Mapas de actividades comunitarias y activos para la salud: ¿Cómo trabajar con ellos?

El modelo de activos para la salud tiene relaciones íntimas con el paradigma de la Promoción de la Salud, de modelos de Desarrollo Comunitario o de la Teoría Salutogénica de Antonovsky, siendo su punto de partida la Salud Positiva de una comunidad y de las personas que la integran

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Development and evaluation of a training programme on asset-based community development aimed at general practice trainees: protocol for a mixed-method multilevel and multicentric action research study

Introduction Asset-based community development (ABCD) is a strategy aimed at strengthening communities of interest through the identification and enhancement of those protective resources (also called ‘health assets’) that contribute to improve population health. Although primary care is specially well placed to contribute to ABCD by facilitating patients’ access to community health assets, the implementation of ABCD approaches is limited, in part due to training deficiencies amongst general practitioners. In this study, we will develop a training programme on ABCD aimed at general practice trainees and evaluate its implementation and scale-up in Andalusia, Spain. We will also investigate whether the programme may contribute to strengthen the community orientation of the primary care practices involved in the study.Methods and analysis We will undertake a mixed methods, multilevel and multicentric action research study drawing on theoretical frameworks relevant to learning (pedagogy) and community health promotion. The intervention will be implemented and evaluated in eight different study areas over 48 months. It will comprise a classroom-based session and a practical exercise, which will involve general practice trainees producing a map of community health assets relevant to common health conditions. In each study area, we will set up a stakeholder group to guide our study. We will run the intervention sequentially across the eight study areas, and modify and refine it iteratively by incorporating the findings from the evaluation. We will employ qualitative (interviews and focus groups with general practice trainees, primary care workers, members of the teaching units and policymakers) and quantitative methods (self-administered questionnaires with an approximate sample of 157 general practice trainees and 502 primary care workers).Ethics and dissemination Ethics approval from the Andalusian Regional Health Council has been granted (6/2020). It is envisaged that this research will provide relevant, evidence-based guidance on how best to incorporate learning on ABCD into the general practice training curriculum. Findings will be disseminated in an ongoing manner and will target the following audiences: (1) general practice trainees, primary care workers and members of the teaching units, (2) policymakers and strategic decision makers and (3) the academic community

Proposals for the community orientation of primary health care: to identify key agents for training

Objetivo: Identificar las fortalezas disponibles para la orientación comunitaria de la atención primaria desalud (APS) en el contexto de la evaluación del pilotaje de un programa formativo en salud comunitariapara especialistas internos residentes en Andalucía.Método: Estudio cualitativo explicativo de dise˜no fenomenológico, en el que se analiza la opinión de laspersonas participantes, que fueron 67 profesionales pertenecientes a seis distritos sanitarios de Andalucíaimplicados en el proceso formativo del Proyecto de Apoyo a la Revitalización de la Atención Primaria Activospara la Salud Comunitaria (PARAC).Resultados: Existe consenso en que la formación tiene un papel clave en la orientación comunitaria dela APS. Se identifican como activos los agentes vinculados a la docencia: los/las residentes, jóvenes pro-fesionales en formación que traen perspectivas y enfoques renovados a los centros de salud docentes,donde los/las profesionales deben dar respuesta a las necesidades de sus residentes, coordinados con lasunidades docentes multiprofesionales responsables de la formación de los/las residentes en un sistemasanitario con la vista puesta en el medio y largo plazo con estructuras que permitan organizar y apoyenla labor comunitaria de los centros de salud.Conclusiones: La orientación comunitaria de la APS es un objetivo que requiere el concurso de todos losniveles del sistema sanitario. Conocer y trabajar con los activos de la APS puede aportar propuestas paraavanzar hacia la orientación comunitaria de esta.Objective: To identify the strengths available for the community orientation of primary health care (PHC)in the context of the evaluation of the piloting of a training program in Community Health for ResidentInternal Specialists in Andalusia (Spain).Method: We will conduct a qualitative, phenomenologically-oriented, explanatory research in which theopinion of the participants is analyzed. Sixty-seven professionals from six PHC Districts of Andalusiawhich were part of the training program called Project to Support the Revitalization of Primary Care Assetsfor Community Health (PARAC) were interviewed.Results: There is consensus in giving training a key weight in the community orientation of PHC. For thisreason, those agents linked to training are identified as assets: general practice (GP) trainers, young pro-fessionals in training who bring updated perspectives and approaches to accredited PHC training centers,whose professionals must respond to the needs of their GP trainees, the multi-professional teaching unitsresponsible for the GP trainees training and a medium and long-term health system thinking along withstructures that coordinate and support the community work at the PHC centers.Conclusions: The community orientation of PHC is an objective that requires the participation of all levelsof the health system. Knowing its assets and working with them can contribute to provide proposals toadvance towards a community-oriented PHC system.Contrato Programa Servicio Andaluz de Salud – Escuela Andaluza de Salud Públic

