Relación de la calidad de vida profesional y el burnout en médicos de atención primaria

ObjetivoConocer la relación, si es que la hay, entre la calidad de vida profesional (CVP) y burnout de facultativos de atención primaria.DiseñoEstudio transversal mediante cuestionario CVP-35 y MBI (Maslach Burnout Inventory), por correo postal.ÁmbitoTres centros urbanos y 3 zonas de atención rural. Participó un total de 131 profesionalesMedicionesDel CVP-35 se obtienen puntuaciones que van de 0 (mínimo) a 10 (máximo). El cuestionario Maslach clasifica en nivel alto, medio y bajo de cada dimensión.ResultadosContestó a la encuesta el 71,7%. La edad media era de 44 años y la media de tarjetas sanitarias, 1.339. El número de consultas/día fue de 37; en cuanto las visitas domiciliarias, realizaban una diaria. El valor medio de la CVP fue de 4,48 (intervalo de confianza [IC] del 95%, 4,08-4,88). La percepción de la demanda tuvo una puntuación de 5,9 (IC del 95%, 5,6-6,1); la motivación intrínseca del profesional se situó en 6,5 (IC del 95%, 6,2-6,7) y el apoyo de los directivos en 3,8 (IC del 95%, 3,6-4,1). En cuanto al cuestionario MBI, se observó una despersonalización alta en el 54,3%, cansancio emocional alto en un 56,2% y realización personal alta en el 9,3%. La correlación mayor fue entre las demandas en el puesto y el cansancio emocional (r=0,6; p<0,0001), la motivación intrínseca y la realización personal (r=0,46; p<0,0001) y la calidad de vida profesional frente al cansancio emocional (r=−0,4; p<0,0005).ConclusionesLa CVP y el burnout miden dimensiones diferentes pero relacionadas. Por tanto, su utilidad es diferente en función de los objetivos. Con estos instrumentos se pueden identificar elementos clave de la gestión de personas que pueden mejorar la calidad de vida profesional.ObjectiveTo know the relationship, if this exists, between the quality of professional life (CPL) and the burnout of primary health care staff.DesignTransversal study employing CVP-35 test and MBI (Maslach Burnout Inventory), both sent by postmail.Setting3 urban centers and 3 rural centers. Total: 131 professionals.MeasuresIn the CVP-35 test, scores from 0 (minimum) to 100 (maximum) are obtained. Maslach categorised each dimension into high, medium and low level.Results71.7% answered. Medium age 44 years, average of 1339 sanitary cards. The number of visits/day was 37, home visits 1 per day. The CVP average was 4.48 (95% CI, 4.08-4.88). The damage perception in the post 5.9 (95% CI, 5.6-6.1); the professional intrinsic motivation 6.5 (95% CI, 6.2-6.7), and the manager support 3.8 (95% CI, 3.6-4.1). MBI: high depersonalization 54.3%, emotional exhaustion (r=0.6; P<.0001), intrinsic motivation, and personal accomplishment (r=0.46; P<.0001) and profesional quality of life front emotional fatigue (r= −0.4; P<.0005).ConclusionsCPL and burnout measure different but related dimensions. Therefore, its utility is dependent on the objectives. Target elements, which can improve the quality of professional life, can be identified from these tools

Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study

BACKGROUND: Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. METHODS: It included 2459 adults (range 20–92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. RESULTS: In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. CONCLUSIONS: The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women

Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review

Background Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. Methods For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. Results We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m2 in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. Conclusions The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study result

Valoración del tratamiento farmacológico antihipertensivo en un centro de salud en función de las patologías crónicas asociadas y grado de control de la HTA

