General Practice/Family Medicine Portuguese doctors: “technicists” or “systemics”? / Medicina General/Medicina de Familia. Médicos portugueses: ¿«técnicos» o «sistémicos»?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. “Technicists” doctors, only classifying “P” codes and “Systemics” classifying “P+Z” or only “Z” ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were “technicists”, for Assessment n=93 (40.8%) were “technicists” and for P chapter classification 56.8% were “technicists”. For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more “systemic” for the S and A chapters of the SOAP model, And “technicists” in the P chapter.(AU)

El enfoque de la medicina centrada en el paciente (MCP) es cada vez más importante debido a su asociación de efectos positivos sobre el médico y el paciente. El presente estudio tuvo como objetivo conocer si el abordaje de un caso clínico, a través de la clasificación de problemas de consulta de un caso ficticio por médicos de Medicina General y de Familia, presenta características de abordaje mecanicista o sistémico. Estudio observacional transversal en una muestra de conveniencia de la población de Medicina General/Medicina Familiar, incluidos los internos, en abril del 2020, aplicando un caso clínico del mundo real modificado de Portugal y los especialistas en Medicina General/Medicina Familiar de Azores y de Portugal central. Especialistas en Medicina General/Medicina Familiar e internados. Los médicos fueron invitados a participar, de forma anónima, mediante invitación electrónica, ya sea en la red oficial de pasantías o en la red social de un médico específico, la red MGFamiliar. Se utilizó un cuestionario autocumplimentable para verificar la clasificación de un caso clínico en subjetivo, evaluación y planificación (de la metodología SOAP) con las opciones de respuesta de la Clasificación Internacional de Atención Primaria de Salud (CIPC2) en los capítulos P (Psicológico) y Z (Social) posible para este caso. Se definieron médicos «técnicos» solo clasificando con códigos «P» y «sistémicos» clasificando «P+Z»’ o solo con códigos ICPC2 «Z». Se estudiaron las diferencias entre géneros, lugar de trabajo, ser interno o especialista, ser tutor en formación especializada. En una muestra de 227 sujetos, 30% (n=68) varones, los especialistas representaron el 66% (n=149), de los cuales el 49% (n=73) fueron tutores internos y el 34% (n=78), internos. Para la clasificación en el capítulo subjetivo de la metodología SOAP, el 44,1% (n=100) eran «técnicos», para la evaluación n=93 (40,8%) eran «técnicos» y para la clasificación del capítulo P el 56,8% eran «técnicos».(AU)

General Practice/Family Medicine Portuguese doctors: "technicists" or "systemics"?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. "Technicists" doctors, only classifying "P" codes and "Systemics" classifying "P+Z" or only "Z" ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were "technicists", for Assessment n=93 (40.8%) were "technicists" and for P chapter classification 56.8% were "technicists". For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more "systemic" for the S and A chapters of the SOAP model, And "technicists" in the P chapter.

Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study.

BACKGROUND AND OBJECTIVE: The estimation of cardiovascular risk (CVR) with scores at 30 years old has a special interest in reclassifying in a suitable way <60 year subjects with intermediate CVR. This study analyzes what percentage of patients with intermediate CVR included in the MARK study is reclassified by applying the 30-year Framingham score (FS30). It also analyzes the degree of agreement between the two equations to classify high risk subjects. PATIENTS AND METHODS: Cross-sectional study of 966 subjects included in the MARK study. The CVR was calculated with the two versions of the FS30 (based on lipids and body mass index) for "hard" cardiovascular events in subjects with intermediate CVR. RESULTS: The 59% and 61% of the subjects with intermediate CVR would be classified as if they had high CVR to undergo a hard event if we used the FS30 in both versions. 70% of men and 35% of women would be classified as high CVR (p<0.01). The agreement percentage, measured with the Kappa index, between the equations FS30L and FS30BMI to classify the high-risk subjects was 67.9% (in men 67.4% and in women 68.7%). CONCLUSIONS: In subjects with intermediate CVR the FS30 reclassifies more than the half as high RCV, 2 out of 3 men and 1 out of 3 women.

