Senses and meanings of primary health care academic visions in nursing / Sentidos y significados de las visiones académicas de la atención/cuidado primaria de salud en enfermería / Sentidos e significados das visões acadêmicas da atenção básica/cuidado em enfermagem

Introduction: Primary Health Care (PHC) has acquired different meanings for different people, at specific times and places, which poses important challenges for its understanding. Objective: To analyze the meaning(s) and sense(s) of Primary/Basic Health Care in the academic views on Nursing/Health in the context of undergraduate Nursing courses offered at two public Higher Education Institutions. Materials and methods: Qualitative study with an exploratory approach. Semi-structured interviews and documentary analysis were used as data collection techniques. Results: The senses/meanings of Primary Health Care converge with the population's gateway to the health system at the first care level and with the first contact of a person with the health service. However, it is still considered as a less important service within the care network. Conclusion: Primary Health Care means a relevant possibility for Nursing/Health care through health promotion and disease prevention actions, with a commitment to respond to most of the population's health needs.

Introducción: La Atención Primaria de Salud ha adquirido diferentes significados para diversas personas, en momentos y lugares específicos, lo cual plantea importantes retos para su entendimiento. Objetivo: Analizar los significados y sentidos de la Atención Primaria de Salud desde una visión académica en Enfermería y en el contexto de cursos de pregrado en Enfermería ofrecidos en dos Instituciones Públicas de Educación Superior. Materiales y métodos: Estudio cualitativo con un enfoque exploratorio, para la recolección de datos se emplearon entrevistas semiestructuradas y análisis documental de contenidos. Resultados: Los sentidos/significados de la Atención Primaria de la Salud convergen con el ingreso de la población al sistema de salud en el primer nivel de atención y la primera experiencia de la persona con el servicio de salud. Sin embargo, dicha Atención Primaria todavía se considera un servicio de baja importancia dentro de la red asistencial. Conclusión: La Atención Primaria de Salud representa una posibilidad relevante para el cuidado de Enfermería a través de acciones de promoción de la salud y prevención de enfermedades, que debe fortalecerse para responder la mayoría de las necesidades de salud de la población.

Introdução: A Atenção Primária à Saúde tem adquirido diferentes significados para diferentes pessoas, em momentos e locais específicos, o que coloca desafios importantes para a sua compreensão. Objetivo: Analisar os sentidos e significados da Atenção Primária à Saúde na perspectiva acadêmica em Enfermagem e no contexto dos cursos de graduação em Enfermagem oferecidos em duas Instituições de Ensino Superior Públicas. Materiais e métodos: Estudo qualitativo com abordagem exploratória, utilizou-se entrevistas semiestruturadas para coleta de dados e análise de conteúdo documental. Resultados: Os sentidos/significados da Atenção Primária à Saúde convergem com a entrada da população no sistema de saúde no primeiro nível de atenção e a primeira experiência da pessoa com o serviço de saúde. Contudo, a referida Atenção Básica ainda é considerada um serviço de baixa importância dentro da rede de saúde. Conclusão: A Atenção Primária à Saúde representa uma possibilidade relevante para o cuidado de Enfermagem por meio de ações de promoção da saúde e prevenção de doenças, que devem ser fortalecidas para responder à maioria das necessidades de saúde da população.

Detection of subclinical atherosclerosis using vascular ultrasound as a vascular risk assessment method. Simplified protocol. / Detección de aterosclerosis subclínica mediante ecografía vascular como método de evaluación de riesgo vascular. Protocolo simplificado.

Cardiovascular disease secondary to atherosclerosis is the main cause of morbidity and mortality in the world. Cardiovascular risk stratification has proven to be an insufficient approach to detect those subjects who are going to suffer a cardiovascular event, which is why for years other markers have been sought to help stratify each individual with greater precision. Two-dimensional vascular ultrasound is a excellent method for vascular risk assessment.

Abordaje de la obesidad infantil. Comparativa entre comunidades autónomas / Approach to Childhood Obesity in Spain. A comparison among autonomies

Fundamentos: la obesidad infantil representa un grave problema de salud pública y, dado su carácter multifactorial y sus consecuencias, resulta necesario llevar a cabo un abordaje eficaz. El sistema de autonomías español, con competencias delegadas, podría acentuar la desigualdad en su abordaje. El objetivo del estudio fue conocer la existencia o no de dichas desigualdades. Métodos: se llevó a cabo un estudio transversal descriptivo, entre los meses de febrero-abril de 2022, en el que se comparó el abordaje de la obesidad infantil entre las diecisiete comunidades y dos ciudades autónomas, mediante el análisis de los siguientes indicadores: personal de pediatría; enfermería pediátrica; personal de nutrición y su reconocimiento legal; existencia de planes integrales; y gasto sanitario para obesidad infantil. La búsqueda de información se realizó mediante revisión bibliográfica y solicitud de acceso a información pública a las correspondientes consejerías autonómicas. Hubo cálculo de ratios de pediatras y enfermeros por 1.000 habitantes y gasto sanitario por habitante. Resultados: se observó que a nivel nacional los pediatras poseen una ratio acorde a las recomendaciones internacionales (1,21), no así enfermería general y pediátrica (con una ratio de 0,65, que equivale a aproximadamente 1.544 habitantes por cada enfermera), ni el personal de nutrición. Entre comunidades autónomas se apreciaron grandes variaciones para las tres categorías. Los planes integrales de abordaje se encontraron desactualizados o, directamente, ausentes, al igual que el análisis periódico del gasto derivado de la obesidad.Conclusiones: el abordaje de la obesidad infantil parece variar de forma considerable entre autonomías según los indicadores analizados. Por ello, sería recomendable encauzar todos los esfuerzos en homogenizarlo, para mejorar la calidad asistencial e igualar las oportunidades de prevención y tratamiento en todo el ámbito nacional.(au)

