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Background: A consistent referral system and patient patronage are the primary connections between the three tiers in the healthcare delivery system. Patients were scheduled to visit primary care clinics for the first time. Subsequently, patients are moved to more distinguished healthcare facilities to receive additional care. Objectives: This study aims to investigate the reasons behind patients' transfer from primary and secondary care to tertiary care, as well as the critical factors that influence these referrals. Methods: This study employs a mixed‐methods approach to explore factors determining referral service provision across primary, secondary, and tertiary healthcare levels. Along with conducting semi‐structured interviews with healthcare professionals, we systematically examined a wealth of retrospective data on 1331 referred patients from 130 health facilities, including patient records, demographics, referral status, and clinical presentation. All statistical analysis was processed in R, and Corel Draw 12 was also used for graphical illustration. Results: Healthcare facilities referred most emergencies to several departments, including the cardiac care unit, medical, urology, intensive care unit/emergency, obstetrics and gynaecology, children's, orthopaedic, and psychiatry. The percentage of all cases referred is displayed ward‐by‐ward; the intensive care unit/emergency wards have a high referral ratio of 65.51%, while the obstetrics and gynaecology wards have an 18.40% referral ratio. Conclusion: There is a need for increased government investments to strengthen the capacity, human resources, and availability of equipment in primary, secondary, and tertiary public health facilities to deliver quality services in order to reduce the patient referral ratio. Key Points: Formalizing and institutionalizing the referral system and retraining all health‐care professionals.Reduce the epidemic's negative effects on social services, health systems, and the economy.Physicians must diligently perform systematic treatment for referral cases. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of GeSec: Revista de Gestao e Secretariado is the property of Sindicato das Secretarias e Secretarios do Estado de Sao Paulo (SINSESP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of GeSec: Revista de Gestao e Secretariado is the property of Sindicato das Secretarias e Secretarios do Estado de Sao Paulo (SINSESP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Iberoamericana de Enfermería Comunitaria (RIdEC) is the property of Revista Iberoamericana de Enfermeria Comunitaria de la Asociacion de Enfermeria Comunitaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Iberoamericana de Enfermería Comunitaria (RIdEC) is the property of Revista Iberoamericana de Enfermeria Comunitaria de la Asociacion de Enfermeria Comunitaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and objectives: Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. Material and methods: In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. Results: 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. Conclusion: BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC. Resumen: Introducción y objetivos: Los test cognitivos breves (TCB) se utilizan en atención primaria (AP) para la detección de deterioro cognitivo (DC) pero existen pocos datos sobre su utilidad diagnóstica (UD) en el ámbito comunitario.Este trabajo evalúa la UD de Fototest, T@M, cuestionario AD8 y MMSE en una muestra representativa de la población y aporta nuevos puntos de corte (PdC) que se han validado en un grupo de personas que consultan por quejas cognitivas. Material y métodos: Ambas muestras, la poblacional y la de validación, se realizó una evaluación en dos fases; una primera de cribado y administración de los TCB y una segunda de diagnóstico clínico, ciego a los resultados de los TCB, aplicando los criterios NIA-AA actuales.La UD de los TCB en la muestra poblacional se evaluó con el área bajo la curva ROC (aROC). Para elegir los PdC óptimos, se evaluaron dos métodos: el índice de Youden y el PdC con mejor especificidad que asegurase una sensibilidad del 80%. En la muestra de validación se calcularon los parámetros de sensibilidad, especificidad, y valores predictivos para estos PdC. Resultados: Se han incluido 260 participantes (23,1% con DC) de la muestra poblacional y 177 (42,4% con DC) de la de validación. El Fototest tiene la mejor UD a nivel poblacional (aROC 0,851), que mejora con la combinación de Fototest y AD8 (aROC 0,875; p

Copyright of Revista Arbitrada Interdisciplinaria de Ciencias de la Salud, Salud & Vida is the property of Fundacion Koinonia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Entramado is the property of Universidad Libre Seccional Cali and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermeir@s is the property of Colegio Oficial de Enfermeria de Lugo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Según el último estudio sobre Edadismo realizado en España entre personas mayores de 65 años, la situación más frecuente de discriminación por edad se produce en la Atención Primaria cuando un médico justifica las dolencias como “cosas de la edad”. El objetivo de este estudio piloto fue aplicar herramientas y metodologías de la Economía Conductual para diseñar intervenciones conductuales dirigidas a reducir el edadismo en consultas de Atención Primaria y mejorar la experiencia del paciente. Se diseñaron diecisiete iniciativas de intervención basadas en nudges, boosting, personalización, normas sociales, prestigio social y principio de compromiso. Las iniciativas se filtraron a través de una matriz de impacto y esfuerzo. Las intervenciones finalistas mejor valoradas por los médicos de Atención Primaria fueron las basadas en la personalización, las normas sociales y el principio de compromiso. La propuesta de nuevo protocolo de consulta médica basado en los conocimientos de la Economía Conductual fue valorada positivamente por los médicos y los mayores encuestados. Se concluye que las metodologías y herramientas de la Economía Conductual pueden aplicarse en el ámbito de la Salud para reducir las situaciones de edadismo y mejorar la experiencia del paciente.

Objective: This study aimed to assess the cause of acute pharyngitis and determine the duration of severe and moderate symptoms based on the aetiology. Design: Prospective observational study. Site: One urban health care centre. Participants: Patients aged 15 or older with acute pharyngitis were included. Interventions: Bacterial identification was carried out in the microbiology lab using MALDI-TOF in two throat samples. Patients received a symptom diary to return after one week. Main measurements: Number of days with severe symptoms, scoring 5 or more in any of the symptoms included in the symptom diary, and moderate symptoms, scoring 3 or more. Results: Among the 149 patients recruited, beta-haemolytic streptococcus group A (GABHS) was the most common aetiology. Symptoms and signs alone as well as the mean Centor score cannot distinguish between GABHS and other bacterial causes in patients with acute pharyngitis. However, there was a trend indicating that infections caused by Streptococcus dysgalactiae and Streptococcus agalactiae presented more severe symptoms, whereas infections attributed to the Streptococcus anginosus group, Fusobacterium spp., and those where oropharyngeal microbiota was isolated tended to have milder symptoms. S. dysgalactiae infections showed a trend towards longer severe and moderate symptom duration. Conclusion: GABHS was the most prevalent, but group C streptococcus caused more severe and prolonged symptoms. Resumen: Objetivo: Evaluar la etiología de los episodios de faringitis aguda y determinar la duración de los síntomas graves y moderados según la etiología. Métodos: Estudio observacional prospectivo. Emplazamiento: Un centro de salud urbano. Participantes: Se incluyeron pacientes de 15 años o más con faringitis aguda. Intervenciones: Se realizó identificación bacteriana en el laboratorio de microbiología utilizando MALDI-TOF en 2 muestras faríngeas. Los pacientes recibieron un diario de síntomas que devolvieron a la semana. Medidas prinicpales: Número de días con síntomas graves, aquellas puntuaciones de 5 o más en cualquiera de los síntomas del diario de síntomas, y síntomas moderados con puntuaciones de 3 o más. Resultados: Entre los 149 pacientes incluidos, el estreptococo beta-hemolítico del grupo A (EBHGA) fue la etiología más común. Tanto los síntomas y signos como la puntuación media de la escala de Centor no permiten distinguir la infección de EBHGA de las otras causas bacterianas en pacientes con faringitis aguda. Sin embargo, se observó una tendencia en que las infecciones por S. dysgalactiae y agalactiae presentaban síntomas más graves, mientras que S. grupo anginosus, Fusobacterium spp. y aquellos con microbiota orofaringea solían presentar síntomas más leves. Las infecciones por S. dysgalactiae mostraron una tendencia hacia una mayor duración de síntomas graves y moderados. Conclusión: El EBHGA es el más prevalente, pero el estreptococo del grupo C causa síntomas más graves y prolongados.

