Investigación en Medicina Familiar y Comunitaria en Iberoamérica / Research in Family and Community Medicine in Ibero-America / Pesquisa em Medicina de Família e Comunidade na Ibero-América

El grupo de trabajo # 4 de la VI Cumbre Iberoamericana de Medicina Familiar en San José, Costa Rica, 2016 se conformó para lograr contribuir al desarrollo de la investigación en Medicina Familiar y Atención Primaria en Iberoamérica, así como para consolidar la Red IBIMEFA. Estuvo integrado por 54 médicos de 21 países. Se nombraron 2 coordinadores generales y 10 coordinadores para dirigir los cinco subgrupos. El trabajo realizado por este grupo durante ocho meses, obtuvo como resultado la identificación de líneas activas y prioritarias de investigación en medicina familiar, la necesidad de realizar estrategias para promover la producción científica, tales como: a) desarrollo de pasantías de investigación en diferentes regiones; b) identificación de fuentes de financiamiento; c) lograr una plataforma virtual, soporte para asesorías y foros de investigación coordinados por IBIMEFA.

In order to contribute to the development of research in Family Medicine and Primary Care in Ibero-America and the consolidation of the IBIMEFA Network, the Work Group #4 was created for the VI Ibero-American Summit of Family Medicine in San José, Costa Rica, 2016, which was composed by a group of 54 family physicians from 21 countries. Two general coordinators and 10 subgroup coordinators were designated. The work developed by this group throughout an 8-month period has resulted in the identification of both active and priority research lines in Family Medicine and the need to develop strategies for the promotion of scientific production, such as: a) the development of research internships across the different regions, b) the identification of sources of financing; c) the design of a virtual platform with support for consultancy and research forums coordinated by IBIMEFA

O grupo de trabalho nº 4 da VI Cúpula Ibero-Americana de Medicina Familiar em San Jose, Costa Rica de 2016 se organizou para colaborar com o desenvolvimento da pesquisa em Medicina de Família e Atenção Primaria na Ibero-América, assim como consolidar a Rede IBIMEFA. Foi composto por 54 médicos de 21 países. Dois coordenadores gerais e 10 sub-coordenadores foram nomeados para organizar os cinco subgrupos. O trabalho realizado durante oito meses por este grupo obteve como resultado a identificação de linhas ativas e prioritárias de pesquisa em Medicina de Família e a necessidade de serem estabelecidas estratégias para promover a produção científica tais como: a) implementação de estágios de pesquisa em diferentes regiões; b) identificação de fontes de financiamento; c) desenvolver uma plataforma virtual, dar suporte para consultoria e realizar fóruns de pesquisa coordenados pela IBIMEFA.

Health care utilization of mexican patients with medically unexplained physical symptoms / Uso de los servicios de salud de pacientes mexicanos con síntomas físicos medicamente inexplicables

Abstract Objective: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. Methods: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. Results: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). Conclusions: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs....au

Resumen Objetivo: Determinar la prevalencia de Síntomas Físicos Medicamente No Explicables y las características y uso de los servicios de salud entre el grupo de pacientes con Síntomas Físicos Medicamente No Explicables, y el grupo con otras enfermedades. Métodos: Estudio transversal, retroprospectivo y multicéntrico. Se incluyeron a 1,043 pacientes mayores de 18 años, en 30 unidades de atención primaria de una institución gubernamental en salud, en 11 estados de la República Mexicana, atendidos por 39 médicos familiares. Se estimó la prevalencia de Síntomas Físicos Medicamente No Explicables y se compararon los dos grupos con y sin estos síntomas, en cuanto al uso de medicamentos, estudios de laboratorio, de gabinete, incapacidades y referencias en los últimos seis meses. El grupo de Síntomas Físicos Medicamente No Explicables fue diagnosticado por el Patient Health Questionnaire (son los síntomas físicos más comúnmente referidos por estos pacientes en el primer nivel de atención), además de criterios diagnósticos de Reid et al. Se excluyeron urgencias o con enfermedad terminal. Se utilizó prueba Chi cuadrada con p <0.05 para significancia estadística. Resultados: El 7.0% (73) se diagnosticó como Síntomas Físicos Medicamente No Explicables, la mayoría mujeres (91.8%); el síntoma predominante pertenece al sistema gastrointestinal con 76.7% (56). Este grupo demandó mayor uso de estudios de gabinete y referencias a otros servicios (media 1.1 vs. 0.5; p <0.0001 y 0.8 vs 0.6; p <0.01, respectivamente). Conclusiones: La prevalencia de Síntomas Físicos Medicamente No Explicables fue baja, pero con impacto significativo en el uso de algunos servicios de salud. Esto pudiera representar un mayor costo comparado con otro grupo de pacientes...au

Working Towards Accreditation by the International Standards Organization 15189 Standard: How to Validate an In-house Developed Method an Example of Lead Determination in Whole Blood by Electrothermal Atomic Absorption Spectrometry

Laboratories working towards accreditation by the International Standards Organization (ISO) 15189 standard are required to demonstrate the validity of their analytical methods. The different guidelines set by various accreditation organizations make it difficult to provide objective evidence that an in-house method is fit for the intended purpose. Besides, the required performance characteristics tests and acceptance criteria are not always detailed. The laboratory must choose the most suitable validation protocol and set the acceptance criteria. Therefore, we propose a validation protocol to evaluate the performance of an in-house method. As an example, we validated the process for the detection and quantification of lead in whole blood by electrothermal absorption spectrometry. The fundamental parameters tested were, selectivity, calibration model, precision, accuracy (and uncertainty of measurement), contamination, stability of the sample, reference interval, and analytical interference. We have developed a protocol that has been applied successfully to quantify lead in whole blood by electrothermal atomic absorption spectrometry (ETAAS). In particular, our method is selective, linear, accurate, and precise, making it suitable for use in routine diagnostics.