Background: childhood obesity represents a serious public health problem and given its multifactorial nature and its con-sequences; it is necessary to carry out an effective approach. The spanish system of autonomies, with delegated powers, could accentuate inequality in its approach. The objective of the study was to know the existence or not of these inequalities. Methods: a descriptive cross-sectional study was carried out between the months of february-april 2022, in which the approach to childhood obesity was compared among the seventeen communities and two autonomous cities, through the analysis of the following indicators: pediatric staff, pediatric nursing, nutrition personnel and their legal recognition, the existence of comprehensive plans and health expenditure on childhood obesity. The search for information has been carried out through a bibliographic review and a request for access to public information to the corresponding regional councils. It were performed ratios of paediatricians and nurses per 1,000 inhabitants and health expenditure per inhabitant were calculated.results: it was observed that in spain paediatricians have a ratio according to international recommendations (1.21), but not ge-neral and paediatric nursing (with a ratio of 0.65, which is equivalent to approximately 1,544 inhabitants for each nurse), and nutrition professionals. Among autonomies there were large variations for the three categories. Comprehensive plans were outdated or absent altogether, as well as the periodic analysis of obesity expenditure. Conclusions: the approach to childhood obesity seems to vary considerably among autonomies according to the analysed indicators. Thus, it would be advisable to lead all efforts to homogenize it, to improve care quality and prevention and treatment choices in all national regions.(AU)

Chilean consensus by expert panel using the Delphi technique for primary and secondary prevention of gastric cancer. / Estrategias para la prevención primaria y secundaria del cáncer gástrico: consenso chileno de panel de expertos con técnica Delfi.

INTRODUCTION: Gastric cancer (GC) is the first cause of cancer-related death in Chile and 6th in Latin America and the Caribbean (LAC). Helicobacter pylori (H. pylori) is the main gastric carcinogen, and its treatment reduces GC incidence and mortality. Esophageal-gastro-duodenoscopy (EGD) allows for the detection of premalignant conditions and early-stage GC. Mass screening programs for H. pylori infection and screening for premalignant conditions and early-stage GC are not currently implemented in LAC. The aim of this study is to establish recommendations for primary and secondary prevention of GC in asymptomatic standard-risk populations in Chile. METHODS: Two on-line synchronous workshops and a seminar were conducted with Chilean experts. A Delphi panel consensus was conducted over 2 rounds to achieve>80% agreement on proposed primary and secondary prevention strategies for the population stratified by age groups. RESULTS: 10, 12, and 12 experts participated in two workshops and a seminar, respectively. In the Delphi panel, 25 out of 37 experts (77.14%) and 28 out of 52 experts (53.85%) responded. For the population aged 16-34, there was no consensus on non-invasive testing and treatment for H. pylori, and the use of EGD was excluded. For the 35-44 age group, non-invasive testing and treatment for H. pylori is recommended, followed by subsequent test-of-cure using non-invasive tests (stool antigen test or urea breath test). In the ≥45 age group, a combined strategy is recommended, involving H. pylori testing and treatment plus non-invasive biomarkers (H. pylori IgG serology and serum pepsinogens I and II); subsequently, a selected group of subjects will undergo EGD with gastric biopsies (Sydney Protocol), which will be used to stratify surveillance according to the classification Operative Link for Gastritis Assessment (OLGA); every 3 years for OLGA III-IV and every 5 years for OLGA I-II. CONCLUSION: A "test-and-treat" strategy for H. pylori infection based on non-invasive studies (primary prevention) is proposed in the 35-44 age group, and a combined strategy (serology and EGD) is recommended for the ≥45 age group (primary and secondary prevention). These strategies are potentially applicable to other countries in LAC.

Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19 / Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic

Objetivo:Evaluar si la aparición de una situación de crisis como la que ha supuesto la pandemia por el SARS-CoV-2, junto a los cambios organizativos adoptados en Atención Primaria, han influido en la implementación de actividades preventivas cardiovasculares en pacientes de 40 a 74 años. Diseño: Estudio descriptivo multicéntrico retrospectivo durante tres años (2019-2022) en Atención Primaria.Ámbito: 35 centros de salud de Atención Primaria de la Dirección Asistencial Norte de Madrid. Participantes: Se incluyeron 1.008 pacientes de ambos sexos entre 40 y 74 años con diagnósticos de hipertensión, diabetes mellitus y/o dislipemia. Método: Se recogen a partir de la historia clínica informatizada las siguientes variables: actividades preventivas sobre el estilo de vida (consumo de tabaco, alcohol, consumo de dieta mediterránea y práctica de ejercicio) considerando óptimo tres de los cuatro parámetros; datos de exploración (registro de tensión arterial) y registro de analítica (glucemia, HbA1c, colesterol total, HDL, LDL) considerando óptimo cuatro de los cinco parámetros. Se analizan diferencias entre tiempo de prepandemia (15/03/2019-14/03/2020), pandemia (15/03/2020-14/03/2021) y transición (15/03/2021-14/03/2022). Análisis estadístico: Prueba de McNemar para comparar las variables principales entre los periodos de estudio. Resultados: Se recogen datos de 1.008 pacientes. El registro de actividades preventivas sobre el estilo de vida fue de 180 pacientes (17,9%) (IC 95%: 0,155-0,204) en prepandemia, 29 pacientes (2,9%) (IC 95%: 0,019-0,041) en pandemia y 55 pacientes (5,5%) (IC 95%: 0,041-0,070) en la etapa de transición (p < 0,05). La exploración estaba registrada en 393 pacientes (39%) (IC 95%: 0,360-0,421) en la prepandemia, 133 pacientes (13,2%) (IC 95%: 0,112-0,154) en pandemia y en 218 pacientes (21,6%) (IC 95%: 0,191-0,243) en la transición (p < 0,05).(AU)

Objective:To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. Design: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. Setting: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. Participants: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. Method: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). Statistical analysis: MC Nemar's test to compare the main variables between the study periods. Results: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05).(AU)

[Primary prevention of gender-based violence]. / Prevención primaria de la violencia de género.

Gender-based violence is a serious public health problem and a violation of human rights. The vast scale of the problem indicates that it is necessary to advance in its primary prevention. The health sector has an important role to play, especially Primary Health Care, based on its community orientation and with the involvement of all members of the team. The intervention framework defined by the acronym "RESPECT", promoted by the World Health Organization, shows the 7 strategies that are currently promising to lead to reductions in gender-based violence, based on the best scientific evidence available to date. Using a participatory, life-cycle approach, promoting coordination and partnership across sectors, and implementing combined interventions are some of the guiding principles from which to work today.

Validation of the IberScore model in a primary care population.

BACKGROUND: This study aimed to validate the IberScore cardiovascular risk model in a population attended in the primary care setting. METHODS: A cohort of patients with no history of cardiovascular disease visited in a primary care center during the years 2008 and/or 2009 and followed up until 2018 was selected. Cardiovascular risk was calculated with the IberScore formula for all the subjects of the cohort and the model was calibrated, graphically represented by risk deciles the proportion of expected events and proportion of observed events at 10-year follow-up, stratified by sex. The area under the ROC curve was calculated to assess the discrimination of the model. RESULTS: A total of 10,085 patients visited during the years 2008 and/or 2009 were included in the study. Men showed a mean 10-year risk of suffering a fatal or non-fatal cardiovascular events according to IberScore of 17.07% (SD 20.13), with a mean estimated vascular age of more than 4 years higher than the biological age; while women had a mean 10-year risk of 7.91% (SD 9.03), with an estimated vascular age of more than 2 years above the biological age. The area under the ROC curve showed a discrimination index of the model of 0.86 (95% CI 0.84-0.88) in men and 0.82 (95% CI 0.79-0.85) in women. CONCLUSION: IberScore model discriminates well in the population attended in primary care but the model overestimates the risk.

[Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]. / Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19.

OBJECTIVE: To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. DESIGN: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. SETTING: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. PARTICIPANTS: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. METHOD: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). STATISTICAL ANALYSIS: MC Nemar's test to compare the main variables between the study periods. RESULTS: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05). CONCLUSIONS: Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.

Teleenfermería en salud mental: efecto sobre los síntomas de ansiedad y el consumo de alcohol durante la pandemia de COVID-19 / Telenursing in mental health: effect on anxiety symptoms and alcohol consumption during the COVID-19 pandemic / Telenfermagem em saúde mental: efeito em sintomas de ansiedade e consumo de álcool durante a pandemia COVID-19

Objetivo: investigar el efecto de una intervención a distancia sobre los síntomas de ansiedad y el consumo de alcohol en usuarios del servicio de Atención Primaria de Salud. Método: estudio cuasiexperimental, realizado con 1270 participantes que respondieron al Alcohol Use Disorders Identification Test y al State-Trait Anxiety Inventory 6. De estos, 1033 encuestados obtuvieron puntajes de síntomas de ansiedad moderada/grave (STAI-6 > 3) y consumo de alcohol de riesgo moderado/grave (AUDIT-C>3), y recibieron las intervenciones mediante llamada telefónica con un seguimiento de siete y 180 días. Para analizar los datos se utilizó un modelo de regresión de efectos mixtos. Resultados: el efecto de la intervención realizada fue positivo para reducir los síntomas de ansiedad entre T0 y T1 (µ=1,6 p<0,001) y para reducir el patrón de consumo de alcohol entre t1 y t3 (µ=1,57 p< 0,001). Conclusión: los resultados del seguimiento sugieren que la intervención tuvo un efecto positivo en la reducción de la ansiedad y el patrón de consumo de alcohol que tiende a mantenerse en el tiempo. Existe evidencia de que la intervención propuesta puede ser una alternativa para la atención preventiva en salud mental, en situaciones donde se comprometa la accesibilidad del usuario o del profesional.

Objective: to investigate the effect of a remote intervention on anxiety symptoms and alcohol use in users of the Primary Health Care service. Method: a quasi-experimental study conducted with 1,270 participants who answered the Alcohol Use Disorders Identification Test and the State-Trait Anxiety Inventory-6. Of these, 1,033 interviewees scored for moderate/severe anxiety symptoms (STAI-6 > 3) and moderate/severe risk alcohol use (AUDIT-C > 3), and received the interventions via telephone calls with follow-up periods lasting seven and 180 days. For data analysis, a mixed-effects regression model was used. Results: the effect of the intervention performed was positive in reducing anxiety symptoms between T0 and T1 (µ=1.6, p<0.001) and in reducing the alcohol use pattern between T1 and T3 (µ=1.57, p<0.001) Conclusion: the follow-up results suggest a positive effect of the intervention in reducing anxiety and the alcohol use pattern, which tends to be maintained over time. There is diverse evidence that the intervention proposed can be an alternative for preventive care in mental health, in situations where accessibility of the user or the professional is compromised.

Objetivo: investigar o efeito de uma intervenção remota nos sintomas de ansiedade e no uso de álcool em usuários do serviço de Atenção Primária à Saúde. Método: estudo quase experimental, realizado com 1270 participantes que responderam o Alcohol Use Disorders Identification Test e a State-Trait Anxiety Inventory 6. Desses, 1033 entrevistados pontuaram para sintomas de ansiedade moderada/severa (STAI-6>3) e uso de risco de álcool moderado/severo (AUDIT-C>3), e receberam as intervenções via chamada telefônica com follow-up de sete e 180 dias. Para análise dos dados utilizou-se um modelo de regressão de efeitos mistos. Resultados: o efeito da intervenção realizada foi positivo na redução dos sintomas de ansiedade entre T0 e T1 (µ=1,6 p<0.001) e na redução do padrão de uso de álcool entre t1 e t3 (µ=1,57 p<0.001). Conclusão: os resultados do follow-up sugerem efeito positivo da intervenção na redução da ansiedade e no padrão de uso de álcool, o qual tende a se manter ao longo do tempo. Há evidências de que a intervenção proposta pode ser uma alternativa para o cuidado preventivo em saúde mental, em situações nas quais a acessibilidade do usuário ou do profissional encontram-se comprometidas.

Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses / Interdisciplinary intervention for the primary prevention of dental caries in children under 18 months

Introducción: la caries es la enfermedad crónica más frecuente en la infancia. La presencia de caries en la dentición temporal es el principal factor de riesgo para desarrollar caries en la dentición definitiva. La mayoría de los factores de riesgo de la caries son modificables y pueden convertirse en elementos para la prevención y control de la enfermedad. Con el objetivo de reducir la incidencia de caries a la edad de 18 meses se diseña una intervención interdisciplinaria de prevención primaria dirigida a familias con niños que se visitan siguiendo el Protocol d’activitats preventives i de promoció de la salut a l’edat pediátrica (PAPPS). Material y métodos: ensayo clínico no aleatorizado, realizado en dos centros de asistencia primaria de Catalunya desde enero de 2019 hasta junio de 2022. En uno de los centros se diseñó e implementó una intervención educativa de prevención primaria de la caries con consejos y habilidades para las familias. En el otro centro se mantuvo el protocolo habitual de recomendaciones. Se evaluó y comparó la incidencia de caries en ambos grupos a la edad de 18 meses con un modelo de regresión logística estimado con el programa R. Resultados: la incidencia de caries a los 18 meses fue superior en los niños del grupo control (OR = 6,0; IC 95% 1,8-20,2), a pesar de que la valoración del riesgo de caries basada en el sistema llamado Caries Management by Risk Assessment (CAMBRA) indicó mayor riesgo de desarrollo de caries en los lactantes del grupo intervención. Conclusión: la intervención interdisciplinaria de prevención primaria de la caries incorporada en los programas de salud infantil reduce la incidencia de caries en los primeros años de vida. (AU)

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the goal of reducing the incidence of caries in children at age 18 months, we designed an interdisciplinary primary prevention intervention aimed at families with children who attended routine preventive visits within the PAPPS (“Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica”) child health programme. Methodology: non-randomized clinical trial carried out in two primary care centres in Catalonia between January 2019 and June 2022. In one of the centres, an educational intervention for the primary prevention of caries was designed and implemented to provide families with guidance and skills. In the other centre, patients received standard care. The incidence of caries was assessed and compared in both groups at age 18 months by means of a logistic regression model fitted with the R software. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI: 1.8-20.2), despite the fact that the caries risk assessment by means of the “Caries Management by Risk Assessment” (CAMBRA) protocol indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention integrated into the child health prevention and promotion programme achieved a reduction in the incidence of caries in early childhood. (AU)

Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto / Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain

Introducción y objetivos En los ensayos clínicos la reducción eficaz de la presión arterial (PA) produce una disminución de la incidencia de la morbimortalidad cardiovascular (CV). Nuestro objetivo principal es conocer si en las condiciones reales de la práctica clínica el control de la PA reduce a largo plazo los eventos CV. Pacientes y métodos El estudio se realizó en 164 pacientes con hipertensión arterial (HTA) elegidos entre los pacientes que acudían a las consultas de medicina de familia por HTA. Se hizo un análisis entre los pacientes que presentaban una PA clínica inferior a 140/90mmHg y los que la tenían más elevada. Los pacientes se seguían hasta que se producía un evento CV o hasta un máximo de 20 años, en que se finalizaba el seguimiento. Resultados Del total de los 164 pacientes alcanzaron un buen control clínico de la HTA 93 (56,7%) pacientes y no lo alcanzaron 71 (42,2%). En el análisis multivariante quedó únicamente como variable predictora de eventos CV la falta de control estricto de la HTA (HR: 2,93; IC 95%: 1,45-5,89; p=0,003), y el sexo femenino fue protector para eventos CV (HR: 0,37; IC 95%: 0,18-0,74; p=0,005) Conclusiones La variable predictora fundamental de morbimortalidad CV en pacientes con HTA es la falta de control estricto de la HTA; las mujeres también tuvieron menos complicaciones CV (AU)

Introduction and aims During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. Patients and methods The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. Results Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). Conclusions The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications (AU)

[Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain]. / Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto.

INTRODUCTION AND AIMS: During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. PATIENTS AND METHODS: The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. RESULTS: Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). CONCLUSIONS: The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications.

Limitaciones de los puntajes de riesgo cardiovascular en prevención primaria. ¿Una oportunidad para los moduladores de riesgo? / Limitations of cardiovascular risk scores in primary prevention. An opportunity for risk modulators?

RESUMEN Introducción : Los puntajes de riesgo cardiovascular tienen limitaciones relacionadas con la calibración, la discriminación y la baja sensibilidad. Se han identificado diferentes "moduladores de riesgo" que permiten mejorar la estratificación del riesgo cardiovascular: placa aterosclerótica carotídea (PAC), puntaje de calcio arterial coronario (pCAC) y lipoproteína(a) [Lp(a)]. Objetivos : 1) determinar la prevalencia de los moduladores de riesgo citados en una población en prevención primaria; 2) determinar la concordancia entre los 2 métodos de detección de aterosclerosis subclínica; 3) establecer qué proporción de pacientes deberían recibir estatinas inicialmente, según su puntaje de riesgo, y posteriormente con el conocimiento de los moduladores de riesgo. Material y métodos : Se incluyeron individuos de 18 a 79 años, que asistieron para una evaluación de riesgo cardiovascular y que no estaban recibiendo tratamiento hipolipemiante. Se calculó el puntaje de riesgo (ASCVD Risk Estimator) en cada paciente. Se evaluó la presencia de PAC, el pCAC y el nivel plasmático de Lp(a). Resultados : Se incluyeron 348 pacientes (edad media 55,6 ± 12,2 años, 45,4% hombres). En la población total, 29,8%, 36,8% y 53,2% de los pacientes mostraron un valor de Lp(a) ≥ 50 mg/dL, PAC o un pCAC > 0, respectivamente. La prevalencia de PAC y pCAC fue progresivamente mayor según la categoría de riesgo cardiovascular; sin embargo, la proporción de sujetos de bajo riesgo que tenían moduladores de riesgo fue considerable (Lp(a) ≥ 50 mg/dl: 25,7%; PAC: 22%; pCAC > 0: 33%). En los 60 individuos menores de 45 años la prevalencia de pCAC > 0 y PAC fue de 18,3% y 10%, respectivamente. La concordancia entre los dos métodos para determinar la presencia de ateromatosis subclínica fue discreta (kappa 0,33). La indicación del tratamiento con estatinas aumentó un 31,6% luego de evaluar la presencia de moduladores. Conclusión : La presencia de moduladores de riesgo fue frecuente en esta población en prevención primaria, incluso en sujetos de bajo riesgo o menores de 45 años. La detección de moduladores de riesgo podría mejorar la estratificación inicial y llevar a reconsiderar el tratamiento con estatinas.

