Impacto del confinamiento durante la pandemia de COVID-19 en la prevalencia de la enfermedad tromboembólica venosa / Impact of strict confinement during the COVID-19 pandemic on the prevalence of venous thromboembolic disease

Objetivo: comparar la frecuencia de eventos tromboembólicos agudos en pacientes atendidos en urgencias de un hospital comarcal durante las primeras semanas de la pandemia de COVID-19 del año 2020 respecto al año anterior.Material y métodos: estudio retrospectivo en pacientes mayores de 40 años atendidos en urgencias del Hospital de Riotinto (Huelva) desde el 15 de marzo al 30 de abril de los años 2019 y 2020. La recogida de información se llevó a cabo a partir de una revisión de historias clínicas y el cuestionario de recogida de datos contenía variables clínicas y sociodemográficas.Resultados: se incluyeron 1.245 pacientes. Edad media: 71,2 años (desviación estándar [DE]: 13,7) y un 51,1% eran mujeres. En 2019 se atendieron a 797 mayores de 40 años y en 2020 fueron 448, suponiendo un descenso del 43,79%. La prevalencia de embolismo pulmonar fue superior en 2020 respecto a 2019 (1,6% frente a 0,4%; p = 0,024). La frecuencia de eventos trombóticos venosos fue superior también en 2020 respecto a 2019 (1,35% frente a 0,4%; p = 0,054). La prevalencia global de la enfermedad tromboembólica venosa con variable compuesta (tromboembolismo pulmonar + trombosis venosa) fue significativamente superior en 2020 frente a 2019 (2,9% frente a 0,8%; p = 0,003). Ningún paciente fue diagnosticado de COVID-19 y tromboembolismo.Conclusiones: en el período de confinamiento durante la pandemia hubo un incremento del número de eventos tromboembólicos agudos en adultos, tanto de tromboembolia pulmonar como de trombosis venosa profunda respecto al año previo. (AU)

Aim: to compare the frequency of acute thromboembolic events in patients visited in the casualty department of a regional hospital during the first few weeks of the COVID-19 pandemic in 2020 with the same period of previous year.Material and methods: retrospective study of patients aged over 40 years of age treated in the casualty department of Hospital de Riotinto (Huelva) from 15 March to 30 April 2019 and same period of 2020. The information was collected from a review of medical records. The data collection questionnaire contained clinical and sociodemographic variables.Results: a total of 1245 patients were included. Mean age was 71.2 (SD:13.7) years old and 51.1% were women. In 2019, 797 patients aged over 40 years of age were treated, while in 2020, the patients seen were 448, which represented a decrease of 43.79%. The prevalence of pulmonary embolism was higher in 2020 compared to 2019 (1.6% vs. 0.4%; P=0.024). The frequency of venous thrombotic events was also higher in 2020 compared to 2019 (1.35% vs. 0.4%; P=0.054). The overall prevalence of venous thromboembolic disease with composite variable (pulmonary thromboembolism + venous thrombosis) was statistically significantly higher in 2020 versus 2019 (2.9% versus 0.8%; P=0.003). None of our patients were diagnosed with COVID-19 and thromboembolism.Conclusions: during the period of confinement during the pandemic there was an increase in the number of acute thromboembolic events in adults, both PE and VTE compared to the previous year.(AU)

Influencia de los estilos de vida de la madre en el inicio de la lactancia materna: estudio de casos y controles / Influence of the mother's lifestyles on the initiation of breastfeeding: A case-control study

Introducción: La lactancia materna es la alimentación óptima durante los primeros meses de vida. El objetivo principal de este estudio fue analizar los factores relacionados con no iniciar la lactancia materna, tanto referidos a los estilos de vida maternos como a las características epidemiológicas y la información sobre lactancia. Material y método: Estudio analítico observacional de casos y controles en 6 centros de salud. Se seleccionaron mujeres con algún hijo menor de 5 años, estimando un tamaño muestral de 166 casos (mujeres que no iniciaron lactancia materna) y 166 controles (que iniciaron lactancia). Se midieron variables sociodemográficas y estilos de vida maternos antes y durante la gestación, como la actividad física mediante el cuestionario BPAAT, la dieta con el cuestionario MEDAS-14 y el consumo de tabaco y alcohol. Se valoró la información y opiniones sobre lactancia, así como la experiencia previa. Resultados: Se incluyeron 348 mujeres (174 casos y 174 controles) con una edad media de 33,4 años (DE 5,4). Fueron variables asociadas de manera independiente con no iniciar lactancia: ausencia de experiencia previa con lactancia (OR: 12,75), tomar la decisión durante la gestación o el parto (OR: 10,55), no estar casada o con pareja (OR: 3,42) y permanecer sedentaria≥2h/día durante la gestación (OR: 1,77). Conclusiones: En nuestro estudio, los factores determinantes que se asocian a no iniciar lactancia materna son la ausencia de experiencia previa con lactancia, el momento de la decisión sobre la lactancia y el estado civil. Entre los estilos de vida, solo el sedentarismo se asocia a no iniciar lactancia materna, mientras que no tienen influencia los hábitos alimentarios u otros. (AU)

Introduction: Breast milk is the optimal food during the first months of life. The main objective was to analyse the factors associated with not initiating breastfeeding in terms of maternal lifestyles, epidemiological characteristics and information on breastfeeding. Material and method: Observational analytical study of cases and controls in 6 primary care centres. The sample included women with a child under 5 years, with an estimated necessary sample size of 166 cases (women who did not initiate breastfeeding) and 166 controls (women who began breastfeeding). Sociodemographic and maternal lifestyle variables were measured before and during pregnancy, such as physical activity using the BPAAT questionnaire, diet with the MEDAS-14 questionnaire, and tobacco and alcohol consumption. We assessed the information and opinions about breastfeeding as well as previous experience with it. Results: The study included 348 women (174 cases and 174 controls) with a mean age of 33.4 years (SD 5.4). The variables independently associated with not initiating breastfeeding were: absence of previous experience with breastfeeding (OR 12.75), making the decision during pregnancy or delivery (OR 10.55), not being married or in a partnership (OR 3.42) and being sedentary for periods of 2h or greater/day during pregnancy (OR 1.77). Conclusions: In our study, the determining factors associated with not initiating breastfeeding were the lack of previous experience with breastfeeding, the timing of the decision about breastfeeding, and marital status. When it came to lifestyle, only a sedentary lifestyle was associated with not initiating breastfeeding, while dietary or other habits had no influence. (AU)

Influence of the mother's lifestyles on the initiation of breastfeeding: A case-control study.

INTRODUCTION: Breast milk is the optimal food during the first months of life. The main objective was to analyse the factors associated with not initiating breastfeeding in terms of maternal lifestyles, epidemiological characteristics and information on breastfeeding. MATERIAL AND METHOD: Observational analytical study of cases and controls in 6 primary care centres. The sample included women with a child under 5 years, with an estimated necessary sample size of 166 cases (women who did not initiate breastfeeding) and 166 controls (women who began breastfeeding). Sociodemographic and maternal lifestyle variables were measured before and during pregnancy, such as physical activity using the BPAAT questionnaire, diet with the MEDAS-14 questionnaire, and tobacco and alcohol consumption. We assessed the information and opinions about breastfeeding as well as previous experience with it. RESULTS: The study included 348 women (174 cases and 174 controls) with a mean age of 33.4 years (SD, 5.4). The variables independently associated with not initiating breastfeeding were: absence of previous experience with breastfeeding (odds ratio [OR], 12.75), making the decision during pregnancy or delivery (OR, 10.55), not being married or in a partnership (OR, 3.42) and being sedentary for periods of 2 hours or greater/day during pregnancy (OR, 1.77). CONCLUSIONS: In our study, the determining factors associated with not initiating breastfeeding were the lack of previous experience with breastfeeding, the timing of the decision about breastfeeding, and marital status. When it came to lifestyle, only a sedentary lifestyle was associated with not initiating breastfeeding, while dietary or other habits had no influence.

