Validez de predicción de un cuestionario de conocimientos y actitudes hacia la medicina familiar

ResumenObjetivoconocer la validez de predicción de un cuestionario que evalúa los conocimientos y las actitudes de los estudiantes de medicina hacia la medicina familiar (mf).Material y métodoestudio de cohorte; los sujetos de estudio fueron estudiantes matriculados en una asignatura de Atención Primaria (ap) entre 2005 y 2006, que se graduaron en 2010 y eligieron especialidad en 2011. Se diseñó un cuestionario con 34 preguntas cerradas. A los estudiantes se les invitó a contestar antes y después de cursar ap, así como a los matriculados en el sexto curso (2009-2010). Se registró la especialidad que eligieron; para calcular la validez predictiva del cuestionario se estimó su sensibilidad y especificidad, analizando las curvas cor (características operativas del receptor).Resultadosrespondieron el cuestionario 44 estudiantes antes de cursar la asignatura y 79 después. Al final del sexto curso contestaron 76. El área bajo la curva cor fue, respectivamente, 0.299 (ic 95%: 0.094-0.504), 0.482 (ic 95%: 0.280-0.684) y 0.688 (ic 95%: 0.282-1.093). Solamente en el último caso la curva cor estaba por encima de la diagonal. El mejor punto de corte en este caso fue 31, con sensibilidad=0.75 y especificidad=0.714.Conclusionesel cuestionario tiene una deficiente validez de predicción en relación con la elección de la mf. Sólo mejora en el último curso de la licenciatura.SummaryObjectiveto learn about the validity of prediction of a questionnaire that assesses knowledge and attitudes of students of medicine towards Family Medicine (fm).Material and methodscohort study; the studied individuals were students enrolled in a Primary Care course (pc) between 2005 and 2006, who graduated in 2010 and chose a specialty in 2011. It was designed a questionnaire with 34 closed questions. Students were invited to answer before and after taking the pc course, as well as those students enrolled in the sixth course (2009-2010). The specialty chosen was registered; to calculate the predictive validity of the questionnaire, their sensitivity and specificity was estimated, analyzing the roc (receiver operating characteristic) curves.Resultsthe questionnaire was answered by 44 students before studying the course and 79 after studying it. At the end of the sixth course, 76 students answered the questionnaire. The area under the roc curve was, respectively, 0.299 (ic 95%: 0.094-0.504), 0.482 (ic 95%: 0.280-0.684) and 0.688 (ic 95%: 0.282-1.093). Only in the latter case the curve roc was above the diagonal. The best cut-off point was 31, with sensitivity=0.75 and specifcity=0.714.Conclusionsthe questionnaire has a poor validity of prediction concerning the choice of fm. It only improves during the last year of the degree

Diagnóstico del alcoholismo en atención primaria de salud / Francisco Escobar Rabadán ; director Fernando Espí Martínez.

Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 265.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-769

At what stage in the undergraduate curriculum is it best to train in family medicine? A study from two medical schools in Spain.

A course in family medicine (FM) could dispel the possibility of negative stereotyping about this speciality, and instil in students a greater interest. However, when is it preferable: at the beginning or at the end of undergraduate training? To determine changes in knowledge and attitudes towards FM by medical students completing a course in primary care at the beginning or the end of the undergraduate training and whether those changes anticipate the choice of speciality. Students from Albacete and Seville medical schools (primary care course in second and sixth years, respectively) were asked to respond to the 'valuation of attitudes towards and knowledge of family medicine questionnaire' (CAMF). Students from Albacete answered before and after the course, and in Seville second-year students answered at the end of the first trimester. All students were invited to respond again at the end of their undergraduate training. Afterwards, we investigated the score on the speciality exam (order for the election from highest to lowest score) and their choice of speciality. The outcome measures were the MIR exam score, the number in the ranking, the chosen speciality and the result of the CAMF. In Albacete 88 and 64 and in Seville 50 and 98 students responded in their second and sixth years, respectively. In Albacete, mean CAMF scores were 15.4, 22.7 before and after the course, and 21.8 at the end while in Seville, 13.9 in the second year, and 23.5 in the sixth year. Logistic regression analysis showed an association of the choice of FM only with the score on the speciality exam (OR: 0.667; 95%CI: 0.553-0.806). There were no significant differences between CAMF scores at the end of undergraduate training. Only the score on the speciality exam predicts FM choice: the higher the score, the lower the probability of choosing FM

