¿A cuántos?

Determinar a cuantos pacientes le realizamos prácticas recomendadas en promoción y prevención de la salud y pesquisa de enfermedades prevalentes en atención primaria.Determine to how many patients we carried out best practices in health promotion, prevention or investigation of prevalent diseases in primary care.Fil: Gasull, Andrea. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Lascano, Soledad. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Matile, Carlos. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Salomon, Susana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Carena, José. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica Médic

Caracterización de una población de estudiantes de medicina

Introducción: La carrera de Medicina demanda atributos, condiciones y competencias mínimas necesarias y suficientes de sus alumnos para garantizar una formación de grado de excelencia. Objetivo: Caracterizar una población de estudiantes de Medicina de dos Universidades (una pública y otra privada) y realizar un análisis comparativo con estudiantes de otras carreras. Material y Métodos: Se realizó un estudio descriptivo, transversal. Se empleó una encuesta autoadministrada anónima, en donde se incluyeron características sociodemográficas, horas de descanso y de estudio, motivo de elección de la carrera, consumo de tabaco, alcohol, problemas de alimentación y actividad sexual en alumnos de Medicina. Se describen medidas de tendencia central, de dispersión y test exacto de Fisher. Se consideró significativa una p<0,05. Resultados: Se incluyeron 129 estudiantes de Medicina. 75 mujeres (58% IC95%55.1;72.3). Edad promedio 23,1 años (DS±3.14); 95% solteros, 1% casados, 2% en unión consensual, 12% vive solo, 76% con la familia, 2% tienen hijos. El 61% tienen una relación sentimental. El 33% cursaban tercer año, 42% quinto año, 12% PFO y 84% en Universidad pública. En promedio estudian 4.73 hs (DS±2.79) por día, 5.32 hs (DS±2.32) por día de fin de semana, con un promedio de hs de sueño de 6.67 (DS±1.78). En general tenían 2 materias desaprobadas. El principal motivo de la elección de la carrera fue por vocación en el 68%, interés en la ciencia en el 36%, 21% compromiso social, 10% motivos académicos, 6% reputación de la carrera, 4% proyección económica, 3% prestigio y en ninguno por mandato familiar. El 67% considera que el prestigio social de la medicina es adecuado y el 26% que es excesivo. 31% consideran que el estudio constantemente interfiere en su vida. El 11% fuma; 7% más de 20 cigarrillos por día. El 64% han tenido intentos de cesación. El 48% toma más de 5 tragos de alcohol por día. El 2% consume laxantes o se provoca vómitos para perder peso. El 70% se automedica, principalmente con AINES (72%), antibióticos (11%), hipnóticos (2%). El 72% tiene conciencia del daño de automedicarse. El 58% había iniciado sus relaciones sexuales, 56% usa preservativo siempre. El 88% reconoce que conoce los riesgos de no usarlo y 50% refiere disminución de la frecuencia de relaciones sexuales. Del análisis comparativo con estudiantes que no estudian medicina solo el mayor número de horas de estudio, el menor número de horas de descanso, y la percepción que el estudio interfiere constantemente con la vida privada fueron más frecuentes en los de Medicina (p<0.05).Introduction: The school of medicine demands minimum necessary and sufficient students’ skills to ensure their academic excellence. Objective: To characterize a population of medical students from two universities (one public and another private) and compare them with students of other careers. Material and Methods: A descriptive, cross-sectional study was performed. An anonymous self-administered survey was used, including sociodemographic characteristics, study and break time, reason for career choice, tobacco use, alcohol consumption, eating disorders and sexual activity. Measures of central tendency, were 6.67 (SD ± 1.78). In general, they had failed 2 subjects. The main reason for college choice was vocation in 68%, interest in science in 36%, 21% social, 10% academic reasons, 6% career reputation, 4% future economic benefits, 3% prestige and none for family mandate. 67% believe that the social prestige of medicine is appropriate and 26% that it is excessive. 31% believe that study interferes in everyday life. 11% smoke; 7% more than 20 cigarettes per day, having 64% at least one discontinuance attempt. 48% have more than 5 alcoholic drinks per day. 2% use laxatives or vomiting to lose weight. 70% self-medicate, mainly with NSAIDs (72%), antibiotics (11%), hypnotics (2%). 72% are aware of the damage of self-medication. 58% had started sexual relations, and 56% always use condoms. 88% know the risks of not using it, and 50% report decreased frequency of sexual relations. Comparative analysis with students who do not study medicine demonstrates that more hours of study, the fewer hours of rest, and the perception that the study constantly interferes with private life were more frequent in Medicine (p <0.05).Fil: Gasull, Andrea. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Salomón, Susana Elsa. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Di Lorenzo, Gabriela. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Zizzias, Santiago. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Suso, Andrea. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Carena, José Alberto. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

¿Por qué la elección de la especialidad se ha transformado en un dilema actual para la salud pública?

