Evolución del perfil comunicacional de los médicos residentes de medicina de familia

ObjetivoConocer cómo evolucionan en los residentes de medicina de familia las habilidades de relación con los pacientes, al comienzo y al final de su tercer año de residencia, cuando atienden a problemas de salud comunes en su especialidad.DiseñoEstudio cuasi-experimental (antesdespués), multicéntrico, de ámbito nacional. Un total de 193 médicos residentes de tercer año de medicina familiar de 8 unidades docentes, que realizaron su residencia entre 1996–1999. Durante este período los residentes realizaron las actividades formativas y asistenciales habituales que marca el Programa Nacional de la Especialidad. Se valoraron 6 escenarios clínicos videograbados con pacientes estandarizados (3 al inicio del tercer año y 3 al finalizar) mediante el cuestionario GATHA-RES. Análisis estadístico descriptivo, bivariado y multivariante.ResultadosSe evaluó un total de 1.024 entrevistas. El tiempo empleado con cada paciente disminuye significativamente al finalizar la residencia; se observa una relación directamente proporcional entre el tiempo de consulta y las puntuaciones obtenidas (p < 0,05). Se detectan mejorías en los aspectos formales y organizativos de la consulta. Por el contrario, las habilidades relacionadas con la exploración de los aspectos personales y contextuales de la dolencia, así como las habilidades negociadoras, empeoran al finalizar el estudio. Las variables que mejor predicen el perfil comunicacional de los residentes fueron: edad (inversamente), duración de la entrevista, formación del tutor en entrevista clínica y unidad docente.ConclusionesLos residentes aprenden a acortar el tiempo de consulta en detrimento de habilidades de comunicación básicas para la realización de una correcta asistencia a los problemas de salud de sus pacientes. Estos resultados sugieren la necesidad de cambios sustanciales en la formación de los médicos residentes de medicina de familia en España.AimsTo study the development of patient relation skills, as used during interviews with patients for health problems that are common within their specialty, in family medicine residents during the third year of their residency program.MethodsQuasi-experimental (before-after), national-level, multicenter study. The participants were 193 third-year residents in family medicine at 8 training units who were trained between 1996 and 1999. During this period all residents participated in the usual training and clinical activities included in the National Plan for this specialty. The GATHA-RES questionnaire was used to evaluated six clinical scenarios in video recordings of encounters with standardized patients (3 at the start of the third year and 3 at the end of the third year). Descriptive, bivariate and multivariate statistical analyses were used.ResultsA total of 1,024 interviews were analyzed. The time spent with each patient decreased significantly at the end of the residency program; the duration of the visit was directly proportional to the score on the GATHA-RES questionnaire (p < 0.05). Improvements were seen in formal and organizational aspects of the interview. In contrast, skills related with the exploration of personal and contextual aspects of the problem, and negotiating skills, were worse at the end of the study. The variables that best predicted residents’ communicational profile were age (inverse relation), duration of the interview, training of the tutor in clinical interviewing, and teaching unit.ConclusionsResidents learn to shorten the duration of the visit to the detriment of communication skills that are basic to appropriate care for their patients’ health problems. These results suggest the need for substantial changes in the training of family medicine residents in Spain

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

The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents

OBJECTIVES: To know the patients’ expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes. DESIGN: A prospective cohort study. PARTICIPANTS: Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires. MEASUREMENTS: Before each visit, the patients’ expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor’s suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used. RESULTS: The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32–3.75], and the fulfilling of the patients’ main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73–7.8; adherence OR 1.80, CI: 1.11–2.92; clinical evolution OR 1.54, CI: 1.01–2.35; and seeking further care later OR 0.54, CI:0.36–0.81) CONCLUSIONS: Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors

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

Teoría en la acción sobre la relación con el paciente. Una perspectiva diferente de representar y entender el comportamiento del médico de familia en la consulta.

Objetivo Identificar la «teoría en la acción» según el concepto de Argyris y Schon de un grupo de médicos de familia y comprobar si esta «teoría» aparece como una representación válida de su comportamiento y congruente con otros estudios. Diseño Descriptivo transversal. Emplazamiento Atención Primaria. Participantes Diez médicos de familia con una experiencia mínima de 10 años de otros tantos centros de salud de una ciudad y su comarca. Método Selección por muestreo intencional en función de la antigüedad, sexo, características del centro de referencia y estilo de práctica. Grabación y trascripción de audiograbaciones y observación de consultas. Formulación y agrupación inductiva de las proposiciones a partir de la identificación de las conductas en la consulta y su contexto siguiendo las propuestas de Argyris y Schon. Comparación de las proposiciones de los participante entre sí y con la literatura. Resultados y discusión Las 84 proposiciones de los entrevistados se agrupan en 9 categorías temáticas que en orden del peso de su presencia son: confianza/interés, medicalización, dimensión subjetiva, dirección, negociación, distancia e información, calidad clínica, comunicación clínica. Las proposiciones de los dos primeros temas son básicamente coincidentes mientras que en el resto aparecen diferencias en la teoría en la acción de distintos médicos. Las proposiciones pueden ser integradas con los resultados de otros estudios. Conclusión Es factible formular la teoría en la acción de los MF que aparece como una representación global y coherente de su comportamiento en la consulta.post-print521 K

