Mobility and gait disorders are frequent problems in the elderly population and are rarely evaluated in outpatient medical consultation. Gait speed has been described as the main indicator of morbidity and mortality in this group of patients and for this reason it is considered essential to assess the degree of mobility limitation, sarcopenia and frailty. There are different batteries of tests that can be applied in the outpatient clinic and allow to quickly and easily assess the degree of mobility limitation. The following article reviews mobility disorders, their impact on the health of the elderly population and the way in which these can be evaluated by the clinician in the primary health care centers.
Desarrollo de un modelo de intervención en salud para adultos mayores de alto riesgo en la comunidad
La situación de la población de adultos mayores en nuestro país, es sin duda un tema de creciente importancia desde el punto de vista social y político. Así queda reflejado al analizar los numerosos programas que han ido surgiendo a nivel nacional y comunal.
Por otra parte, los modelos de intervención en salud en la comunidad, carecen en nuestro oaís de un adecuado nivel de participación, y no poseen claros indicadores de impacto que los validen.
El tipo de intervención desarrollado en esta experiencia, pretende lograr un modelo de trabajo con la comunidad que sea participativo, replicable, y por tanto utilice los recursos locales disponibles, y que incorpore indicadores de impacto que permitan tener una clara idea de la eficacia de la intervención que se desarrolla. Al tener estos elementos, se obtiene una estrategia sustentable que le da sentido a la participación comunitaria.
Los resultados favorables en las variables biomédica, funcional, económica y de aislamiento social obtenidos en la población de adultos mayores de alto riesgo en este estudio, hacen suponer que se ha logrado en ellos un avance significativo en su calidad de vida, aunque este parámetro no haya sido medido directamente.
En resumen, puede decirse que el modelo de intervención utilizado logró, mediante la utilización de recursos locales, intervenir en un grupo de adultos mayores de alto riesgo, obteniendo una disminución en el corto plazo en todos sus parámetros de riesgo y provocando modificaciones concretas en el funcionamiento del centro de salud y organización de la comunidad.
Laboratorio e imágenes para el tamizaje de enfermedades en el Adulto Mayor, parte II: Neoplasias
It is estimated that the older adult population could reach 30% of the total by 2050, and being the age group that concentrates the greatest burden of disease, it is important to have tools for prevention and early diagnosis of these diseases. In Chile, ministerial guidelines for mass screening of this population date from 2013, with little evidence to support them. The objective of this publication is to contribute to an adequate use of tests that allow screening and prevention of metabolic and neoplastic diseases in the elderly. Through a non-exhaustive bibliographic review of the literature, different national and international recommendations were compiled. Based on this, a profile of tests to be requested together with the ¨Examen de medicina Preventiva del Adulto mayor (EMPAM)/Examen Funcional del Adulto Mayor (EFAM)¨ is proposed. As a result, considering the evidence reviewed, it seems reasonable to include 8 examinations to the EMPAM/EFAM, including some that were already proposed by the Ministry of Health. It seems relevant to contrast the examinations currently requested in primary care in order to reach a consensus at national level, based on evidence and adapted to our local reality.
Médicos ¿experto en disciplina infantil?
A lo largo de los años se han analizado las distintas técnicas disciplinarias utilizadas por los padres, su real impacto y consecuencias en el comportamiento y en el actuar de los niños tanto en su presente inmediato como en su futuro.
Laboratorio e imágenes para el tamizaje de enfermedades en el Adulto Mayor, parte I: Enfermedades crónicas no transmisibles
It is estimated that the older adult population could reach 30% of the total by 2050, and being the age group that concentrates the greatest burden of disease, it is important to have tools for prevention and early diagnosis of these diseases. In Chile, ministerial guidelines for mass screening of this population date from 2013, with little evidence to support them. The objective of this publication is to contribute to an adequate use of tests that allow screening and prevention of metabolic and neoplastic diseases in the elderly. Through a non-exhaustive bibliographic review of the literature, different national and international recommendations were compiled. Based on this, a profile of tests to be requested together with the “Examen de medicina Preventiva del Adulto mayor (EMPAM)/Examen Funcional del Adulto Mayor (EFAM)” is proposed. As a result, considering the evidence reviewed, it seems reasonable to include 8 examinations to the EMPAM/EFAM, including some that were already proposed by the Ministry of Health. It seems relevant to contrast the examinations currently requested in primary care in order to reach a consensus at national level, based on evidence and adapted to our local reality.