Reprodutibilidade e validade do Questionário Internacional de Atividade Física (IPAQ) em homens idosos / Reproducibilidad y validez del Cuestionario Internacional de Actividad Física (IPAQ) en hombres ancianos / Reproducibility and validity of the International Physical Activity Questionnaire (IPAQ) in elderly men

É necessário encontrar meios para quantificar de maneira eficiente e econômica o nível de atividade física da população. Os questionários são formas viáveis e econômicas, embora seja discutível a fidedignidade dessas medidas. Este estudo objetivou determinar a reprodutibilidade e a validade do Questionário Internacional de Atividade Física (IPAQ) em homens idosos. A amostra foi composta por 29 homens idosos acima de 60 anos, com média de idade de 66,6 anos (DP = 4,3), participantes do programa de extensão da Universidade Federal de Santa Catarina. Os instrumentos utilizados foram: a) IPAQ, forma longa; b) pedômetro; e c) Diário de Atividade Física de Bouchard (DAF). Para a reprodutibilidade foram realizadas duas aplicações do IPAQ, com intervalo de 21 dias (r s = 0,95). A análise estatística adotada foi a correlação de Spearman (r s), o percentual de concordância ( por centoC), o índice kappa (k) e a plotagem de Bland e Altman. A amostra foi dividida, utilizando-se como critério a mediana. A reprodutibilidade apresentou correlação de r s = 0,95. A associação entre o IPAQ e o DAF foi de: r s = 0,38; por centoC = 69 e k = 0,04 e a associação entre o IPAQ e o pedômetro de: r s = 0,24; por centoC = 62 e k = 0,19. Concluiu-se que a validade variou de moderada a baixa, enquanto a reprodutibilidade foi adequada.

It is necessary to efficiently and economically find means to quantify the level of physical activity of the population. Questionnaires are viable and economical; however, their trustworthiness is questionable. This study aimed to determine the reproducibility and validity of the International Physical Activity Questionnaire (IPAQ) in elderly men. The sampling was composed of 29 elderly men over the age of 60, average age of 66.6 years (SD = 4.3), who were members of the extension program at the Federal University of Santa Catarina. The instruments used were: a) IPAQ extended version; b) pedometer and c) Bouchard's Physical Activity Diary (PAD). For reproducibility, the IPAQ was applied twice with a 21 day interval (r s = 0.95). The statistical analysis used was Spearman Correlation (r s); Concordance Percentile ( percentC); Kappa Index (k); and Bland and Altman plot. The sample was divided using the median as criterion. The reproducibility showed a correlation of r s 0.95. The combination between IPAQ and PAD was: r s = 0.38; percentC = 69 and k = 0.04. The combination between IPAQ and the Pedometer was: r s = 0.24; percentC = 62 and k = 0.19. It was concluded that the validity varied from moderate to low while the reproducibility was adequate.

Es necesario encontrar medios para cuantificar de manera eficiente y económica el nivel de actividad física de la población. Los cuestionarios son formas viables y económicas, aunque se discuta la fidedignidad de estas medidas. Este estudio ha tenido como objetivo determinar la reproducibilidad y la validez del Cuestionario Internacional de Actividade Física (IPAQ) en hombres ancianos. La muestra se compuso de 29 hombres ancianos con más de 60 años, con edad media de 66,6 años (DP = 4,3), participantes del programa de extensión de la Universidad Federal de Santa Catarina. Los instrumentos utilizados fueron: a) IPAQ, forma larga; b) pedómetro y c) Diario de Actividad Física de Bouchard (DAF). Para la reproducibilidad fueron realizadas dos aplicaciones de IPAQ, con intervalo de 21 días (r s = 0,95). El análisis estadístico adoptada fue el de correlación de Spearman (r s), el porcentaje de concordancia ( por cientoC), el índice kappa (k) y el "plotaje" de Bland y Altman. La muestra fue dividida, utilizando como criterio la mediana. La reproducibilidad presentó una correlación de r s = 0,95. La asociación entre el IPAQ y el DAF fue de: r s = 0,38; por cientoC = 69 y k = 0,04 y la asociación entre el IPAQ y el pedómetro de: r s = 0,24; por cientoC = 62 y k = 0,19. Se concluye que la validez varió de moderado a bajo, mientras que la reproducibilidad fue adecuada.