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In addition to the loss of over 200,000 lives due to the COVID-19 pandemic, racist violence, riots, wildfires, storms and political controversies in an election year, the United States of America might now also see acts of genocide. If recent reports are confirmed, multiple acts of genocide have been committed against migrants from Central America, targeting in particular women and children. This text outlines the elements which define the crime of genocide under international law and explains the special, jus cogens, status the prohibition of genocide has under both international treaty law and customary international law. It includes a call for further investigations, pursuant to the obligation of all States to combat genocide.

Resumen Objetivo: Se estima que al año entre el 50-60% de los pacientes tratados con fármacos para la osteoporosis son incumplidores. Disponemos de diferentes métodos indirectos de valoración del cumplimiento. Nuestro objetivo es testar una única determinación del telopéptido carboxiterminal del colágeno tipo I (CTX) para valorar el cumplimiento en pacientes tratadas con bifosfonatos, de forma aislada o junto al cuestionario de Morinsky-Green. Material y método: Estudio de validación diagnóstica realizado en 10 centros de Cataluña. Mediante muestreo consecutivo se seleccionaron mujeres postmenopáusicas con osteoporosis y tratadas con un mismo fármaco antirresortivo en el último año; se excluyeron aquellas tratadas con un fármaco diferente a bifosfonato, con deterioro cognitivo, enfermedad terminal, o insuficiencia renal avanzada, o fractura en el año previo. Se recogieron datos sobre el diagnóstico de osteoporosis y tipo de tratamiento. Se solicitó analítica con determinación del CTX. Como gold-standard se utilizó la tasa de posesión de medicación (Medication Possession Ratio, MPR). Mediante metodología de la curva ROC se estableció el punto de corte teórico del CTX. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos para estimar el cumplimiento terapéutico. Resultados: Se incluyeron 100 pacientes, de las cuales más de la mitad recibían alendronato. Según la MPR, un 70% eran cumplidoras. El valor medio del CTX fue de 0,193±0,146 ng/ml, siendo inferior en las pacientes cumplidoras. Se estableció como punto de corte para valorar el cumplimiento un valor de 0,196 ng/ml. La valoración conjunta del CTX junto al cuestionario de Morinsky-Green presentó mayor capacidad discriminativa. Conclusiones: La realización de una única determinación del CTX (

ObjetivoValorar el poder predictivo de la ingesta de calcio a través de los lácteos y la influencia que ésta tiene sobre el aporte total de calcio alimentario.DiseñoEstudio tranversal.EmplazamientoCentros de atención primaria urbanos y rurales en España.ParticipantesIndividuos de edad 20 ≥ años que acudían a la consulta por cualquier motivo dentro del período establecido. Criterio de exclusión: enfermedad terminal. Se incluyen 1.546 encuestas.Mediciones principalesConsumo de raciones de calcio lácteo y no lácteo.ResultadosLa ingesta de lácteos representó un 66,8% de la ingesta total de calico (rango, 0–93%). El consumo de ≤ 2 raciones de lácteos al día supuso una ingesta total de calcio inferior a 1.000mg/día; el consume de > 3 raciones, una ingesta global de 1.000–1.500mg/día, y > 4 raciones, un total de 1.500mg/día. En los sujetos con una baja ingesta de lácteos (≤ 2 raciones lácteos/día), el valor predictivo de éstos con respecto al calcio total era bajo (10–30%) y si consumían >4 raciones, era del 70%ConclusionesEl cálculo de la ingesta total de calcio a través del calcio lácteo es útil en la consulta pero infravalora el aporte real al no tener en cuenta alimentos no lácteos. Sólo la ingesta de >4 raciones de lácteos al día resulta bastante predictiva.ObjectiveTo assess the predictive value of calcium intake from milk products and its effect of this on the total contribution of food calcium.DesignCross-sectional study.SettingUrban and rural health centres in Spain.ParticipantsPatients aged 20 or over who attended for consultation for whatever reason in the time-period set. Criterion for exclusion: terminal illness. 1546 questionnaires were included in the study.Main measurementsConsumption of calcium from milk products and from other sources.ResultsThe intake of milk products accounted for 66.8% of the total intake of calcium (0%-93%). The consumption of ≤2 rations of milk products per day supposed a total calcium intake of under 1000mg/day; of >3 rations, a total intake of 1000–1500mg/day; and of >4 rations, 1500mg/day. In subjects with low milk product intake (≤2 rations per day), the predictive value of this for total calcium was low (10%–30%); and in those with >4 rations, its predictive value was 70%ConclusionsCalculation of the total intake of calcium in milk products is useful in the consultation, but undervalues the real contribution, as it takes no notice of calcium from other food sources. Only the intake of >4 rations of milk products a day is sufficiently predictive.

