Estudio sobre la prevalencia del burnout en los médicos del Área Sanitaria de Talavera de la Reina

ObjetivoDeterminar el grado de burnout, o desgaste profesional, en los médicos del Área Sanitaria de Talavera de la Reina y los factores asociadosDiseñoEstudio descriptivo transversalSujetosMédicos dedicados a la atención primaria (AP) (n = 106) y atención especializada (AE) (n = 129)MedicionesCuestionario Maslach Burnout Inventory (MBI) y encuesta con variables sociodemográficas y sugerencias. Ambos anónimos y autoadministrablesResultadosContestaron 144 médicos (61,27%), 63 de AP y 81 de AE, varones el 72,2% y con una media de edad de 45 años (con una escasa variabilidad entre AP y AE). La media de años trabajados fue de 18,65. Realizan guardias 102 (70,83%). El tipo de contrato es fijo en 85 (59,02%), interino en 49 (34,02%) y "otros" en 10(6,94%). Presenta burnout el 76,4% de los profesionales (moderado en el 38,9% y alto en el 37,5%). Resulta estadísticamente significativa la diferencia entre burnout de AP y AE (el 85,7 frente al 69,1%). En el resto de las variables estudiadas edad, sexo, estado civil, realización de guardias no encontramos diferencias significativas. Como sugerencias para mitigar el burnout destacan la petición de apoyo de mejoras laborales, un mayor reconocimiento personal y profesional, la implicación de la Administración y la Gerencia, la remuneración económica, facilitar formación e investigación, etcConclusiones.El grado de desgaste profesional (burnout) es muy elevado en nuestra área, con un mayor porcentaje en AP que en AEObjectiveTo determine the degree of burnout or professional wear-and-tear in doctors from the Talavera de la Reina Health Area and linked factorsDesignTransversal, descriptive studyParticipantsDoctors in primary care (PC)(n=106) and specialist care (SC) (n=129)Measurements and ResultsMaslach Burnout Inventory (MBI) questionnaire and a survey with social and demographic variables and suggestions. Both were anonymous and self-administeredResults144 (61.27%) answered, 63 from PC and 81 SC. 72.2% were male, with a meanage of 45 (with little variability between PC and SC). Average years worked were 18.65.102 (70.83%) worked cover. 85 (59.02%) had an indefinite contract, 49 (34.02%) a temporary one, and 10 (6.94%) other kinds.76.4% of the professionals suffered burnout(moderate in 38.9% and high in 37.5%). The difference between PC and SC burnout(85.7% vs 69.1%) was statistically significant.In the remaining variables studied (age, sex, marital status, working of cover shifts…) we found no significant differences. Among suggestions to mitigate burnout were demands to support improvements in working conditions, greater personal and professional recognition, involvement of the government and management, economic remuneration,providing more training and research, etcConclusionsProfessional wear-and-tear or burnout is very high in our area, and is higher in PC than in S

Attitudes towards Immigration among Students in the First Year of a Nursing Degree at Universities in Coimbra, Toledo and Melilla

Increased migration has led to increased prejudice towards immigrant populations. This study aims to analyse attitudes towards immigration among student nurses in three universities, two in Spain and one in Portugal. Methodology: A descriptive, transversal, prospective study was carried out among student nurses (n = 624), using the Attitude towards Immigration in Nursing scale. Results: Nursing students showed some positive attitudes towards immigration, such as that immigrants should have the right to maintain their customs or that immigrants should have free access to healthcare and education, in contrast to some negative attitudes, such as that crime rates have increased due to immigration or that immigrants receive more social welfare assistance than natives. Significant di erences in attitudes were revealed between students from the three universities. Discussion: Training in transcultural nursing is necessary for all nursing students in order to reduce negative attitudes towards the immigrant population and increase the awareness and sensitivity of future healthcare sta in caring for patients of all backgrounds

Assessment of Sensory Processing and Executive Functions at the School: Development, Reliability, and Validity of EPYFEI-Escolar

The authors thank the parents and teachers for their participation in this study. Especially to the teachers of the CEIP Ntra. Sra. Del Prado de Talavera de la Reina, Toledo (Spain) and CEIP Parque de las Infantas, Granada (Spain).The aim of this study was to determine the psychometric properties of the Assessment of Sensory Processing and Executive Functions at the School (EPYFEI-Escolar), a questionnaire designed to assess the sensory processing and executive functions as underlying processes for school participation. The total sample consisted of 536 children aged between 3 and 11 years old who lived in Spain. A total of 103 teachers completed the questionnaire. An exploratory factor analysis was conducted, which showed five main factors: (1) initiation, organization, execution, and supervision of the action; (2) inhibitory control; (3) sensory processing; (4) emotional self-regulation and play; and (5) self-competence. Some of these factors were similar to those found in the EPYFEI for parents in the home context. The reliability of the analysis was high, both for the whole questionnaire and for the factors it is composed of. The results provide evidence of the potential usefulness of the EPYFEI-Escolar in school contexts for determining academic needs and difficulties of children; moreover, this tool can also be used to plan intervention programs in the school environment according to the needs of each child and school.This study was supported by University of Málaga