Capacidad aeróbica, felicidad y satisfacción con la vida en adolescentes españoles

Analizar la asociación entre capacidad aeróbica, felicidad subjetiva y satisfacción con la vida en adolescentes. Método: Participaron 388 adolescentes (207 mujeres) de 12-18 años de edad. La capacidad aeróbica se evaluó mediante el test de 20 metros de ida y vuelta. La felicidad subjetiva y la satisfacción con la vida se evaluaron mediante las escalas Subjective Happiness Scale y Satisfaction With Life Scale, respectivamente. Se midió el peso y la talla de los adolescentes y se calculó el índice de masa corporal (IMC). Los adolescentes indicaron el nivel de estudios de la madre. Resultados: Los análisis de regresión lineal mostraron que la capacidad aeróbica se asocia positivamente con felicidad subjetiva (ß no estandarizada = .09 ± .03, r = .128, p = .013) y satisfacción con la vida (ß no estandarizada = .31 ± .13, r = .118, p = .022), independientemente del sexo, IMC y estudios de la madre. Conclusión: Los resultados de este estudio sugieren que los adolescentes que tienen una mejor capacidad aeróbica también son más felices y tienen una mayor satisfacción con la vida. Hacen falta estudios de intervención para corroborar si un programa dirigido a la mejora de la capacidad aeróbica puede también influir en el nivel de felicidad y satisfacción vital en adolescentes.To analyse the interrelations among cardiorespiratory fitness, subjective happiness and satisfaction with life in adolescents. Method: The study was based on a total of 388 Spanish adolescents (207 females) aged 12-18. Cardiorespiratory fitness was assessed by means of the 20-metre shuttle run test. Subjective happiness and satisfaction with life were assessed using the Subjective Happiness Scale and Satisfaction with Life Scale respectively. The adolescents' height and weight were measured and their body mass index (BMI) calculated. They were asked to report the educational level of the mother. Results: The linear regression analysis showed that cardiorespiratory fitness was positively associated with subjective happiness (ß non standardized = .09 ± .03, r = .128, p = .013) and satisfaction with life (ß non standardized = .31 ± .13, r = .128, p = .022), regardless of the subjects' sex, BMI, and educational level of the mother. Conclusion: These findings suggest that adolescents with a good level of cardiorespiratory fitness are happier and more satisfied with life. Intervention studies are needed to confirm whether an intervention programme aimed at improving aerobic performance might also lead to improvements in adolescents' level of happiness and satisfaction with life

Understanding the adipose tissue acetylome in obesity and insulin resistance

Obesity is a widely prevalent pathology with a high exponential growth worldwide. Altered lipid accumulation by adipose tissue is one of the main causes of obesity and exploring lipid homeostasis in this tissue may represent a source for the identifica-tion of possible therapeutic targets. The study of the proteome and the post -transla-tional modifications of proteins, specifically acetylation due to its involvement in energy metabolism, may be of great interest to understand the molecular mechanisms involved in adipose tissue dysfunction in obesity. The objective of this study was to characterize the subcutaneous and omental adipose tissue acetylome in conditions of obesity and insulin resistance and to describe the importance of acetylation of key molecules in adipose tissue to use them as therapeutic targets. The results describe for the first time the acetylome of subcutaneous and omental adipose tissue under physio-logical and physiopathological conditions such as obesity and insulin resistance. New evidence showed different acetylation patterns between two main depots and high-light the molecular complexity of adipose tissue. Results showed changes in FABP4 acetylation in subcutaneous fat in relation to insulin resistance, thus unveiling a poten-tial marker of depot-specific dysfunctional expansion in obesity-associated metabolic disease. Furthermore, it is shown that the acetylation of FABP4 affects its function, mod-ulating the capacity of differentiation in adipocytes. In conclusion, this study demon-strates a profound, depot-specific alteration of adipose tissue acetylome, wherein the acetylation of FABP4 may play a key role in adipocyte differentiation and lipid accu-mulation