Burnout y malestar psicológico en los residentes de Medicina Familiar y Comunitaria

ObjectiveTo estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions.DesignCross-sectional study.LocationPrimary Care.ParticipantsOn-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%.Main measurementsPrevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use.Outcomes72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7)depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training.In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress.ConclusionsThe prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures.     

Factores que influyen en la dieta y los hábitos alimentarios de la población inmigrante china en Cataluña

ObjectiveTo characterize the diet and eating habits of adult immigrants of Chinese origin residing in Santa Coloma de Gramenet (Barcelona, Spain), and to identify the factors that influence the changes in diet and eating habits.MethodQualitative study conducted in 2017 through a discussion group with eight adults of Chinese origin (one man and seven women). The information was complemented by five interviews with key informants (three men and two women) and non-participant observation in health promotion workshops aimed at Chinese patients of a health center in Santa Coloma de Gramenet.ResultsChinese adults made three meals a day and tended to snack between meals. Their diet was based on rice, soy and proteins of vegetable origin. Participants rarely consumed milk and milk derivatives but highlighted their consumption of snacks, sugary drinks and pastries, as well as the incorporation of foods, new dishes and cooking techniques from the host country. The Chinese immigrants tried to maintain their diet of origin, however there were various barriers to this, such as the preference of the local diet by the children, work schedules and lack of time.ConclusionsA tendency towards dietary acculturation is observed among the participants. Health promotion activities aimed at Chinese families are needed to improve aspects of their diet and eating habits, aiming to reduce the consumption of snacks and sugary products.     

Visión crítica y argumentación sobre los programas de atención de la cronicidad en Atención Primaria y Comunitaria

The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care.Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date.Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care.     

Elaboración de una herramienta para la vigilancia de indicadores de calidad de la docencia en la formación especializada de Medicina Preventiva y Salud Pública

This study describes the process of developing an instrument intended for use in assessing satisfaction with the quality of training in preventive medicine and public health for resident physicians. To develop this instrument, the National Survey of Satisfaction with Medical Residency was adapted by an expert panel consisting of 23 resident physicians in preventive medicine and public health belonging to 9 autonomous communities in Spain. The adaptation of the survey to the specialty rotations included new dimensions and items and was evaluated with a 5-point Likert scale. The most important dimensions were planning and the achievement of specific objectives, supervision, delegation of responsibilities, resources and work environment, personal assessment, encouragement, support, and whether the rotation resulted in a publication or research project, etc. The development and utilization of this tool will enable future trainees in preventive medicine and public health to make an informed choice about their training itineraries.     

Determinantes de la elección del primer nivel de atención en medicina como ámbito de formación y laboral: un estudio cualitativo

ObjectiveTo explore the determinants of eligibility and the choice of the first level of care as a workplace and training environment for health professionals.DesignQualitative study.SettingFour universities in the Metropolitan Area of Buenos Aires, Argentina.ParticipantsRecently graduated doctors and medical students.MethodBased on the grounded constructivist theory, semi-structured interviews and focus groups were conducted for data collection and subsequent analysis.Results31 interviews and three focus groups were conducted during 2019–2020. Emerging concepts were organized in main axes for analysis. Positive and negative experiences were identified in relation to primary health care (PHC) in curricular spaces and practical rotations, and a significant lack of knowledge of its scope. For the choice of medical specialties, personal interests, future projections, social prestige, economic income and knowledge of a specific area of medicine are important. There is a devaluation in terms of the role and resolution capacity of PHC, and it is also associated with the assistance of populations with low socioeconomic resources.ConclusionsLittle knowledge of PHC, its lack of prestige, and insufficient remuneration for first-level care professionals were identified as the main barriers to choosing PHC as a place of work and training. In contrast, social commitment, the possibility of having a better lifestyle, and the type of doctor–patient relationship appear as the main facilitators.     

Percepción de la atención sanitaria en la primera experiencia de maternidad y paternidad

ObjectiveTo explore the perceptions of new mothers and fathers about the health care received during the transition to parenthood.MethodQualitative study based on 12 semi-structured interviews with seven women who conformed a self-help group, and five of their partners, in Segovia, Spain (2018–2019). A qualitative content analysis was used.ResultsFive categories were identified: (1) health care received during the prenatal stage; (2) health care received during childbirth; (3) postpartum care for women; (4) health response during parenting; and (5) gestation and benefits of a self-help group. In the prenatal period they needed more information about childbirth and postpartum and preparation to support them in the transition to parenthood. In childbirth, there was a failure to meet expectations regarding the health care received. In the postpartum period, they expressed the need for greater follow-up of women from a biopsychosocial perspective. In pediatric visits, the importance of encouraging the participation of fathers was reported. Women stated that there are currently no health benefits that favor the establishment of support networks and safe spaces where they can express their feelings and emotions.ConclusionsIt is necessary to reformulate existing spaces such as childbirth preparation classes and breastfeeding support groups, and to implement new strategies from the health care point of view. It is also essential to reinforce comprehensive, humanized health care that encourages parental involvement.