Características de las Familias y exigencias de intervención familiar en discapacitados institucionalizados
Los pacientes con discapacidad severa mantenidos por largos periodos institucionalizados, generan situación de abandono y desprotección por parte del grupo familiar de referencia y alto costo en su mantención. Para facilitar su inclusión se requiere conocer las condiciones socio-familiares y elaborar un plan de intervención.
Cognitive impairment approach for primary health care physicians
The cognitive problems have a high prevalence, a high social economic and public health impact, being an important cause of morbimortality and dependence and causing an important psycosocial impact in patients and their families/caregivers. Because of these reasons, it was created in Chile the National Programme of Dementia, which is in a pilot phase from 2017 and the inclusion of the Alzheimer and other Dementia to the Explicit Health Guarantees in October 2019, in which primary care plays a leading role. Is of vital importance that the physician who works in primary care, have the necessary skills to deal with patients living with dementia, in a comprehensive manner with an appropriate technical medicine based approach, under the principles of the comprehensive health care model. The objectives of this article is to review the epidemiology and impact of the cognitive impairment as a great public health problem, identify the main cognitive tests and their usefulness in the clinic evaluation, know the diagnostic study process and integral management in the context of Primary Care of a patient with suspicion and/or confirmation of cognitive impairment.
Estudio de concordancia diagnóstica en la realización de fondo de ojos como screening de retinopatía diabética entre médico de Familia capacitado y oftalmólogo, Cesfam Padre Damián, Valparaíso, 2002 – 2003
La Diabetes Mellitus produce pérdida visual irrecuperable y se asocia a un importante deterioro de la calidad de vida. En Chile, la retinopatía diabética es la primera causa de ceguera evitable, este riesgo en los diabéticos es 25 veces mayor que en la población general. Existen evidencias claras, que con los tratamientos actuales para la retinopatía diabética se podría reducir la pérdida de visión en un 50%. Además, con una detección precoz y tratamiento oportuno, se podría reducir la pérdida de visión hasta 90%.
Falls prevention and technical aids in the elderly, aproach for Chilean primary health care.
Falls represent an important public health problem due to their high frequency of occurrence, morbimortality, disability and associated costs. This article is aiming to deliver an up-to-date, friendly document for primary care physicians, offering summarized information about risk factors for falls in older people, and measures that have shown to be effective in fall prevention. Among the most effective interventions to reduce the incidence of falls in the elderly are exercise, orthotics, clinic-level improvement strategies, and the combination of these. Also, evidence-based tools for a comprehensive fall risk assessment in older adults are suggested. According to patient evaluation and clinical judgment, 3 risk groups are proposed (low, moderate, and high risk), aiming to assist the provider in selecting measures to be executed and suggest a management plan for preventing future falls. A summary of orthotics, technical aids and prevention programs available in Chilean primary care is incorporated as well, including motor kinesthetic therapy. The goal of this article is to encourage healthcare teams to include the suggested measures in their treatment plans, with the hope of improving the quality of life in older people and reduce healthcare costs in Chile.
Análisis Descriptivo de las Publicaciones Contenidas en la Revista Chilena de Medicina Familiar en el Período 1999 – 2004
La Revista Chilena de Medicina familiar es el principal medio de comunicación de los médicos de familia en nuestro país. Objetivo: Realizar un trabajo bibliométrico de los trabajos publicados en esta revista.