Evaluación formativa mediante el portafolio de 4 promociones de residentes de medicina de familia y comunitaria de la Unidad Docente de Murcia

ObjectiveTo evaluate the performance and quality of the 10 groups of training tasks envisaged in the portfolio training model undertaken by all residents of the Primary Care Teaching Unit in Murcia.DesignA cross-sectional study was conducted on the portfolios provided and completed by all residents in May 2011.ParticipantsAll residents who were in training at that time (131).MethodTen groups of training tasks were established from those recommended by the National Commission for the specialty. The performance of each one in each of the portfolios was evaluated, and the compliance for each training task was calculated. The quality of the performance of each of the tasks was given a score, 0 points (very poor) to 10 points (excellent).ResultsAs regards compliance, the tasks that were most performed were: filling in the Resident book correctly and using the resident skills guide, both with 99.24%, followed by reflection reports on the training visits. All tasks had a compliance rate higher than 67%. The mean percentage of compliance was 86.49%. All tasks obtained an average score greater than 7 (outstanding). The overall mean score was 7,8 points.ConclusionsThe level of perfomance of the tasks set out in the portfolio by the residents was very satisfying. It is necessary to continue working on improving the performance of the portfolio.     

Manipulation pharmacologique de l'anabolisme : l'exemple de l'hormone de croissance

Optimal enteral or parenteral nutrition is not sufficient to correct protein catabolism during major metabolic stress or to systematically improve protein anabolism in chronic malnutrition. The administration of anabolic factors is therefore logical. The availability of human recombinant growth hormone (rhGH) and Insulin-like Growth Factor-I (rhIGF-I) permits their utilization in cases of metabolic stress and muscle catabolism. Their efficiency has been globally demonstrated. On the other hand, the data regarding possible clinical benefits are practically non-existent and the risk-benefit and cost-benefit ratios require further evaluation.This review summarizes the main clinical studies of rhGH and rhIGF-I and the relationship with catabolism or protein deficit. The main pathophysiological bases are presented.     

Validez y confiabilidad de la escala de sentido de coherencia en estudiantes de grado de enfermería de una universidad española

ObjectiveTo analyze the factor structure of the OLQ-13 scale and to study the direct relationship between sense of coherence and lifestyles in university students of nursing.MethodCross-sectional study. Location: University of Jaén. Andalusia, Spain. Participants: 384 students from the first three years of the nursing degree in the University of Jaén. Main measurement: Internal consistency was studied by Cronbach's alpha, reliability test-retest was measured by intraclass coefficient correlation (ICC) and construct validity was analysed by exploratory factor analysis, confirmatory factor analysis and known-groups technique.ResultsThe internal consistency of the scale was adequate (Cronbach α = 0.809). The ICC for the reliability test-retest was 0.91. The exploratory factor analysis showed 3 factors explaining 50.13% of the variance. The confirmatory factor analysis showed f goodness-of-fit indexes for the proposed model CFI = 0.965; RMSA = 0.041; GFI = 0.963; SRMR = 0.041. Statistically significant differences in sense of coherence were found among the subgroups of students with healthy and unhealthy lifestyles (p < 0.001).ConclusionsThe study confirms the multidimensionality of the OLQ-13 scale, in which 3 factors were identified: external meaningful, comprehensibility and manageability, and internal comprehensibility and manageability. The OLQ-13 may be a valid and reliable scale for use in the Spanish university population.     

Logros y retos de género de la Encuesta Nacional de Salud de 2006: análisis de los cuestionarios de adultos y hogar

Objectives

To examine the ability of the 2006 Spanish Health Survey (SHS-2006) to analyze the population’s health from a gender perspective and identify gender-related inequalities in health, and to compare the 2006 version with that of 2003.

Method

A contents analysis of the adults and households questionnaires was performed from the gender perspective, taking gender as (a) the basis of social norms and values, (b) the organizer of social structure: gender division of labor, double workload, vertical/horizontal segregation, and access to resources and power, and (c) a component of individual identity.

Results

The 2006 SHS uses neutral language. The referent is the interviewee, substituting the head of the family/breadwinner of past surveys. A new section focuses on reproductive labor (caregiving and domestic tasks) and the time distribution for these tasks. However, some limitations in the questions about time distribution were identified, hampering accurate estimations. The time devoted to paid labor is not recorded. The 2006 version includes new information about family commitments as an obstacle to accessing healthcare and on the delay between seeking and receiving healthcare appointments.

Conclusions

The SHS 2006 introduces sufficient variations to confirm its improvement from a gender perspective. Future surveys should reformulate the questions about the time devoted to paid and reproductive labor, which is essential to characterize gender division of labor and double workload. Updating future versions of the SHS will also involve gathering information on maternity/paternity and parental leave. The 2006 survey allows delays in receiving healthcare to be measured, but does not completely allow other delays, such as diagnostic and treatment delays, to be quantified.     

Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza

AimFamily medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine.DesignReliability of a questionnaire.SettingUniversity of Zaragoza.Participants371 students from the 1^st, 3^rd, 5^th, and 6^th years.MethodThe internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest.ResultsOn scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C.ConclusionsThe 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire.     

Medida de la importancia de las dimensiones de la satisfacción en la provisión de servicios de salud

Objective

Identifying users’ perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement.

Method

A questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n = 332], outpatient specialty care [n = 410] and hospital emergency care [n = 413]) to measure user satisfaction and assess the importance given to the aspects analyzed.

Results

The main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals’ willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions.

Conclusions

The tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity.     

Estado de salud y frecuentación de los servicios sanitarios de los menores hijos de inmigrantes

ObjectiveTo provide empirical evidence to assess whether having immigrant parents is a source of variation in health status and in health services’ utilization among children.MethodThe analysis was based on the sample of children from the Catalan Health Survey, 2006. Modelling of health status and use of health services was developed from the specification of distinct probabilistic models.ResultsThe results indicate that the children of immigrants had a significantly fewer chronic diseases, while perceived health status, according to the self-evaluation of the parents or responsible person, was worse if both parents belonged to this group. Significant differences were found in the utilization of distinct health services.ConclusionsThe analyses developed suggest that parental origin leads to differences in the utilization of the various levels of the Spanish health system. While no widespread pattern of increased or decreased utilization of the whole system was identified, differences were found in the number of specialist visits and admissions. Statements of the child's perceived health status were influenced by immigrant families’ socioeconomic conditions, which probably affected outcomes.