Objetivos: Caracterizar en estudiantes (est) avanzados de Medicina la elección de la especialidad médica y la sede donde realizarla. Conocer la opinión respecto a especialidades muy demandadas versus especialidades poco demandadas. Material y Métodos: Se realizó un estudio descriptivo y transversal. Se empleó una encuesta autoadministrada anónima y vía internet en la que se interrogó sobre la intención de realizar una especialización, la especialidad (Es) elegida, el motivo de elección de la sede, conocimiento del sistema (Ss) de residencias (R), opinión sobre Es ± demandadas y estrategias para disminuir la brecha entre las necesidades del sistema de salud y la oferta de especialistas. Análisis estadístico: medidas de tendencia central, de dispersión y test exacto de Fisher. Resultados: Se incluyeron 102 est, 59% mujeres. Edad promedio: 24.6 años (DS±4.24). El 64% considera que tener pareja o hijos influye en la decisión de especializarse (Espz). El 98% piensa en Espz, principalmente por no sentirse capacitado para desempeñarse con los conocimientos obtenidos. El 83% haría R por considerarla la mejor forma de Espz y por no conocer otra forma; El 10% lo haría luego de un año “sabático"; el 9% por la “experiencia de ser residente". El 51% ha elegido Es clínica, 10% quirúrgica; 34% clínico-quirúrgica y 5% salud pública. Al momento de elegir la Es, el 78% privilegia la formación adecuada, 58% el crecimiento personal/profesional; 52.5% el tiempo libre; el 21% jerarquiza la beca de ayuda económica (BAE). El 68% conoce “algo" del Ss de R. El 49.5% eligió la Es en el ciclo clínico; 19% al cursar alguna materia, 16% en PFO y 18 % no la ha elegido aún. El 93% considera que “docentes motivadores favorecen la elección", 91% “que la falta de información sobre la práctica médica (provincia y país) puede disuadir a muchos estudiantes a elegir especialidad o sede". En cuanto a los motivos por los que Terapia Intensiva y Neonatología son especialidades poco elegidas: horarios, vacaciones y compatibilidad de vida laboral y familiar y mala praxis fueron los más frecuentes. En el caso de CM: escasa remuneración, sobrecarga burocrática y amplitud de conocimiento; y en el caso de Medicina de Familia: poco prestigio y reconocimiento por el equipo de salud y la sociedad, exigua remuneración, poco desarrollo profesional a futuro, por ser considerada aburrida y con pocas posibilidades de realizar investigación. En las Es muy elegidas influyó: horarios, vacaciones y la preservación de la vida personal y familiar y la retribución económica (Dermatología, Psiquiatría y Anestesia). Sugieren que posibles soluciones serían: mejorar los programas de R 77%; garantía de salida laboral por el estado 58%; jerarquizar algunas Es 51%; mejorar becas económicas 46.5% y que las facultades pongan énfasis en estas Es 42%. Conclusiones: Los estudiantes encuestados piensan en su mayoría especializarse por no sentirse capacitados para desempeñarse como médicos. En general conocen poco sobre el sistema de residencias y a la hora de elegir la Es priorizan prestigio, tiempo libre y vida personal, remuneración, mala praxis y amplitud del conocimiento. Se propone como alternativas para aumentar la elección de Es poco elegidas: la presencia de docentes y planes de estudio motivadores en la facultad, la mejora de programas de residencias, salida laboral y becas económicas y la jerarquización de la especialidad.Objective: Characterize advanced medical students the choice of medical specialty and the headquarters where to do it. Meet the opinion regarding very in-demand specialties and little in-demand specialties. Material and methods: a descriptive, crosssectional study was performed. Used an anonymous self-administered survey, via internet. Included intention specialization, chosen specialty, reason for choice of venue, knowledge of the system of residences, opinion on very in-demand and little-in demand specialties and strategies to reduce this gap. Statistical analysis: measures of central tendency, dispersion and Fisher's exact test. Results: 102 students, 59% women were included. Average age: 24.6 years (DS±4. 24). 64% considered that having partner or children influences the decision to specialize. 98% think of developing expertise because they do not feel qualified to perform with the obtained knowledge. 