ObjetivosValorar la adecuación del tratamiento farmacológico antihipertensivo prescrito según la patología asociada en cada paciente y analizar el control de cifras tensionales.DiseñoEstudio descriptivo, transversal.EmplazamientoCentro de salud de área urbana.ParticipantesLa población diana fueron los pacientes hipertensos en tratamiento farmacológico y controlados en el centro de salud. Se realizó muestreo aleatorio estratificado por cupos del total de hipertensos, y la muestra fue de 219 hipertensos.MedicionesSe revisó la historia clínica de los pacientes seleccionados. Para la evaluación del tratamiento antihipertensivo establecimos tres niveles de adecuación (adecuado, intermedio y no adecuado) basándonos en el protocolo de hipertensión arterial de 1999 de la Sociedad Española de Medicina de Familia y Comunitaria, teniendo en cuenta la patología concomitante en cada paciente.ResultadosDe 219 casos, el tratamiento fue adecuado en 71 (32,4%), intermedio en 91 (41,6%) y no adecuado en 57 (26%). El grupo farmacológico más frecuentemente indicado fue el de inhibidores de la enzima de conversión de la angiotensina (IECA) y en asociación: IECA + diuréticos. Respecto al control de tensión arterial, un 66,5% presentó un control óptimo, el 23,2% un control parcial y un 9% mal control. Conclusiones. La mayoría de los tratamientos se encuentran en un nivel de adecuación intermedio: sin efectos beneficiosos ni indeseables sobre la patología asociada. Esto nos hace pensar en la necesidad de optimizar las indicaciones farmacológicas antihipertensivas.ObjectiveTo assess the suitability of whatever hypertension medication is prescribed for the associated pathology in each patient, and to analyse the monitoring of blood pressure figures.DesignA cross-sectional descriptive study.SettingUrban health centre.PatientsThe target population were the hypertension patients being treated with medication and monitored at the health centre. Stratified random sampling by quotas of the total number with hypertension was performed. The sample numbered 219 patients.MeasurementsThe clinical history of each patient selected was reviewed. To evaluate the hypertension treatment, we established three levels of suitability with regard to the accompanying pathology of each patient (suitable, intermediate, unsuitable), using the 1999 Hypertension Protocol of the Spanish Society of Family and Community Medicine.ResultsOut of 219 cases, treatment was suitable in 71 (32.4%), intermediate in 91 (41.6%), and unsuitable in 57 (26%). The most frequently indicated drug group was the angiotensin converting enzyme inhibitor (ACEI) group and, jointly, ACEI and diuretics. Regarding the monitoring of blood pressure: 66.5% had very good monitoring, 23.2% partial and 9% poor.ConclusionsMost treatments are at an intermediate level of suitability: without beneficial or undesirable effects on the associated pathology. This makes us think we need to optimize the drug indicators for hypertension

Risk factors associated with Helicobacter pylori infection: A population-based study conducted in the province of Ourense Factores de riesgo asociados a la infección por Helicobacter pylori: Un estudio de base poblacional en la provincia de Ourense

Objectives: to identify the relationship between Helicobacter pylori infection and various factors that have been described in other studies in the general adult population in the province of Ourense. Material and methods: three hundred and eighty-three participants were enrolled in a study on the prevalence of Helicobacter pylori infection. All participants filled in a questionnaire under supervision, and the data obtained were examined by means of a univariate analysis. The odds ratio corresponding to each variable studied was calculated with their corresponding 95% confidence intervals. Furthermore, a multivariate analysis was performed. Results: the univariate analysis revealed an association between infection and: age, place of residence during childhood, current social status based on the head of the family's profession, current blue collar/white collar profession of the head of the family, sharing a bedroom during childhood, type of drinking water, and contact with animals during childhood. No association was found with respect to the presence of dyspeptic symptoms. The multivariate analysis disclosed that only age is an independent risk factor associated with infection. Conclusion: age has been identified as the only independent risk factor associated with Helicobacter pylori infection in this population-based study. The univariate analysis has detected other factors. No association has been identified with respect to dyspeptic symptoms.Objetivos: identificar en la población general adulta de la provincia de Ourense, la relación entre la infección por Helicobacter pylori y diversos factores que se han descrito en otros estudios. Material y métodos: se han incluido los 383 participantes en un estudio de prevalencia de la infección por Helicobacter pylori. Todos han completado un cuestionario bajo supervisión y los datos se han examinado mediante análisis univariante. Se han calculado las odds ratio correspondientes a cada variable estudiada, con sus intervalos de confianza al 95%. Además, se ha efectuado un análisis multivariante. Resultados: el análisis univariante demuestra asociación de la infección con: edad, lugar de residencia en la infancia, clase social actual por la profesión del cabeza de familia, profesión no manual/manual del cabeza de familia actual, compartir dormitorio en la infancia, tipo de agua de consumo y el contacto con animales en la infancia. No se ha encontrado asociación con la presencia de síntomas dispépticos. El análisis multivariante ha mostrado que solamente la edad es un factor de riesgo independiente asociado a la infección. Conclusión: en este estudio de base poblacional la edad es el único factor de riesgo independiente que se ha identificado asociado a la infección por Helicobacter pylori. En el análisis univariante se han identificado otros factores. No se demuestra asociación con síntomas dispépticos