[Evaluation of the diagnostic test for rapid detection of covid-19 antigen (Panbio Covid rapid test) in primary care]. / Evaluación de la prueba diagnóstica de detección rápida de antígeno de covid-19 (Panbio Covid rapid test) en atención primaria.

OBJECTIVE: COVID-19 infection requires early diagnosis, with PCR being the gold standard test. The protocols advocate the use of rapid antigenic tests that require evaluation in actual clinical practice. The objective was to evaluate the diagnostic test for rapid antigen detection, Panbio Covid rapid test, compared with PCR, in patients with symptoms of 5 or less days of evolution and with a high-suspicion of infection by COVID-19 in a health center. MATERIALS AND METHODS: 103 patients over 14 years of age who attended an urban health center located in the Usera District of Madrid, with high-suspicion of COVID-19 infection, in the first 5 days of evolution from the onset of symptoms during the month of November 2020. INTERVENTIONS: diagnostic tests for COVID-19 are performed: antigen and PCR. RESULTS: The prevalence of the disease was 24.3% according to the PCR test and 17.5% according to the rapid antigenic test. The sensitivity was 72% (95% CI: 54.3-89.6%). The specificity was 100%. The positive and negative predictive values were 100% and 91.8% respectively. In the bivariate analysis, there was no relationship between symptoms and the presence of disease, except for myalgias (p=0.030). The multivariate analysis found a relationship between cough, dyspnea, fever, myalgia, anosmia/ageusia, and ocular symptoms and the presence of disease. CONCLUSIONS: The sensitivity and specificity for the Panbio rapid antigen test are similar to other studies performed in primary care. In high-prevalence of disease and with highly suspected symptoms, positive test results can be considered definitive, but negative results will require confirmation. Myalgia, fever, dyspnea, anosmia/ageusia, and ocular symptoms may be more related to the presence of COVID-19.

[Descriptive study of hepatic steatosis and associated morbidity in Primary Care. (ESTEATOAP Study)]. / Estudio descriptivo de la esteatosis hepática y la morbilidad asociada en atención primaria. (Estudio ESTEATOAP).

OBJECTIVE: To study the recorded prevalence of hepatic steatosis in Primary Care, as well as the proportion of patients diagnosed with fatty liver diseases (FLD) including simple non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) versus steatosis by other causes. In addition, the proportion of cardiometabolic morbidities associated with NAFLD liver was studied. MATERIAL AND METHODS: A descriptive observational study was carried out on a population that included all patients with a recorded diagnosis of hepatic steatosis in an urban health centre that serves a population of 25,747 over the age of 14. A sample size of 229 patients was calculated. The demographic and clinical characteristics associated with hepatic steatosis are described. RESULTS: The prevalence of steatosis was 2.17% and 1.51% for NAFLD. The mean age was 62.42 years. The study included 114 (50.2%) women and 113 (49.8%) males. NAFLD was found in 147 (64.8%), and 64 (28.2%) were steatosis due to other causes. The proportion of patients with NAFLD and high transaminases was 24.13%, and the proportion of patients with NAFLD and GGT elevation was 18.6%. A high proportion of NAFLD had been found with cardiometabolic risk factors: 93.9% overweight and obesity, 55.1% diabetes, 54.4% hypertension, 32.9% metabolic syndrome, 35.2% hypertriglyceridaemia, and HDL risk 19.6%. A significant association was found between cardiometabolic risk factors and NAFLD in diabetes, obesity, and metabolic syndrome. DISCUSSION: Prevalence was only 1.51%, perhaps because of the low importance given to this disease. There is a high proportion of NAFLD with cardiometabolic risk factors and more in the general population. If all the causes of steatosis are considered there is a significant association between obesity, diabetes mellitus, and metabolic syndrome with NAFLD. CONCLUSIONS: The recorded prevalence of NAFLD is much lower than that of population studies, and a high presence of cardiometabolic factors has been found in these patients.

El proyecto AP21: una oportunidad de mejora / No disponible

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Proyecto AP21: estrategias para la Atención Primaria del siglo XXI / AP 21 project: strategies for XXI century primary health care

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Estudio de la calidad de vida profesional en los trabajadores de atención primaria del Área 1 de Madrid / Study of the professional quality of life of primary care workers in Madrid Area 1

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[Working atmosphere in primary care: what needs improving?]. / Clima laboral en atención primaria: qué hay que mejorar?

OBJECTIVE: To evaluate the factors linked to the perception of professional quality of life (PQL) in a health area. DESIGN: Analytical cross-sectional study. SETTING: Area 11, primary care, Madrid. PARTICIPANTS: The professionals in the area (1436) were stratified into three groups: I) doctors, pharmacists and psychologists; II) nurses, midwives, physiotherapists and social workers, and III) administrative and nursing assistants and caretakers. INTERVENTIONS: A satisfaction questionnaire (PQL-35) was sent out to 450 professionals selected at random. 282 replies were received (62.7%). All calculations used 95% confidence intervals. RESULTS: The mean PQL score (scale from 1 to 10) was 5.14 (4.90-5.37); for intrinsic motivation (IM), 7.41 (7.26-7.53); for management support (MS), 4.80 (4.64-4.96); and for work-loads (WL), 6.06 (5.91-6.21). Perception of PQL was higher in women, group II and professionals with fewer work demands. Perception of best MS was in women, urban centres and people in charge of administrative areas. Women and temporary workers had higher IM. WL perception was higher in groups I and III. Age, marital status, work shift, length of employment, number of companions and belonging to management committees were not related to PQL. In the multi-variate analysis MS was found to be the factor most affecting PQL. CONCLUSIONS: Perception of PQL is medium-low, with adequate intrinsic motivation but a certain discontent related to high work-loads and perception of scant management support.