83% would make residence, by considering it as the best way of specialization and do not know another way; 10% after a "sabbatical"; 9% for the "experience of being resident". 51% have chosen clinical specialty, 10% surgical; 34% clinical-surgical and 5% public health. At the time of choosing specialty 78% favors adequate training; 58% personal/professional growth; free time 52.5%; and 21% categorizes the grant of financial assistance, 68% knows 'something' about the system of residences. 49.5% chose the specialty in clinical cycle; 19%. to pursue any matter; 16% in Final Practice and 18% have not chosen yet. 93% considered that "motivating teachers favor the choice"; 91% think that "the lack of information about medical practice (province and country) can deter many students". As for the little indemand specialties: schedules, holidays, compatibility of work and family life and malpractice were more frequent for intensive therapy and neonatology; for clinician: the low-paying, bureaucratic overload and breadth of knowledge; for family medicine: little prestige; recognition by the team of health and society, meager pay, little professional development future, be boring and little possibility of investigating. The chosen of the very-in demand specialties were influenced by: schedules, holidays; work and family life and economic retribution (Dermatology, Psychiatry and Anesthesia). They suggest that possible solutions would be to improve residence programs 77% ; ensure work output by State 58%; to arrange in order the specialties 51%; to improve economic scholarships 46.5% and that schools emphasize these specialties 42%. Conclusions: Most of the surveyed students think of getting a specialty because they do not feel qualified to serve as physicians. In general, they know little about the system of residences and when choosing the specialty prioritize prestige, leisure and personal life, compensation, malpractice and breadth of knowledge. Teachers and motivators study plans at the faculty, to improve residencies, job, best scholarship programs and rank are some alternatives for some of the less chosen specialties.Fil: Gasull, Andrea. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Di Lorenzo, Gabriela. Hospital Universitario (Mendoza, Argentina)Fil: Miranda, Raúl. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Carena, José Alberto. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Salomón, Susana Elsa. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Is there an appropriate following up process of residents in the medical clinic field during their training?

Objetivos: Caracterizar el proceso de enseñanza, aprendizaje, evaluación y acompañamiento de los Residentes (R) en las Residencias (Re) de Clínica Médica (CM); comparar Re estatales (ReE) vs privadas (ReP) de Mendoza. Material y métodos: Estudio protocolizado, descriptivo y comparativo. Encuesta validada, autoadministrada y anónima a residentes (R) y jefe de residentes (JR) de CM de ReE y ReP. Incluyó datos sociodemográficos, formación y actividad académica, investigación y conformidad R con institución (In). Análisis estadístico: medidas de tendencia central, medidas de dispersión, test exacto de Fisher, ANOVA. Resultados: Encuestas 86. Mujeres 69%, edad 28 ±3.4, R1 39%, R2 21%, R3 19%, R4 16% y JR 6%. Comité de docencia e investigación (CODEI) 84%. Instructor residentes (IR) 95% y JR 87%. Consulta a médico clínico (MC) en guardia (G): no presencial 60.5%, presencial 26%, sin posibilidad 14%. Máximo responsable G R superior 73.5%. Comparten la G 4 R 51%. Atención pacientes ambulatorios solos y sin supervisión 64.5%. Decisiones asistenciales supervisadas por MP en CE poco frecuente 41% e internación siempre 53%. Investigación: publicación en revistas científica (PRC) 63%, presentación oral (PO) en jornadas y congresos 96.5%. Evaluación: fin rotación evaluación teórica (ET) 89% y práctica (EP) 51%, anual ET 96% y EP 70%, final Re ET 82% y EP 60%; no son evaluados 4%. Tienen programa 92%, lo conocen parcialmente 52%, se cumple satisfactoria-mente 48%. Recorridos de sala y clases teóricas diarias 93%, ateneo (At) semanal 73%, reuniones de mortalidad (RM) nunca 72%, bibliográfica semanal (BS) 63%, auditora de internación 56%, At de errores médicos nunca 47%. El 26% participa de cursos de formación continua. Evaluación Re: compromiso y dedicación MP con formación, conformes 44%, compromiso de In, conformes 52%, formación académica y capacitación conformes 50%. Análisis comparativo: ReP vs ReE: R/guardia 1.6 ±1.1 vs 3.4 ±1.1 p<0.001. Investigación: PRC 30% vs 68.5% p=0.03, PO 90% vs 97% (pNS), PI 60% vs 95% p=0.005. CODEI 80% vs 99% p=0.03, IR 70% vs 99% p=0.004, JR% 40% vs 93% p<0.001. Evaluación: Lista de procedimiento realizados (LRP) 67% vs 83% (pNS). Máximo responsable G: R superior 40% vs 75% p=0.03. BS 30% vs 67% p=0.03, RM, epicrisis y At semanal pNS. Compromiso MP en la formación conforme 80% vs 39% p=0.01. Compromiso In conforme 40% vs 53% (pNS). Conclusiones: las decisiones asistenciales en la internación son supervisadas por MP en la mitad de los casos, menos frecuente en CE. 1 de cada 3 R atiende solo y sin supervisión y solo 1 de cada 5 puede consultar. Más de la mitad han realizado publicaciones científicas. Se realizan actividades académicas en un alto porcentaje, pero el 72% no reflexiona respecto a la mortalidad de sus pacientes. La mitad nunca ha hecho un ateneo de errores médicos. Las ReP investigan menos, tienen menos CODEI y menos presencia de JR e IR. En las ReE hay menor compromiso de los MP. A pesar de esto un alto porcentaje está muy conforme con la formación académica.Objectives: to characterise the teaching and learning process, assessment, and following up process of residents (R) at residences (Re) in the field of medical clinic (MC); to compare public (PRe) vs Private ones (PriRe) in Mendoza. Materials and methods: Protocol, descriptive and comparative study. Validated, self-administrated and anonymous survey to residents and chief resident (CR) of MC in Pre and PriRe. It included socio-demographic data, training and academic activity, research and R accordance with the institution. Statistics analysis: measures of central tendency and dispersion, Fisher’s exact test and variance ANOVA test. Results: 86 Surveys. Women 69%, aged 28 ±3.4, R1 39%, R2 21%, R3 19%, R4 16% y JR 6%. Teaching and Research Committee (CODEI) 84%. Resident Instructor (IR) 95% and JR 87%. Clinician consultation (MC) on call (G): no present 60.5%, present 26%, without possibility 14%. Superior maximum responsible G R 73.5%. on-call shared G 4 R 51%. Outpatient care along and without supervision 64.5%. Caring decisions supervised by MP at CE infrequent 41% and admission 53%. Research: scientific publication journal (PRC) 63%, oral presentation (PO) at seminars and conferences 96.5%. Assessment: end-rotation theoretical examination (ET) 89% and practice (EP) 51%, annual ET 96% and EP 70%, final Re ET 82% and EP 60%; there are no evaluated 4%. Having program 92%, the program is partially known 52%, the program is satisfactory fulfilled 48%. Rounds and theorical classes on a daily basis 93%, weekly Ateneo (At) 73%, meetings about mortality (RM) never 72%, weekly bibliographic (BS) 63%, auditor of admission 56%, At of medical mistakes never 47%. 26% participates of continuous training seminars and courses. Evaluation Re: MP commitment and dedication with training, satisfied 44%, In commitment, satisfied 52%, academic training satisfied 50%. Comparative analysis: ReP vs ReE: R/on call 1.6 ±1.1 vs 3.4 ±1.1 p<0.001. Research: PRC 30% vs 68.5% p=0.03, PO 90% vs 97% (pNS), PI 60% vs 95% p=0.005. CODEI 80% vs 99% p=0.03, IR 70% vs 99% p=0.004, JR% 40% vs 93% p<0.001. Assessment: List of procedures made (LRP) 67% vs 83% (pNS). Maximum responsible G: R superior 40% vs 75% p=0.03. BS 30% vs 67% p=0.03, RM, epicrisis y At pNS weekly. MP commitment in the training, satisfied 80% vs 39% p=0.01. In commitment satisfied 40% vs 53% (pNS). Conclusion: Decisions on assistance in admission are supervised by MP in half the cases, this is less frequent at CE. 1 in 3 R sees patients alone and without supervision and only 1 in 5 can consult. More than half of them have made scientific publications. Although academic activities are made in a high percentage, 72% don’t reflect upon the mortality of their patients. Half of them have never made an Ateneo on medical mistakes. ReP do less research, they have less CODEI and less presence of JR and IR. At ReE there are less MP compromise. Despite this, a high percentage is very satisfied with academic training.Fil: Gasull, Andrea. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Hoffman, María Paula. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Fernandez, Matías . Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Lascano, Soledad. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Gisbert, Patricia. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Salomón, Susana. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

