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Osteoporosis is characterized by decreased bone mineral density and deterioration of bone microarchitecture, leading to increased skeletal vulnerability and susceptibility to fracture. These fractures impose a substantial clinical, social, and economic burden, significantly elevating morbidity and mortality. However, a relevant gap persists in diagnosis and therapeutic management, particularly within primary care. This document presents the first consensus recommendations developed by four scientific societies (SEIOMM, SEMERGEN, semFYC, and SEMG), derived from a Delphi process and supported by the most current scientific evidence. Its objective is to unify clinical criteria and improve coordination across healthcare levels. The recommendations are structured around: identification and assessment of fracture risk, treatment, follow-up, and referral criteria. The use of 10-year fracture risk assessment tools such as FRAX (Fracture Risk Assessment Tool) and dual-energy X-ray absorptiometry (DXA) is proposed for risk stratification, and clear guidelines are established for initiating treatment based on the patient's profile. The importance of treatment adherence, periodic reassessment, and patient participation in decision-making is emphasized. La osteoporosis (OP) se caracteriza por la disminución de la densidad mineral y el deterioro de la microarquitectura ósea, lo que incrementa la fragilidad y la susceptibilidad a fracturas. Las fracturas por fragilidad generan un elevado impacto clínico, social y económico, aumentando de forma significativa la morbimortalidad. Sin embargo, persiste una brecha relevante en su diagnóstico y tratamiento, especialmente en atención primaria. Este documento presenta las primeras recomendaciones consensuadas por cuatro sociedades científicas (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina de Familia y Comunitaria [semFYC], Sociedad Española de Médicos Generales y de Familia [SEMG] y Sociedad Española de Investigación Ósea y del Metabolismo Mineral [SEIOMM]), derivadas de un consenso Delphi y sustentadas en la evidencia científica más actual. Su objetivo es unificar criterios y mejorar la coordinación entre niveles asistenciales. Las recomendaciones se estructuran en: identificación y evaluación del riesgo de fractura, tratamiento, seguimiento y criterios de derivación. Se propone el uso de herramientas de evaluación del riesgo de fractura a 10 años como Fracture Risk Assessment Tool (FRAX) y la densitometria ósea (DXA) para estratificar el riesgo y se establecen pautas claras para iniciar tratamiento según el perfil del paciente. Se enfatiza la importancia de la adherencia terapéutica, la reevaluación periódica y la participación del paciente en la toma de decisiones.
In Spain, it is estimated that the prevalence of chronic kidney disease (CKD) is 7-30%. CKD is associated with a significant risk of kidney disease progression, as well as cardiovascular complications and death. CKD is currently underdiagnosed, which implies the need for greater screening in the population at risk (arterial hypertension, diabetes), through the determination of estimated glomerular filtration rate and albuminuria. On the other hand, evidence from clinical trials has demonstrated the benefits of four pharmacological groups in patients with diabetic CKD, including renin-angiotensin system inhibitors, SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists (currently finerenone) and GLP1 receptor agonists, in particular subcutaneous semaglutide. Consequently, comprehensive treatment should be promoted through the early use of the combination of these pharmacological groups. In patients with non-diabetic CKD, renin-angiotensin system inhibitors and SGLT2 inhibitors would be indicated as the treatment of choice. Primary care is the optimal setting for screening, initial diagnosis and follow-up of patients with CKD, as well as the initiation and optimization of medical treatment for these patients. However, there is considerable room for improvement between what the guidelines indicate and clinical practice. The objective of this SEMERGEN position paper is to facilitate and improve care for patients with CKD in primary care.