ObjetivoConocer el abordaje de la osteoporosis en atención primaria en España antes de la edición de la Guía de Osteoporosis de la semFYC.DiseñoEncuesta autoadministrada a médicos de atención primaria remitida por correo comercial (agrupados por provincias).EmplazamientoCinco mil consultas de medicina de familia de España.ParticipantesMédicos que trabajaban en atención primaria.MedicionesNivel de actuación ante la osteoporosis en la consulta diaria (identificación de factores de riesgo, cribado, quién realiza el diagnóstico y seguimiento, nivel de acceso a densitometría y especialista) y datos identificativos (provincia, tipo de centro de trabajo y número de visitas al día).Resultados principalesSe obtuvieron 414 respuestas que abarcaban centros reformados y no reformados de todo el país, con diferente sobrecarga asistencial. El 32,3% manifestó que la osteoporosis era considerada como una actividad preventiva en su centro y tan sólo el 35,5% interrogaba sistemáticamente por el antecedente familiar de osteoporosis. El cribado de osteoporosis era elevado en determinadas situaciones (el 82,9% en aplastamiento vertebral, el 78,3% en fractura de cadera) y deficiente en otras (el 59,6% en tratamiento con glucocorticoides, el 46,6% en fractura de Colles, el 36% en nefropatía crónica, el 29,2% en delgadez, el 17,1% en hepatopatía crónica y el 11,8% en tratamiento con antiepilépticos o litio). El 73,9% no podía solicitar densitometrías óseas y el 64,3% consideraba que el acceso a otros ámbitos asistenciales era complicado, pero el 51,9% manifestaba proseguir el estudio de la osteoporosis. La imposibilidad de solicitar densitometría o el acceso dificultoso condicionaba el grado de cribado. Se observaron diferencias en el acceso según las comunidades autónomas, siendo Cataluña la que tenía un mejor acceso a la densitometría (75%), seguida de las comunidades de Madrid, Valencia y el País Vasco (30%).ConclusionesEl abordaje de la osteoporosis en atención primaria es deficiente y en parte viene condicionado por la dificultad en el acceso a pruebas diagnósticas y a la falta de sistematización de su cribado.ObjectiveTo discover how osteoporosis is tackled in Spanish primary care before the publication of the semFYC osteoporosis guide.DesignSelf-filled questionnaire for primary care doctors sent out by commercial mail (in blocks per province).Setting. Five thousand family medicine clinics in Spain.ParticipantsDoctors working in primary care.MeasurementsLevel of activity relating to osteoporosis in daily consultations (identification of risk factors, screening, who conducts diagnosis and follow-up, level of access to densitometry and specialist) and identification data (province, type of work centre and number of consultations per day).Main results414 replies embracing reformed and non-reformed centres from the entire country, with different case overloads. 32.3% stated that osteoporosis treatment was viewed as a preventive activity in their centre and only 35.5% systematically asked for family history of osteoporosis. Osteoporosis screening was high in determined situations (82.9% in vertebral compression, 78.3% in hip fracture) and deficient in others (59.6% in glucocorticoid treatment, 46.6% in colles fractures, 36% in chronic nephropathy, 29.2% in thinness, 17.1% in chronic hepatopathy and 11.8% in treatment for epilepsy or with lithium). 73.9% could not request bone densitometry and 64.3% thought that access to other care levels was complicated. 51.9% said they continued to monitor osteoporosis. The impossibility of requesting densitometry or difficult access conditioned the screening level. There were differences in access according to autonomous communities, with Catalonia having best access to Densitometry (75%), followed by the communities of Madrid, Valencia and Euskadi (30%).ConclusionsDiagnosis of osteoporosis in primary care is deficient and is partly conditioned by difficulty in access to diagnostic tests and the lack of systematic screening.

OBJECTIVE: To assess the predictive value of calcium intake from milk products and its effect of this on the total contribution of food calcium. DESIGN: Cross-sectional study. SETTING: Urban and rural health centres in Spain. PARTICIPANTS: Patients aged 20 or over who attended for consultation for whatever reason in the time-period set. Criterion for exclusion: terminal illness. 1546 questionnaires were included in the study. MAIN MEASUREMENTS: Consumption of calcium from milk products and from other sources. RESULTS: The intake of milk products accounted for 66.8% of the total intake of calcium (0%-93%). The consumption of ≤2 rations of milk products per day supposed a total calcium intake of under 1000 mg/day; of >3 rations, a total intake of 1000–1500 mg/day; and of >4 rations, 1500 mg/day. In subjects with low milk product intake (≤2 rations per day), the predictive value of this for total calcium was low (10%–30%); and in those with >4 rations, its predictive value was 70% CONCLUSIONS: Calculation of the total intake of calcium in milk products is useful in the consultation, but undervalues the real contribution, as it takes no notice of calcium from other food sources. Only the intake of >4 rations of milk products a day is sufficiently predictive.

