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.     

Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound.     

Competencias y contenidos comunes de salud pública del Grado en Medicina en las universidades españolas

ObjectiveTo reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into undergraduate medical degrees.MethodsThe 2 nd Forum of University Teachers was held at the Rey Juan Carlos University (Madrid, 11-12 December 2014). Twenty-four university professors and lecturers from 19 Spanish universities imparting medical degrees participated in the forum. They were distributed in three working groups during three working sessions. In the first session, they were asked to identify and classify core public health competencies for medical degrees. In the second, they were asked to propose public health contents for the identified competencies. In the third session, the participants organized these contents in thematic blocks. The results were discussed in distinct plenary sessions.ResultsThe highest number of core competencies was identified in the activities related to the public health functions «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organised into five units: Concept of health, public health and its determinants; Epidemiology and health research; Determinants and health problems; Strategies, interventions and policies; and health systems, clinical and healthcare management.ConclusionsThe public health core competencies and contents identified in this Forum may be considered as a starting point to improve and update public health training programmes for future medical professionals.     

Medicina herbal china ofertada en páginas web en español: calidad de la información y riesgos

Objective

The growing use of purchase online via Internet retailers favours the access to potentially toxic natural products. It also contributes to the quick dissemination of the claims made by the retailers on efficacy and safety, these claims being not always based upon reliable information. Here, we have conducted an online search to find Spanish-language retail websites for Chinese herbal medicine and we have analysed them for the quality of product information and the potential health risks.

Necesidad y uso de productos de apoyo y facilitadores arquitectónicos en población dependiente

ObjectiveTo describe the use and perception of the need for assistive devices and identify their relationship with instruments to measure dependence and caregiver burden.DesignCross-sectional study.LocationPrimary Health Care in the southern area of Pontevedra.ParticipantsA total of 112 informal caregivers providing care to 125 dependent persons.Key measurementsThrough a personal interview, data was collected on the use and perception of the need for these devices. In addition, sociodemographic data and information on the time dedicated to daily care, caregiver burden, the Dependency Rating Scale, and the DEP-6D dependency indicator were obtained. A contrast mean was used to identify whether there are significant differences in these indicators, depending on whether or not they use the facilitator devices. A logistic regression was performed to identify those variables most associated with not having a need covered.ResultsMore than half (60%: 95% CI; 50.9-68.7) of dependent persons have unmet needs for these devices. These needs are mainly associated with a low family income, a high degree of dependence, and better health of the caregiver; although in extreme situations of greater dependence and worse health of the caregiver these deficiencies are smoothed out.ConclusionsThere is a strong association between the level of dependence and the use of these devices. However, there is a high percentage of the sample that do not have the products that they need, which are associated with the socioeconomic situation of the household as well as with the characteristics of the dependent person and the caregiver.     

Consumo intensivo de alcohol y cannabis,y prácticas sexuales de riesgo en estudiantes universitarios

ObjectiveTo determine the incidence of unsafe sex among university students and its association with heavy episodic drinking (HED) and cannabis use.MethodA cohort study was carried out from 2005 to 2011 among university students of the Compostela Cohort (n = 517). HED was measured using the third question of the Alcohol Use Disorders Identification Test (AUDIT). Unsafe sex was considered to be sex under the influence of alcohol (SUA) and sex without a condom (SWC). Logistic regression models were created.ResultsThe incidence of SUA was 40.9% for women and 53.0% for men, while the SWC incidence ranged from 13.7% for women to 25.7% for men. HED and cannabis use were associated with SUA in both women (OR = 2.08, 95% CI: 1.03-4.21; OR = 2.78, 95%CI: 1.57-4.92) and men (OR = 4.74 (95%CI: 1.49-15.09; OR = 4.37, 95%CI: 1.17- 16.36). Moreover, cannabis use in women was associated with SWC (OR = 2.96, 95%CI: 1.52-5.75). The population attributable fractions of SUA for HED were 24.7% and 52.9% for women and men, respectively.ConclusionsHED and cannabis use represent a public health problem due to their association with a variety of problems, including engagement in unsafe sex. Our results suggest that a significant proportion of unsafe sex could be avoided by reducing this consumption pattern of alcohol.     

Grado de control metabólico y de factores de riesgo cardiovascular en pacientes con diabetes tipo 2 con y sin enfermedad cardiovascular

AimsTo determine the proportion of patients with type 2 diabetes with and without cardiovascular disease achieving the main cardiovascular goals.MethodsDesign: Cross-sectional study. Setting: A regional health district in a European country, Spain. Year: 2013. Participants: Adult patients diagnosed with type 2 diabetes with and without cardiovascular disease. Measurements: Study using secondary data obtained from electronic records of clinical history. Haemoglobin A1c, blood pressure, LDL cholesterol, smoking and medication were covered. n=49,658ResultsThe proportion of patients with diabetes achieving cardiovascular goals (among those with recent measurement) was: haemoglobin A1c 68.8% (CI95%:68.2%-69.4%), blood pressure 74.3% (CI95%:73.9%-74.7%), LDL cholesterol 59.8% (CI95%:59.0%-60.6%), tobacco 80.2% (CI95%:79.6%-80.8%). Only 40%-67% of patients has recent measurement. Only 48.0% (CI95%: 46.6%-49.4%) of patients who needed statins were receiving them. Higher proportion of patients with cardiovascular disease were achiving goals. Differences were small but significant.ConclusionsCardiovascular goals were measured in around half of patients with diabetes. Proportion of patients achiving cardiovascular goals were similar to published and best in patients with cardiovascular disease but it could improve. This points to prioritising interventions in this group of patients at very high risk, improving the implementation of guidelines and patient adherence.     

Cambios de regulación y de gobierno de la sanidad. Informe SESPAS 2014

The economic and fiscal crisis of 2008 has erupted into the debate on the sustainability of health systems; some countries, such as Spain, have implemented strong policies of fiscal consolidation and austerity. The institutional framework and governance model of the national health system (NHS) after its devolution to regions in 2002 had significant weaknesses, which were not apparent in the rapid growth stage but which have been clearly visible since 2010. In this article, we describe the changes in government regulation from the national and NHS perspective: both general changes (clearly prompted by the economic authorities), and those more specifically addressed to healthcare. The Royal Decree-Law 16/2012 represents the centerpiece of austerity policies in healthcare but also implies a rupture with existing political consensus and a return to social security models. Our characterization of austerity in healthcare explores impacts on savings, services, and on the healthcare model itself, although the available information only allows some indications. The conclusions highlight the need to change the path of linear, rapid and radical budget cuts, providing a time-frame for implementing key reforms in terms of internal sustainability; to do so, it is appropriate to restore political and institutional consensus, to emphasize «clinical management» and divestment of inappropriate services (approach to the medical profession and its role as micro-manager), and to create frameworks of good governance and organizational innovations that support these structural reforms.