The sustained improvement in cancer survival has highlighted the growing impact of cardiovascular toxicity related to anticancer therapies, which has become a leading cause of non-cancer morbidity and mortality. This position statement aims to provide a practical and standardized framework for the comprehensive management of cardiotoxicity in oncology patients from the perspective of Primary Care (PC) in Spain, acknowledging its pivotal role in prevention, early detection, risk stratification, and long-term follow-up. The document reviews the main forms of cardiovascular toxicity associated with systemic anticancer therapies, as well as local treatments such as thoracic radiotherapy, incorporating current definitions and recommendations from European and international guidelines. A structured model based on the oncology care continuum is proposed, encompassing the initial phase, active treatment, and survivorship, allowing cardiovascular surveillance to be tailored according to baseline risk, type of treatment, and clinical evolution. Special emphasis is placed on early cardiovascular risk assessment, proactive optimization of cardiovascular risk factors and comorbidities, and the establishment of clear referral and coordination pathways between PC, Oncology, Hematology and Cardiology. The central role of PC in the follow-up of long-term cancer survivors is also highlighted, as this growing population remains at risk of late cardiovascular complications that may persist or increase over time. This position statement seeks to promote coordinated, equitable, and patient-centered care, reducing clinical variability and improving cardiovascular outcomes and quality of life for oncology patients within the National Health System.
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Magistral compounding is a relevant therapeutic tool in dermatology due to its ability to personalize treatments for common dermatoses. The aim of this study was to describe the use of magistral compounding in dermatological conditions among family physicians belonging to the Dermatology Working Group of SEMERGEN and to identify the most frequently treated clinical entities. An observational, cross-sectional, and descriptive study was conducted using a 30-item online survey addressed to members of the SEMERGEN Dermatology Working Group. Participation was voluntary, anonymous, and unpaid. Sociodemographic variables, frequency of magistral compounding use in 22 dermatological conditions, and recommendations of active cosmetic ingredients were collected. Descriptive analysis was performed using absolute and relative frequencies. A total of 50 valid surveys were analyzed. Seventy-eight percent of participants were women, and the predominant age group was 30-40 years (52%). Most respondents worked in public primary care (88%) and in urban settings (66%). Magistral compounding was most frequently used for diaper dermatitis (58%), anal fissure (46%), atopic dermatitis of the external auditory canal, and herpetic infections (44%). It was also used in psoriasis, rosacea, and hyperpigmentation disorders (32%). Its use was less frequent in oral mucosal conditions and in diseases with well-established commercial alternatives. All physicians reported recommending anti-aging active ingredients, predominantly via commercial products. Magistral compounding remains a useful therapeutic option for common dermatoses where treatment personalization provides clinical benefit. Educational and logistical barriers persist, highlighting the need to strengthen specific training and improve coordination with compounding pharmacies.
To evaluate the effectiveness of adding a digital therapeutic intervention to usual care for smoking cessation in patients attended in primary care. A randomized controlled trial including 220 smokers allocated to two groups: usual care (G1; n=110) and usual care plus digital therapy (G2; n=110). Usual care followed the SEMERGEN REVERSE protocol. Sociodemographic and clinical variables, smoking history, nicotine dependence (Fagerström test), motivation to quit (Richmond test), and comorbidities were collected. Primary outcomes were smoking abstinence at 3 and 6months; secondary outcomes included percentage reduction in cigarette consumption. Abstinence at 3months was higher in the digital therapy group than in the usual care group (59.1% vs. 44.5%; P=0.043). At 6months, abstinence rates were 50.0% in G2 and 35.5% in G1 (P=0.041). The percentage reduction in cigarette consumption was significantly greater in the digital therapy group (46.5±12.7%) compared with controls (25.4±12.0%) (P<0.001). In a real-world primary care setting, adding a digital therapeutic intervention to usual care was associated with higher smoking abstinence rates and greater consumption reduction in the short and medium term.
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Primary care practitioners (PCPs) play a critical role in the management of persons living with obesity (PwOs). PCPs are often involved in all phases of the PwO's journey, from diagnosis to follow-up. There are constraints that preclude PwOs from deriving maximum benefits from their interaction with PCPs: time paucity, disalignment, lack of communication, stigma. Strategies to place PwOs at the center of value-based care should contribute to overcoming these drawbacks. Specific recommendations are detailed to guide PCPs in their daily practice and a roadmap is outlined to guide the journey of PwOs while in the primary care setting. The model is inspired by Obesity Canada's 5As of Obesity Management, which helped us to design a well-arranged visitation plan. PwOs' opinion is always considered. Decisions regarding lifestyle and pharmacological treatment are jointly shared. These recommendations could lead to a better use of the resources available to PCPs while increasing PwOs' well-being.