Conocimiento y uso de metodos anticonceptivos por la poblacion femenina de una zona de salud

FUNDAMENTO: El uso de métodos anticonceptivos está en relación, entre otros, con factores demográficos, sociales, económicos, educativos e ideológicos. El objetivo de este trabajo es conocer qué métodos anticonceptivos conocen las mujeres en edad fértil, así como la prevalencia de su uso. MÉTODOS: A partir del listado de tarjeta sanitaria se seleccionaron mediante muestreo sistemático 389 de las 5800 mujeres en edad fértil (15-45 años) asignadas a un centro de salud. Previo envío de una carta, comunicando el motivo del estudio, se contactó telefónicamente con ellas para la realización de una encuesta, la cual incluía preguntas acerca del conocimiento y uso de métodos anticonceptivos, características socioculturales y actividad sexual. Las mujeres que no tenían teléfono fueron citadas en el centro de salud. RESULTADOS: Se contactó con 178 mujeres, de las que participaron 166 (tasa de respuesta de 42,7%). De ellas utilizaban algún método anticonceptivo 86 (51,8%; IC:44,2-59,4%). Sin embargo, entre mujeres con riesgo de embarazo no deseado, la prevalencia de uso era del 70,5% (IC: 62,4-78,6%), destacando el hecho de que en el grupo de mujeres de 40 a 45 años sólo utilizaran anticonceptivos el 45,4%, con una frecuencia significativamente inferior a los otros grupos de edad. Los métodos más conocidos eran el preservativo (90,4%), los contraceptivos orales (89,2%) y el dispositivo intrauterino (78,3%), siendo escaso el conocimiento de otros métodos. CONCLUSIONES: La tasa de utilización de métodos anticonceptivos en mujeres con riesgo de embarazo no deseado es aceptable, si bien entre 40 y 45 años es llamativamente baja. Los métodos más conocidos son el preservativo, los contraceptivos orales y el dispositivo intrauterino

Conocimiento y uso de metodos anticonceptivos por la poblacion femenina de una zona de salud

BACKGROUND: The use of contraceptives is related to factors including those of a demographic, social, economic, educational and ideological nature. The purpose of our study is that of ascertaining with what contraceptive methods the women of child-bearing age assigned to a given health care center are familiar, in addition to prevalence of the use thereof. METHODS: Based on the health care card listing, 389 of the 5800 women of child-bearing age (15-45 years old) assigned to the health care center in question were selected by means of a systematic sampling. After sending them a letter notifying them of the reason for this study, they were contacted by telephone to fill out the survey, which included questions regarding their knowledge and use of contraceptive methods, their sociocultural characteristics and sexual activity. Appointments at the health center were made with those women who did not have telephones. RESULTS: 178 women were contacted, 166 of whom took part in the survey (42.7% response rate). 86 of these women (51.8%; CI: 44.2-59.4%) were using some means of contraception. Nevertheless, among women at risk of unwanted pregnancies, the prevalence of use was 70.5% (CI: 62.4-78.6%), being worthy of special mention the fact that solely 45.4% of the women within the 40-45 age group were using contraceptives, revealing a frequency significantly lower than the other age groups. The methods known to the greatest degree were the condom (90.4%), oral contraceptives (89.2%) and the IUD (78.3%), the knowledge of other means being scant. CONCLUSIONS: The rate of use of contraceptive methods among women at risk of unwanted pregnancy is acceptable, although strikingly low among the women in the 40-45 age group. The methods known most were the condom, oral contraceptives and the intrauterine device.FUNDAMENTO: El uso de métodos anticonceptivos está en relación, entre otros, con factores demográficos, sociales, económicos, educativos e ideológicos. El objetivo de este trabajo es conocer qué métodos anticonceptivos conocen las mujeres en edad fértil, así como la prevalencia de su uso. MÉTODOS: A partir del listado de tarjeta sanitaria se seleccionaron mediante muestreo sistemático 389 de las 5800 mujeres en edad fértil (15-45 años) asignadas a un centro de salud. Previo envío de una carta, comunicando el motivo del estudio, se contactó telefónicamente con ellas para la realización de una encuesta, la cual incluía preguntas acerca del conocimiento y uso de métodos anticonceptivos, características socioculturales y actividad sexual. Las mujeres que no tenían teléfono fueron citadas en el centro de salud. RESULTADOS: Se contactó con 178 mujeres, de las que participaron 166 (tasa de respuesta de 42,7%). De ellas utilizaban algún método anticonceptivo 86 (51,8%; IC:44,2-59,4%). Sin embargo, entre mujeres con riesgo de embarazo no deseado, la prevalencia de uso era del 70,5% (IC: 62,4-78,6%), destacando el hecho de que en el grupo de mujeres de 40 a 45 años sólo utilizaran anticonceptivos el 45,4%, con una frecuencia significativamente inferior a los otros grupos de edad. Los métodos más conocidos eran el preservativo (90,4%), los contraceptivos orales (89,2%) y el dispositivo intrauterino (78,3%), siendo escaso el conocimiento de otros métodos. CONCLUSIONES: La tasa de utilización de métodos anticonceptivos en mujeres con riesgo de embarazo no deseado es aceptable, si bien entre 40 y 45 años es llamativamente baja. Los métodos más conocidos son el preservativo, los contraceptivos orales y el dispositivo intrauterino

Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes

ABSTRACT: CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option

Variabilidad en los controles de la terapia anticoagulante oral entre atención primaria y hospital en Albacete (2009)

Background: After taking control of oral anticoagulant therapy in our health center it became necessary to detect possible differences with regard to hospital monitoring. The aim of our study was to determine the variability in the International Normalized Ratio (INR) values of patients on oral anticoagulant therapy (OAT), and the possible relation to control in primary care or hospital. Methods: We analyzed the last 6 controls of 291 patients in an urban health centre in routine control by OAT. In order to analyze the variability, we calculated the standard deviation (SD) of natural logarithm (ln) of INR values, comparing by Student t test their mean between patients whose treatment had been scheduled in primary care and those on some occasions ruled by them and others in hospital. We compared also the proportion of controls within range in each group (chi2). Results: 153 (52.6%) patients were women, and the mean age was 73.8 years (SD: 11.3). We analyzed a total of 1710 INR controls, of which 1412 have been validated by family physicians and 298 by haematologists; there were no significant differences in INR values. Patients whose treatment had been scheduled by professionals of the health centre had mean values of the SD of the ln of the INR of 6 controls analyzed significantly lower (p <0.0001) than in those who had taken a mixed control. Also, a higher proportion of controls within range (68.0% vs 38.6%, p <0.0001). Conclusions: Patients who are followed only by professionals in the health centre have less variability and more appropriate INR control than those with a mixed control health centre / hospital.Fundamento: Tras asumir el control de la terapia anticoagulante oral en nuestro centro de salud surgió la necesidad de detectar posibles diferencias con respecto al seguimiento hospitalario. El objetivo de nuestro trabajo fue conocer la variabilidad en los valores del Cociente Normalizado Internacional (INR) de los pacientes en tratamiento anticoagulante oral (TAO), y su posible relación con el control en centro de salud u hospital. Métodos: Se analizaron los 6 últimos controles de 291 pacientes de un centro de salud urbano en control rutinario por TAO. A fin de analizar su variabilidad, se ha calculado la desviación estándar (DE) de los logaritmos neperianos (ln) de los valores de INR, comparando por medio del test t de Student la media de las mismas entre aquellos pacientes cuyo tratamiento había sido pautado por profesionales del centro de salud y aquellos pautados en unas ocasiones por éstos y en otras en hospital. Se comparó asimismo la proporción de controles dentro de rango en cada grupo (chi2). Resultados: Eran mujeres 153 (52,6%) de los pacientes, y la media de edad era 73,8 años (DE: 11,3). Se han analizado un total de 1.710 controles de INR, de los que 1.412 han sido validados por médicos de familia y 298 por hematólogos, sin que existieran diferencias significativas en los valores de INR analizados por unos y otros. Los pacientes cuyo tratamiento había sido pautado siempre por profesionales del centro de salud presentaron unos valores medios de DE de los ln de los INR de los 6 controles analizados significativamente inferior (p<0,0001) al de aquellos que habían llevado un control mixto. Asimismo, presentaban una mayor proporción de controles dentro de rango (un 68,0% vs 38,6%; p<0,0001). Conclusiones: Los pacientes que son seguidos exclusivamente por los profesionales del centro de salud presentan una menor variabilidad y más adecuados controles de INR que aquellos con un control mixto centro de salud/hospital