El impacto de "la pandemia" sobre la fibrosis quística

Fil: Gasull, Andrea Silvana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Unidad de Fibrosis QuísticaFil: Bergas Gimbernat, María Noelia. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Reconociendo el estrés académico... conocer para prevenir

Los objetivos de la investigación son determinar el nivel del estrés académico (EA) en estudiantes de medicina (EM) y realizar un análisis comparativo entre EM avanzados de la carrera (4º-5º-6º año). Material y métodos Estudio protocolizado, descriptivo, transversal a través de una encuesta autoadministrada anónima, vía internet. Se incluyó datos sociodemográficos, motivo de elección de la carrera y el inventario SISCO modificado para EM que evalúa estresores (E), reacciones físicas (RF), psicológicas (RP), comportamentales (RC) y afrontamiento (A) con una escala tipo Likert mediante 5 adverbios (de “nunca" a “siempre") para cada situación. Se agregaron preguntas del equipo investigador. Criterios de inclusión: EM de 4º, 5º y 6º año. Análisis estadístico: medidas de tendencia central, de dispersión y test exacto de Fisher. Resultados Se incluyeron 241 EM, de Universidad Pública 61%, mujeres 68%, 4º 34%, 5º 40%, 6º 26%. Edad promedio 24 años (DS±2.87). El 55% tiene pareja, 3% tiene hijos, 71% vive con familia. Eligieron la carrera por gusto 81%, Interés por la ciencia 54%, académico 26% y social 24%, proyección económica 17%, mandato familiar 2% y ninguno por vocación. El 34% cree que el prestigio de la carrera es excesivo. El 94% refiere en los últimos 6 meses preocupación o nerviosismo. Análisis comparativo E: siempre percibe más sobrecarga de tarea 5° vs 4° (74 vs 52%; p <0.02). Las evaluaciones “siempre" inquietan más a 5° vs 4° (80 vs 63%; p<0.03). No le molesta la personalidad de los profesores significativamente a 5° vs 6º (77 vs 50%; p<0.02). Sobre RF tiene menos problemas para dormir 4° y 6° que 5° (22% y 21% vs 37%; p<0.05). Se siente significativamente más cansados 5° vs 6° (61 vs 42%; p<0.02). Tiene más “dolor de cabeza" 5° vs 4° (36 vs 22%; p <0.05); más diarrea/constipación 5° vs 4° (40 vs 20%; p=0.008) y 5° vs 6° (39 vs 20%; p <0.01). RP: se siente más “triste" 5° vs 6° (28 vs 16%; p<0.08) y se puede concentrar menos 4º vs 6° (73 vs 58%; p=0.09). RC tiene menos conflictos 4° vs 6° (86 vs 96%; p<0.04). También respondieron que “trabaja duro, pero sin resultados óptimos" 5° vs 6° (33 vs 18%; p<0.05). Se siente siempre más frustrados 5° vs 6° (37 vs 21%; p<0.04). “Lo social le molesta" más frecuente a 5° vs 4° (24 vs 11%; p <0.03) y 5° vs 6° (24 vs 4%; p=0.001) y “tener sexo no le entusiasma" más frecuente a 5° vs 4° (22 vs 5%; p<0.01) y 5° vs 6° (22 vs 4%; p=0.001); pero “se ha enfermado menos" 5° vs 6° (27 vs 14%; p=0.07). Del análisis comparativo de A (hacer plan de tareas, religiosidad y verbalización) el “nunca" usarlas y “ocasionalmente" fueron más frecuentes, pero pNS. Tuvo peor rendimiento académico (RA): 5° vs 6º (94 vs 81% p=0.01) y 5º vs 4° (94 vs 85% p=0.08). Se encontró al menos una dimensión afectada en todos los EM encuestados. Conclusiones Los EM de 5° son los más estresados. El EA impacta negativamente en el proceso de aprendizaje y con ello en el RA, pero sobre todas las cosas es predecesor de burnout por lo que deben hacerse intervenciones para mejorar las estrategias de afrontamiento.The goal of this study is to determine the level of academic stress (AS) in medical students (MS) and to carry out a comparative analysis among advanced undergraduates in the 4th, 5th and 6th year of their career. Materials and methods The protocol-based, descriptive, cross-sectional study was carried out by means of an anonymous on-line, self- administered survey. It included socio-demographic data, information on career choice, the SISCO inventory for academic stress adapted to medical students (S), data on physical reactions (PR), psychological reactions (PsR), behavioral reactions (BR) and coping strategies(C) on a Likert scale of 5 frequency adverbs ranging from “never" to “always" for each situation. The research team also added questions of their own. Only 4th, 5th and 6th-year MS were considered for inclusion in the study. The statistical analysis consisted of central tendency and dispersion measures and Fisher’s exact test. Results Two hundred and forty-one (241) medical students (MS) were included in the study. The sample consisted of 61% public university undergraduates, 68 % female, 34% 4th-year, 40% 5th-year, and 26% 6th-year MS. The average age of the participants was 24 years old (SD±2.87). At the time of the study, 55% said they had a partner,3% had children and 71% lived at the family home. The reasons given for their choice of career were varied: 81% stated own preference, 54% an interest in science, 26% an academic interest and 24% a desire for high social status. In addition, 17% cited economic prospects, 2% the continuance of a family tradition and no participants asserted medicine to be their “calling"; 34% found the career to have been accorded excessive status; 94% declared they had been nervous or worried within the previous six months. The comparative analysis yielded that 74% 5th-year vs. 52% 4th-year MS felt distressed by excessive workload (p<0.02); 80% 5-year vs. 63% 4th-year MS found themselves “always" worried by exams (p<0.03); 77% 5th-year vs. 50% 4th year MS were not bothered by the personality of their professors. Regarding PR, 4th and 6th year MS found it easier to fall asleep than 5th year MS (22%, 21% and 37% respectively; p<0.05). A larger percentage of 5th-year MS said they were “significantly more tired" than 6th-year MS (62 vs. 42%; p<0.02). 5th-year MS suffered from headaches more than 4th year MS (36 vs. 22% p<0.05) as well as from diarrhea and constipation (40 % vs. 20%; p<0.08); 5th year were also higher than 6th year on the latter point (39% vs. 20%; p=0.01). With regard to PsR, 28% 5th-year and 16% 6th-year MS said they were feeling “sad" (p<0.08). 4th-year had shorter attention spans than 6th year MS (73 vs. 58%; p=0.09); As for BR, 4th-year MS said they had fewer conflicts in their lives than 6th year MS (86 vs. 96 %; p<0.04). More 5th-year than 6th – year MS said they “work hard without achieving optimal results" (33 vs. 18%; p<0.05) and felt “always" more frustrated (37 vs. 21%; p<0.04). 5th year MS found themselves more often bothered by social activities than 4th year MS (24 vs. 11%; p<0.003). 5th –year MS more often found sex unexciting than 4th year MS (22 vs. 5%; p= 0.01) and 6th – year MS (22 vs. 4%; p=0.001) 5th-year MS said they fell ill less frequently than 6th-year MS (27 vs. 14%; p=0.07). For the comparative analysis, C participants were asked about coping strategies (e.g. drawing up task plans, resorting to religion/ spirituality and voicing concerns). The prevailing answer “never" and “occasionally" proved statistically non-significant. Academic performance (AP) was lower for 5th-year than 6th year (94 vs. 81%;p=0.01) and 5th year performed less satisfactorily than 4th year on this point (94 vs. 85%;p=0.08). We found that all participants were affected in at least one of the previous dimensions. Conclusions 5th – year MS were found to suffer from stress the most. We know that academic stress impacts the leaning process directly and takes a toll on academic performance; but above all is a precursor of burnout. The current situation calls for interventions aimed at improving coping strategies.Fil: Gasull, Andrea Silvana. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Elaskar, María Cielo. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Di Lorenzo, Gabriela. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Miranda, Raúl. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Lascano, Soledad. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Carena, José. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Salomón, Susana. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Expectativas de los ciudadanos en la atención de los servicios de salud en la nueva normalidad

