Validez y fiabilidad de un instrumento para la valoración de la entrevista clínica en médicos residentes de medicina de familia: el cuestionario GATHA-RES

ObjetivoComprobar la validez de contenido, la consistencia interna y la fiabilidad intraobservador de un cuestionario para la evaluación de la comunicación médico-paciente de los residentes de medicina de familia.DiseñoEstudio observacional, de validación de un instrumento de medida.EmplazamientoNivel de atención primaria. Unidades docentes de medicina de familia y comunitaria.Población de estudioPara el análisis de validez, 25 médicos residentes de medicina familiar y comunitaria. Para el análisis de fiabilidad, 48 médicos de la misma especialidad.Mediciones e intervencionesPara la construcción del cuestionario, se partió de una versión (GATHA-BASE), compuesta por 42 ítems seleccionados por un panel compuesto por 60 médicos de familia. Para la validez de contenido, se utilizaron 68 encuentros clínicos con pacientes simulados, que fueron videograbados y evaluados. La validez de contenido del cuestionario se estudió mediante un análisis factorial, y para medir su consistencia interna se calcularon los coeficientes alfa de Cronbach. La fiabilidad intraobservador de la versión GATHA-RES fue evaluada mediante los índices kappa y los coeficientes de correlación intraclase.ResultadosObtuvimos una versión del GATHA-RES con 27 ítems. El análisis factorial reveló la existencia de 9 factores: «empatía», «anamnesis», «bidireccionalidad», «negociación», «información», «miscelánea 1», «miscelánea 2» y «centrado en el paciente», que mostraron una buena correlación con los contenidos teóricos y formales del cuestionario original (inicialmente agrupados en 3 secciones: actitudes, tareas comunicacionales y habilidades). Todos los coeficientes de correlación intraclase presentaron cifras ≥ 0,90.ConclusionesEl cuestionario GATHA-RES es un instrumento válido y fiable que puede ser usado para la evaluación de las habilidades comunicacionales de los médicos de familia en formación.ObjectiveTo check the validity of content, the internal consistency and the intra-observer reliability of a questionnaire to evaluate the doctor-patient communication of family medicine residents.DesignObservation study, to validate a measurement instrument.SettingPrimary care. Family and community medicine teaching units.Study populationFor the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality.Measurements and interventionsThe questionnaire was constructed on the basis of a version (GATHABASE) composed of 42 items selected by a panel of 60 general practitioners. For content validity, 68 clinical encounters with simulated patients, video-recorded and evaluated, were used. The questionnaire's validity content was studied through a factorial analysis. To measure its internal consistency, Cronbach's alpha coefficients were calculated. Intra-observer reliability of the GATHA-RES version was evaluated through the kappa indexes and the intra-class correlation coefficients.ResultsWe obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors («empathy», «anamnesis», «two-way communication», «negotiation», «information», «miscellaneous 1», «miscellaneous 2» and «patient-focused») which showed close correlation with the theoretical and formal contents of the original questionnaire (originally grouped in three sections: attitudes, communication tasks and skills). All the intraclass correlation coefficients had figures ≥ 0.90.ConclusionsThe GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training

Opinions and beliefs held by Spanish teenagers regarding tobacco and alcohol consumption: A descriptive study

Background: Preventive strategies are the most effective approach for dealing with issues of substance abuse, particularly in teenagers. Such strategies adapt well to this target population. Our objective was to reveal the opinions and beliefs held by teenagers about tobacco and alcohol as types of drugs, and their effects on health. Methods: In this cross-sectional study, participants completed a self-administered questionnaire based on the World Health Organization “Health Behaviour of School-aged Children” study. Our sample included 1,005 schoolchildren aged between 11 and 13 years, resident in the province of Co´rdoba in Spain. Descriptive and univariate analyses were performed using a chi-squared test. Results: Of respondents, 25% (95% confidence interval [CI]: 22.2–27.6%) and 61% (95% CI: 58.0–64.1%), respectively, did not consider tobacco or alcohol to be drugs. No relationship was found between tobacco and alcohol use, and the belief that these are drugs (p = 0.477 and p = 0.217, respectively). A total 98.2% of adolescents surveyed (95% CI: 97.3–99.1%) believed that tobacco causes physical damage, mainly to the lungs, heart, and to the developing fetus. Additionally, 92.4% (95% CI: 90.6–94.0%) believed that alcohol is detrimental to health and identified the liver as the organ most frequently damaged by alcohol consumption. The media was identified as the main source of information about these substances by 78.0% of respondents (95% CI: 75.4–80.6%). Conclusions: Teenagers possess an acceptable level of knowledge and information about the negative effects of tobacco and alcohol on health; however, many of them do not consider these substances to be drug

Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria

ObjetivoComprobar la efectividad del consejo médico antialcohólico que se da en las consultas de atención primaria.DiseñoEstudio cuasi-experimental de tipo «antes-después», abierto, multicéntrico.EmplazamientoCatorce consultas médicas de atención primaria (7 rurales y 7 urbanas) de la provincia de Córdoba (España).ParticipantesUn total de 306 pacientes de ambos sexos, captados mediante búsqueda de casos, que presentaban un consumo de alcohol ≥ 35 (varones) y 21 (mujeres) U a la semana, y/o síndrome de dependencia alcohólica (SDA) (MALTS-O ≥ 11).IntervencionesA todos se les ofreció consejo médico breve antialcohólico y se les hizo un seguimiento para valoración de su estado a los 3 meses, 1 y 2 años.Mediciones principalesLa variable de respuesta fue la suma del consumo autorreferido, más valores normales de GGT, y la confirmación del familiar. El análisis del estudio fue por «intención de tratar».ResultadosDe los 306 pacientes incluidos, en un 95,1% de los casos se trataba de varones y un 78,4% presentaba SDA. Al cabo de 2 años, el 38,89% (IC del 95%, 32,2-44,3%) había alcanzado el objetivo terapéutico: un 23,85% se encontraba en abstinencia total y el 15,0% presentaba un consumo moderado de alcohol, por debajo del límite de riesgo. El comienzo del consumo excesivo antes de los 16 años (odds ratio [OR], 3,0885), vivir en un barrio marginal (OR, 3,2103), consumir tabaco (OR, 1,7187) y un test de CAGE positivo (OR, 1,9949) se asociaron al fracaso de la intervención (p < 0,05).ConclusionesSe demuestra la alta efectividad del consejo antialcohólico impartido por el médico de familia en condiciones habituales de consulta, tanto en bebedores excesivos como en aquellos con SDA.AimTo determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers.DesignQuasi-experimental, open, multicenter before-after study.Setting14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain).Participants306 patients of both sexes, recruited with a case-finding strategy, who consumed ≥35 (men) or ≥21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O≥11).InterventionsAll patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later.Main measuresThe response variable was selfreported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis.ResultsOf the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05).ConclusionsCounseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS

Mindfulness in primary care healthcare and teaching professionals and its relationship with stress at work: a multicentric cross-sectional study

Background: Work stress is a common problem among the health personnel of the Spanish National Health System. The objective of this paper is to assess the state of mindfulness among Spanish primary care providers and to evaluate its potential relationship with work stress and basic labor and sociodemographic characteristics. Methods: Cross-sectional, multi-centric study. Primary care nurses, teachers, teaching collaborators and residents assigned to six Spanish Family Medicine/Family and Community Care Departments were invited to participate (n = 475). A template was designed in Google Forms, including sociodemographic and work-related variables. The state of mindfulness was measured with the Five Facet Mindfulness Questionnaire (FFMQ), while work-related stress was measured using an ordinal scale ranging from 0 to 10 points. Descriptive and inferential statistical analyses were carried out, as well as bivariate and multivariate statistics. Results: The mean age of participants was 40, 14 ± 13.12 (range:23–65 years); 66.9% were women, 42.5% internal medicine residents, 29.3% family physicians, and 20.2% nurses. More than half (54.5%) knew about mindfulness, with 24.0% have received training on it, and 22.5% were usual practitioners. The average level of mindfulness was 127.18 ± 15.45 (range: 89–177). The average score of stress at work was 6.00 ± 2.44; 49.9% (range: 0–10). 49.9% of participants scored 7 or more on the stress at work scale. There was an inverse correlation between the levels of mindfulness (FFMQ total score) and work-related stress (Spearman’s r = - 0.155, p = 0.003). Significant relationships between the mindfulness practice and the level of mindfulness (F = 29.80, p < 0.001), as well as between the mindfulness practice and the level of work-related stress (F = 9.68, p = 0.042), were also found. Conclusions: Levels of mindfulness in primary care health providers were in line with those levels observed in other groups of health professionals. Half of all of the primary care providers suffered from a high degree of stress. Although weak, inverse relationships were observed between levels of mindfulness and stress at work, with lower values of stress at work among those who practiced mindfulness. Trial registration: NCT03629457

Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol

Background: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. Methods: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). Discussion: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well

Mindfulness-based program for anxiety and depression treatment in healthcare professionals: A pilot randomized controlled trial

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; ¿2 = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; ¿2 = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; ¿2 = 0.071—F (2.79) = 2.874; p = 0.049; ¿2 = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Validez y fiabilidad de un instrumento para evaluar la comunicación clínica en las consultas: el cuestionario CICAA

