Collection: Revista Chilena de Medicina Familiar

El tema de las cirugía ambulatoria ejemplifica un abordaje razonable que puede ser aplicado a múltiples otras condiciones de salud que son de alta prevalencia y de baja complejidad, pero que por razones históricas se llevan a cabo a nivel secundario o terciario. Con el desarrollo de la Medicina Familiar (general) se nos presenta la oportunidad cierta de volver a realizar procedimientos diagnósticos y terapéuticos a nivel de la atención primaria, ampliando y diversificando nuestra capacidad resolutiva.

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.

La cirugía menor comprende aquellos procedimientos quirúrgicos sencillos y de corta duración, realizados sobre los tejidos superficiales o estructuras fácilmente accesibles, bajo anestesia local y tras los que no se espera que existan complicaciones postquirúrgicas importantes. En general pueden abordarse en atención primaria lesiones menores de 5 cm de diámetro en la piel y tejidos subcutáneos.

En la Carta de Ottawa para la Promoción de la Salud de 1986, se incluye dentro de los cinco componentes de la promoción, el concepto de reorientación de servicios de salud. Desde entonces, gran parte del debate y los artículos sobre el tema ha permanecido a nivel de los principios o de intervenciones especificas aisladas de una concepción que permita introducir cambios sistemáticos de la organización de los sistemas de salud. Luego, en la V Conferencia Mundial de Promoción realizada en México 2000, se presenta un marco operacional para el desarrollo del tema, desde la perspectiva de las reformas de salud.

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.

En mayo de este año, en la ciudad de Sevilla, se celebró la I Cumbre Iberoamericana de Medicina Familiar, organizada por CIMF, la Sociedad Española de Medicina Familiar y Comunitaria y OMS-OPS, donde asistieron como representantes de Chile los Dres. Oscar Fernandez y Dagoberto Duarte, Presidente y Vicepresidente de la sociedad Chilena de Medicina Familiar respectivamente, y Roberto Tapia, representante del Ministerios de Salud de Chile, en el contexto de los 17 países presentes. El trabajo conjugado de los grupos durante los meses anteriores al eventos y los aportes hechos  por los participantes durante los días de cumbres, sirvieron para elaborar unos documentos técnicos y la llamada Declaración de Sevilla cuyos contenidos serán de gran ayuda para seguir avanzando en el desarrollo de modelos innovadores de Atención  Primaria de Salud (APS) dentro de la reforma de los Sistemas de Salud, en los que la salud de las familia y la Medicina Familiar pueden y deben jugar un papel preponderante. Asimismo, estos materiales serán de gran valor para reforzar su presencia en los programas de formación de pregrado, postgrado y capacitación.

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.

Ser padres es una de las tareas para la cual se tiene menor preparación. La crianza es uno de sus puntos más complejos; significa acompañar a los hijos y proveerles del cuidado material y emocional para un buen desarrollo físico, cognitivo y social. En este sentido, la disciplina y las estrategias para lograrla, son una tarea básica que deben asumir todas las familias.

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.