Formación en salud comunitaria: retos, amenazas y oportunidades. Informe SESPAS 2018

Resumen: La incorporación de contenidos docentes relativos a la salud comunitaria en los programas formativos de enfermería y medicina contribuye a acrecentar la calidad, el rigor y la sostenibilidad de las intervenciones comunitarias. En este artículo dialogamos sobre cómo la medicina familiar y comunitaria y la atención primaria siguen sin ser consideradas disciplinas nucleares y transversales en las facultades de medicina españolas. Durante la formación especializada médica y enfermera existe una gran variabilidad en el aprendizaje sobre salud comunitaria, dependiendo de la capacitación, las prioridades y la motivación de los profesionales de atención primaria, las unidades docentes y sus residentes. La creciente inestabilidad laboral y los actuales sistemas de contratación dificultan la puesta en práctica de las competencias adquiridas, el desarrollo de actividades comunitarias y la consolidación de espacios y redes para la formación. A pesar de las adversidades, existen iniciativas que potencian con ilusión una formación de calidad en salud comunitaria, y que merecen ser impulsadas y visibilizadas. Abstract: Incorporating community health teaching in the undergraduate nursing and medicine curriculum and postgraduate training programmes contributes to enhance the quality, rigour and sustainability of health-promoting community interventions. In this article, we discuss the failure of Spanish Medical Universities to include family and community medicine and primary health care as integrated and cross-cutting disciplines on the undergraduate curriculum. During specialized medical and nursing training, community health teaching varies widely depending on the qualification, priorities and motivation of the primary health care workers, teaching units and trainees. Growing job instability and current nurse and medical recruitment systems, are hindering learning being put into practice, as well as the development of health-promoting community activities and the strengthening of training networks and facilities. Amid such adversity, there are initiatives that provide quality training on community health and should, accordingly, be fostered and acknowledged. Palabras clave: Salud comunitaria, Atención primaria, Enseñanza, Enfermería en salud comunitaria, Residencia médica, Keywords: Community health, Primary health care, Teaching, Community health nursing, Internship and residenc

New Perspectives for Low Muscle Mass Quantity/Quality Assessment in Probable Sarcopenic Older Adults: An Exploratory Analysis Study

Background: Low muscle mass quantity/quality is needed to confirm sarcopenia diagnosis; however, no validated cut-off points exist. This study aimed to determine the diagnostic accuracy of sarcopenia through muscle mass quantity/quality parameters, using the bioimpedance analysis (BIA), isokinetic, and ultrasound tools in probable sarcopenic community-dwelling older adults (≥60 years). Also, it aimed to suggest possible new cut-off points to confirm sarcopenia diagnosis. Methods: A cross-sectional exploratory analysis study was performed with probable sarcopenic and non-sarcopenic older adults. BIA, isokinetic, and ultrasound parameters were evaluated. The protocol was registered on ClinicalTrials.gov (NCT05485402). Results: A total of 50 individuals were included, 38 with probable sarcopenia (69.63 ± 4.14 years; 7 men and 31 women) and 12 non-sarcopenic (67.58 ± 4.54 years; 7 men and 5 women). The phase angle (cut-off: 5.10° men, p = 0.003; 4.95° women, p p p p = 0.007; 54.70 J women, p = 0.001), and mean power (cut-off: 87.8 Watts (W) men, p = 0.003; 48.95 W women, p = 0.008) in leg extension, as well as the the forearm muscle thickness (cut-off: 1.41 cm (cm) men, p = 0.017; 0.94 cm women, p = 0.041), had great diagnostic accuracy in both sexes. Conclusions: The phase angle, peak torque, total work, and mean power in leg extension, as well as forearm muscle thickness, had great diagnostic accuracy in regard to sarcopenia, and the suggested cut-off points could lead to the confirmation of sarcopenia diagnosis, but more studies are needed to confirm this

Bacteremia in Systemic Lupus Erythematosus in Patients from a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes.

To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors. All bacteremic episodes from the Spanish RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted. The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p Bacteremia occurred mostly in patients with active SLE and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities, and disease-related damage were associated with bacteremia

Bacteremia in Systemic Lupus Erythematosus in Patients From a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes

Objective: To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors. Methods: All bacteremic episodes from the Spanish RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted. Results: The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p < 0.001), cancer (OR 5.32, 95% CI 2.23-12.70; p < 0.001), immunosuppressors (OR 6.35, 95% CI 3.42-11.77; p < 0.001), and damage (OR 1.65, 95% CI 1.31-2.09; p < 0.001). Conclusion: Bacteremia occurred mostly in patients with active SLE and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities, and disease-related damage were associated with bacteremia.This work was supported by the Spanish Foundation of Rheumatology. JMPR is supported by grant 316265 (BIOCAPS) from the European Union 7th Framework Programme (FP7/ REGPOT-2012-2013.1) and FIS/ISCIII-Fondo Europeo de Desarrollo regional (FEDER) (Grant number PI11/02857)