Objetivo: Identificar las expectativas de la comunidad, posterior a las primeras olas pos pandemia, en la atención de los servicios sanitarios en la “nueva normalidad" en diferentes escenarios. Material y métodos: Estudio protocolizado, descriptivo y transversal a través de una encuesta estructurada, autoadministrada, anónima, con preguntas cerradas y abiertas, vía internet, a población general, en relación a expectativas en la atención que esperan recibir, en ambulatorio, internación y guardia, en la “nueva normalidad". Análisis estadístico: medidas de tendencia central, dispersión, test de chi2. Criterio de significación p<0.05. Resultados: 305 encuestas. 78.5% mujeres; edad promedio: 46.65. Cobertura de salud 86%. Comórbidas 48%, más frecuentes HTA, hipotiroidismo, obesidad y DM. Se atendió durante las primeras olas de la pandemia 44% y considero trato no adecuado el 25%. Atención ambulatoria fueron expectativas altas: “trato con respeto y amabilidad", “que el profesional inspire confianza", “tiempo para explicarte que pasa" “que comprendas los tratamientos que te indican", “interés del profesional en tu problema" (p<0.05) y no lo fueron “adquirir turno con rapidez", “que se respeten turnos" o “accesibilidad y confort del consultorio"(pNS). Guardia tienen alta expectativa: “que hayan insumos, remedios, materiales", “que el profesional inspire confianza", “ser examinados", “ser tratados bien", “que el profesional muestre interés", y no lo fueron: “ser atendido inmediatamente llegue" (p<0.05). Internación tiene altas expectativas: “enfermería te trate con respeto"; “profesional explique la importancia de la internación"; “sanitarios limpios"; “te expliquen cómo respondes al tratamiento"; “el profesional conteste dudas a la familia" y “comprender el porqué de los tratamientos indicados" (p<0.05). Conclusión: Los encuestados tienen altas expectativas de que en los sistemas de salud revisemos nuestro profesionalismo, recuperemos la dimensión humanística en la relación médico-paciente, optimicemos el tiempo en cada experiencia y jerarquicemos el momento y estrategias de comunicación y acompañamiento del proceso salud-enfermedad.Objective: To identify community expectations, post-pandemic, in the care of health services in the "new normal" in different scenarios. Material and methods: protocolized, descriptive and cross-sectional study through a structured, self-administered, anonymous survey, with closed and open questions, via Internet, to the general population, in relation to expectations regarding the care they expect to receive, in outpatient, inpatient and on-call care, in the "new normality". Statistical analysis: measures of central tendency, dispersion, chi2 test. Significance criterion p<0.05. Results: 305 surveys. 78.5% women; average age: 46.65. Health coverage 86%. Comorbidities 48%, most frequently HT, hypothyroidism, obesity and DM; 44% during the first waves of the pandemic and 25% considered inadequate treatment. Outpatient care had high expectations: "treatment with respect and kindness", "that the professional inspires confidence", "time to explain what is happening", "that you understand the treatments indicated", "interest of the professional in your problem" (p<0.05) and not "to acquire an appointment quickly", "that appointments are respected" or "accessibility and comfort of the office" (pNS). Emergency attention: "that there are supplies, medicines, materials", "that the professional inspires confidence", "to be examined", "to be treated well", "that the professional shows interest", and the following were not: "to be attended immediately upon arrival" (p<0.05). Hospitalization has high expectations: "nursing treats you with respect"; "professional explains the importance of hospitalization"; "clean toilets"; "they explain how you respond to treatment"; "the professional answers the family's doubts" and "understand the reason for the indicated treatments" (p<0.05). Conclusion: Respondents have high expectations that in health systems we should review our professionalism, recover the humanistic dimension in the doctor-patient relationship, optimize time in each experience and prioritize the moment and strategies of communication and accompaniment of the health-illness process.Fil: Guidarelli, Giuliana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Casarotto, Mariana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Fernández, Matías. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Gómez P., Francisco. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Carón, Nicole. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Gisbert, Patricia. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Gasull, Andrea. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Salomón, Susana Elsa. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit