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1.
Aten. prim. (Barc., Ed. impr.) ; 47(9): 596-602, nov. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-146997

RESUMO

A propósito de cinco casos en donde el proceso diagnóstico se inició en 'la huella que no debería estar allí' o 'signo de Robinson' –como le pasó a Robinson Crusoe que vio una huella humana en la playa de su isla 'desierta': ¿cómo podía encontrarse allí?; era un misterio–, y basándonos en metáforas, revisamos los mecanismos de la operación mental de identificar la enfermedad en medicina de familia. Encuadramos el mecanismo de 'la huella que no debería estar allí' principalmente en la primera fase o intuitiva del razonamiento clínico, pero esta intuición del médico debe mantenerse acompañando a todo el proceso diagnóstico, como el 'bajo continuo' de la música barroca, permitiendo la improvisación y el estilo personal, y de este modo, eventualmente la observación de la huella 'que no tenía que estar allí' puede surgir tanto en la fase analítica como en la de verificación de las hipótesis elaboradas (AU)


We review the mechanisms of the mental operation to identify the disease in family medicine, using five cases where the diagnosis process began in 'the trace that should not be there' or 'Robinson sign' as happened to Robinson Crusoe when he saw a human footprint on the beach of the 'desert island'. How could it be there?; It was a mystery, and based on metaphors, we framed the mechanism of 'the trace that should not be there' mainly in the first phase of clinical or intuitive reasoning, but this intuition of the doctor should be accompanied by the diagnostic process, like the 'basso continuo' of Baroque music, allowing improvisation and personal style, and in this way, eventually observing the footprint 'that should not have been there' that may arise in the analytical, as well as in the verification phase of the assumptions made (AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoavaliação Diagnóstica , Medicina de Família e Comunidade/instrumentação , Medicina de Família e Comunidade/métodos , Educação Médica/legislação & jurisprudência , Educação Médica/métodos , Metáfora , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/normas , Educação Médica/organização & administração , Educação Médica/normas , Análise Qualitativa/análise , Análise Qualitativa/métodos
2.
Aten Primaria ; 47(9): 596-602, 2015 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-25959290

RESUMO

We review the mechanisms of the mental operation to identify the disease in family medicine, using five cases where the diagnosis process began in "the trace that should not be there" or "Robinson sign" as happened to Robinson Crusoe when he saw a human footprint on the beach of the "desert island". How could it be there?; It was a mystery, and based on metaphors, we framed the mechanism of "the trace that should not be there" mainly in the first phase of clinical or intuitive reasoning, but this intuition of the doctor should be accompanied by the diagnostic process, like the "basso continuo" of Baroque music, allowing improvisation and personal style, and in this way, eventually observing the footprint "that should not have been there" that may arise in the analytical, as well as in the verification phase of the assumptions made.


Assuntos
Diagnóstico , Medicina de Família e Comunidade/educação , Humanos
4.
Aten. prim. (Barc., Ed. impr.) ; 46(2): 68-76, feb. 2014. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-119024

RESUMO

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 (AU)


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 (AU)


Assuntos
Descrição de Cargo , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde , Competência Profissional , Avaliação Educacional , Especialização , Paraguai , México , Peru , Espanha
6.
Aten Primaria ; 46(2): 68-76, 2014 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-24183657

RESUMO

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.


Assuntos
Medicina de Família e Comunidade , Adulto , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Paraguai , Peru , Médicos de Família , Espanha , Trabalho
9.
Aten. prim. (Barc., Ed. impr.) ; 44(12): 720-726, dic. 2012. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-108134

RESUMO

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)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Ansiedade/induzido quimicamente , Depressão/induzido quimicamente , Anti-Inflamatórios/efeitos adversos , Antibacterianos/efeitos adversos , Ansiedade/epidemiologia , Depressão/epidemiologia , Relações Médico-Paciente , Placebos/uso terapêutico
10.
Aten Primaria ; 44(12): 720-6, 2012 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-22981131

RESUMO

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.


Assuntos
Sintomas Afetivos/induzido quimicamente , Sintomas Afetivos/epidemiologia , Ansiedade/induzido quimicamente , Ansiedade/epidemiologia , Depressão/induzido quimicamente , Depressão/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
12.
Aten. prim. (Barc., Ed. impr.) ; 44(4): 232-236, abr. 2012.
Artigo em Espanhol | IBECS | ID: ibc-97968

RESUMO

Los síntomas en medicina de familia no son señales de enfermedad, sino «de vida»; en la consulta «entra, junto al paciente, toda su vida». Cada consulta es primariamente un problema biopsicosocial: el individuo en relación con su Yo y su contexto percibe una disfunción o alteración. Fundamentar la valoración en la sola molestia física expuesta por el paciente puede ser un error al no haber identificado el problema real. Las distintas tipologías posibles de los síntomas están «enmarañadas» o encadenadas unas con otras: los síntomas pueden ser apropiados o inevitables; ser expresiones de alteraciones bioquímicas, símbolos para el paciente, expresiones del contexto grupal, o modos de afrontar una situación; y dependen del funcionamiento psicológico previo del paciente, la severidad del déficit de la función psicológica asociada a la enfermedad, las habilidades residuales, la adaptación y el afrontamiento de las limitaciones funcionales, la relación médico-paciente, así como de la influencia del contexto(AU)


The symptoms in family medicine are not signs of disease, but “signs of life”; in the consultation “all patient life comes together with him”. Every consultation is primarily a biopsicosocial problem: the person perceives a dysfunction or alteration in relation with himself and his context. To do a diagnosis only with physical symptoms, can be a mistake because these do not identify the real problem. The different types of symptoms are “entangled” or chained some in others: the symptoms can be fitted or inevitable; to be expressions of biochemical alterations, symbols for the patient, group context expressions, or kinds of facing the facts; and they depend on the previous psychological patient performance, the severity of the deficit of the psychological function associated with the disease, the residual skills, the adjustment and the confrontation of the functional limitations, the relation doctor-patient, as well as on the influence of the context(AU)


Assuntos
Humanos , Masculino , Feminino , Sinais e Sintomas/história , Medicina de Família e Comunidade/ética , Sinais e Sintomas/métodos , Sinais e Sintomas/tendências , Medicina de Família e Comunidade/métodos , Doença , Sinais e Sintomas , Sinais e Sintomas/uso terapêutico , Sinais e Sintomas/classificação , Medicina de Família e Comunidade/tendências , Medicina Preventiva/métodos , Medicina Preventiva/tendências
13.
Aten Primaria ; 44(4): 232-6, 2012 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-21782291

RESUMO

The symptoms in family medicine are not signs of disease, but "signs of life"; in the consultation "all patient life comes together with him". Every consultation is primarily a biopsicosocial problem: the person perceives a dysfunction or alteration in relation with himself and his context. To do a diagnosis only with physical symptoms, can be a mistake because these do not identify the real problem. The different types of symptoms are "entangled" or chained some in others: the symptoms can be fitted or inevitable; to be expressions of biochemical alterations, symbols for the patient, group context expressions, or kinds of facing the facts; and they depend on the previous psychological patient performance, the severity of the deficit of the psychological function associated with the disease, the residual skills, the adjustment and the confrontation of the functional limitations, the relation doctor-patient, as well as on the influence of the context.


Assuntos
Diagnóstico , Medicina de Família e Comunidade , Humanos , Vida
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