Elevated pulse pressure and cardiovascular risk associated in Spanish population attended in primary care: IBERICAN study

Introduction: Elevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD. Objective: To evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD). Materials and methods: Observational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out. Results: The mean of PP was 52.35 mmHg, and was significantly higher (p < 0.001) in patients with HTN (56.58 vs. 48.45 mmHg) The prevalence of ePP adjusted for age and sex was 23.54% (25.40% men vs. 21.75% women; p < 0.0001). The ePP prevalence rates increased linearly with age (R2= 0.979) and were significantly more frequent in population aged ≥65 than in population aged <65 (45.47% vs. 20.98%; p < 0.001). HTN, left ventricular hypertrophy, low estimated glomerular filtration rate, alcohol consumption, abdominal obesity, and CVD were independently associated with ePP. 66.27% of patients with ePP had a high or very high CVR, as compared with 36.57% of patients without ePP (OR: 3.41 [95% CI 3.08–3.77]). Conclusions: The ePP was present in a quarter of our sample, and it was increased with the age. Also, the ePP was more frequent in men, patients with HTN, other TOD (as left ventricular hypertrophy or low estimated glomerular filtration rate) and CVD; because of this, the ePP was associated a higher cardiovascular risk. In our opinion, the ePP is an importer risk marker and its early identification lets to improve better diagnostic and therapeutic management

The ERICE-score: the new native cardiovascular score for the low-risk and aged mediterranean population of Spain

[Abstract] Introduction and objectives. In Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. Methods. Seven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11 800 people (6387 women) representing 107 915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. Results. Age was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic = 0.789 in men and C = 0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. Conclusions. The ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain.[Resumen] Introducción y objetivos. En España no existen unas cohortes poblacionales suficientemente grandes para hacer predicciones precisas del riesgo cardiovascular. Las ecuaciones de Framingham y EuroSCORE calibradas son las más utilizadas en España. El objetivo es desarrollar la primera ecuación de predicción autóctona para estimar con precisión el riesgo cardiovascular individual en España. Métodos. Análisis conjunto de siete cohortes españolas de población de mediana edad y anciana. La población del estudio —11.800 personas (6.387 mujeres)— aportó un total de 107.915 personas-año de seguimiento y 1.214 eventos cardiovasculares (633 de ellos, mortales). Se efectuó un análisis de regresión de Cox para examinar la contribución de los diferentes factores al riesgo de cualquier evento cardiovascular (mortal y no mortal). Resultados. La edad fue el principal factor de riesgo de eventos cardiovasculares. La presión arterial sistólica, la diabetes mellitus, el tabaquismo y el tratamiento antihipertensivo fueron factores predictivos fuertemente asociados con el riesgo cardiovascular. En cambio, la contribución del colesterol total sérico fue pequeña, especialmente en los mayores de 70 años. El modelo final de riesgo mostró un buen poder discriminatorio (estadístico C = 0,789 en varones y C = 0,816 en mujeres). Conclusiones. ERICE es una nueva ecuación de riesgo cardiovascular genuinamente española obtenida a partir del riesgo concurrente individual de los participantes en varias cohortes. La ecuación ERICE ofrece una estimación directa y fiable del riesgo cardiovascular total teniendo en cuenta factores como la diabetes mellitus y el tratamiento farmacológico de los factores de riesgo cardiovascular, habitualmente no incluidos en otras ecuaciones.Instituto de Salud Carlos III; G03/065Instituto de Salud Carlos III; PI05/1464Instituto de Salud Carlos III; RD06/0014/001

Efficacy of a videogame in the treatment of patients with schizophrenia

For some years there has been considerable interest in using virtual reality for rehabilitation in schizophrenia, although there is little evidence of its usefulness. Th e aim of this study was to evaluate the effi cacy of an intervention through Nintendo Wii® to improve cognitive domains, self-esteem and quality of life. 40 patients were randomized into two groups: experimental and control. A statistically signifi cant improvement in cognitive domains was found, especially in working memory. Results in quality of life and self-esteem have not obtained statistical signifi cance, though a large eff ect size appeared. Long-term studies are needed to test the effi cacy of virtual reality systems on quality of life and self-esteem, as changes in these constructs may develop in a relatively longer time

Echographic and Kinetic Changes in the Shoulder Joint after Manual Wheelchair Propulsion Under Two Different Workload Settings

AbstractManual wheelchair users with spinal cord injury have a high prevalence of shoulder pain, due to the use of the upper extremity for independent mobility, transfers and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with spinal cord injury while they performed high and low intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics