[Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care]. / Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria.

BACKGROUND: The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). OBJECTIVES: to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. DESIGN: Multicenter retrospective observational study. PARTICIPANTS: Patients with T2D in Tenerife, Canary Islands, Spain. MAIN MEASUREMENTS: Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. RESULTS: 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. CONCLUSIONS: The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened.

Caracterización del desempeño profesional del médico de familia en nefrogeriatría en Consolación del Sur / Characterization of the Professional Performance of the family Physician in Nephrogeriatrics in Consolación del Sur Municipality

Introducción: La atención a pacientes nefrogeriátricos requiere de nuevas acciones que propicien mejores resultados de forma armónica e integrada. Objetivo: Caracterizar el estado actual del desempeño profesional del médico de familia en nefrogeriatría en la Atención Primaria de Salud. Métodos: Estudio observacional, descriptivo y transversal, desde mayo de 2014 a mayo de 2015, dirigido a 39 médicos de familia del área 5 de septiembre. Se emplearon métodos teóricos, empíricos y estadísticos para evaluar el desempeño profesional del médico de familia en nefrogeriatría. Se tuvo en cuenta el consentimiento informado. Resultados: Se identificó el estado actual de la variable estudiada, con la identificación de problemas relacionados con la dimensión cognitiva, asistencial, educativa e investigativa en la atención al paciente nefrogeriátrico en la Atención Primaria de Salud. Conclusiones: El desempeño profesional del médico de familia en nefrogeriatría carece de integración en la atención integral a los pacientes, la familia y la comunidad(AU)

Introduction: The care for nephrogeriatric patients requires new actions with better outcomes in a harmonic and integrated way. Objective: To characterize the current state of professional performance of family physicians in nephrogeriatrics in primary healthcare. Methods: Observational, descriptive and cross-sectional study carried out from May 2014 to May 2015, targeted at 39 family physicians belonging to 5 de Septiembre health area. Theoretical, empirical and statistical methods were used to evaluate the professional performance of the family physician in nephrogeriatrics. Informed consent was taken into account. Results: The current state of the studied variable was identified, with the identification of problems related to the cognitive, assistance, educational and investigative dimensions in the care of nephrogeriatric patients in primary healthcare. Conclusions: The professional performance of the family physician in nephrogeriatrics lacks integration regarding the comprehensive care of patients, family and the community(AU)

Apuntes históricos sobre del proceso de formación del médico general integral en Cuba / Historical notes on the training process of the comprehensive general doctor in Cuba

La salud pública cubana se sustenta en la Atención Primaria de Salud y, con ello, la instauración de la especialidad de medicina general integral en 1985, con cambios sustanciales hasta la actualidad, ha dado un importante paso de avance en la accesibilidad y calidad en los servicios médicos; transformación necesaria en el Sistema Nacional de Salud. Teniendo en cuenta lo anterior se realizó el presente estudio con vistas a profundizar en las tendencias históricas por las que ha transitado el proceso de formación del médico general integral en Cuba. Se concluye que dicho proceso ha tenido transformaciones que obedecen a las necesidades nacionales e internacionales, donde todas las versiones del programa consideran la educación en el trabajo como protagonista en los servicios de salud.

The Cuban public health is sustained in the Primary Health Care which improvement has been favored with the establishment of the comprehensive general medicine specialty in 1985, with substantial changes until the present time that have propitiated a step of important advance in the accessibility and quality in the medical services. Taking into account the above-mentioned the present study was carried out aimed at deepening in the historical tendencies that the training process of the comprehensive general doctor in Cuba has gone through. It was concluded that this process has had transformations that obey the national and international necessities, where all the versions of the program consider the education at work as main character in health services.

Relationship between initial symptoms and prognosis of patients with Covid-19 / Relación entre los síntomas iniciales y el pronóstico de los pacientes con COVID-19