To evaluate whether the antibiotic treatment of acute bacterial pharyngitis has improved following the implementation and intervention of community antimicrobial stewardship. An observational before-after study was conducted. The study included patients who underwent a rapid antigen detection test for Streptococcus pyogenes in Primary Care, with results documented in electronic health records. Test registration data and antibiotic treatments prescribed within five days of testing were compared across two respiratory infection seasons separated by a four-year interval (October 2019 - March 2020 and October 2022 - March 2023). Between both periods, the community antimicrobial stewardship provided training sessions to the primary care teams. Positive results increased from 29.3% in the first season to 40.4% in the second one. Among patients with positive results, penicillin use increased from 49% to 65% of patients, reaching 90% if amoxicillin is included. The use of amoxicillin+clavulanic acid decreased by 47%. The use of other antibiotics that are not first-line therapies for acute bacterial pharyngotonsillitis decreased too (cefuroxime, ciprofloxacin, and levofloxacin). The implementation of antimicrobial stewardship programs in primary care in our community significantly improved the treatment of bacterial pharyngotonsillitis, with a higher percentage of cases complying with the National Health System's antimicrobial therapy guidelines.
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Acquired lifestyle is one of the most important predictive factors for explaining health status in adulthood. We subjected the structure of the E-VEVSA scale, validated in 2023 by Rodríguez-García et al., to a confirmatory factor analysis (CFA) using structural equation modeling. After removing outliers, the final sample consisted of 756 participants. We calculated absolute, incremental, and parsimony fit indices, as well as standardized estimates, removing all items with low (below 0.3) and non-significant factor loadings. After excluding items with loadings below 0.3, we obtained a refined version of the instrument consisting of 47 items grouped into seven dimensions. This new version of the E-VEVSA scale demonstrated excellent internal consistency (Cronbach's alpha=0.934) and explained 72.511% of the total variance. The main fit indices were: Chi-square=267, P<.0005; GFI=0.931; RMSEA=0.052; AGFI=0.926; TLI (NNFI)=0.954; NFI=0.917; PGFI=0.627; and CMIN/DF=1.987. Although confirmatory factor analysis does not invalidate or replace the original validation based on principal component analysis and varimax rotation conducted by Rodríguez-García et al. (2023), it does provide a better model fit. This refined structure enables a more precise and organized understanding of adult lifestyle, offering a solid foundation for future interventions and research in public health.
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The objective of the study was to assess the feasibility, reliability and ability to detect quality problems of a previously validated set of indicators for the management of overweight or obesity, applied in Primary Care within the Murcia Health Service. An observational, retrospective and cross-sectional study was designed in a Health Center belonging to Area VI of the Region of Murcia. The final sample consisted of 60 electronic medical records of adult patients (18-79 years) diagnosed with overweight or obesity, using proportional stratified random sampling. Medical records were independently reviewed by 2evaluators. The percentages of compliance of the 11included indicators, interobserver reliability and the number of non-compliances were calculated. Of the 158 records reviewed, 98 were excluded for not meeting criteria, leaving a total of 60 (62% women and 38% men). The indicators with the highest compliance were: documentation of the diagnosis of obesity (53%), adults with obesity (53%) and Body Mass Index (50%). Indicators related to lifestyle (physical activity and fruit consumption) showed 0% compliance due to the absence of specific fields in the registry. The agreement between evaluators was ≧95%, with Kappa values between 0.85 and 1, except in those without registered cases. Three applicable and reliable indicators were identified for incorporation into Primary Care (documented diagnosis, Body Mass Index and adults with obesity). It is necessary to adapt the electronic medical record, strengthen professional training and scale its validation to multicenter studies.
To evaluate the effectiveness of an ultrashort lung ultrasound training program based on advanced clinical simulation for the acquisition of diagnostic and technical skills among Family and Community Medicine residents. A prospective quasi-experimental pre-post study without a control group was conducted in 80 residents from the Bahía de Cádiz-La Janda Health District between October and November 2025. The 2-hour intervention included baseline assessment, a 15-minute theoretical session, supervised hands-on training using the U/S Mentor™ simulator, and immediate reassessment. Diagnostic knowledge, self-perceived confidence, technical autonomy, and examination time were analyzed. A remote follow-up assessment was performed 40 days later. The proportion of residents reporting high confidence (4-5/5) increased from 11.3% to 100.0%, and the proportion achieving a high overall score in the theoretical test (4-5 correct answers) rose from 38.8% to 98.8%. All clinical cases showed significant improvement (P<.001). A total of 70.0% achieved the maximum technical performance score, and mean examination time was 188.4±50.5 s, with no differences across residency years (P=.336). At 40 days, high satisfaction and a strong perceived clinical usefulness of the technique persisted. An ultrashort advanced clinical simulation-based program rapidly and consistently improves knowledge, confidence, and technical performance in lung ultrasound, and may represent a feasible educational strategy for postgraduate training.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) are highly prevalent conditions that share pathophysiological mechanisms. The possible bidirectional association between these diseases has gained increasing relevance, particularly due to the prognostic role of liver fibrosis in renal outcomes. This systematic review aims to update the current knowledge on this topic. A systematic review was conducted following the PRISMA 2020 guidelines. The literature search was performed in PubMed, Scopus, and Web of Science, covering the period from August 2020 to February 2025, without language restrictions. Prospective studies with at least 12 months of follow-up were included, enrolling adults with MASLD diagnosed by imaging techniques or validated non-invasive indices. Renal outcomes of interest were reduced glomerular filtration rate (GFR <60mL/min/1.73 m2) or albuminuria (≥30mg/g). Study selection and analysis were performed by a single reviewer, which represents a potential limitation due to the increased risk of selection bias. Data were systematically extracted and synthesized, focusing on the incidence, prevalence, and progression of CKD in patients with MASLD. A meta-analysis was subsequently performed using the inverse-variance method under a fixed-effects model, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using Cochran's Q test (X2) and quantified with the I2 statistic. Eighteen studies met the inclusion criteria. Most reported a positive association between MASLD and incident CKD. Liver fibrosis was consistently identified as a key determinant, significantly increasing the risk of renal impairment and accelerating its progression. The prevalence of CKD was higher in patients with MASLD compared to individuals without the condition. However, in the quantitative analysis heterogeneity was generally high, reflecting methodological and clinical differences among the included studies. MASLD is associated with an increased risk and faster progression of CKD, particularly in the presence of advanced fibrosis. These findings highlight the need for early identification of renal damage in MASLD patients and support the integration of non-invasive fibrosis assessment tools into clinical practice. However, the results should be interpreted with caution due to the substantial heterogeneity observed.
The paired Student's t test is a statistical tool widely used in the clinical setting to assess changes between two related measurements performed in the same patient. The objective of this article is to review, from a practical approach, its main assumptions, advantages, and limitations, as well as to illustrate its application through a clinical example. For this purpose, data from a study conducted in patients with obesity were analyzed using the SPSS program. The pairing of observations, normality of the differences, absence of outliers, and independence between pairs were previously verified. The results showed a significant and clinically relevant reduction in body mass index (BMI), with a large effect size. In this way, the paired t test is considered a simple, robust, and particularly useful technique in primary care to assess the impact of clinical interventions in pre-post studies.
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Non-oncological chronic pain is one of the leading causes of disability and reduced quality of life worldwide. Its management in Primary Care is essential due to its accessibility and continuity. Based on the biopsychosocial model, which integrates physical, psychological, and social factors, this study evaluated the effectiveness of a group intervention for patients with non-oncological chronic pain treated in this setting. A randomized, controlled, single-blind clinical trial was conducted with 64 participants divided into an experimental group (n=31) and a control group (n=33). The experimental group participated in a 13-week multicomponent program combining pain neurophysiology education, cognitive-behavioral therapy, mindfulness, and coping strategies. Pain intensity, quality of life, functional capacity, anxiety and depression symptoms, coping, and medication use were assessed. The results showed that the experimental group experienced a significant improvement in anxiety and depressive symptoms (mean reductions of -3.32 in BDI-II and -1.55 in Hamilton), with medium-to-large effect sizes. Improvements were also observed in quality of life and active coping, along with a trend toward reduced medication use. In conclusion, the biopsychosocial intervention may represent a complementary resource for the management of non-oncological chronic pain in primary care; however, studies with larger sample sizes are required to confirm its full effectiveness and its medium and long-term impact.