Introducción: la hipertensión arterial es una enfermedad crónica que a su vez constituye un factor de riesgo para la derivación en enfermedades cardiovasculares, reconocida como una de las principales causas de decesos en los últimos años. Objetivo: describir el comportamiento clínico-epidemiológico de la hipertensión arterial en el consultorio 5. Métodos: se realizó un estudio observacional, descriptivo, transversal en 342 pacientes hipertensos del CMF 5 de Puerto Padre durante el primer cuatrimestre del 2023. La información se obtuvo del Análisis de la Situación de Salud, de las historias clínicas y de un cuestionario elaborado por los autores. Las variables estudiadas fueron: factores de riesgo no modificables, comorbilidades, factores de riesgo modificables, tratamiento médico preventivo, tratamiento farmacológico, adherencia al tratamiento, complicaciones. En el procesamiento de la información se empleó la estadística descriptiva. Resultados: predominaron el sexo femenino y el grupo etario comprendido entre 65-74 años. El 82,75 % tenía antecedentes familiares de HTA. La diabetes mellitus y obesidad fueron las comorbilidades presentes con predominio en las mujeres. En los hombres predominó el tabaquismo. El 75,15 % cumplía el tratamiento farmacológico y un bajo porciento llevaba a la práctica acciones encaminadas a un estilo de vida saludable. Entre las complicaciones se identificaron la cardiopatía isquémica y la insuficiencia cardíaca con mayor número de afectados. Conclusiones: se describió el comportamiento de la HTA en el consultorio 5 donde es necesario el accionar de los profesionales del sector para elevar la responsabilidad individual y colectiva.

Objetivos: Comparar la validez diagnóstica entre la escala Neuropathy Disability Score (NDS) sin Monofilamento (MF) y NDS modificada con MF frente a Electromiograma (EMG) de extremidades Inferiores. Concordancia entre neuropatía detectada y registrada en Historial Clínico Informatizado (HCI) Metodología: Estudio de concordancia. Duración: 12 meses. Ámbito: Dos centros de Atención Primaria (AP) del Institut Català de Salut. Población diana: Personas con EMG registrado en HCI por sospecha de neuropatía diabética y otras neuropatías de extremidad inferior. Muestreo: Para un coeficiente kappa de 0,8 y precisión de 0,2 necesitamos 104 personas. Criterios de inclusión por Grupos: A: DM con registros del pie de riesgo sin neuropatía. B: DM con diagnóstico de neuropatía. C: Sin neuropatía ni DM conocidas. Selección: Simple, mediante listado de candidatos por centros participantes. Captación: Telefónica y programados en agenda única. Intervenciones: Entrevista clínica (Cuestionario sintomático Neuropathy Symptoms Score) (NSS) (0-9 puntos), Examen clínico: (Valoración sensitivomotora mediante escala NDS modificada (0-5 puntos por pie). Neuropatía si NDS > 6 puntos). Exploraciones: Tres por Enfermería, dos consecutivas y una espaciada 2 semanas. Variables Independientes: Puntuación de NDS y NSS. Dependientes: Factores de Riesgo Cardiovascular. Complicaciones DM. Análisis estadístico: Si la muestra es homogénea, mediante t de Student y ANOVA. Se calculará la fiabilidad y validez inter observador. Concordancia mediante Kappa, sin descartar métodos no paramétricos si la distribución lo aconseja. STATA. Resultados esperados: Disponer de un procedimiento exploratorio que mejore la actual valoración del pie de riesgo en AP. Aplicabilidad: Mejorar el diagnóstico de neuropatía diabética en AP. ABSTRACT Objectives: Compare the diagnostic validity between the Neuropathy Disability Score (NDS) scale without Monofilament (MF) and NDS modified with the MF and Lower Extremity Electromyogram (EMG). Concordance between neuropathy detected and recorded in the Computerized Clinical History (HCI) Methodology: Concordance study. Duration: 12 months. Setting: Two Primary Care (PC) centers of the Institut Català de Salut. Target population: People with EMG recorded in HCI for suspected diabetic neuropathy and other lower extremity neuropathies. Sampling: For a kappa coefficient of 0.8 and precision of 0.2 we need 104 people. Inclusion criteria by Groups: A: DM with risk foot records without neuropathy. B: DM with diagnosis of neuropathy. C: No known neuropathy or DM. Selection: Simple, through a list of candidates by participating centers. Capture: Telephone and scheduled in a single agenda. Interventions: Clinical interview (Neuropathy Symptoms Score) (NSS) symptomatic questionnaire (0-9 points), Clinical examination: (Sensorimotor assessment using modified NDS scale) (0-5 points per foot). Neuropathy if NDS > 6 points. Examinations: Three per Nursing, two consecutive and one spaced 2 weeks apart.Variables Independent: NDS and NSS score. Dependents: Cardiovascular Risk Factors. DM complications. Statistical analysis: If the sample is homogeneous, using Student's t-test and ANOVA. Inter-observer reliability and validity will be calculated. Agreement using Kappa, without ruling out non-parametric methods if the distribution recommends it. STATA. Expected results: To have an exploratory procedure that improves the current assessment of the risk foot in PC. Applicability: Improve the diagnosis of diabetic neuropathy in PC.