Objective: Aims to describe the initial symptoms most related to the prognosis of Covid-19.DesignThis is a retrospective cross sectional, quantitative, data analyzed study.SiteThis study was made in the family medicine centers (n=82) of Çorlu district of Tekirdağ province, in Turkey.ParticipantsThe study included patients (n=1.506) who had a positive PCR test for Covid-19 from March to September 2020. And we asked them their initial symptoms which bring them to the family medicine centers before the test.Main measurementsThe participants’ age, gender, presence of chronic disease, and initial symptoms which they come to a healthcare facility were evaluated. These variables were analyzed in terms of length of hospital stay, intensive care unit admission and mortality rates.ResultsThe most common initial symptom in Covid-19 patients was cough. The presence of a chronic disease, the shortness of breath, malaise, the loss of smell and taste, and vomiting were found to be associated with an increased mortality rate. Advanced age, the presence of cough, malaise, the loss of smell and taste, and vomiting as the initial symptoms were found to have increased the likelihood of being admitted to the intensive care unit.ConclusionsThe authors advise placing more attention on the initial symptoms of cough, malaise, the loss of smell and taste and vomiting in Covid-19 patients. Because these symptoms are related with severe prognosis indicators.

Objetivo: Describir los síntomas iniciales más relacionados con el pronóstico de COVID-19.DiseñoEste es un estudio retrospectivo de análisis de datos transversales, cuantificativos.EmplazamientoEste estudio se realizó en los centros de medicina familiar (n=82) del distrito de Çorlu de la proviencia de Tekirdağ, en Turquía.ParticipantesEl estudio incluyó pacientes (n=1.506) que tuvieron una prueba de PCR positiva para COVID-19 de marzo a septiembre de 2020. Se les preguntaron sus síntomas iniciales que los llevan a los centros de medicina familiar antes de la prueba.Mediciones principalesSe evaluaron la edad, el sexo, la presencia de enfermedad crónica y los síntomas iniciales de los participantes que llegaron a un centro de atención médica. Estas variables se analizaron en términos de duración de la estancia hospitalaria, ingreso a la unidad de cuidados intensivos y tasas de mortalidad.ResultadosEl síntoma inicial de presentación más común en los pacientes con COVID-19 fue la tos. La presencia de una enfermedad crónica, la falta de aliento, el malestar, la pérdida de olor y sabor y los vómitos se asociaron a una mayor tasa de mortalidad. La edad avanzada, la presencia de tos, malestar, la pérdida de olor y sabor, y vómitos fueron los síntomas iniciales que se encontraron para incrementar la probabilidad de ser admitido en la unidad de cuidados intensivos.ConclusionesLos autores aconsejan prestar más atención a los síntomas iniciales de tos, malestar, pérdida de olor y sabor y vómitos en pacientes con COVID-19, porque estos síntomas están relacionados con indicadores de pronóstico severo.

Relationship between initial symptoms and prognosis of patients with Covid-19.

OBJECTIVE: Aims to describe the initial symptoms most related to the prognosis of Covid-19. DESIGN: This is a retrospective cross sectional, quantitative, data analyzed study. SITE: This study was made in the family medicine centers (n=82) of Çorlu district of Tekirdag province, in Turkey. PARTICIPANTS: The study included patients (n=1.506) who had a positive PCR test for Covid-19 from March to September 2020. And we asked them their initial symptoms which bring them to the family medicine centers before the test. MAIN MEASUREMENTS: The participants' age, gender, presence of chronic disease, and initial symptoms which they come to a healthcare facility were evaluated. These variables were analyzed in terms of length of hospital stay, intensive care unit admission and mortality rates. RESULTS: The most common initial symptom in Covid-19 patients was cough. The presence of a chronic disease, the shortness of breath, malaise, the loss of smell and taste, and vomiting were found to be associated with an increased mortality rate. Advanced age, the presence of cough, malaise, the loss of smell and taste, and vomiting as the initial symptoms were found to have increased the likelihood of being admitted to the intensive care unit. CONCLUSIONS: The authors advise placing more attention on the initial symptoms of cough, malaise, the loss of smell and taste and vomiting in Covid-19 patients. Because these symptoms are related with severe prognosis indicators.

Médico de familia y atención integral a la salud del trabajador / Family Medicine Doctor and Comprehensive Care of Workers' Health

ntroducción: En Cuba, el Ministerio de Salud Pública tiene organizado en el consultorio médico de la comunidad la realización de los chequeos médicos a los trabajadores que en su centro no cuentan con Equipo Básico de Salud, aunque reconoce se debe perfeccionar su calidad, sistematicidad y la superación médica sobre el tema. Objetivo: Analizar el proceso de formación y actualización sistemática del médico de familia en materia de ambiente laboral para la atención integral a la salud del trabajador. Métodos: Se realizó una revisión bibliográfica en el período comprendido marzo a septiembre de 2020, para lo cual se utilizaron diferentes motores de búsqueda que permitieron acceder a varias bases de datos referenciales, que ofrecían textos completos, índices y publicaciones periódicas académicas, entre ellas BIREME, Ebsco, SciELO regional, PubMed y otras. Los principales procedimientos teóricos aplicados fueron la inducción-deducción, análisis-síntesis, la abstracción e integración que posibilitaron realizar una valoración histórica y sistemática del objeto estudiado. Conclusiones: La superación profesional influye en el mejoramiento de la calidad de los servicios, el nivel de satisfacción y el reconocimiento social; el médico de familia es el pilar en los logros de la salud de la población, que incluye a los trabajadores; es quien, al ofrecerles las herramientas y las asesorías necesarias, podrá brindar una atención médica integral a la comunidad asignada(AU)

Introduction: In Cuba, the Ministry of Public Health has organized medical check-ups in the family medical office for workers who do not have a basic health team in their work centers, although the Ministry recognizes that its quality, systematicity and medical improvement on the subject should be upgraded. Objective: To analyze the process of training and systematic updating of the family medicine doctors on issues concerning work environment for the comprehensive care of the workers' health. Methods: A bibliographic review was carried out in the period from March to September 2020. Different search engines were used, which allowed access to various referential databases. These offered full texts, indexes and academic periodical publications, and included BIREME, Ebsco, SciELO regional, PubMed and others. The main theoretical procedures applied were induction-deduction, analysis-synthesis, as well as abstraction and integration, which made it possible to carry out a historical and systematic assessment of the object studied. Conclusions: Professional improvement influences the upgrading of the quality of services, as well as the level of satisfaction and social recognition. The family medicine doctor is the cornerstone for the achievements of population health, which includes workers. Such physician is who, by offering them the necessary tools and advice, will be able to provide comprehensive medical care to the assigned community(AU)

Experiencia de Atención Comunitaria en residencias de ancianos durante la primera ola de la pandemia COVID-19 / Experience in Community Care in nursing homes during the first wave of the COVID-19 pandemic

La COVID-19 ha producido muchas muertes en las residencias geriátricas. El compromiso de las enfermeras/os y médicos de Atención Primaria (AP) con la población que atienden hacía indispensable realizar acciones comunitarias para mejorar la atención de estas personas.El objetivo general fue implementar el “Plan de Acción para la Gestión de Personas en el Ámbito Residencial y la Asistencia Sanitaria en Situación de Pandemia por COVID-19” de la Generalitat de Cataluña y adecuarlo a las necesidades concretas en los centros atendidos. La intervención fue realizada por enfermeras y médicas de AP en dos residencias de ancianos de un núcleo urbano de Barcelona entre marzo y mayo de 2020. Constó de tres etapas: 1) Valoración: las dos residencias atendían 41 residentes (78,6% mujeres; edad media 84,5 años). El 100% tenía patología crónica, el 41,5% presentaba dependencia total, un 21,9% dependencia grave y el 26,8% tenía deterioro cognitivo. Un 63,4% estaba asintomático. Se identificaron carencias de material, infraestructuras y conocimientos. 2) Acciones de coordinación: desinfección de residencias por el servicio de bomberos y toma de muestras PCR que fueron negativas en el 100% de residentes y positivas en cuatro cuidadoras. 3) Taller de educación sanitaria para personal con trato directo a las personas residentes.Las residencias se mantuvieron libres de COVID-19 hasta el momento del inicio de la desescalada a finales de mayo de 2020. Se mantuvo la relación posterior con las residencias. La intervención comunitaria puede haber contribuido a la falta de casos de contagio de trabajadoras y personas residentes.(AU)

COVID-19 has caused many deaths in geriatric homes. The commitment by female Primary Care doctors and nurses with the population they manage made it essential to conduct community actions in order to improve the care for these persons.The general objective was to implement the “Plan of Action for Managing Persons in the Nursing Home Setting and Healthcare during the COVID-19 Pandemic” of the Government of Catalonia, and to adapt it to the specific needs in the centres managed. The intervention was conducted by female Primary Care nurses and doctors, in two nursing homes from an urban area of Barcelona between March and May, 2020. It consisted of three stages: 1) Assessment: Both nursing homes cared for 41 persons (78.6% were female; mean age: 84.5 years). Of these, 100% had a chronic condition, 41.5% presented total dependence, 21.9% presented severe dependence, and 26.8% suffered cognitive deterioration; 63.4% of them were asymptomatic. Lack of materials, infrastructures, and knowledge were detected. 2) Coordination actions: Disinfection of nursing homes by the Fire Department, and extraction of PCR samples, which tested negative in 100% of patients and positive in four caregivers. 3) Health Education Workshop for staff in direct contact with the persons living in the nursing home.Nursing homes stayed free of COVID-19 until the start of de-escalation by the end of May, 2020. Subsequent contact was maintained with nursing homes. Community intervention might have contributed to the lack of infection cases among workers and persons living in the nursing homes.(AU)