Clima laboral en atención primaria: ¿qué hay que mejorar? / Working atmosphere in primary care: what needs improving?

Objetivo. Evaluar los factores asociados a la percepción de la calidad de vida profesional (CVP) en un área de salud. Diseño. Estudio transversal analítico. Ámbito. Área 11 de Atención Primaria de Madrid. Participantes. Los profesionales del área (1.436) fueron estratificados en tres grupos: I) médicos, farmacéuticos y psicólogos; II) enfermeras, matronas, fisioterapeutas y trabajadores sociales, y III) auxiliares administrativos y de enfermería y celadores. Intervenciones. Se envió un cuestionario de satisfacción (CVP-35) a 450 profesionales seleccionados por azar y se obtuvieron 282 contestaciones (62,7 por ciento). Se presentan las estimaciones con intervalos de confianza (IC) del 95 por ciento. Resultados. La puntuación media de CVP (escala de 1 a 10) fue de 5,14 (4,90-5,37), la motivación intrínseca (MI) de 7,41 (7,267,53), el apoyo directivo (AD) de 4,80 (4,64-4,96) y las cargas de trabajo (CT) de 6,06 (5,91-6,21). La percepción de CVP era más alta en las mujeres, el grupo II y los profesionales con menores demandas de trabajo. La mejor percepción de AD se dio en mujeres, centros urbanos y responsables de áreas administrativas. Las mujeres y los trabajadores interinos mostraron una MI más alta. La percepción de CT fue mayor en los grupos I y III. La edad, el estado civil, el turno de trabajo, la duración de empleo, el número de compañeros y la pertenencia a comisiones directivas no se relacionaron con la CVP. En el análisis multivariante el AD se mostró como el factor más influyente en la CVP. Conclusiones. La percepción de CVP es medio-baja, con una adecuada MI pero con cierto descontento relacionado con una alta CT y una escasa percepción de AD (AU)

Próxima estación: motivación, recursos y cooperación para responder a las necesidades de salud de la población / The next stage: motivation, resources and cooperation to respond to the population's health

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La agenda de calidad en atención primaria: pasos previos

Objetivo: Evaluar las características de las citas tramitadas en una unidad administrativa con el objeto de proponer los cambios organizativos necesarios para adecuar las agendas a las necesidades de la población y de la propia unidad. Diseño: Estudio descriptivo transversal. Emplazamiento: Unidad administrativa de un centro de salud urbano. Resultados principales: Una cuarta parte de la población historiada es la que ocupa la mayor parte del tiempo de los profesionales. Un 70,3 por ciento de las citas se hacen por la mañana y el 29,7 por ciento por la tarde. La mayoría entre las 8 y las 11 h. Un número elevado de peticiones de cita para otro día y para la realización de análisis coinciden con el momento de máxima presión en el mostrador. También coincide con la extracción de historias. El lunes es el día de mayor citación. El porcentaje de los que no acuden a consulta a demanda es del 10,8 por ciento. Conclusiones: Una pequeña proporción de usuarios ocupan la mayor parte del tiempo de los profesionales. Hay que favorecer que nuevos usuarios entren en el sistema para aumentar nuestras coberturas y para ello hay que disminuir la frecuentación innecesaria. Hay una gran fluctuación en la distribución de la solicitud de citas. Son más por la mañana, a primera hora, los lunes y las que se realizan telefónicamente. Estos datos servirán para reorganizar nuestro trabajo y confeccionar una agenda de citas que responda a las necesidades de los pacientes y profesionales. Se proponen algunas medidas para mejorar la capacidad de respuesta del área administrativa de los centros de salud en cuanto a la citación de usuarios: informar a los ciudadanos del mejor horario para obtener cita, extraer las historias de la mañana por la tarde del día anterior, citar todo lo concertable desde las consultas y acoplar la cita concertada a los días de menor demanda (AU)

[What is the prevalence of elderly persons at high risk in primary care?]. / Cuál es la prevalencia de ancianos de alto riesgo en atención primaria?

OBJECTIVES: To find the prevalence in a Health District of elderly people at high risk and the reasons for their inclusion in this category. To evaluate the percentage of patients requiring home care. DESIGN: A crossover descriptive study. SETTING: Urban health centre. STUDY POPULATION: patients over 65, TARGET POPULATION: elderly people with their medical notes at our centre. SAMPLE: 329 individuals chosen by systematic sampling of everyone over 65. MEASUREMENTS AND MAIN RESULTS: The elderly person is defined as at high risk or fragile when he/she fulfils one of the following criteria: a recent hospital release, physical incapacity, mental deterioration, over 80, in an institution, confinement to the home, living alone or being widowed, and recent change of home. There was 38.07% prevalence of elderly people at high risk. The main reasons for classification as elderly people at high risk were: age over 80, living alone and physical incapacity. There is a significant link between being an elderly person at high risk and female. 31.7% of elderly people at high risk have a physical incapacity which prevents their attendance at the health centre. CONCLUSIONS: It needs to be bome in mind that almost 40% of the over-65s are included in the groups of elderly people at high risk and therefore need special attention from Primary Care professionals. Our organisation needs to be adapted to the growing demand for home visits, which should cover at least 12% of those over 65 and 31% of the fragile elderly.