La mujer en la investigación en la sociedad científica. Una aproximación mediante un análisis de producción científica en la semFYC / Women in research in the scientific society. An approximation by means of an analysis of scientific production in the semFYC

Objetivo: conocer el grado de feminización de la autoría de los estudios y proyectos de investigación presentados en las reuniones científicas nacionales de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC). Métodos: se realizó un estudio descriptivo transversal mediante el análisis de las bases de datos de las comunicaciones de investigación presentadas en los congresos nacionales de la semFYC entre los años 2007 y 2021, así como de los proyectos presentados para las becas de investigación para tesis doctorales. Se recogieron las variables de género, comunidad autónoma, universidad, año de celebración del congreso y áreas temáticas estudiadas. Resultados: se analizaron 6.057 comunicaciones de investigación, siendo el 66,7% (IC 95%: 65,5-67,8) presentadas por una mujer con primera autora. Las comunidades a las que corresponden el mayor porcentaje de comunicaciones de autoría femenina fueron Cataluña (42%), Andalucía (19%), Madrid (8%), Comunidad Valenciana (5%) y Murcia (5%). Aragón es la que presenta mayor ratio de mujeres/hombres (72%), seguida de Cataluña (69%) y Andalucía (69%). Se analizaron 273 proyectos de tesis doctorales, siendo una investigadora principal en el 72% (IC 95%: 66,7-77,7), y procedente de Cataluña (23,9%), Andalucía (18,9%). Las universidades más representadas son la Autónoma de Barcelona (12,5%), Zaragoza (6,4%) y Valladolid (5,5%), estas dos últimas con la mayor ratio de feminización (100%, 48%, respectivamente). Conclusiones: la investigación presentada en los eventos de la semFYC está feminizada, siendo reflejo de la feminización de la medicina de familia, y manteniéndose a lo largo del tiempo. Las comunidades autónomas (CC. AA.) con estructuras específicas de investigación para la Atención Primaria (AP) son también las que más contribuyen a dicha feminización.(AU)

Aim: to ascertain the degree of feminization of authorship of research studies and projects presented at Spanish scientific meetings of the Spanish Society of Family and Community Medicine (semFYC in Spanish). Methods: a transversal, descriptive study was performed by means of analysis of databases from notifications of studies presented at semFYC Spanish Conferences between 2007 and 2021, in addition to projects presented for research grants for doctoral theses. Variables on sex, autonomous community, university, year of holding the Conference and subject areas studied, were collated. Results: a total of 6057 research notifications were analyzed; 66.7% (95% CI: 65.5-67.8%) were presented by a woman as lead author. The autonomous communities comprising the highest percentage were Catalonia (42%), Andalusia (19%), Madrid (8%), Valencian Community (5%) and Murcia (5%). Aragon was the community that presented the highest male to female ratio (72%), followed by Catalonia (69%) and Andalusia (69%). A total of 273 doctoral theses were analyzed; there was a female principal investigator in 72% (95% CI: 66.7-77.7%) originating from Catalonia (23.9%) and Andalusia (18.9%). The universities most represented are Barcelona Autonomous University (12.5%), Zaragoza (6.4%) and Valladolid (5.5%). The latter two had the highest ratio of feminization (100%, 48% respectively). Conclusions: the study presented at semFYC events includes women. This is a reflection of the feminization of family medicine and is upheld over time. Spanish Autonomous Communities with specific research structures for primary care are also those that most contribute to this feminization.(AU)

Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna / Influence of multipathology and comorbidity on hospital admission in a cohort of patients from a Primary-Internal continuous care unit

Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario. Diseño: estudio observacional retrospectivo de casos y controles. Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete. Participantes: se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos). Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos. Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17). Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.(AU)

Objective: to estimate the frequency of multiple pathologies and comorbidity in patients followed up in a Primary-Internal care continuity unit (PICCU), and to ascertain their clinical characteristics and degree of association between multiple pathologies and comorbidity with hospital admission. Design: retrospective case-control observational study. Site: Primary Care and Internal Medicine Continuity of Care Unit (UCAPI) of Albacete Teaching Hospital. Participants: a total of 1591 patients treated in a PICCU (292 with a hospital admission in the last year and 1299 without admission) were analyzed. Main measurements: age, sex, health problems, Charlson index, drug use and use of health services in the previous three years. Results: of the total sample, 18.4% (95% CI: 16.4-20.3) were cases with an admission; 23.3% had multiple pathologies (95% CI: 21.1-25.4) and comorbidity (Charlson index ≥ 2) 32.6% (95% CI: 30.2-34.9). Variables independently associated with hospital admission were multiple pathologies (OR: 2.51; 95% CI: 1.64-3.83; P <0.001), comorbidity (Charlson ≥ 2) (OR: 1.81; 95% CI): 1.18-2.78; P = 0.006), more than three health problems (OR: 1.49; 95% CI: 1.07-2.07; P = 0.017), a higher number of primary care consultations (OR: 1.01; 95% CI: 1.00-1.02; P = 0.005), Hospital (1.03; 95% CI: 1.01-1.05), P < 0.001) and making more visits to the hospital accident and emergency department (OR: 1.12, 95% CI: 1.07-1.17). Conclusions: almost a quarter of patients followed up in a care continuity unit between internal and family medicine presented multiple pathologies and a third presented comorbidity. Multiple pathologies and comorbidity are predictive characteristics of hospital admission together with a greater use of health services.(AU)

Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care-APHOSDIAB-COVID-19 Multicenter Study.

The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.

Análisis de la variabilidad en la Formación Sanitaria Especializada en Medicina Familiar y Comunitaria en España / Analysis of variability in specialised health training in Family and Community Medicine in Spain

Objetivo: analizar los itinerarios formativos de todas las Unidades Docentes (UUDD) de Medicina Familiar y Comunitaria (MFyC) del país y conocer el grado de adecuación al Programa Oficial de la Especialidad (POE). Diseño: transversal, de análisis de datos secundarios. Emplazamiento y participantes: UUDD que forman residentes de MFyC en el estado español. Mediciones principales: en junio del 2020 se hizo una búsqueda (internet, correo electrónico y llamadas telefónicas a las UUDD) de los itinerarios formativos de todas las UUDD del país (180 en total). Se describen las diferentes rotaciones incluidas en los itinerarios formativos y se comprueba la adaptación a las recomendaciones del POE. Se utilizó estadística descriptiva con el programa IBM SPSS Statistics 24. Resultados: se analizaron un total de 179 itinerarios formativos. Las rotaciones por unidades clínicas identificadas son 44 y hay 4 de ellas que se establecen en la práctica totalidad (medicina interna, salud mental, dermatología y la rotación final con el tutor o tutora). Solamente un 10% de las UUDD se adaptan por completo a las recomendaciones del POE, siendo la rotación inicial en el centro de salud (CS) la recomendación más implantada (91,1%). Conclusiones: existe una cierta homogeneidad en los itinerarios formativos, con un núcleo de rotaciones que se repiten en la mayoría de UUDD. Solo se cumplen totalmente las directrices marcadas por el POE (referidas sobre todo al peso de la formación en Atención Primaria) en 1 de cada 10 itinerarios.(AU)

Objective: to analyze the training programs of all the country’s Family and Community Medicine Teaching departments and find out the degree of adaptation to the Specialty Programme (SP). Design: secondary data analysis. Location and participants: teaching departments that train Family and Community Medicine residents in Spain. Main measurements: a search was carried out (internet, by mail and telephone calls to the teaching departments) of the training programs of all the teaching departments in the country (180 in total), in June 2020. The different rotations included in the training itineraries were described and correct adaptation to the recommendations of the SP is checked. Descriptive statistics of the variables were used with SPSS 24. Results: a total of 179 training programs were analyzed. A total of 44 clinical rotations were identified, 4 of which are practically always scheduled (Internal Medicine, Mental Health, Dermatology and the final rotation with the instructor). Just 10% of the programs fully comply with the recommendations of the Official Programme of the Specialty, with the initial rotation in the Health Centre being the most implemented recommendation (91.1%). Conclusions: there is a certain homogeneity in the training programs, with a core of rotations that are repeated in most of the teaching departments. The guidelines set out in the Specialty Programme (which especially refers to the importance of training in Primary Care) are only fully complied with in 1 out of 10 programs.(AU)

Un día en la consulta de Medicina de Familia entre las olas de la pandemia / A day at the family physician’s surgery between the waves of the pandemic