ObjetivoValorar la validez y la fiabilidad de un instrumento para evaluar la comunicación clínica de un profesional sanitario.DiseñoEstudio descriptivo de validación de un instrumento.EmplazamientoAtención primaria y especializada.ParticipantesParticiparon 20 profesionales expertos en comunicación y se realizaron 31 entrevistas con pacientes atendidos por enfermeros, médicos de atención primaria y especializada, residentes con pacientes agudos y crónicos, reales y estandarizados.IntervencionesPartiendo de una escala evaluativa de 3 niveles, multidimensional con 36 ítems basada en un modelo teórico de entrevista (CICAA) se realizó: a) estudio de validez aparente, de consenso y contenido: los expertos en comunicación clínica realizaron dos evaluaciones, una primera de tipo cualitativo y una segunda para ponderar la importancia de los ítems restantes, y b) estudio de la consistencia interna y la fiabilidad intraobservador. Un experto evaluó 31 entrevistas videograbadas en dos ocasiones con un intervalo de 1-2 meses.ResultadosSe obtuvo una escala de 29 ítems. El valor de alfa de Cronbach fue 0,957 (intervalo de confianza [IC] del 95%, 0,932-0,976). El coeficiente de correlación intraclase global fue de 0,967 (IC del 95%, 0,933-0,984). Los valores kappa de los ítems fueron < 0,4 en 3; 0,4-0,6 en 6; 0,6- 0,8 en 14, y > 0,8 en 4.ConclusionesEl CICAA es un cuestionario válido y fiable para evaluar la comunicación clínica de diferentes profesionales sanitarios y pacientes.ObjectiveTo assess the validity and reliability of a tool for evaluating the clinical communication skills of health professionals.DesignDescriptive study of the validation of a tool.SettingPrimary and specialist care.ParticipantsTwenty communication experts, in 31 interviews with patients seen by real and standardised nurses, primary care, and specialist doctors, residents with acute and chronic patients.InterventionsThe study looked at a 36-item, multidimensional evaluative scale on 3 levels, based on the CICAA theoretical model of an interview and examined: 1) its apparent validity, consensus, and content: the clinical communication experts made 2 assessments, a qualitative one and one to weigh the importance of the remaining items; 2) its internal consistency and intra-observer reliability. An expert evaluated 31 interviews, video-recorded on 2 occasions with a 1-to-2 month interval.ResultsA 29-item scale was obtained. Cronbach's alpha was 0.957 (95% CI, 0.932-0.976). The overall Intra-class Correlation Coefficient was 0.967 (95% CI, 0.933-0.984). The Kappa values of the items were <0.4 in 3, 0.4-0.6 in 6, 0.6-0.8 in 14, and >0.8 in 4.ConclusionsThe CICAA is a valid and reliable questionnaire for evaluating the clinical communication between various health professionals and patients

Prevalencia de actividad física y su relación con variables sociodemográficas y ciertos estilos de vida en escolares cordobeses

BACKGROUND: Regular physical exercise is not a widespread habit among the population. Early childhood in a crucial stage for acquiring this habit. The objective of this study was that of ascertaining the behavior of school-age children with regard to the degree of physical activity they do and to examine the factors involved. METHODS: An observational study was conducted by means of a survey based on a questionnaire which 6th and 8th grade students in a Basic Health Care District of Cordoba (N-585) filled out on their own. Questions were asked regarding the frequency of exercise, preferences and prospects for practicing sports, the children’s physical shape and school physical education classes, in addition to other behavior comprising their lifestyles. A dual-variable (p<0.05) and a multiple-variable analysis was conducted employing logistic regression. RESULTS: A total of 548 students filled out the survey (response rate=97.8%). 79.3% (IC95% 75.7-82.6) were involved in extracurricular physical activities, 21.0% (IC95% 17.1-24.7%) being involved in intense physical exercise. 50.5% (IC95% 46.3-54.8) did not think that they were in good physical shape. The age, sex, type of residence, the involvement in sports on the part of their parents or a close friend and what they considered their degree of healthiness to be comprised the variables quite strongly linked to doing exercise (p<0.001). CONCLUSIONS: The prevalence of physical exercise is high, although it progressively decreased with age, especially for girls. A major number of students considered themselves to be in unsatisfactory physical condition.FUNDAMENTO: El ejercicio físico regular es una práctica poco extendida entre la población. La infancia es una etapa crucial para adquirir este hábito. El objetivo del estudio fue conocer la conducta de los escolares respecto al grado de actividad física que desarrollan y examinar los factores que se relacionan. MÉTODOS: Se llevó a cabo un estudio observacional mediante encuesta basada en un cuestionario autoadministrado a los escolares de 6º y 8º de Enseñanza General Básica de una Zona Básica de Salud de Córdoba (N=585). Se interrogó sobre la frecuencia de ejercicio, preferencias y expectativas para la práctica deportiva, estado de forma física y clases de educación física del colegio, además de otras conductas constitutivas de los estilos de vida. Se llevó a cabo un análisis bivariado (p<0,05) y multivariado con aplicación de regresión logística. RESULTADOS: Contestaron la encuesta un total de 548 alumnos (tasa de respuesta=97,8%). El 79,3% (IC 95%: 75,7-82,6) realizaban actividades físicas extraescolares, y el 21,0% (IC 95%: 17,7-24,7) ejercicio físico intenso. El 50,5% (IC 95%: 46,3-54,8) no consideran bueno su estado de forma física. La edad, el sexo, el tipo de residencia, la práctica deportiva en los padres o el amigo y estado de salud percibido constituyen las variables más fuertemente asociadas a la realización de ejercicio (p<0,001). CONCLUSIONES: Aunque la prevalencia de ejercicio físico es elevada, va declinando con la edad, sobre todo en las niñas. Un importante número de escolares consideran insatisfactorio su estado de forma física