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands’ advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe. Resumen: Este artículo proporciona un análisis profundo de la transformación digital en la atención primaria (AP) en Europa. Evalúa el impacto de la tecnología digital en la provisión y en la gestión de la atención sanitaria, destacando las variaciones en la madurez digital en el contexto europeo. Enfatiza la importancia de las herramientas digitales, especialmente durante la pandemia causada por la COVID-19, para mejorar la accesibilidad y la eficiencia en la atención sanitaria. Se discute la integración de la telemedicina, la monitorización remota y las soluciones de e-salud, mostrando su papel en el empoderamiento del paciente y el cuidado proactivo. Se incluyen ejemplos de varios países, como el sistema de prescripción electrónica de Grecia, la adopción de consultas remotas en Lituania, el uso de soluciones de estratificación de riesgo poblacional en España y el uso avanzado de soluciones de telemonitorización en los Países Bajos, para ilustrar la diversa implementación de soluciones digitales en AP. El artículo ofrece perspectivas sobre los desafíos y las oportunidades de incorporar tecnologías digitales en un marco de atención sanitaria multidisciplinario, apuntando hacia futuras direcciones para la AP en Europa.

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim: To explore primary care professionals (PCPs)' perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods: A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results: The most important points in the opinions of the PCPs were: exploring the patients' values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion: In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions: Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings. [ABSTRACT FROM AUTHOR]

Objetivo: Describir los efectos secundarios y cuidados post vacuna contra la COVID-19 en personal de salud de Perú. Método: Investigación cualitativa descriptiva, participaron 12 trabajadores de salud de atención primaria obtenidos por la técnica de saturación y redundancia. Los datos se recolectaron con una guía de entrevista semiestructurada, y se procesaron manualmente mediante análisis de contenido. Resultados: Se obtuvo tres categorías: a) Efectos locales y sistémicos post vacuna contra la COVID-19, b) Variabilidad, tiempo de aparición y duración de los efectos secundarios según dosis y tipo de vacuna contra la COVID-19, c) Cuidados post vacuna contra la COVID-19. Conclusiones: Algunos de los efectos secundarios de la vacuna contra la COVID-19 son los mismos que se esperan en todo proceso vacunal, ninguno fue de gravedad y en su mayoría remitieron solos, o con medicamentos convencionales. Tal como experimenta el personal de salud la vacunación contra la COVID-19 fue segura, lo que permite que ellos extrapolen y concienticen a la población en general frente a la vacunación en nuevas pandemias.

Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The rising prevalence of diabetes among older adults is an increasing concern in the United States and is expected to nearly triple within the next 40 years. The purpose of this study was to investigate whether the utilization of Medicare Annual Wellness Visits (AWVs) is associated with changes in type 2 diabetes (T2D) outcomes among older adults Medicare beneficiaries. We conducted an observational retrospective cohort study to compare the T2D outcomes between those who attended AWVs and those who did not from 2017 to 2019. The criteria used for this study include having at least two readings (hemoglobin A1c [A1c] levels, glucose levels, and the number of T2D medications), and for the AWV cohort, the AWVs had to occur between those readings. A total of 508 (2%) Medicare beneficiaries fit our selection criteria. Only 154 (30%) of these patients with T2D participated in AWVs. At baseline, the AWV cohort had lower A1c levels and fewer comorbidities than the non‐AWV cohort. No other statistically significant findings were found. These findings indicate that providers did not utilize AWVs on the more complicated patients, who may need it the most. Key points: We investigated whether the utilization of Annual Wellness Visits (AWVs) is associated with changes in diabetes outcomes in people with type 2 diabetes among older adults Medicare beneficiaries.We found that individuals with more complicated diabetes are receiving fewer AWVs than those with less complicated diabetes. These more complicated diabetes individuals may benefit the most from preventive care because a resulting AWV care plan may provide an opportunity to outline changes in diabetes medications and education leading to fewer diabetes‐related complications.Future study is needed to determine strategies that increase the number of people with complicated diabetes receiving AWVs. [ABSTRACT FROM AUTHOR]

Early referral of patients with suspicious of rheumatoid arthritis (RA) has an impact on prognosis. Our study aimed to evaluate the clinical characteristics of patients with hands arthralgia who were referred from primary care physicians (PCP) to the rheumatologist. A descriptive, observational, prospective cohort study was performed. We included patients who visited a PCP for the first time for hands arthralgia. Demographics and the European Alliance of Associations for Rheumatology criteria for arthralgia suspicious for progression to RA plus seven complementary questions, the time to referral, the pressure needed to provoke pain with an automatic squeeze test machine in the metacarpophalangeal joints of both hands, and the diagnoses established at the last review of medical charts from patients on follow-up were documented. The primary outcome was the referral to a rheumatologist. A total of 109 patients were included. The mean age was 49.9 years, 81.6% were women. 30.3% were referred to the rheumatologist. The time to referral was a median of 38 days. The main clinical characteristics associated with referral to the rheumatologist were the "most severe symptoms are present after midnight" (OR = 6.29) and the "difficulty with making a fist" (OR = 3.67). An isolated "positive squeeze test of metacarpophalangeal joints" was not associated with a referral to the rheumatologist. Among patients with hands arthralgia who attended PCP, those with most severe symptoms after midnight and difficulty making a fist were more likely to be referred to the rheumatology clinic. Isolated positive squeeze tests are not a parameter for referral, it should only be performed if arthralgia is clinically suspected. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The concern with the development of preceptorship activities in the practice environments of the Sistema Único de Saúde has become more and more constant. The preceptors' knowledge of teaching and learning strategies can contribute to the progress of these activities. The study aimed to validate a distance learning course on teaching and learning strategies in Primary Health Care practice settings. This methodological study is a content and semantic validation of the course, between 2020 and 2021. The data collection was through the judges' responses during content validation regarding objectives, structure/presentation, and relevance and semantic validation as to the clarity, objectivity, and relevance. The data were analyzed using the Content Validity Index = to 0.9 and the binomial test to assess statistically significant differences between the judges' opinions. In content validation, there was greater than 90% agreement in all items related to the calculation of the Content Validity Index, binomial test, and Overall Content Validity Index equal to 1. In the semantic validation, the individual Content Validity Index values showed agreement higher than 90% in 11 of the 14 items and 83% in 3 items. The binomial test showed agreement higher than 90% and an overall content validity index equal to 0.96. The course was validated by the judges for content and semantics and resulted in three pedagogical units, each with learning objectives, divided into cognitive and affective domains. [ABSTRACT FROM AUTHOR]

Background: Nursing professionals are a risk group for COVID-19 because they are in the front line of health care delivery. Objective: To determine the prevalence of COVID-19 infections and post-COVID-19 symptoms among nursing professionals in the primary health care sector and identify the factors associated. Methodology: A cross-sectional study was conducted among nursing professionals in the primary health care sector in a region of the Brazilian state of Rio Grande do Sul. Data were collected in 2022 using an online questionnaire. Results: Among the professionals tested for COVID-19 (83.8%), 43.8% tested positive once, 16.4% were re-infected, and 39.6% experienced post-COVID-19 symptoms, mainly memory loss or difficulty concentrating, followed by body aches and loss of smell and taste, among others. The prevalence of COVID-19 infections and post-COVID-19 symptoms was higher among health professionals taking regular medication for a medically diagnosed chronic condition. Conclusion: Strategies for monitoring the health of nursing professionals are suggested, as the results will help manage future health crises. [ABSTRACT FROM AUTHOR]

Physiotherapy is included in primary health care (PHC) as a way to expand coverage and provide people with comprehensive health care. Thus, the present study aimed to analyze the contributions of physiotherapists in the context of Primary Health Care in the scientific literature. Thus, it is an integrative literature review research with a descriptive and exploratory approach, developed with the findings on a portal and in databases such as: Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL), Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO), from 2013 to 2023, using the scientific works that met the eligibility criteria. 9 articles were selected to compose this study, which highlight that the physiotherapist's contributions are directed towards health promotion and disease prevention through activities and actions. With this, it is clear that the physiotherapy professional has a relevant role in PHC, since through his work, like other professionals, he contributes to health promotion and prevention. [ABSTRACT FROM AUTHOR]

To report the experience of the physiotherapist-resident in primary family and community health care in the city of Icapuí through an experience report. This is an experience report, developed based on the work/experience process by the professional, in the municipality of Icapuí in the state of Ceará, in two primary care units (UAPS), from March 2022 to December 2023. It was possible to identify the potential and importance of the residency, as well as the insertion of professional physiotherapists in the ESF, as they work broadly in primary care, knowing the challenges and potential of their work, which will result in an improvement in the quality of the service provided as well as their professional qualifications. It is necessary to include and value the physiotherapist in primary care, for a comprehensive system guaranteeing accessibility for users with physiotherapeutic assistance, as a health promoter together with a qualified and trained team, ensuring greater resolution of health problems. [ABSTRACT FROM AUTHOR]

The study aims to analyze the perception of parents/caregivers participating in the program 'Cresça com seu Filho/Criança Feliz' about language development in early childhood. It was carried out in Fortaleza, Ceará. The descriptive quantitative study involved 22 parents/caregivers, registered with the program, using questionnaires applied during home visits. The majority reported moments of dialogue and play, highlighting periods of leisure and socializing. However, the children's reading practice was limited. As for speech therapy, half of the participants associated this area predominantly with speech/language. The results point to a positive interaction but reveal gaps in reading practice and partial knowledge about speech therapy, focusing mainly on speech/language. [ABSTRACT FROM AUTHOR]

Introduction: The degenerative pathology of shoulder rotator cuff has a high prevalence in Primary Care. Telerehabilitation applied in musculoskeletal pathology gives us positive results regarding the improvement of functionality and pain. Objectives: To analyse the effectiveness of an intervention using telerehabilitation in adult population affected by degenerative pathology of shoulder rotator cuff in Primary Care. Methodology: A protocol was designed defining the area of application, target population, inclusion/exclusion criteria, intervention plan and measures to be evaluated. Results: A total of five women with degenerative pathology of shoulder rotator cuff participated. After finishing the intervention, test scores improved at 2, 5, 8 and 12 weeks. Conclusions: The intervention through telerehabilitation allows the approach of a problem with high prevalence in Primary Care such as the degenerative pathology of shoulder rotator cuff, facilitating access to the population, avoiding journeys to the healthcare center and offering quality care to patients. The results obtained allow us to sense that this intervention seems to be effective and viable to treat this pathology, but a clinical trial is required for its validation. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate and determine the efficacy of a brief transdiagnostic treatment in group format for people with mild and moderate emotional disorders, and to establish correlations between the changes after treatment in the different variables. We use a single experimental group (n =11) design with pre-post measures. Participants were assessed pre- and post-intervention with the following measures: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B, and CERQ-18. Brief transdiagnostic therapy was found to be effective in reducing depressive symptoms (p = .005), anxious symptoms (p = .011), and worry (p = .020) with high/moderate effect sizes. In addition, significant positive correlations were found between changes in depressive symptoms and worry variables, and between changes in anxious symptoms and rumination. In conclusion, brief transdiagnostic treatments can be a treatment to consider for patients with mild and moderate emotional disorders in primary care due to their efficacy in some symptoms and their characteristics. [ABSTRACT FROM AUTHOR]

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Introducción: el envejecimiento poblacional, junto al aumento de enfermedades crónicas no transmisibles han llevado a un incremento en la prevalencia de las personas en situación de dependencia severa, requiriendo que familiares, amigos o vecinos asuman roles de cuidadores. Este estudio se enfoca en identificar a la población de cuidadores de personas con dependencia severa y facilitar su adherencia en programas de capacitación para en un Centro de Salud Familiar (CESFAM) en Puente Alto, Santiago de Chile. Métodos: se detectaron 82 cuidadores de pacientes con dependencia severa, de los cuales 47 seguían siendo cuidadores activos. Se encuestó telefónicamente a 35 cuidadores de pacientes con dependencia severa. Se recopiló información sobre acceso a internet, tiempo disponible y conocimiento sobre la disponibilidad de capacitaciones. Además, se evaluó el nivel de sobrecarga en los cuidadores utilizando la escala de Zarit abreviada (EZA). Resultados: el 83% de los cuidadores encuestados tenía acceso a internet, aunque se identificaron barreras como la falta de tiempo y conocimiento sobre las capacitaciones disponibles. Se encontró que el 62.8% de los cuidadores experimentaba sobrecarga severa. Estos resultados sugieren la falta de mecanismos para el cuidado de pacientes dependientes y la necesidad de facilitar la participación en programas de capacitación. Conclusiones: el estudio ofrece una breve representación sobre los cuidadores de personas con dependencia severa en un contexto de atención primaria. Se concluye que se requieren intervenciones multidisciplinarias para acercar instancias de capacitación y optimizar el cuidado del cuidador. Como parte de estas intervenciones, se desarrolló un manual del cuidador que servirá como recurso para el equipo de salud del CESFAM Madre Teresa de Calcuta, con el fin de brindar apoyo efectivo a los cuidadores.

Introducción. El síncope es una pérdida transitoria de conocimiento debida a una hipoperfusión cerebral que se recupera espontáneamente. Se caracteriza por una disminución de la presión arterial que resulta en reducción del flujo sanguíneo cerebral y se puede clasificar en tres grupos: reflejo, cardiogénico y secundario a hipotensión ortostática. El diagnóstico se basa en una historia clínica y un examen físico exhaustivos y los exámenes paraclínicos ayudan en el diagnóstico diferencial. Se presenta en el 50% de la población en algún momento de la vida con dos picos notables: uno entre los 10 y 30 años, generalmente benigno, y otro en personas mayores de 65 años, indicativo de problemas orgánicos. El tratamiento se enfoca en estratificar el riesgo y determinar el mecanismo subyacente para tomar las medidas adecuadas. Este estudio se enfoca en revisar las recomendaciones basadas en evidencia para el diagnóstico del síncope y destaca la importancia de una evaluación precisa en casos potencialmente graves. Metodología. Se realizó una búsqueda de la literatura científica en las bases de datos de PudMed/Medline, Scielo y LILACS. Resultados y discusión. En estudios internacionales se ha observado que el síncope afecta a 9.5 de cada 1000 personas por año. En nuestro país se estudió una población que buscó atención médica debido a episodios de síncope y los resultados revelaron que la edad promedio de los pacientes fue de 58 años con 46.5% de mujeres. Además, se encontró que el 41.6% tenía hipertensión arterial y el 21% tenía antecedentes de enfermedad cardíaca. El 75% de los casos se clasificó como síncope no cardíaco, el 23% como síncope cardíaco y el 2% no tuvo una causa identificable. Conclusión. El síncope es la manifestación de una variedad de trastornos subyacentes e identificar a aquellos pacientes con sospecha de patologías cardíacas es importante para proporcionar atención médica especializada de manera prioritaria. Es fundamental destacar la importancia de la estratificación del riesgo ya que permite un enfoque diagnóstico adecuado e implica la realización de pruebas más específicas para los pacientes de alto riesgo y la implementación de un tratamiento adecuado y dirigido a la causa subyacente.

La migraña es una patología de carácter neurológico frecuente, donde interaccionan diferentes estructuras anatómicas con múltiples mecanismos fisiopatológicos que involucran la activación de la vía trigémino-vascular y que conllevan la aparición de 5 fases. Conocerlas resulta de gran importancia, ya que con ello se pueden explorar opciones terapéuticas. Existen ciertos criterios diagnósticos en el momento de evaluar al paciente con migraña, los cuales permiten un adecuado diagnóstico y posteriormente abordaje. Las estrategias para el manejo óptimo de la migraña abarcan medidas no farmacológicas y farmacológicas. El tratamiento farmacológico agudo debe iniciarse de forma temprana, siguiendo una pauta personalizada y escalada en el manejo del dolor. El tratamiento preventivo representa un reto para los facultativos, dado que se suelen utilizar fármacos que originalmente se crearon con otro enfoque terapéutico, entre ellos se pueden encontrar antihipertensivos como los beta bloqueadores, antidepresivos tricíclicos y antiepilépticos. Recientemente, han florecido nuevas terapias innovadoras en el manejo de la migraña, como los anticuerpos monoclonales dirigidos hacia CGRP. Medicamentos como erenumab, fremanezmab, galcanezumab y eptinezumab han surgido como opciones en la prevención de episodios migrañosos específicamente en esta vía bioquímica.

Objective: To analyze the opinions of nursing professionals on the current limitations and future potential of digital tools in healthcare. Design: Qualitative and descriptive study. Location: The study took place during an asynchronous MOODLE course on the use of ICT in healthcare, specifically aimed at nursing professionals. Participants: The number of nurses enrolled in the course was 150. Methods: A qualitative study was conducted focusing on the positive and negative aspects that telenursing can offer in the context of a Moodle training in new technologies for nurses. A thematic analysis was carried out following the method proposed by Braun and Clarke. Results: In the end 68 nurses participated in the forum. Their statements, opinions and perceptions were analyzed and 28 descriptive codes were obtained and subsequently categorized into positive and negative aspects. Conclusions: Nurses positively value the usefulness of digital tools and identify a wide range of benefits of telenursing in daily practice. At the same time, they point out crucial limitations that may slow down the adoption of telenursing, pointing to areas for improvement such as training and digital literacy of both patients and professionals. They consider that telenursing can humanise care, but insist on the need to prevent its use from increasing health inequalities. Resumen: Objetivo: Analizar las opiniones de los profesionales de enfermería sobre las limitaciones actuales y el potencial futuro de las herramientas digitales en la atención sanitaria. Diseño: Estudio cualitativo y descriptivo. Lugar: El estudio se desarrolló durante un curso MOODLE asíncrono sobre el uso de las TIC en la atención sanitaria, dirigido específicamente a profesionales de enfermería. Participantes: El número de enfermeras inscritas en el curso fue de 150. Métodos: Se realizó un estudio cualitativo centrado en los aspectos positivos y negativos que puede ofrecer la teleenfermería en el contexto de una formación Moodle en nuevas tecnologías para enfermeras. Se realizó un análisis temático siguiendo el método propuesto por Braun y Clarke. Resultados: Finalmente participaron en el foro 68 enfermeras. Se analizaron las declaraciones, las opiniones y las percepciones de las mismas, obteniéndose 28 códigos descriptivos que posteriormente se categorizaron en aspectos positivos y negativos. Conclusiones: Las enfermeras valoran positivamente la utilidad de las herramientas digitales e identifican una amplia gama de beneficios de la teleenfermería en la práctica diaria. Al mismo tiempo, señalan limitaciones cruciales que pueden ralentizar la adopción de la teleenfermería, señalando áreas de mejora como la formación y la alfabetización digital tanto de pacientes como de profesionales. Consideran que la teleenfermería puede humanizar la asistencia, pero insisten en la necesidad de evitar que su uso aumente las desigualdades en salud.