenino y el sobreenvejecimiento. Los pacientes fallecen en su domicilio (47,3%), en un hospital de atención intermedia (37,2%) o en un hospital de agudos (15,5%) en función de determinados factores explicativos. Conclusiones: En la población analizada la prevalencia y características de la enfermedad avanzada comunitaria coinciden con la reportada en la literatura. La atención primaria es el nivel de atención potencialmente referente de estos pacientes, especialmente si incorpora el entorno residencial en su ámbito de actuación

Objective: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. Design: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. Location: Three Primary Care teams of Osona (Catalonia). Participants: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. Main measurements: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. Results: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. Conclusions: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice

[Every week counts: Use of health services and related costs of a community-based cohort of people with advanced chronic diseases]. / Cada semana cuenta: uso de dispositivos sanitarios y costes relacionados de una cohorte comunitaria de personas con enfermedades crónicas avanzadas.

OBJECTIVE: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. DESIGN: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. LOCATION: Three primary care teams (EAP) of Osona, Cataluña. PARTICIPANTS: 224 people identified as advanced patients through a systematic population strategy. MAIN MEASUREMENTS: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). RESULTS: Patients made an average of 1.1 admissions per year (average stay=6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p<0.001), living in a nursing-home facility (p<0.001) and over-aging (p<0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p<0.05). CONCLUSIONS: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it.

[Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs]. / Busca tu 1%: prevalencia y mortalidad de una cohorte comunitaria de personas con enfermedad crónica avanzada y necesidades paliativas.

OBJECTIVE: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION: Three Primary Care teams of Osona (Catalonia). PARTICIPANTS: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. MAIN MEASUREMENTS: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. RESULTS: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. CONCLUSIONS: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice.

Necesidades formativas percibidas al envejecer. Cómo afrontar un envejecimiento saludable / Educational perceived needs when aging. How to face a healthy aging

Objetivo: Explorar necesidades formativas percibidas por las personas mayores de 60 años al envejecer y conocer los beneficios o barreras de participar en cursos de formación dirigidos a ellos. Metodología: Estudio cualitativo con grupos focales realizado en áreas básicas de salud y un centro social de Mataró (Barcelona). Se estudiaron 29 sujetos divididos en: personas mayores de 60 años que acudían a un centro de atención primaria y personas mayores de 60 de una asociación de personas mayores. Se organizaron 4 grupos focales estratificados por segmentos. Se transcribieron las grabaciones elaborando categorías, se codificaron y analizaron. Resultados: Los participantes tenían vidas plenas, apoyos emocionales y vínculos positivos con su comunidad y familia. Manifestaron que es importante planificar el envejecimiento y actividades para realizar al jubilarse. Conclusión: Es necesario recibir formación al envejecer. Principales barreras: obligación de cuidar, falta de tiempo y coste económico

Objective: To explore formative needs perceived by people older than 60 years when aging and to know the benefits and/or barriers of participating in training courses focused on them. Methods: Qualitative study with focus groups made in basic areas of primary care and a social center of Mataró (Barcelona).29 subjects were studied, divided into: people over 60 years attending a primary care center and people over 60 belonging to an association of elderly. 4 focus groups stratified by segments were organized. The recordings were transcribed elaborating categories, they were codified and analyzed. Results: The participants had full lives, emotional support and positive links with their community and family. They stated that it is important to plan aging and activities to do when retiring. Conclusions: To receive training is needed when aging. Main barriers: obligation to take care of, lack of time, economic cost

Tercer Congreso de la Profesión Médica de Catalunya: consenso sobre los retos del profesionalismo y su impacto en las organizaciones docentes / The Third Congress of the Medical Profession of Catalonia: a consensus on the challenges of professionalism and their impact on medical education organizations

Introducción. En tiempos donde los condicionantes demográficos, epidemiológicos, socioeconómicos y tecnológicos determinan fuertemente la manera en que se ejerce la medicina, foros como el Congreso de la Profesión Médica de Catalunya pueden aportar luz en los nuevos enfoques que exige el profesionalismo médico actual y futuro. Objetivo. Mostrar el proceso y las conclusiones de un consenso, llevado a cabo en la edición 2016 del congreso, acerca de los nuevos retos del profesionalismo y del perfil del médico que la sociedad de las próximas décadas va a necesitar. Sujetos y métodos. Se lleva a cabo un proceso participativo y estructurado de consenso, implementado en tres fases consecutivas: panel de expertos, peer-review telemático y debate intracongresual. Resultados. La participación activa de 21 expertos, de 2.025 aportaciones telemáticas y de 131 delegados congresuales genera un documento de propuestas compartidas que cuenta con índices de aprobación cercanos al 95% y que permite identificar y priorizar los retos percibidos en el profesionalismo y los atributos de los médicos del futuro reciente. Conclusiones. El profesionalismo médico se verá directamente interpelado por las nuevas condiciones sociales y por las nuevas propuestas para los sistemas sanitarios del futuro, donde los elementos de empoderamiento ciudadano, de toma compartida de decisiones clínicas, de prácticas colaborativas y marcos éticos impecables, asociados a una apuesta decidida por posiciones de liderazgo profesional y social del colectivo médico, van a constituir el contexto emergente de la práctica de la medicina, al que las organizaciones docentes deberán adaptarse (AU)

Introduction. In times where demographic, epidemiological, socio-economic and technological conditions strongly determine the way in which medicine is practiced, forums such as the Congress of the Medical Profession of Catalonia can inform on the new approaches required by current and future medical professionalism. Aim. To show the process and the conclusions of a consensus, carried out in the 2016 edition of the Congress, about the new challenges of professionalism and the profile of the physician that the Catalan society will need the next decades. Subjects and methods. A participatory and structured consensus process is implemented in three consecutive phases: expert panel, telematic peer-review and intra-congressional debate. Results. The active participation of 21 experts, 2,025 telematic contributions and 131 congressional delegates generated a document of shared proposals that has approval rates around 95% and that allows the identification and prioritization of the perceived challenges in professionalism and the attributes of physicians for the recent future. Conclusions. Medical professionalism will be directly challenged by the new social conditions and by the proposals for the health systems of the future, where the elements of citizen empowerment, of shared decision-making procedures, of collaborative practices in impeccable ethical frameworks and solid positions of professional and social leadership of doctors will constitute the emerging context of the practice of medicine, to which teaching organizations will have to adapt (AU)

Is there any alternative to traditional food frequency questionnaire for evaluating habitual dietary intake?