Los cambios organizativos que se hicieron durante la pandemia se vivieron como una oportunidad de desarrollar prácticas de valor y resolutivas, priorizar intervenciones que han demostrado eficacia y dejar de hacer lo que no deberíamos hacer. Después de varias olas, la Atención Primaria (AP) ha aumentado considerablemente el número de visitas, principalmente por motivos no clínicos (casi un 60%) y, entre estos, consultas de bajo valor, banales o poco oportunas. Destacan la repetición de derivaciones por anulaciones y rechazo de visitas desde el segundo nivel asistencial, la petición de informes y certificados por múltiples motivos no médicos, las incapacidades temporales (IT) por contactos con positivos de COVID y las consultas relacionadas con la vacunación COVID. Parte de la población ha vivido los cambios como una falta de accesibilidad, lo que ha aumentado la agresividad hacia el personal sanitario. Los médicos y médicas de familia manifiestan impotencia, pérdida de la ilusión, falta de tiempo, desbordamiento, hartazgo, sensación de que no se hace medicina y de que «no hay salida». La AP está al borde del colapso por un trabajo cada vez menos clínico que hace que se deje de atender a los verdaderos enfermos. Y no parece haber una voluntad política de incrementar el presupuesto para una AP que la Organización Mundial para la Salud (OMS) recomendó reforzar para hacer frente a la pandemia, y que ha demostrado que puede alcanzar mejores resultados en términos de salud, equidad y eficiencia y ser garante de la sostenibilidad económica y social del sistema sanitario.(AU)

Organisational changes made during the COVID-19 pandemic were seen as an opportunity to develop valuable and resolutive tasks, to prioritise interventions that have proven effective and to stop doing what we should never do. After several waves, visits to Primary Care providers have increased significantly, mainly for non-clinical reasons (almost 60%), and among these, consultations with little value, which are banal or poorly justified. The repetition of referral requests due to cancellations and the rejection of appointments from second level care, the demand for medical reports and certificates for multiple non-medical issues, temporary work disability due to COVID-19 close contacts and queries related to the COVID-19 vaccination are common. These changes have often been seen as a lack of accessibility, increasing aggressive attitudes towards health workers. Family doctors reveal powerlessness, deception, a lack of time, overflow, the feeling of not working as a doctor and that there is no way out. Primary Care is near to collapse due to these non-clinical tasks that do not leave time for patients who are truly ill. Politicians have not shown a will to increase the budget for Primary Care, which the WHO advised be strengthened in order to deal with the pandemic. It has shown to achieve better results in terms of health equity and efficiency, and must be the guarantee of the economic and social health system sustainability.(AU)

Descripción de la implantación y grado de desarrollo de tecnología de comunicación e informática de los equipos de Atención Primaria en los servicios autonómicos de salud en España / Description of the implementation and degree of development of primary care telecommunication and information technology in regional health services in Spain

Objetivo: Describir la situación, percepciones y opiniones de los profesionales sanitarios de Atención Primaria (AP) respecto a los sistemas de telecomunicación y telemedicina de este ámbito, así como determinar su grado de satisfacción. Método: Estudio descriptivo observacional transversal realizado en profesionales sanitarios de Atención Primaria mediante un cuestionario autocumplimentado con variables sociodemográficas, características laborales, opiniones y percepciones sobre desarrollo informático, sistemas de información, accesibilidad telemática, seguridad para pacientes y el grado de satisfacción de los profesionales respecto al desarrollo informático. Resultados: Los resultados muestran que se puede acceder a informes de alta hospitalaria y urgencias en el 89,2% (intervalo de confianza [IC] 95%: 86,4-92,0) y 87,2% (IC 95%: 84,2-90,2) de casos, respectivamente. Existe opción de teleconsulta con hospitalaria según un 95,1% de encuestados. Un 38,9% indicó disponer de alertas de recepción de informes de hospital, y el 73,3%, tener accesibilidad telemática para sus pacientes. El 34,8% señaló que no había ninguna mejora en general en las vías de comunicación, y el 51,7% y tampoco veía mejoras en los recursos tecnológicos en general tras la pandemia. Un 13,0% manifestó estar muy insatisfecho y el 27,3% dijo estar insatisfecho con el nivel de desarrollo informático en sistemas de telemedicina y telecomunicación en la AP de su área sanitaria. Conclusiones: La mayoría de los equipos de Atención Primaria de los Servicios Autonómicos disponen de historia clínica compartida con el hospital, mientras que solo una parte cuenta con sistemas de alertas de recepción de informar del ámbito hospitalario. El obligado cambio de la asistencia sanitaria no ha mejorado sustancialmente los recursos tecnológicos tras la pandemia y existe un considerable grado de insatisfacción de los profesionales.(AU)

Objective: To report Primary Care healthcare professionals’ circumstances, insight and points of view in regard to telecommunication systems and telemedicine as well as determine their degree of satisfaction. Method: Descriptive, observational, transversal study performed on primary healthcare professionals by means of a self-completion questionnaire with socio-demographic variables, job characteristics, views and perceptions in regard to IT development, information systems, online accessibility, patient safety and the degree of satisfaction of healthcare professionals with IT development. Results: The results showed that it is possible to access discharge reports from hospitalized patients and from the accident and emergency department in 89.2% (95%CI: 86.4-92.0) and 87.2% (95%CI: 84.2-90.2) of cases, respectively. According to 95.1% of people polled, there is an option for remote consultation with hospital care. A total of 38.9% of survey respondents pointed out that they receive e-notifications of hospital reports and 73.3% claimed to have online access to their patients’ information. A total of 34.8% and 51.7% of clinicians stated that, in general, there was no improvement in communication channels or technological resources after the pandemic, respectively. A total of 13.0% of respondents expressed that they are very unsatisfied and 27.3% unsatisfied with IT development in primary healthcare telemedicine systems and telecommunication in their health area. Conclusion: Most Primary Care healthcare teams in regional health services have access to medical histories shared with hospitals. However, just some of them have electronic notification systems for hospital reports. The mandatory change in healthcare has not substantially improved technological resources after the pandemic and there is a considerable level of dissatisfaction among professionals.(AU)

El reto de la pandemia de la COVID-19 para la Atención Primaria / The challenge of the COVID-19 pandemic for Primary Care

La COVID-19 ha provocado muchos cambios en el sistema sanitario y, por supuesto, en Atención Primaria. La pandemia ha marcado un antes y un después, tanto a nivel organizativo en los centros de salud como en la manera de abordar las demandas y necesidades de los pacientes, y en el desempeño de la Medicina Familiar. En marzo de 2020 todos veíamos con preocupación cómo la Atención Primaria era invisible para las administraciones. La forma inicial de abordar la atención a la pandemia con un enfoque hospitalocentrista ha condicionado probablemente el diseño organizativo a lo largo de las diferentes oleadas. Al comienzo de la pandemia, la Atención Primaria no disponía de pruebas para el diagnóstico de la COVID-19, y fuimos testigos de cómo la inquietud y el miedo se apoderaba de los médicos y médicas de familia, muy especialmente en aquellas comunidades autónomas (CCAA) en las que el virus azotaba con fuerza a la población. La Atención Primaria, como siempre, se mantuvo cerca de la ciudadanía, priorizando la atención telefónica y dando respuesta a las demandas de los pacientes, muy especialmente al abordaje de la COVID-19. La Atención Primaria trabajó no solo como un eficaz muro de contención de la epidemia, sino también gestionando y resolviendo en el domicilio los casos leves o moderados que no necesitaban ingreso hospitalario. Sin embargo, para seguir haciendo frente a la pandemia y a la nueva situación se precisaban cambios organizativos y de gestión, más profesionales y nuevos roles. Es importante constatar que, para el buen desempeño de la Medicina Familiar del siglo XXI, para que la Atención Primaria salga reforzada de esta pandemia, las soluciones pasan por una adecuada financiación y una apuesta firme por mantener la longitudinalidad.(AU)

The COVID-19 pandemic has led to many changes in the healthcare system including of course in Primary Care. The pandemic has marked a before and after for primary care both on an organisational level in healthcare centres, how patient requests and requirements are tackled and how family medicine is conducted. In March 2020 we all worried at how primary care appeared to be invisible for administrations. How the pandemic was initially managed with a hospital-centric approach probably conditioned the organisational design over the different waves. At the onset of the pandemic, Primary Care did not have tests to diagnose COVID-19, and we witnessed how concern and fear took hold over family doctors, most especially in those autonomous communities in which the virus whipped the population hard. Primary Care as always, stayed close to citizens and priority was given to telephone attention and responding to patient requests, most especially when tackling COVID-19. Primary Care worked not only as an effective protective wall for the epidemic but also to manage and resolve mild or moderate cases at home that needed hospital admission. However, to continue managing the pandemic and the new situation organisational and management changes, more professionals and new roles were all required. It is important to observe that for family medicine to function correctly in the 21st century and so that Primary Care comes out of this pandemic stronger, solutions entail both correct financing and a firm commitment to upholding continuity.(AU)

Frecuencia de aparición y validez predictiva de la disfunción olfatoria y del gusto en pacientes con infección por SARS-CoV-2 / Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection

Antecedentes y objetivo: La disfunción olfatoria (DO) y gustativa (DG) han demostrado ser síntomas de la infección por SARS-CoV-2. Sin embargo, su presencia en determinadas poblaciones, sobre todo en aquellas con cuadros clínicos leves, aún debe aclararse. El objetivo fue estimar la frecuencia de DO y DG, y su validez predictiva en pacientes detectados en Atención Primaria.Pacientes y métodosSe realizó un estudio transversal en el Sistema Nacional de Salud español. Se administró una encuesta epidemiológica dirigida a pacientes a los que se les solicitó la prueba PCR para SARS-CoV-2. Se estimaron las odds ratio (OR) para medir la magnitud de la asociación entre la DO y DG y la existencia de infección por SARS-CoV-2. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos (VPP) y negativos (VPN) de estos síntomas en la infección por SARS-CoV-2.ResultadosSe captaron 1.038 pacientes, de los cuales el 20,1% presentaban infección por SARS-CoV-2. Las DO y DG estuvieron presentes en el 64,4% (IC 95% 56,0-72,1) y el 56,2% (IC 95% 47,9-64,2) de los sujetos con infección, respectivamente. La OR para la DO fue de 12,2 (IC 95% 8,26-18,06) y para la DG de 7,95 (IC 95% 5,48-11.53). La DG presentó una sensibilidad del 41,1% (IC 95% 34,4-46,1), una especificidad del 91,9% (IC 95% 89,8-93,7), un VPP del 56,2% (IC 95% 48,0-64,2) y un VPN de 86,1% (IC 95% 83,6-88,3), mientras que la DO mostró una sensibilidad del 45,0% (IC 95% 37,6-51,5), una especificidad del 93,7% (IC 95% 91,8-95,0), un VPP del 64,4% (IC 95% 56,0-72,1) y un VPN del 87,1% (IC 95% 84,7-89,2).ConclusionesMás de la mitad de los sujetos con infección por SARS-CoV-2 presentan DO o DG. La presencia de DO o de DG podría ser de utilidad diagnostica por su capacidad para predecir la infección en más de la mitad de las ocasiones. (AU)

Background and objective: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care.Patients and methodsA cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated.ResultsOf 1,038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2).ConclusionsMore than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases. (AU)

Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection.

BACKGROUND AND OBJECTIVE: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care. PATIENTS AND METHODS: A cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated. RESULTS: Of 1038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2). CONCLUSIONS: More than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases.

ANTECEDENTES Y OBJETIVO: La disfunción olfatoria (DO) y gustativa (DG) han demostrado ser síntomas de la infección por SARS-CoV-2. Sin embargo, su presencia en determinadas poblaciones, sobre todo en aquellas con cuadros clínicos leves, aún debe aclararse. El objetivo fue estimar la frecuencia de DO y DG, y su validez predictiva en pacientes detectados en Atención Primaria. PACIENTES Y MÉTODOS: Se realizó un estudio transversal en el Sistema Nacional de Salud español. Se administró una encuesta epidemiológica dirigida a pacientes a los que se les solicitó la prueba PCR para SARS-CoV-2. Se estimaron las odds ratio (OR) para medir la magnitud de la asociación entre la DO y DG y la existencia de infección por SARS-CoV-2. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos (VPP) y negativos (VPN) de estos síntomas en la infección por SARS-CoV-2. RESULTADOS: Se captaron 1.038 pacientes, de los cuales el 20,1% presentaban infección por SARS-CoV-2. Las DO y DG estuvieron presentes en el 64,4% (IC 95% 56,0­72,1) y el 56,2% (IC 95% 47,9­64,2) de los sujetos con infección, respectivamente. La OR para la DO fue de 12,2 (IC 95% 8,26−18,06) y para la DG de 7,95 (IC 95% 5,48−11.53). La DG presentó una sensibilidad del 41,1% (IC 95% 34,4­46,1), una especificidad del 91,9% (IC 95% 89,8­93,7), un VPP del 56,2% (IC 95% 48,0­64,2) y un VPN de 86,1% (IC 95% 83,6­88,3), mientras que la DO mostró una sensibilidad del 45,0% (IC 95% 37,6­51,5), una especificidad del 93,7% (IC 95% 91,8­95,0), un VPP del 64,4% (IC 95% 56,0­72,1) y un VPN del 87,1% (IC 95% 84,7­89,2). CONCLUSIONES: Más de la mitad de los sujetos con infección por SARS-CoV-2 presentan DO o DG. La presencia de DO o de DG podría ser de utilidad diagnostica por su capacidad para predecir la infección en más de la mitad de las ocasiones.

[Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection]. / Frecuencia de aparición y validez predictiva de la disfunción olfatoria y del gusto en pacientes con infección por SARS-CoV-2.

BACKGROUND AND OBJECTIVE: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care. PATIENTS AND METHODS: A cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated. RESULTS: Of 1,038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2). CONCLUSIONS: More than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases.

Características clínico-epidemiológicas de la infección por el virus SARS-CoV-2 en médicos de familia: un estudio de casos y controles / Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study

Objetivo: Identificar las características sociodemográficas, clínicas y epidemiológicas asociadas a la presencia de infección por el virus SARS-CoV-2 en médicos de familia que desempeñan su actividad laboral en atención primaria (AP) o en urgencias de hospital. Diseño: Estudio observacional analítico de casos y controles. Emplazamiento: Atención primaria. Participantes: Un total de 969 médicos de AP, urgencias hospitalarias y otros centros extrahospitalarios que dispusieran de RT-PCR para la detección del virus SARS-CoV-2. De estos, 133 participaron como casos (PCR positiva) y 836 como controles (PCR negativa).Intervenciones: No. Mediciones principales: Variables sociodemográficas y laborales, contacto con enfermo de COVID-19, síntomas presentes durante el proceso, primer síntoma manifestado, enfermedades crónicas previas y consumo de tabaco. Resultados: Del total de la muestra el 13,7% (IC 95%: 11,6-16,0), eran casos infectados con el SARS-CoV-2. Los síntomas declarados más frecuentemente por los infectados fueron sensación de fatiga/cansancio (69,2%; IC 95%: 60,9-77,4%), tos (56,4%; IC 95%: 47,6-65,2%) y cefalea (55,6%; IC 95%: 46,8-64,4%). Mediante regresión logística, las variables asociadas de manera independiente con la infección por virus SARS-CoV-2 en médicos de familia fueron: contacto previo con enfermo COVID-19 (OR: 2,3; IC 95%: 1,2-4,2), presentar fatiga/cansancio (OR: 2,2; IC 95%: 1,2-3,9), alteración del olfato (4,6; IC 95%: 1,7-12,5), alteración del gusto (OR: 32,0; IC 95%: 9,6-106,8), tos (OR: 3,0; IC 95%: 1,7-5,3) y fiebre (OR: 6,1; IC 95%: 3,2-11,4). Conclusiones: Los síntomas relacionados de forma independiente con la infección por el virus SARS-CoV-2 en médicos de familia fueron la fatiga, la fiebre, la tos y la alteración del gusto y del olfato. La presencia de estos síntomas podría facilitar el diagnóstico de sospecha de enfermedad COVID-19 y la selección más precoz de aquellos que precisan pruebas de confirmación.(AU)

Objective: To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies. Desing: Observational analytical case-control study. Site: Primary care. Participants: 969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative). Interventions: No. Main measurements: Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use. Results: 13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4). Conclusions: Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.(AU)

[Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study]. / Características clínico-epidemiológicas de la infección por el virus SARS-CoV-2 en médicos de familia: un estudio de casos y controles.

OBJECTIVE: To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies. DESING: Observational analytical case-control study. SITE: Primary care. PARTICIPANTS: 969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative). INTERVENTIONS: No. MAIN MEASUREMENTS: Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use. RESULTS: 13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4). CONCLUSIONS: Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.