ABSTRACT
Introduction: The symptomatology of eating disorders includes psychological and behavioral aspects with subclinical and long-standing eating concerns. These are a clear precursor to the development of established and often severe eating disorders. For this reason, it is crucial to investigate its antecedents and correlates to later inform the development of prevention programs. This article has been prepared with the main objective of providing Primary Care health professionals with the most up-to-date and relevant information for the early identification of eating behavior disorders (EDs), helping them to make the best decisions about the problems emerging in their practice. It seeks to join together the growing but still limited body of literature that advocates a greater emphasis on programs to prevent and anticipate the recognition of this group of disorders at the first level of the health system.
Introducción: La sintomatología de los trastornos alimentarios comprende aspectos psicológicos y conductuales con preocupaciones alimentarias subclínicas y de larga evolución. Estas constituyen un claro precursor del desarrollo de trastornos alimentarios establecidos y con frecuencia graves. Por ello resulta crucial investigar sus antecedentes y correlatos para informar posteriormente el desarrollo de programas de prevención. Este artículo ha sido elaborado definiendo como objetivo principal el proporcionar a los profesionales sanitarios de Atención Primaria la información más actual y relevante para la identificación precoz de trastornos de la conducta alimentaria (TCA), ayudándoles a tomar las mejores decisiones sobre los problemas que plantea su asistencia inicial. Busca sumarse al creciente pero aun reducido cuerpo de literatura que aboga por un mayor énfasis en los programas para impedir y anticipar el reconocimiento de este grupo de trastornos en el primer nivel del sistema sanitario.
Subject(s)
Feeding and Eating Disorders , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/prevention & control , Humans , Primary Health Care , Risk Assessment , Surveys and QuestionnairesABSTRACT
La sintomatología de los trastornos alimentarios comprende aspectos psicológicos y conductuales con preocupaciones alimentarias subclínicas y de larga evolución. Estas constituyen un claro precursor del desarrollo de trastornos alimentarios establecidos y con frecuencia graves. Por ello resulta crucial investigar sus antecedentes y correlatos para informar posteriormente el desarrollo de programas de prevención. Este artículo ha sido elaborado definiendo como objetivo principal el proporcionar a los profesionales sanitarios de Atención Primaria la información más actual y relevante para la identificación precoz de trastornos de la conducta alimentaria (TCA), ayudándoles a tomar las mejores decisiones sobre los problemas que plantea su asistencia inicial. Busca sumarse al creciente pero aun reducido cuerpo de literatura que aboga por un mayor énfasis en los programas para impedir y anticipar el reconocimiento de este grupo de trastornos en el primer nivel del sistema sanitario (AU)
The symptomatology of eating disorders includes psychological and behavioral aspects with subclinical and long-standing eating concerns. These are a clear precursor to the development of established and often severe eating disorders. For this reason, it is crucial to investigate its antecedents and correlates to later inform the development of prevention programs. This article has been prepared with the main objective of providing Primary Care health professionals with the most up-to-date and relevant information for the early identification of eating behavior disorders (EDs), helping them to make the best decisions about the problems emerging in their practice. It seeks to join together the growing but still limited body of literature that advocates a greater emphasis on programs to prevent and anticipate the recognition of this group of disorders at the first level of the health system (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Feeding and Eating Disorders/prevention & control , Primary Health Care , Feeding and Eating Disorders/diagnosis , Binge-Eating Disorder/diagnosis , Bulimia Nervosa/diagnosis , Anorexia Nervosa/diagnosis , Early Diagnosis , Risk GroupsABSTRACT
Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease (CKD). We analyzed the prevalence of CKD in the population with diabetes in Extremadura (Spain). retrospective observational study was carried in the diabetic population attended in the Extremadura Health System in 2012-2014. A total of 38,253 patients, ≥18 years old were included. Estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration equation. CKD was defined as follow: an eGFR <60 mL/min/1.73 m2 in a time period ≥ of three months or the presence of renal damage, with or without reduced eGFR, if the urine albumin-creatinine ratio (UACR) was ≥30 mg/g, also in a time period ≥ of three months. The prevalence rate of CKD was 25.3% (27.6% in women; 23.0% in men) and increases with age (34.0% in ≥65 years-olds). 24.9% of patients with CKD were in the very-high risk category for cardiovascular events (6.3% of the diabetic population). If CKD were diagnosed without requiring sustained eGFR <60 mL/min/1.73 m2 and/or sustained UACR ≥30 mg/g (as it is frequently found in the literature) this would overestimate the prevalence of CKD by 23%.
ABSTRACT
La medicina familiar y comunitaria es una disciplina académica, una especialidad y una profesión sanitaria que contiene un cuerpo asistencial, docente, investigador y de gestión. Su objeto de conocimiento es la persona entendida como un todo. La medicina familiar y comunitaria como disciplina académica, y la atención primaria como ámbito educativo sanitario, deben ser incorporadas en la universidad de manera nuclear. Su ausencia causa sesgos formativos y tiene importantes repercusiones sobre la calidad, la coordinación y la seguridad. El desarrollo de la Ley de Ordenación de las Profesiones Sanitarias (LOPS) y la construcción del Espacio Europeo de Educación Superior (EEES) propician, actualmente, su presencia en la Universidad. Desde los años 1960 se ha consolidado la disciplina académica, con departamentos de medicina familiar y comunitaria en prácticamente todas las universidades europeas, y un importante número de profesores médicos de familia. Se ha establecido el equilibrio entre un sistema basado en el hospital, orientado a la teoría, la enfermedad y el modelo biológico, con un modelo centrado en el paciente, basado en la resolución de problemas, orientado a la comunidad y con un modelo biopsicosocial. La introducción de la medicina familiar y comunitaria como asignatura propia, como materia longitudinal a lo largo de los años y transversal con otras disciplinas, y la atención primaria como ámbito de prácticas, supone una adecuación de la enseñanza a las necesidades de la sociedad y una normalización con respecto a la enseñanza en Europa, y da respuesta a las distintas normas legales que la amparan. Y esta nueva situación precisa una estructura (departamentos) y un profesorado (catedráticos, titulares y profesores asociados) (AU)
Family and community medicine is an academic subject, a medical specialty and a health profession with distinct dimensions: healthcare, teaching, research and management. In this discipline, the object of knowledge is the person, understood as a whole. Family medicine, as an academic subject, and primary care, as a health education setting, should be incorporated into the core graduate and postgraduate curricula. The absence of these elements leads to training bias and has major repercussions on quality, coordination and patient safety. The development of the Health Professions Act and the construction of the European Higher Education Area (EHEA) have created a favorable climate for the presence of this discipline in the university.Since the 1960s, family medicine has been consolidated as an academic subject with its own departments in almost all European universities, and a significant number of family physicians are teachers. A balance has been achieved between the hospital-based system (based on theory, disease, and the biological model) and the patient-centred model (based on problem solving, community-oriented and the bio-psycho-social model). The introduction of family and community medicine as a specific subject, and as a transverse subject and as an option in practicals, represents the adaptation of the educational system to social needs. This adaptation also represents a convergence with other European countries and the various legal requirements protecting this convergence. However, this new situation requires a new structure (departments) and faculty (professors and associate and assistant professors) (AU)
Subject(s)
Humans , Universities/trends , Family Practice/education , Specialization/trends , Primary Health Care/trends , Outcome and Process Assessment, Health Care/trends , Schools, Medical/trends , Education, Medical/trendsABSTRACT
Family and community medicine is an academic subject, a medical specialty and a health profession with distinct dimensions: healthcare, teaching, research and management. In this discipline, the object of knowledge is the person, understood as a whole. Family medicine, as an academic subject, and primary care, as a health education setting, should be incorporated into the core graduate and postgraduate curricula. The absence of these elements leads to training bias and has major repercussions on quality, coordination and patient safety. The development of the Health Professions Act and the construction of the European Higher Education Area (EHEA) have created a favorable climate for the presence of this discipline in the university. Since the 1960s, family medicine has been consolidated as an academic subject with its own departments in almost all European universities, and a significant number of family physicians are teachers. A balance has been achieved between the hospital-based system (based on theory, disease, and the biological model) and the patient-centred model (based on problem solving, community-oriented and the bio-psycho-social model). The introduction of family and community medicine as a specific subject, and as a transverse subject and as an option in practicals, represents the adaptation of the educational system to social needs. This adaptation also represents a convergence with other European countries and the various legal requirements protecting this convergence. However, this new situation requires a new structure (departments) and faculty (professors and associate and assistant professors).
Subject(s)
Community Medicine/education , Curriculum/standards , Education, Medical/standards , Family Practice/education , Schools, Medical , Career Choice , Clinical Competence/standards , Community Medicine/legislation & jurisprudence , Community Medicine/organization & administration , Europe , Faculty, Medical , Family Practice/legislation & jurisprudence , Family Practice/organization & administration , Guidelines as Topic , Health Services Needs and Demand , Hospitals , Humans , International Cooperation , Medicine , Models, Organizational , National Health Programs/legislation & jurisprudence , National Health Programs/organization & administration , Patient-Centered Care , Primary Health Care , Research , Schools, Medical/legislation & jurisprudence , Schools, Medical/organization & administration , Spain , WorkforceABSTRACT
OBJECTIVES: The aims of this study were to evaluate whether hidden chronic renal insufficiency (CRI) may be considered an independent cardiovascular risk factor in patients with hypertension and to calculate cardiovascular risk in this population. METHODS: A total of 756 hypertensive patients of ages from 35 to 74 years (mean 57.0 years; 58.2% women) and without evidence of cardiovascular disease were studied and followed during 10 years. Their glomerular filtration rate (GFR) was estimated using the simplified MDRD (result of the Modification of Diet in Renal Disease study) and Cockcroft-Gault formulas. Hidden CRI was identified by a GFR <60 mL/min/1.73 m(2) with normal serum creatinine concentration (<1.4 mg/dL men; <1.3 mg/dL women). RESULTS: Of the patients with hidden CRI using the MDRD equation, 22% presented cardiovascular events (RR, 1.60; 95% confidence interval (CI), 1.06-2.43; p < 0.05). While the estimated coronary risk using the original Framingham function was similar in patients with and without hidden CRI (18.2%), using the REGICOR function it was higher in those with CRI (7.7 vs. 7.2%, p < 0.05). Logistic regression analysis showed that smoking, male sex, age, and diastolic blood pressure were predictors of cardiovascular events. The presence of hidden CRI was not a statistically significant predictor using either the MDRD (OR, 1.37; 95% CI, 0.72-2.61; p = 0.340) or the Cockcroft-Gault (OR, 1.05; 95% CI, 0.50-2.23; p = 0.893) formulas. CONCLUSIONS: The hypertensive population of 35-74 years in age with hidden CRI showed a higher incidence of cardiovascular events, but hidden CRI may not be considered an independent cardiovascular risk factor.