INTRODUCTION: Dietary assessment methods are an important instrument for nutrition research. Food frequency questionnaires (FFQs) have been the most frequently used dietary assessment tool in epidemiological and intervention studies. There is a great necessity for new methods of determination of habitual dietary intake that overcome the limitations of these traditional methods. OBJECTIVES: The objectives of the present study were to develop a new method, based on an application for mobile phones called e-EPIDEMIOLOGY, designed to record individual consumption data about a short series of foods/drinks, and to compare data collected using this tool with those obtained from a previously validated short paper FFQ. METHODS: University students over 18 years recorded the consumption of certain foods/drinks using e-EPIDEMIOLOGY during 28 consecutive days and then filled out a short paper FFQ at the end of the study period. To evaluate the agreement between both methods, Spearman's correlation coefficient, cross-classification analysis and a weighted kappa statistic were used. RESULTS: One hundred and nineteen participants completed the study (71.4% female and 28.6% male). The mean Spearman's correlation coefficients for food/drink group intake between the two methods was 0.73. The mean percentage of participants cross-classified into categories of "exact agreement + adjacent" was 91.6%. The average weighted kappa statistic was 0.60. CONCLUSIONS: The results indicate that e-EPIDEMIOLOGY has good agreement with the previously validated FFQ short paper. However, it was noted that further testing of e-EPIDEMIOLOGY is required to establish its wider utility.

Is there any alternative to traditional food frequency questionnaire for evaluating habitual dietary intake? / ¿Hay alguna alternativa al tradicional cuestionario de frecuencia de consumo de alimentos para la evaluación de la ingesta alimentaria habitual?

Introduction: Dietary assessment methods are an important instrument for nutrition research. Food frequency questionnaires (FFQs) have been the most frequently used dietary assessment tool in epidemiological and intervention studies. There is a great necessity for new methods of determination of habitual dietary intake that overcome the limitations of these traditional methods. Objectives: The objectives of the present study were to develop a new method, based on an application for mobile phones called e-EPIDEMIOLOGY, designed to record individual consumption data about a short series of foods/drinks, and to compare data collected using this tool with those obtained from a previously validated short paper FFQ. Methods: University students over 18 years recorded the consumption of certain foods/drinks using e-EPIDEMIOLOGY during 28 consecutive days and then filled out a short paper FFQ at the end of the study period. To evaluate the agreement between both methods, Spearman’s correlation coefficient, cross-classification analysis and a weighted kappa statistic were used. Results: One hundred and nineteen participants completed the study (71.4% female and 28.6% male). The mean Spearman’s correlation coefficients for food/drink group intake between the two methods was 0.73. The mean percentage of participants cross-classified into categories of «exact agreement + adjacent» was 91.6%. The average weighted kappa statistic was 0.60. Conclusions: The results indicate that e-EPIDEMIOLOGY has good agreement with the previously validated FFQ short paper. However, it was noted that further testing of e-EPIDEMIOLOGY is required to establish its wider utility (AU)

Introducción: los métodos de evaluación de la dieta son importantes instrumentos para la investigación nutricional. Los cuestionarios de frecuencia de consumo de alimentos (CFCA) han sido los métodos utilizados con mayor frecuencia en los estudios epidemiológicos y de intervención. Hay una gran necesidad de nuevas herramientas que superen las limitaciones de estos métodos tradicionales. Objetivos: los objetivos del presente estudio fueron desarrollar un nuevo método, basado en una aplicación para teléfonos móviles llamada e-EPIDEMIOLOGY, diseñada para registrar los datos de consumo individual de una serie corta de alimentos/bebidas, y comparar estos datos con los obtenidos a partir de un CFCA corto (en papel) validado previamente. Métodos: estudiantes universitarios mayores de 18 años registraron el consumo de ciertos alimentos/bebidas usando e-EPIDEMIOLOGY durante 28 días consecutivos y cumplimentaron un CFCA corto (en papel) al final del periodo de estudio. Para evaluar el acuerdo entre ambos métodos se utilizaron el coeficiente de correlación de Spearman, el análisis de clasificación cruzada y el kappa ponderado. Resultados: un total de 119 participantes completaron el estudio (71,4% mujeres y 28,6% hombres). El coeficiente de correlación de Spearman medio entre ambos métodos fue 0,73. La media del porcentaje de clasificación cruzada en la categoría de «acuerdo exacto + adyacente» fue 91,6%. La media del kappa ponderado fue 0,60. Conclusiones: los resultados indican que e-EPIDEMIOLOGY tiene buena concordancia con el CFCA corto (en papel) previamente validado. Sin embargo, son necesarias más pruebas con e-EPIDEMIOLOGY para establecer su utilidad de forma más amplia (AU)

Cronicidad, profesionalismo y la encrucijada paliativa / Chronicity, professionalism and the palliative care crossroads

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Las necesidades poblacionales, una llamada a la transformación de la atención primaria / Population needs, a call for changes in Primary Care

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Equipos de soporte domiciliario de cuidados paliativos en España / Specialist palliative care home care support teams in Spain

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