12 research outputs found

    Cribado de patología infecciosa y otras condiciones de salud en población migrante en Atención Primaria

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    [spa] INTRODUCCIÓN: La migración es un fenómeno omnipresente que afecta a todas las comunidades. La población migrante tiene unas necesidades de salud específicas relacionadas con su país de origen y la ruta migratoria, diferentes de las de la población autóctona, y que en ocasiones pueden pasar inadvertidas en nuestro sistema sanitario. La Atención Primaria (AP) es la puerta de entrada del sistema sanitario español. Si los profesionales son sensibles a las necesidades en salud de este colectivo se puede generar un gran impacto en su salud. HIPÓTESIS: Si se dota a los profesionales sanitarios de AP de herramientas y conocimiento para identificar y abordar de forma temprana determinadas condiciones de salud en la población inmigrante, la salud de estas personas mejorará. Existen recomendaciones sobre el cribado en población inmigrante, la mayoría de ellas basadas en opiniones de expertos, pero en muchas ocasiones no están contextualizadas en el nivel asistencial de AP. Su implementación depende de la voluntad del profesional sanitario. OBJETIVOS: El objetivo principal de nuestro trabajo es mejorar la salud de la población migrante mediante la detección precoz de ciertas enfermedades infecciosas y otras condiciones de salud como la salud mental (SM) relacionada con la migración y mutilación genital femenina (MGF). Objetivos específicos: 1. Identificar, evaluar buenas prácticas en salud en la atención al migrante y elaborar recomendaciones adaptadas al territorio y al contexto de AP sobre patología infecciosa incluyendo patología importada, SM y MGF. 2. Sensibilizar y formar a los profesionales de AP en las necesidades de salud de la población migrante. 3. Evaluar mediante un estudio piloto, la factibilidad y efectividad de la implementación de un programa de cribado utilizando una herramienta digital incorporada a la historia clínica de AP que ayude al profesional de salud en el proceso de toma de decisiones. 4. Analizar la prevalencia de las patologías incluidas en el programa de cribado.[eng] INTRODUCTION: Migration is an omnipresent phenomenon that affects all communities. The migrant population has specific health needs related to their country of origin and the migratory route, different from those of the native population, and which can sometimes go unnoticed in our health system. Primary Care (PC) is the gateway to the Spanish health system. If professionals are sensitive to the health needs of this group, a great impact can be generated on their health. HYPOTHESIS: If PC health professionals are provided with tools and knowledge to identify and address certain health conditions early, the health of the migrant population will improve. The evidence of screening in the migrant population is low and most of the time, it is not contextualized at PC care level. There are recommendations on screening in the immigrant population, most of them based on expert opinions, but in many cases the implementation depends on health professionals. GOALS: The main objective of our work is to improve the health of the migrant population through the early detection of certain infectious diseases and other health conditions such as mental health (MH) and female genital mutilation (FGM). Specific aims: 1. To identify and evaluate good health practices in migrant care and to develop recommendations adapted to the PC context regarding infectious diseases including imported diseases, MH and FGM 2. To raise awareness and to train PC professionals in the health needs of the migrant population. 3. To evaluate through a pilot study the feasibility and effectiveness of the implementation of a screening program using a computer tool incorporated into the PC clinical history that would help the health professional in the decision-making process. 4. To analyze the prevalence of pathologies included in the screening program

    Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona

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    Background In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. Aim To determine clinical factors of a poor prognosis in patients with COVID-19 infection. Design and setting Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. Method Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. Results We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. Conclusion Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts

    Lung Function sequelae in COVID-19 Patients 3 Months After Hospital Discharge

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    About 20% of patients infected by the SARS-CoV-2 virus develop Coronavirus Disease 2019 (COVID-19) pneumonia and require hospitalization.1 Some recent reports have shown that some of them may present lung function abnormalities at discharge, or soon afterwards.Here, we: (1) describe the presence and characteristics of lung function abnormalities 3 months after hospital discharge in a large prospective cohort of well characterized patients hospitalized because of COVID-19 in our institution; and, (2) explore potential clinical predictors these short-term lung function sequelae

    Clinical Features of Covid-19 in Barcelona City

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    In Spain, the first positive case of SARS-Cov-2 was diagnosed on 31 January 2020. As of 7 May 2020, there have been 221,447 cases, the most in any European Union country. This study aimed to describe the clinical, biological and radiological manifestations, the evolution, treatments and mortality rate of patients with COVID-19 infection in the population of Barcelona city.https://deepblue.lib.umich.edu/bitstream/2027.42/155329/1/FINAL_Manuscript COVID19 Ann Fam Med.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155329/2/FINAL_Figure (1) Ann-Fam-Med.pdfDescription of FINAL_Manuscript COVID19 Ann Fam Med.pdf : Main ArticleDescription of FINAL_Figure (1) Ann-Fam-Med.pdf : Figure

    Atención inicial al paciente inmigrante en atención primaria

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    Resumen: La entrevista clínica a pacientes inmigrantes requiere una competencia cultural que garantice una buena comprensión y una correcta comunicación, además de recoger información específica diferente a pacientes autóctonos, como origen y ruta migratoria o identidad cultural.Se recomienda el cribado de infección tuberculosa latente (ITL) en ciertos casos, y el cribado de otras infecciones, tanto cosmopolitas con mayor prevalencia en migrantes (VIH, lúes, VHB, VHC), como importadas (Chagas, parásitos intestinales, estrongiloidiasis, esquistosomiasis), según procedencia.Es clave comprobar el estado de vacunación y completar la pauta vacunal adaptándola al calendario vigente, priorizando vacunas como sarampión, rubéola y poliomielitis.Proponemos actividades preventivas a realizar ante viajes a países de origen, por sus características y riesgos especiales: consejos generales, explorar riesgo de malaria, valorar vacunaciones específicas, consejo respecto a infecciones de transmisión sexual (ITS) y consideraciones especiales si tienen enfermedades crónicas; y abordaje, si es pertinente, de riesgos de mutilación genital femenina (MGF). Abstract: The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity.Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin.It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis.We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation

    Abordaje de la salud mental del migrante y de la mutilación genital femenina en atención primaria

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    Resumen: La salud mental (SM) y la mutilación genital femenina (MGF) son 2 aspectos de la salud del migrante poco cribados en general, son material sensible en la entrevista clínica y se requieren conocimientos para afrontarlas con profesionalidad.La migración es un acontecimiento vital que per se no conlleva un trastorno mental, pero los hechos vivenciados durante la migración pueden generar problemas de SM de diferente intensidad. Los migrantes tienen los mismos problemas que el resto de la población, difieren en su forma de expresión. Es necesario conocer el contexto cultural y establecer un buen vínculo para abordar tanto la SM como la MGF.La MGF es un problema de salud grave para las niñas y mujeres que cabe afrontar en la consulta de atención primaria para prevenir esta pràctica en las niñas y ofrecer apoyo a las mujeres afectadas. Tratar estos aspectos con los varones y las mujeres de los países de riesgo es imprescindible para facilitar el cambio y ayudar a eliminar esta pràctica. Abstract: Mental Health (MH) and Female Genital Mutilation (FGM) are two aspects of migrant health that should be addressed and screened in primary care. These topics are inherently sensitive, often challenging and difficult to approach in routine consultations. Providing comprehensive care and management needs both knowledge and a careful approach, yet these factors may sometimes result in low screening of both health issues.Migration itself does not inherently lead to MH disorders. However, the various experiences encountered throughout the migration process can contribute to MH challenges. Migrants face the same issues as the rest of the population, but their expressions may differ. Therefore, it is important to understand the cultural contexts and create a supportive environment within healthcare to effectively address both MH and FGM.FGM is a serious health issue for girls and women that should be assessed in primary care. This includes prevention for at-risk girls, support and care for affected women and community initiatives. To engage with individuals from high-risk countries, both men and women is essential to facilitate change and help to end this harmful practice

    Solicitud de VIH en condiciones indicadoras en atención primaria: resultados de una colaboración; Indicator condition guided human immunodeficiency virus requesting in primary health care: Results of a collaboration

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    [Introduction] The search of HIV infected patients guided by indicator conditions (IC) is a strategy used to increase the early detection of HIV. The objective is to analyze whether a collaboration to raise awareness of the importance of early detection of HIV in 3 primary care centers influenced the proportion of HIV serology requested.[Methods] Multicenter retrospective study was conducted comparing the baseline and a post-collaboration period. The collaboration consisted of training sessions and participation in the HIDES study (years 2009-2010). Patients between 18 and 64 years old with newly diagnosed herpes zoster, seborrheic eczema, mononucleosis syndrome, and leucopenia/thrombocytopenia in 3 primary care centers in 2008 (baseline period) and 2012 (post-collaboration period). The sociodemographic variables, HIV risk conditions, requests for HIV serology, and outcomes were evaluated.[Results] A total of 1,219 ICs were included (558 in 2008 and 661 in 2012). In 2008 the number of HIV tests in patients with an IC was 3.9%, and rose to 11.8% in 2012 (P < .0001). The HIV infection rate was 2.2% (95% CI: 0.4-7.3) (n = 2). It was estimated that 25 new cases (12 in 2008 and 13 in 2012) would have been diagnosed if they had performed the test on all patients with IC. Predictors of HIV request were, having an IC in 2012, a younger age, having an mononucleosis syndrome, and not being Spanish.[Conclusions] The HIV request demand tripled, after the collaboration with primary care centers, however in 88% the test was not requested, resulting in diagnostic losses. New strategies are needed to raise awareness of the importance of early detection of HIV.Peer Reviewe

    Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona

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    BACKGROUND: In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. AIM: To determine clinical factors of a poor prognosis in patients with COVID-19 infection. DESIGN AND SETTING: Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. METHOD: Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. RESULTS: We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. CONCLUSION: Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts

    Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study

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    Background: Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods: A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results: Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2–1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8–6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5–3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions: Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services
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