La pesquisa activa. Primer eslabón del enfrentamiento a la COVID-19 en el Policlínico Docente "Antonio Maceo" / Active research. First link in the confrontation with the COVID-19 in Antonio Maceo Teaching Polyclinic

Introducción: Las circunstancias que envuelven la aparición y desarrollo de la COVID-19, requirió se pusiera en marcha un programa de pesquisaje activo en todo el país, apoyados en las experiencias de campañas anteriores ante enfermedades transmisibles, adoptándose nuevas estrategias ajustadas a las actuales circunstancias. Objetivo: Describir los resultados de la pesquisa activa como estrategia de enfrentamiento a la COVID-19 en el Policlínico Docente Antonio Maceo. Material y Métodos: Se realizó un estudio cuantitativo, descriptivo, con carácter retrospectivo de los resultados de la pesquisa activa realizada por estudiantes y profesores, para identificar personas con sintomatología respiratoria de la COVID- 19, del 1 al 30 de abril. Se utilizó el cálculo de promedio y porcentaje como métodos descriptivos. Resultados: En 90,3 por ciento de las viviendas visitadas por día se alcanzó pesquisar 85 por ciento de estas, por Consultorio Médico de la Familia y 63,5 por ciento de los habitantes. Se identificaron personas con sintomatología respiratoria en 96,6 por ciento de los consultorios. Conclusiones: El trabajo realizado a través de la pesquisa activa, permitió identificar casos con síntomas respiratorios relacionados con la COVID-19. Se logró pesquisar diariamente de manera efectiva un alto porciento de viviendas y adultos mayores. Las acciones de promoción de salud realizadas por estudiantes y profesores con la oportuna vigilancia por el Médico y Enfermera de la Familia fueron elementos fundamentales que contribuyeron a detener el avance de la enfermedad(AU)

Introduction: The circumstances that involve the emergence and development of COVID-19, required the implementation of an active research program throughout the country supported by the experiences from previous campaigns against communicable diseases, adopting new strategies adapted to the current circumstances. Objective: To describe the results of the active research as a strategy to confront the COVID-19 in the Antonio Maceo Teaching Polyclinic. Material and Methods: A quantitative, descriptive, retrospective study of the results of the active research made by students and teachers to identify people with respiratory symptoms of COVID-19 was conducted from April 1srt to April 30th. The calculation of average and percentage was used as descriptive methods. Results: Of the 90.3 percent of the homes visited daily, 85 percent of them and 63.5 percent of the inhabitants were investigated by the Family Doctor´s Offices. Persons with respiratory symptoms were identified in 96.6 percent of the doctor´s offices. Conclusions: The work carried out through the active research allowed to identify cases with respiratory symptoms related to COVID-19. A high percentage of houses and elderly people were effectively investigated daily. The health promotion actions carried out by students and teachers with the timely surveillance by the Family Doctor and Family Nurse were fundamental elements that contributed to stop the advance of the disease(AU)

Prescripción social, una dimensión de la promoción de salud en la medicina general integral / Social Prescription, a Dimension of Health Promotion in Family Medicine

La prescripción social permite al médico de familia orientar, indicar, prescribir al paciente servicios y ayudas no médicas disponibles en la comunidad, que podrían proporcionarles bienestar y remediar problemas que tradicionalmente se van de la típica solución ofrecida por el profesional de la atención primaria. La prescripción social está relacionada con la prescripción de activos de salud, estilos de vida, intersectorialidad y determinantes sociales de la salud en la localidad que trabaja el médico de familia, y puede ser un componente de un nuevo modelo de salud en la atención primaria. En este trabajo se ofrecen ejemplos de servicios de prescripción social y se sugiere ampliar la lista con facilitadores/pacientes/usuarios en la comunidad(AU)

Social prescription allows the family physician to guide, indicate, prescribe the patient services and non-medical aids available in the community, which could provide welfare and solve problems that traditionally go away from the typical solution offered by the primary care professional. Social prescription is related to the prescription of health assets, lifestyles, intersectoriality and social determinants of health in the community where the family physicians works and can be a component of a new health model in primary care. This paper offers examples of social prescription services, while it is suggested to expand the list with facilitators, patients and users in the community(AU)

[Analysis of the healthcare of the paediatric population by General Practitioners in a Continuous Care Point]. / Análisis de la atención a la población pediátrica por médicos de familia en un punto de atención continuada.

OBJECTIVE: The main objective of this study is to analyse the management of paediatric emergencies by Family Doctors in Primary Care. The secondary objective is to determine the appropriateness of hospital referrals. MATERIAL AND METHODS: A retrospective, observational, and descriptive study was performed. An analysis was carried out on the visits made by children less than 14years-old during one year in continued care opening hours in a basic health area, after single-stage cluster random sampling of 45days. RESULTS: A total of 447 emergency consultations were made by paediatric patients with a mean age of 6.83years (SD=3.82). Almost all (92.8%) the emergency consultations made by children less than 14years were resolved in situ. The referral rate to hospitals was 7.2% (95%CI: 4.9-10). Just over half (56%: 95%CI: 37.7-73.6) of the children referred had some type of hospital intervention (tests, treatments, assessments by other non-paediatric specialists, observation and or admission). CONCLUSIONS: The referral rate was 7.2%, which is in the upper limit of that found in other studies. Just over half of the children required some type of intervention, which could be considered as justified referrals. Furthermore, good agreement was found (Kappa index=0.778) between the diagnosis from Primary Care and the final diagnosis by paediatricians, inferring that the diagnosis made on paediatric patients by Family Doctors are correct.

[Study of patient satisfaction when performing an ultrasound in Primary Care]. / Estudio de satisfacción del paciente ante la realización de una ecografía en atención primaria.

OBJECTIVE: To analyse the level of patient satisfaction when undergoing a diagnostic ultrasound by a family doctor. MATERIAL AND METHOD: A cross-sectional descriptive observational study was conducted in two health centres in Madrid, between December 2015 and March 2016. An anonymous questionnaire was used, consisting of two parts: one in-house prepared that included the socio-demographic variables, and an adaptation to the study objectives of the "survey of satisfaction of users of health centres" included in the document "Evaluation of the satisfaction of users of public health care services of the Community of Madrid" by the General Directorate of Coordination for Citizen Services and Humanisation of Health Care, Ministry of Health of Madrid, 2014. POPULATION: Patients on whom their family doctor performed an ultrasound for diagnostic purposes. Patients completed the questionnaire after 15 to 30 days, thus minimising the authority bias. The sample was obtained by consecutive non-probabilistic sampling. RESULTS: The level of "satisfied-very satisfied" reached 95%, with the approval of the family doctor compared with the hospital specialist performing the ultrasound. The health centre would be chosen by 92% if they had to undergo an ultrasound for a second time, 96% would recommend it to third parties, and 95% considered that their expectations were met. CONCLUSIONS: The performance of a diagnostic ultrasound by family doctors was evaluated with a high level of satisfaction by the patients. There are no comparable studies in the Primary Care field, and multicentre studies would be needed in order to generalise the results obtained.

Propuesta para la formación en Medicina Familiar y Comunitaria, desde la percepción, conceptualización y experiencia práctica de los enfoques de Salud Familiar / Proposal for training in Family and Community Medicine, from the perception, conceptualization and practical experience of Family Health approaches / Proposta de formação em Medicina Familiar e Comunitária, a partir da percepção, conceituação e experiência prática de abordagens de Saúde Familiar

Resumen La existencia de un Plan Decenal de Salud Pública para Colombia y la definición de una Política de Atención Integral en Salud concretaron un nuevo Modelo de Atención basado en la Atención Primaria de la Salud. Esto ubicó a la Salud Familiar y Comunitaria como núcleo fundamental y definió un rol al Médico y al Profesional Familiar y Comunitario, que dimensiona los procesos transdisciplinarios y la articulación de acciones individuales y colectivas, con esquemas pedagógicos holísticos transformadores. Este planteamiento generó un análisis y reflexión de la opinión de una muestra del 14,6% de los clasificados como Salubristas por el Observatorio Laboral del Ministerio de Educación quienes, con la respuesta a 13 preguntas enviadas por vía electrónica, libremente plantearon su percepción, conceptualización y experiencia práctica de los enfoques de Salud Familiar y Comunitaria. Con esta medición se definieron los contenidos básicos que se presentan en este documento con un nuevo enfoque transversal en el Pregrado y los Posgrados, de acuerdo con una propuesta pedagógica transformadora y con visión práctica, encontrándose aquí como destacable, la importante relación entre la educación y la salud integral; el concepto que en el 80% de las observaciones se expresó al denominar el poco compromiso de la comunidad y los profesionales de la salud con una "Cultura de la Salud Integralmente Concebida".

Abstract The existence of a Decennial Public Health Plan for Colombia and the definition of a Comprehensive Health Care Policy concretized a new Model of Care based on Primary Health Care. This placed Family and Community Health as a fundamental nucleus and defined a role for the Family and Community Physician and Practitioner, who dimension the transdisciplinary processes and the articulation of individual and collective actions, with transformational holistic pedagogical schemes. This approach generated an analysis and reflection of the opinion of a sample of 14.6% of those classified as Salubristas by the Labor Observatory of the Ministry of Education who, with the answer to 13 questions sent electronically, freely raised their perception, conceptualization and practical experience of Family and Community Health approaches. With this measurement the basic contents that are presented in this document with a new transversal approach in the Undergraduate and Postgraduates were defined, according to a pedagogical proposal transforming and with practical vision, being here like remarkable, the important relation between the education and integral health; the concept that in 80% of the observations was expressed when denominating the little commitment of the community and the professionals of the health with an "Culture of the Health Integrally Conceived".

Resumo A existência de um Plano de Saúde Pública de dez anos para a Colômbia ea definição de uma Política Integral de Saúde resultou em um novo Modelo de Cuidados Baseado em Atenção Primária à Saúde. Isso colocou a Familia e a Saúde Comunitária como um núcleo fundamental e definiu um papel para o Médico e o Profissional Familiar e Comunitário, que dimensiona os processos transdisciplinares e a articulação de ações individuais e coletivas, com esquemas pedagógicos transformadores holísticos. Esta abordagem gerou uma análise e reflexão da opinião de uma amostra de 14,6% das classificadas como Salubristas pelo Observatório do Trabalho do Ministério da Educação que, com a resposta a 13 questões enviadas eletronicamente, aumentou livremente sua percepção, conceituação e experiência prática de abordagens de saúde familiar e comunitária. Com esta medida, os conteúdos básicos apresentados neste documento foram definidos com um novo foco transversal em Estudos de Graduação e Pós-Graduação, de acordo com uma proposta pedagógica transformadora e com uma visão prática, sendo aqui a relação notável entre educação e saúde abrangente; o conceito de que em 80% das observações foi expressado chamando o pequeno compromisso da comunidade e os profissionais de saúde com uma "Cultura de Saúde Integralmente Concebida".

La superación profesional en salud ocupacional como una necesidad para la atención médica integral / Professional upgrading in occupational health as a need for comprehensive medical care

Introducción: el proceso de superación constituye una vía primordial para que de manera gradual los profesionales coadyuven a la solución de las insuficiencias académicas en determinados temas y favorezcan el bienestar social. Objetivo: reflexionar sobre la necesidad de la superación profesional del médico de familia en materia de salud ocupacional para prestar una atención médica integral al trabajador. Métodos: estudio cualitativo de carácter descriptivo; donde se emplearon el análisis documental, la sistematización, el análisis y síntesis de revisiones bibliográficas sobre la temática estudiada como métodos teóricos, para ello se valoran los criterios de autores y resultados que se expresan en artículos publicados en revistas indexadas en diferentes bases de datos. Resultados: se abordó sobre la importancia de la superación profesional en salud ocupacional por parte del médico de familia para ofrecer una respuesta oportuna a las demandas sociales de salud de los trabajadores; con la finalidad de fomentar y mantener el más alto nivel de bienestar físico, mental y social en todas las profesiones. Conclusiones: la superación profesional del médico de familia debe estar concebida a partir del diagnóstico científico del estado actual de preparación; en la que se incluyan las vías para la determinación de necesidades de aprendizaje sobre la repercusión en la salud de los factores de riesgo presentes en el ambiente laboral(AU)

Introduction: The upgrading process is an essential way for gradually the professionals to manage with the academic deficiencies in certain issues and to favor social welfare. Objective: To reflect about the need for the professional upgrading of the family doctor regarding occupational health to provide comprehensive medical care to the worker. Methods: Qualitative study of descriptive character, which used, as theoretical methods, documentary analysis, systematization, analysis and synthesis of bibliographic reviews on the subject studied, for which the authors' criteria and results are evaluated, which are expressed in articles published in journals indexed in different databases.Results: The importance of professional upgrading in occupational health by the family doctor was addressed, in order to provide a timely response to the social demands of health workers, with the aim of promoting and maintaining the highest level of physical, mental and social well-being in all professions. Conclusions: The professional upgrading of the family doctor should be conceived from the scientific diagnosis of the current state of training, which includes the ways to determine learning needs about the health impact of the risk factors present in the work environment(AU)

La superación profesional en salud ocupacional como una necesidad para la atención médica integral / Professional upgrading in occupational health as a need for comprehensive medical care

Introducción: el proceso de superación constituye una vía primordial para que de manera gradual los profesionales coadyuven a la solución de las insuficiencias académicas en determinados temas y favorezcan el bienestar social. Objetivo: reflexionar sobre la necesidad de la superación profesional del médico de familia en materia de salud ocupacional para prestar una atención médica integral al trabajador. Métodos: estudio cualitativo de carácter descriptivo; donde se emplearon el análisis documental, la sistematización, el análisis y síntesis de revisiones bibliográficas sobre la temática estudiada como métodos teóricos, para ello se valoran los criterios de autores y resultados que se expresan en artículos publicados en revistas indexadas en diferentes bases de datos. Resultados: se abordó sobre la importancia de la superación profesional en salud ocupacional por parte del médico de familia para ofrecer una respuesta oportuna a las demandas sociales de salud de los trabajadores; con la finalidad de fomentar y mantener el más alto nivel de bienestar físico, mental y social en todas las profesiones. Conclusiones: la superación profesional del médico de familia debe estar concebida a partir del diagnóstico científico del estado actual de preparación; en la que se incluyan las vías para la determinación de necesidades de aprendizaje sobre la repercusión en la salud de los factores de riesgo presentes en el ambiente laboral(AU)

Introduction: The upgrading process is an essential way for gradually the professionals to manage with the academic deficiencies in certain issues and to favor social welfare. Objective: To reflect about the need for the professional upgrading of the family doctor regarding occupational health to provide comprehensive medical care to the worker. Methods: Qualitative study of descriptive character, which used, as theoretical methods, documentary analysis, systematization, analysis and synthesis of bibliographic reviews on the subject studied, for which the authors' criteria and results are evaluated, which are expressed in articles published in journals indexed in different databases.Results: The importance of professional upgrading in occupational health by the family doctor was addressed, in order to provide a timely response to the social demands of health workers, with the aim of promoting and maintaining the highest level of physical, mental and social well-being in all professions. Conclusions: The professional upgrading of the family doctor should be conceived from the scientific diagnosis of the current state of training, which includes the ways to determine learning needs about the health impact of the risk factors present in the work environment(AU)

[Assessment of an intervention on cardiovascular risk factors in patients with rheumatoid arthritis]. / Evaluación de una intervención sobre los factores de riesgo cardiovascular en pacientes con artritis reumatoide.

OBJECTIVES: To evaluate the effectiveness of an intervention on cardiovascular risk factors (CVRF) in patients with rheumatoid arthritis. METHODS: After determining their CVRF and cardiovascular risk (CVR) by modified SCORE, we gave the patients a letter for their general practitioners in which they were requested for their cooperation in controlling CVRF and where the therapeutic goal for LDL cholesterol was specified. Three months later, any therapeutic intervention was recorded as well as the results. RESULTS: We included 211 patients, 29% with a high CVR. There were new diagnoses of CVRF in 100 patients (47%). The general practitioner changed the treatment in 2/12 diabetes, 30/84 HBP, 74/167 with elevation of LDL cholesterol and 21/51 with hypertriglyceridemia. The percentage of patients with good control over CVRF was: a) in HBP, 25 to 73%; b) elevation of LDL cholesterol from 10 to 17%; and c) in hypertriglyceridemia, 25 to 38%. CONCLUSIONS: Through this intervention, a new CVRF was diagnosed in nearly half of the patients. The effectiveness of the intervention on CVRF was low.

[The suitability of therapeutic effort: An end-of-life strategy]. / Adecuación del esfuerzo terapéutico, una estrategia al final de la vida.

End-of-life treatment and attention to the needs of relatives are not adequate for several reasons: Society denies or hides the death; it is very difficult to predict it accurately; treatment is frequently fragmented between different specialists, and there is insufficient palliative medicine training, including communication skills. There are frequent conflicts with decisions made at the end of life, particularly the suitability of therapeutic effort. The attitude of professionals on the adequacy of therapeutic effort is not homogenous, and varies depending on the specialty, experience, and beliefs. Many doctors are still afraid of inconveniencing patients. Primary care is in a privileged position to approach the life and values of our patients and their families, and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills.

[Ultrasound of the large abdominal vessels]. / Ecografía de los grandes vasos abdominales.

Ultrasound has recently become an indispensable tool for the family physician, whether exercised in primary care and emergency department; and likewise it has spread to many other specialties: internal medicine, critical care, neurology, pneumology, digestive, etc. and that ultrasound has proven to be a safe diagnostic tool and have great capacity. We firmly believe that ultrasound done to «bedside¼ the patient by the family doctor, can greatly complement the physical examination and greatly improve clinical effectiveness, allowing the browser an immediate view of the anatomy and physiology of certain structures. It is within this context is particularly relevant ultrasonography of the Aorta and large abdominal vessels, made by the family doctor or the emergency itself, which will develop along this chapter.

[Role of the family doctor in the completion and registration of advance directives documents]. / Papel del médico de familia en la cumplimentación y registro del documento de instrucciones previas.

The attitude of professionals about living wills (advance directives) is not homogenous and varies depending on the specialty, experience and beliefs. Many doctors are still afraid of inconveniencing patients. The situation confronting the professional in an acute care hospital with a relatively unknown patient in a palliative care unit is not the same as consulting a family doctor who is caring for the patient holistically. Primary care has a unique position to approach the life and values of our patients and their families and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills.

Consideraciones generales sobre la evolución de la medicina familiar y la atención primaria de salud en cuba y otros países / General Considerations on the Evolution of Family Medicine and Primary Health Care in Cuba and Other Countries

Introducción: la Medicina Familiar es considerada como la especialidad médica efectora de la Atención Primaria de Salud, cuyo desarrollo se ha influenciado por la presión de atender imperiosas necesidades sociales. Esta especialidad, también llamada Medicina de Familia, es ejercida de forma general por médicos cuya función básica es atender a la comunidad, la familia y el individuo en un área de salud determinada. Objetivo: revisar información sobre la evolución y desarrollo de la medicina familiar y la Atención Primaria de Salud en Cuba y otros países. Métodos: se realizó una búsqueda bibliográfica a través de diferentes fuentes de información, buscadores y bases de datos, entre ellas, Google, Medline, Pubmed y SciELO.Resultados: la medicina familiar resurge a fines de la primera mitad del siglo XX ante el imperativo de satisfacer la necesidad social de una atención médica que garantice un servicio de salud de alta calidad científico-técnica a un costo sostenible, la misma ha tenido su desarrollo en modelos de atención primaria donde se han utilizado diferentes programas de formación, como en México, Brasil, Canadá, Estados Unidos, España y Cuba. Conclusiones: la medicina familiar ha tenido un desarrollo en espiral en el ámbito internacional, logrando algunos modelos más éxitos que otros. El modelo cubano, con una inversión económicamente limitada, se convierte en una de las estrategias más costo-efectivas de la historia(AU)

Introduction: Family Medicine is the medical specialty considered effector of Primary Health Care, whose development has been influenced by the pressure to address compelling social needs. This field, also called family practice is generally exercised by physicians whose primary function is to serve the community, the family and the individual in a particular area of health. Objective: To review information about the evolution and development of Family Medicine and Primary Health Care in Cuba and other countries. Methods: A literature search through different information sources, databases and search engines, including Google, Medline, PubMed and SciELO was performed. Results: family medicine emerges late in the first half of the XX century to meet the imperative social need for health care services to ensure scientific and technical quality health care at a sustainable cost, it has had its development in primary care models which have used different training programs, such as Mexico, Brazil, Canada, USA, Spain and Cuba. Conclusions: Family medicine has had a spiral development internationally, making models - some more success than others. The Cuban model, with a financially limited investment, becomes a cost-effective strategy over history(AU)