A cross-sectional survey was conducted to determine the current situation in Spain regarding diagnosis and care of patients with osteoporosis in the primary care setting. A total of 2,500 primary care physicians who were homogeneously grouped in autonomous communities throughout the country received a postal 30-item anonymous self-administered questionnaire. The questionnaire covered demographics and personal characteristics of the physicians, conditions in everyday consultation, and degree of knowledge with regard to risk factors, diagnosis, treatment, and follow-up of the disease. The overall response was 850 (34%). The mean age of physicians surveyed was 43 years (range 23-66 years). The percentage of physicians specialized in community and family medicine was 46.7%. In 55.2% of cases, years of practice ranged between 11 and 20, and 55.7% of physicians visited between 31 and 50 patients per day. Age and years of practice were not associated with daily number of visits. Only 4% of physicians stated that there were specific programs for osteoporosis implemented in their primary care center. Diagnostic complementary investigations that could be ordered included plain radiographs in 96.2% of cases and bone densitometry in 27.8%. Laboratory tests included serum hormones in 61.6% of cases, PTH in 50.2%, and bone alkaline phosphatase in 33.4%. The diagnosis of osteoporosis was made always personally in 25.2% of cases. Personal diagnosis and follow-up, as well as actions directed to detection of osteoporosis were significantly higher among physicians working in centers with specific programs for osteoporosis. With regard to knowledge about osteoporosis, the mean percentage of correct responses was 63%. The percentage of correct responses was inversely associated with age and years of practice, and positively associated with speciality of community and family medicine. Primary care providers are in a good position to assess risk factors and recommend prevention strategies, as well as to play an active role in the diagnosis, care, and follow-up of patients with osteoporosis. Practitioners of younger age and relatively few years of practice were those with more up-to-date information regarding the disease, and the existence of a specific program for osteoporosis seems to improve the management of this condition.

OBJECTIVE: To discover how osteoporosis is tackled in Spanish primary care before the publication of the semFYC osteoporosis guide. DESIGN: Self-filled questionnaire for primary care doctors sent out by commercial mail (in blocks per province). Setting. Five thousand family medicine clinics in Spain. PARTICIPANTS: Doctors working in primary care. MEASUREMENTS: Level of activity relating to osteoporosis in daily consultations (identification of risk factors, screening, who conducts diagnosis and follow-up, level of access to densitometry and specialist) and identification data (province, type of work centre and number of consultations per day). MAIN RESULTS: 414 replies embracing reformed and non-reformed centres from the entire country, with different case overloads. 32.3% stated that osteoporosis treatment was viewed as a preventive activity in their centre and only 35.5% systematically asked for family history of osteoporosis. Osteoporosis screening was high in determined situations (82.9% in vertebral compression, 78.3% in hip fracture) and deficient in others (59.6% in glucocorticoid treatment, 46.6% in colles fractures, 36% in chronic nephropathy, 29.2% in thinness, 17.1% in chronic hepatopathy and 11.8% in treatment for epilepsy or with lithium). 73.9% could not request bone densitometry and 64.3% thought that access to other care levels was complicated. 51.9% said they continued to monitor osteoporosis. The impossibility of requesting densitometry or difficult access conditioned the screening level. There were differences in access according to autonomous communities, with Catalonia having best access to Densitometry (75%), followed by the communities of Madrid, Valencia and Euskadi (30%). CONCLUSIONS: Diagnosis of osteoporosis in primary care is deficient and is partly conditioned by difficulty in access to diagnostic tests and the lack of systematic screening.

To study the relationship between current and adolescent calcium intake and bone mineral density (BMD) in 76 premenopausal women of 42 y. with regular menses and without pathologies associated with body weight, body morphology or BMD.Was measured: the lumbar and femoral BMD by dual energy X-Ray absorptiometer, calcium and protein intake by a week frequencies questionnaire, and calciuria. Obesity, exercise, alcohol, tobacco and family history of osteoporosis were considered. Levels of BMD-1SD was considered as osteopenia.Calcium intake average was 989 mg/day, 62% by dairy. Twenty-five percent presented osteopenia in some bone site. BMD was not correlated with calcium or protein intake, calcium/protein nor calciuria. No differences was found between normal and osteopenic group for any of the studied variables, except lower body mass index in the femoral osteopenic group. Those women who decreased the calcium intake from adolescence had 8.2% less femoral BMD tha those who increased the consumption (p = 0.05).Current and adolescent calcium intake, family history of osteoporosi calciuria, and exercise have not found useful as screening of osteopenia in premenopausal women with moderated exercise level and low consumption of alcohol and tobacco.

To relate the characteristics of working activity to the level of tiredness at work (low, medium and high).A crossover, observational and random study.Primary Care Centres in Spain, belonging to the new sanitary model.116 doctors (75% General Practitioners, 19% paediatricians and 6% Interns in their third year of Family Medicine (R-3)). An anonymous survey sent by mail over five consecutive days, during a period without any epidemics. Tiredness at work was measured on a scale of 0 to 10 (nil to maximum) by means of 7 questions covering quantitative working activity (the number of patients seen, of discussions between nurse and doctor, of emergencies and home visits), its quality (the type of patient, the bureaucracy involved) and the doctor's length of experience.The tiredness at work found was 4.7 +/- 1.6. Those who showed high levels of tiredness had greater working activity in both the quantitative and qualitative senses than those with medium tiredness; and these, in their turn, greater working activity than those with low tiredness. Doctors' length of experience did not affect the level of tiredness. General Practitioners were more tired than paediatricians and R-3.A doctor's tiredness at work is determined by the number of patients seen, the type of patient and the amount of bureaucracy and organisation. All these factors should be borne in mind when the doctor's working activities are organised.