ABSTRACT Background : Cardiovascular risk scores have limitations related to calibration, discrimination, and low sensitivity. Different "risk modulators" have been identified to improve cardiovascular risk stratification: carotid atherosclerotic plaque (CAP), coronary artery calcium (CAC) score and lipoprotein(a) [Lp(a)]. Objectives : The aims of this study were: 1) to determine the prevalence of risk modulators mentioned in a primary prevention population; 2) determine the concordance between the 2 methods of detecting subclinical atherosclerosis; and 3) establish which proportion of patients should receive statins according to the initial risk stratification and after being recategorized by screening for risk modulators. Methods : Individuals aged 18 to 79 years who consulted for cardiovascular risk assessment and who were not receiving lipid-lowering treatment were included. The risk score was calculated in each patient using ASCVD Risk Estimator. The presence of CAP, CAC score and Lp(a) level were evaluated. Results : The cohort was made up of 348 patients; mean age was 55.6 ± 12.2 years and 45.4% were men. In the total population, 29.8%, 36.8%, and 53.2% of patients showed Lp(a) value ≥50 mg/dL, CAP, or a CAC score >0, respectively. The prevalence of CAP and CAC score was progressively higher according to the cardiovascular risk category; however, the proportion of low-risk subjects who had risk modulators was considerable (Lp(a) ≥50 mg/dl: 25.7%; CAP: 22%; CAC score >0: 33%). In the 60 subjects <45 years, the prevalence of CAC score >0 and CAP was 18.3% and 10%, respectively. The agreement between the two methods for quantifying subclinical atheromatosis was fair (kappa= 0.33). The indication for statin treatment increased by 31.6% after evaluating the presence of modulators. Conclusion : The presence of risk modulators was common in this population in primary prevention, even in low-risk subjects or < 45 years. Detection of risk modulators could improve initial stratification and lead to reconsideration of statin treatment.

Actualización y validación del riesgo cardiovascular de por vida en España: IBERLIFERISK2 / Update and validation of the lifetime cardiovascular risk in Spain: IBERLIFERISK2

Introducción: La función para estimar el riesgo cardiovascular de por vida en España –IBERLIFERISK– en población laboral obtuvo una discriminación satisfactoria; se registró una ligera sobreestimación del riesgo en hombres y una infraestimación del riesgo en mujeres. Objetivo: Recalibrar la ecuación de riesgo de por vida actual tras alargar 3 años el seguimiento. Métodos: Estudio de cohortes retrospectivo. Se incluyeron 762.058 trabajadores que realizaron un examen de salud laboral entre los años 2004 y 2007. Se evaluaron todos los episodios de incapacidad temporal y mortalidad cardiovascular hasta diciembre de 2017. Se combinaron los modelos de regresión para tener en cuenta la presencia de riesgos competitivos en la estimación del riesgo cardiovascular en una cohorte de derivación. La calibración se realizó representando gráficamente la proporción de eventos esperados y observados a los 10 años de seguimiento en la cohorte de validación estratificando por deciles de riesgo y calculando el estadístico Z de Spiegelhalter. La discriminación se evaluó de forma gráfica mediante la curva Receiver Operating Curve (ROC) y calculando el índice C de Harrell. Resultados: La media de edad fue de 35,48 años (DE 10,56). El 71,14% eran hombres. El índice C de Harrell fue de 0,78 (IC 95% 0,76-0,79) en hombres y de 0,73 (IC 95% 0,69-0,77) en mujeres. En general, se registró un ligero grado de infraestimación en mujeres y de sobreestimación en hombres en el último decil de riesgo, aunque el estadístico Z de Spiegelhalter no resultó estadísticamente significativo en ambos sexos (p>0,05). Conclusiones: El modelo actualizado continúa discriminando satisfactoriamente, aunque la calibración del modelo no ha mejorado sustancialmente con la nueva actualización.(AU)

Introduction: The function to estimate lifetime cardiovascular risk –IBERLIFERISK– in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women. Objective: To recalibrate the current lifetime risk equation after extending the follow-up by 3 years. Methods: Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell's C index. Results: The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell's C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05). Conclusions: The updated model continues to discriminate satisfactorily, although the model's calibration has not substantially improved with the new update.(AU)

Uso de aspirina en prevención primaria cardiovascular: es tiempo de cambiar el paradigma

La Aspirina es una droga ampliamente utilizada con un protagonismo indiscutido en el escenario de la prevención secundaria. Sin embargo, el rol de este medicamento en prevención primaria es aún motivo de discusión. Los primeros ensayos que evaluaron la Aspirina en prevención primaria sugerían reducciones en el infarto agudo al miocardio y el accidente cerebrovascular -aunque no en la mortalidad- con un riesgo no despreciable de hemorragia mayor. Esto llevó a diversas sociedades científicas a recomendar su prescripción sólo en aquellos individuos con alto riesgo de eventos cardiovasculares. Desde el año 2018 en adelante, surgen diversos ensayos aleatorizados que han cuestionado estas indicaciones, mostrando beneficios clínicos muy discretos o ausentes. El objetivo de esta revisión es realizar un análisis histórico de la evidencia sobre el rol de la Aspirina en prevención primaria y resumir las recomendaciones actuales en este escenario.

Aspirin is widely used with a clear role in secondary prevention of cardiovascular diseases. However, its benefit in primary prevention is still a matter of discussion. The first trials evaluating Aspirin for primary prevention suggested reductions in acute myocardial infarction and stroke (although not in mortality) but with a non-negligible risk of major bleeding. This led to aspirin being recommended by various scientific societies, albeit limited to individuals at high risk of cardiovascular events. Since 2018 various randomized trials in primary prevention showed minimal or no beneficial effects of aspirin thus questioning its indication for this purpose. The aim of this review is to make an historical analysis of the evidence for the role of Aspirin in primary prevention and suggest modified recommendations for these subjects.

Estrategia para la prevención de la retinopatía diabética en la atención primaria de salud / A Strategy for the Prevention of Diabetic Retinopathy in Primary Healthcare

Introducción: La retinopatía diabética puede prevenirse con el óptimo control de la diabetes mellitus; sin embargo, la constante llegada de pacientes con diagnóstico de retinopatía diabética avanzada a los centros oftalmológicos apunta a la insuficiente prevención primaria de esta enfermedad. Objetivo: Proponer herramientas prácticas vinculadas a los principales factores de riesgo que pueden ser controlados o modificados en pacientes diabéticos para lograr una prevención primaria de la retinopatía diabética más efectiva. Métodos: Se consultaron artículos referentes a la prevención de la retinopatía diabética en la atención primaria de salud durante los meses de noviembre-diciembre de 2020 y enero de 2021; publicados en diversas revistas e indexados en las bases de datos PubMed, SciELO, Medscape; otros textos afines, páginas web y blogs del año 2010 en adelante. Las sintaxis empleadas fueron retinopatía diabética, prevalencia y prevención de retinopatía diabética, prevención primaria, complicaciones oculares de la diabetes mellitus y factores de riesgo de la retinopatía diabética. Conclusiones: La adición de nuevas estrategias al control o modificación de los principales factores de riesgo en los pacientes diabéticos constituye una alternativa para perfeccionar la prevención primaria de la retinopatía diabética(AU)

Introduction: Diabetic retinopathy can be prevented with the optimal control of diabetes mellitus; however, the constant arrival of patients with a diagnosis of advanced diabetic retinopathy to ophthalmologic centers points to insufficient primary prevention of this disease. Objective: To propose practical tools related to the main risk factors that can be controlled or modified in diabetic patients to achieve a more effective primary prevention of diabetic retinopathy. Methods: Articles concerning the prevention of diabetic retinopathy in primary healthcare were consulted, covering the months of November-December 2020 and January 2021, published in various journals and indexed in the PubMed, SciELO and Medscape databases; together with other related texts, websites and blogs from 2010 onwards. The used syntaxes were retinopatía diabética [diabetic retinopathy], prevalencia y prevención de retinopatía diabética [prevalence and prevention of diabetic retinopathy], prevención primaria [primary prevention], complicaciones oculares de la diabetes mellitus [ocular complications of diabetes mellitus] and factores de riesgo de la retinopatía diabética [risk factors for diabetic retinopathy]. Conclusions: The addition of new strategies to the control or modification of the main risk factors in diabetic patients is an alternative to perfect primary prevention of diabetic retinopathy(AU)

Uso del antígeno prostático específico (PSA) para el cribado de cáncer de próstata en la población de 70 años o más de una zona de salud urbana, 2018-2020. Un estudio transversal / Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018–2020: A cross-sectional study

Objetivos Cuantificar, describir el origen y estimar el coste de las solicitudes de antígeno prostático específico (PSA) con fines de cribado a varones de 70 años o más realizadas en una zona de salud urbana. Métodos Estudio transversal. Se obtuvieron todas las determinaciones de PSA a pacientes adscritos a una zona de salud entre los años 2018 y 2020. Se clasificaron retrospectivamente como cribado (PSAc) o no, de acuerdo a criterios preestablecidos revisando historiales clínicos. Se comparó la edad de los pacientes sometidos a cribado con aquellos que no lo fueron. Se calcularon tasas de solicitud por centros y solicitantes de acuerdo a la población de referencia provista por el padrón municipal (VM70). Se estimó el coste consultando las tarifas de facturación. Resultados Fueron estudiadas 2.036 PSA, de 888 hombres ≥ 70 años, y 350 clasificadas como cribado. Se diagnosticaron seis adenocarcinomas. Se estimaron 76,07 PSAc/1.000 VM70-año con origen en cualquier centro, 1,45 solicitudes por individuo cribado, y una prevalencia de 15,71%; población media de referencia de 1.534 hombres (DE 45,37). Los pacientes sometidos a cribado (edad media 75 años, DE 4,04) fueron más jóvenes que aquellos no cribados (media 76,5, DE 4,81). Se estimó un coste del cribado de 9.751 €. Conclusiones Se describe la epidemiología y estima el coste de los cribados con PSA a varones ≥ 70 años sin cáncer prostático en nuestra zona, en atención primaria y hospitalaria. Se trata de una práctica habitual, predominantemente en atención primaria, y en magnitud similar a la reportada en la bibliografía estatal. (AU)

Objectives To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone. Methods A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list. ResultsTwo thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €. Conclusions The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature. (AU)

Avanzamos en salud gracias a la aplicación salud infantil papi: programa de actividades preventivas de la infancia y adolescencia / We advance in health thanks to the PAPI children's health application

Introducción: La estructura familiar y la crianza están cambiando en la sociedad, se incrementa el sedentarismo, el uso de pantallas y de redes sociales. Las familias y los profesionales sanitarios deben aprender a educar, adaptando sus consejos de salud al nuevo entorno social y digital. Material y métodos: Para renovar el Programa de Salud Infantil (PSI) de la Asociación Española de Pediatría de Atención Primaria (AEPap) se envió una encuesta a los representantes de más de 5.000 pediatras. Se incorporaron aportaciones de los programas preventivos de Andalucía, Baleares y Asturias. Se distribuyeron las diferentes intervenciones y consejos en 9 grupos etarios. Resultados: Parte de las recomendaciones están basadas en el trabajo del grupo PrevInfad, llevadas a cabo con metodología de medicina basada en la evidencia, mediante la evaluación y la síntesis de la evidencia de las actividades preventivas propuestas. La AEPap considera que el PSI debe realizarse por el equipo de pediatría: pediatra y enfermera/o, potenciándose así las competencias específicas. La OMS considera primordial empoderar a las personas, familias y comunidades para que optimicen su salud al convertirlas en cuidadoras de sí mismas y de otros, dotándolas de herramientas que protegen el bienestar. Conclusiones: Por todo ello se decide plasmar el PSI en formato de app para dispositivos móviles gratuita, como método innovador y asequible de divulgación de salud infantojuvenil. Se informa sobre consejos de crianza para los familiares, para los niños/as y adolescentes y describe las revisiones de salud para los sanitarios. (AU)

Introduction: The family structure and parenting are changing in society, sedentary lifestyle, the use of screens and social networks is increasing. Families and health professionals must learn to educate, adapting their health advice to the new social and digital environment. Materials and methods: A survey was sent to the representatives of more than 5000 paediatricians to renew the Well Child Visits Program of the Spanish Association of Primary Care Paediatrics (AEPap). Contributions from preventive programs from Andalusia, the Balearic Islands and Asturias were incorporated. The different interventions and advice were distributed in nine age groups. Results: Part of the recommendations are based on the work of the PrevInfad group. It uses the methodology of evidence-based medicine and performs the evaluation and synthesis of the evidence in the proposed preventive activities. The AEPap considers that the Well Child Program should be carried out by the paediatric team: the paediatrician and the nurse, thus enhancing specific skills. The WHO considers it is essential to empower individuals, families, and communities to optimize their health by making them caretakers of themselves and others, equipping them with tools that protect their well-being. Conclusions: Hence, it was decided to capture the Well Child Program in the format of a free APP for mobile devices, as an innovative and affordable method of disseminating child and adolescent health. Information is given on parenting advice for family members, for children and adolescents and describes health check-ups for health workers. (AU)

We advance in health thanks to the PAPI children's health application.

INTRODUCTION: The family structure and parenting are changing in society, sedentary lifestyle, the use of screens and social networks is increasing. Families and health professionals must learn to educate, adapting their health advice to the new social and digital environment. MATERIALS AND METHODS: A survey was sent to the representatives of more than 5000 paediatricians to renew the Well Child Visits Programme of the Spanish Association of Primary Care Paediatrics (AEPap). Contributions from preventive programmes from Andalusia, the Balearic Islands and Asturias were incorporated. The different interventions and advice were distributed in nine age groups. RESULTS: Part of the recommendations are based on the work of the PrevInfad group. It uses the methodology of evidence-based medicine and performs the evaluation and synthesis of the evidence in the proposed preventive activities. The AEPap considers that the Well Child Programme should be carried out by the paediatric team: the paediatrician and the nurse, thus enhancing specific skills. The WHO considers it essential to empower individuals, families, and communities to optimize their health by making them caretakers of themselves and others, equipping them with tools that protect their well-being. CONCLUSION: Hence, it was decided to capture the Well Child Programme in the format of a free APP for mobile devices, as an innovative and affordable method of disseminating child and adolescent health. Information is given on parenting advice for family members, for children and adolescents and describes health check-ups for health workers.

[Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018-2020: A cross-sectional study]. / Uso del antígeno prostático específico (PSA) para el cribado de cáncer de próstata en la población de 70 años o más de una zona de salud urbana, 2018-2020. Un estudio transversal.

OBJECTIVES: To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone. METHODS: A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list. RESULTS: Two thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €. CONCLUSIONS: The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature.