Evaluación de la competencia clínica de tutores de residentes de medicina familiar y comunitaria

ObjetivoDescribir la primera experiencia de una evaluación clínica objetiva y estructurada (ECOE) a tutores de residentes realizada en la comunidad autónoma de AndalucíaDiseñoObservacional descriptivoEmplazamientoUnidad Docente de Medicina Familiar y Comunitaria de HuelvaParticipantesTutores de residentes de medicina familiar y comunitariaMediciones principalesLos componentes competenciales que se consensuaron y ponderaron fueron los siguientes: anamnesis, exploración física, comunicación,habilidades técnicas, manejo, atención a la familia y actividades preventivas. La selección de las 10 situaciones clínicas de las que constaba la prueba se realizó utilizando unos criterios de priorización según la prevalencia, gravedad clínica, importancia de la prevención y del diagnóstico precoz, complejidad del caso, evaluación de la capacidad resolutiva del médico y simplicidad evaluativaResultadosRealizaron la ECOE 13 tutores. La edad media ± desviación estándar de los participantes fue de 42,8 ± 3,64 años. La prueba tuvo un coeficiente de fiabilidad (alfa de Cronbach) de 0,73. Por lo que se refiere a los resultados por participantes, la media global fue de 73 ± 6,2. Al analizar los resultados para los diferentes componentes competenciales, los mejores resultados se obtuvieron en la atención a la familia, la comunicación y las habilidades técnicasConclusionesLas pruebas de evaluación clínica objetiva y estructurada pueden ser útiles para la valoración de los tutores, con el objetivo de orientar su formación en los puntos débiles e incluso para, en un futuro no muy lejano, servir como instrumento para acreditar y reacreditar a los tutores de residentes de medicina familiar y comunitariaObjectivesWe show the first experience of the application of an objetive and structured clinical evaluation (OSCE) procedure to family medicine trainers, that has been carried out in Andalucia. The objective is to use a competence evaluation instrument that, in the short term, will be used not only for trainer accreditation but also for other public sanitary professionalsParticipantsTutors of family and commnity medicine residentsDesignObservational descriptiveSettingEducational unity of family medicinePrincipal measurementsThe competencial components to be assessed are the following: anamnesis, physical exploration, communication, technical skill, management, family attention y preventive activities. The clinical situations were selected using the following priority criteria: prevalence, clinical gravity, prevention and early diagnosis importance, case complexity, doctor's capacity of evaluation and simplicityResultsThirteen family medicine trainers took part in the OSCE. Their average age was 42.8±3.6 years. The test had an overall reliability coefficient (Cronbach's alpha) of 0.73. The overall mean score of the participants was 73±6.2. The best results about the competencial components were family attention, communication and technical skillConclusionsThe OSCE can be a convenient tool for family medical trainer evaluation, helping to orientate their education in the weak points and, in the near future, it can also be used as an instrument do accredit family medicine trainer

Victimization and Perception of Abuse in Adolescent and Young Homosexual and Heterosexual Couples in Spain

Currently, violence in adolescent and young couples has a significant social impact on young people’s physical and psychological health. However, the study of violence in homosexual couples must also be addressed. This research analyzes the levels of violent victimization and the perception of abuse in both homosexual and heterosexual couples. Participants’ ages ranged between 14 and 29 years (M = 20.14, SD = 3.464). We used The Dating Violence Questionnaire-Revised (CUIVNO-R), which was applied in two consecutive studies. The results indicate high levels of victimization, especially in the sample of homosexual participants. The scores generally show a low perception of couple violence but high victimization rates. The results of this study reveal the importance of the issue of violence in couples from minority groups and suggest that couple violence should not be understood as unidirectional, i.e., exclusively from men to women. These findings show the need for education in healthy relationships and consideration of different types of couples in these relationships.This work was supported by the European Regional Development Funds (European Union and Principality of Asturias) through the Science, Technology and Innovation Plan (AYUD/2021/51411) and the State Research Agency of the Ministry of Economic Affairs and Digital Transformation (MCI-21-PID2020-114736GB-100)

¿Estamos de acuerdo con la calidad técnica de nuestras radiografías de tórax? Un radiólogo, un técnico especialista en radiodiagnóstico y un médico de familia intentan corroborarlo

ObjetivoValorar el grado de concordancia en la interpretación de la calidad técnica de las radiografías de tórax de un centro de salud entre el técnico especialista en radiodiagnóstico (TER), el médico de familia y el radiólogo.DiseñoEstudio transversal.EmplazamientoAtención primaria. Centro de Salud de Cartuja en Granada.ParticipantesPacientes del Centro de Salud de Cartuja con estudio radiológico simple de tórax durante 2002. Mediante muestreo aleatorio simple se seleccionaron 150 estudios. Se rechazaron 2 por tratarse de exploraciones repetidas del mismo paciente y 7 porque no presentaban una calidad mínima. La muestra final fue de 141 exploraciones.Mediciones principalesLos observadores cumplimentaron independientemente, para cada exploración, un protocolo de 11 ítems sobre calidad técnica de la imagen. Para cada ítem se calculó el índice kappa entre parejas de observadores, así como el índice kappa global.ResultadosEl 96% de las exploraciones fuerealizado con placas radiográficas de gran tamaño (35×43). Sólo en 2 preguntas hubo una concordancia aceptable o buena entre los 3 observadores (kappa=0,559-0,858). En 5 preguntas, la concordancia fue homogéneamente baja (kappa=0,034-0,375). En algunas preguntas se apreció una fuerte discrepancia entre la valoración del TER y la realizada por los otros 2 observadores.ConclusionesLa concordancia general puede considerarse baja, aunque algo mayor entre el radiólogo y el médico de familia que entre cada uno de éstos y el TER. Esto plantea la necesidad de mejorar la formación de los profesionales en cuanto a la valoración de la calidad técnica de las imágenes. Además, se detecta un gasto innecesario de placas radiográficas de gran tamaño.ObjectiveTo appraise the degree of concordance in the interpretation of the technical quality of chest x-rays at a health centre between an expert in x-ray diagnosis, a family doctor, and a radiologist.DesignTransversal study.SettingPrimary care. Cartuja Health Centre, Granada, Spain.ParticipantsPatients at the Cartuja Health Centre who had a simple chest x-ray in 2002. 150 studies were chosen by simple randomised sampling.Two were rejected because they dealt with a repeat examination of the same patient and seven because they did not reach minimum quality. The final sample was 141 x-rays.Main measurementsThe observers filled in independently, for each examination, an 11- item protocol on the technical quality of the images. The kappa index between pairs of observers was calculated for each item, as was the overall kappa index.Results96% of the examinations were conducted with large x-ray plates (35×43). There was only acceptable or good concordance between the 3 observers in 2 questions (kappa, 0.559-0.858). In 5 questions concordance was homogeneously low (kappa, 0.034-0.375). In some questions there was a strong discrepancy between the appraisal of the expert and that of the 2 other observers.ConclusionsGeneral concordance can be considered low, although it is somewhat greater between the radiologist and the family doctor than between either of these and the expert. This poses the need to improve professional training in evaluation of the technical quality of images. In addition, there was unnecessary expense in large-size x-ray plates

Exposure to perfluoroalkyl substances (PFAS) and association with thyroid hormones in adolescent males

Background: Perfluoroalkyl substances (PFAS) are found in a wide range of consumer products. Exposure to PFAS in children and adolescents may be associated with alterations in thyroid hormones, which have critical roles in brain function. Objective: This study investigated the association between plasma concentrations of PFAS and serum levels of total triiodothyronine (T3), free thyroxine (T4), and thyroid-stimulating hormone (TSH) in adolescent males. Methods: In 2017–2019, 151 boys from the Environment and Childhood (INMA)-Granada birth cohort, Spain, participated in a clinical follow up visit at the age of 15–17 years. Plasma concentrations of ten PFAS (PFHxA, PFHpA, PFOA, PFNA, PFDA, PFUnDA, PFDoDA, PFTrDA, PFOS, and PFHxS) and serum thyroid hormones were measured in 129 of these boys. Linear regression analysis was performed to determine associations of individual PFAS with total T3, free T4, TSH, and free T4/TSH ratio, and quantile g-computation models were performed to assess the mixture effect. Additional models considered iodine status as effect modifier. Results: PFOS was the most abundant PFAS in plasma (median = 2.22 μg/L), followed by PFOA (median = 1.00 μg/L), PFNA (median = 0.41 μg/L), and PFHxS (median = 0.40 μg/L). When adjusted by confounders (including age, maternal schooling, and fish intake), PFOA and PFUnDA were associated with an increase in free T4 (β [95% CI] = 0.72 [0.06; 1.38] and 0.36 [0.04; 0.68] pmol/L, respectively, per two-fold increase in plasma concentrations), with no change in TSH. PFOS, the sum of PFOA, PFNA, PFOS, and PFHxS, and the sum of long-chain PFAS were marginally associated with increases in free T4. Associations with higher free T4 and/or total T3 were seen for several PFAS in boys with lower iodine intake (<108 μ/day) alone. Moreover, the PFAS mixture was association with an increase in free T4 levels in boys with lower iodine intake (% change [95% CI] = 6.47 [–0.69; 14.11] per each quartile increase in the mixture concentration). Conclusions: Exposure to PFAS, considered individually or as a mixture, was associated with an increase in free T4 levels in boys with lower iodine intake. However, given the small sample size, the extent of these alterations remains uncertainSpanish Consortium for Research on Epidemiology and Public Health (CIBERESP)Instituto de Salud Carlos III (ISCIII) (grant no. CP16/00085

Resolución estructural en 3D de electrocerámicas mediante microscopía Raman confocal

Las propiedades de los materiales cerámicos son una combinación entre las propiedades intrínsecas, definidas por los granos cristalinos, y las propiedades extrínsecas, como son bordes de grano y fases secundarias. La relación entre estos dos elementos produce en muchas ocasiones, la presencia de propiedades inusuales que son la base de muchos materiales electrocerámicos. Sirvan como ejemplo algunos materiales tipo como son: varistores cerámicos, termistores, materiales con coeficiente de resistividad positivo, sensores de borde de grano, etc. En un material electrocerámico con respuesta funcional la correlación entre estructura-microestructura -propiedades es una constante, tanto en la etapa de diseño en laboratorio como en la etapa de producción industrial. El empleo de Microscopía Raman Confocal (MRC) se propone como una metodología relevante para el estudio de los factores que afectan a dichas correlaciones en materiales electrocerámicos. La técnica de MRC constituye una potente herramienta que permite determinar no solo la estructura sino las interacciones entre los elementos microestructurales. La correlación entre estas variables con las propiedades funcionales y la posibilidad de determinar las mismas en condiciones de operación, abren unas posibilidades que hasta la fecha solo estaban en la imaginación de los científicos. En esta presentación se resumen brevemente algunos de los principios relacionados con la técnica de Microscopía Raman Confocal, que junto con ejemplos seleccionados permiten visualizar aspectos relacionados con: la orientación de cristales, identificación fases cristalinas; resolución de nanoestructuras e interfases; determinación y dinámica de dominios ferroeléctricos; presencia de tensiones mecánicas; fenómenos de conducción,... sobre diferentes materiales cerámicos. Los trabajos mostrados son ejemplos de alta resolución en 3D de materiales funcionales como son los materiales electrocerámicos

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia

Introduction: Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. Patients and methods: Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. Results: A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94–1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97–1.22). Discussion and conclusion: We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes