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

Maltrato a los profesionales de la salud

La violencia laboral a los profesionales del sector sanitario es un fenómeno emergente, global y cotidiano. Analizarlo puede contribuir a establecer estrategias de prevención que protejan la salud psicofísica de los mismos. Objetivos: Determinar las características de los episodios de hostigamiento y violencia que han padecido los miembros del equipo de salud y de los principales perpetradores. Material y métodos: Estudio protocolizado, observacional, descriptivo y transversal realizado en un Hospital Público. Se realizó una encuesta autoadministrada que incluyó preguntas cerradas y abiertas de variables demográficas, horas de trabajo, percepción de hacer trabajo de otros, relación con compañeros, prestigio de la profesión y características e impacto de los episodios de agresión física (AFi), verbal (Ave) y psíquica (APs). Análisis estadístico: medidas de tendencia central, de dispersión e IC95% Resultados: Se realizaron 100 encuestas, 24 médicos, 30 residentes, 26 enfermeros, 15 técnicos y 5 bioquímicos; 50% mujeres, edad promedio (x): 35,4 años (DS±7.9). Viven con la familia: 65%, pareja estable 72% y 100% son heterosexuales. El 4% admitió abandonar las guardias. El 65% considera que realiza trabajo de otra persona. El 94% prefiere trabajar en equipo y refiere que en el 50% a menudo recibe ayuda de ellos. El 60% tiene una relación con compañeros muy buena. El 45% refiere que a veces su trabajo es valorado por los jefes o superiores. El 74%(IC95%64,27-82,26) ha vivido alguna situación de violencia en el ámbito laboral, 1 a 3 veces 36% y más de seis 11%. La violencia más frecuente fue la AVe (79%)(IC95%69,71-86,51), seguida por APs (31%) (IC95%22,13-41,03) y 3% (IC95%0,62-8,52) AFi. La AVe fue insulto 74% y amenazas 36%. En 13% fue diaria y semanal 22%. Es más frecuente en horario de mañana y en horario de visita. La AFi fue contusión. La principal APs fue humillación 53%. Desencadena la violencia: el nivel sociocultural del usuario 51%, espera prolongada 41%, problemas de comunicación 29%, cansancio 15%, gravedad del enfermo 12%. La repercusión en el individuo fue emocional en el 69%, lo más frecuente fue estrés, impotencia, enojo, llanto y temor. El perpetrador en el 60% es el familiar del paciente y en el 31% el paciente y el principal motivo es la violencia social y los problemas del propio sistema de salud. Otros responsables: colegas 16% y jefes 28%. El 25% sintió alguna vez temor. El 23% ha pensado cambiar su actividad profesional por esto y en el 6% ya ha cambiado alguna vez de trabajo por estar expuesto a violencia. Conclusiones: El personal de la salud está expuesto a un alto índice de violencia, más frecuentemente a Ave seguida por la APs. El principal perpetrador es el familiar del paciente y la principal causa es sociocultural y vinculada con el sistema de salud. Uno de cada cuatro trabajadores ha sentido temor y ha pensado en dejar la actividad por la violencia.Laboral violence to healthcare professionals is a global, daily and emerging phenomenon. Analyzing it can contribute to stablish strategies of prevention that protect the psychophysical health thereof. Objectives Determine the characteristics of the episodes of harassment and violence that the health team and the main perpetrators have suffered Material and Methods Docketed, observational, descriptive and cross sectional study performed in a public hospital. A self-administered survey was used which included open and closed questions of demographic variables, work hours, perception to realize others´ work, relationship with our co-workers, prestige and characteristics of the profession and the impact of the physical (AFi), verbal (Ave) and psychic (Aps) episodes of aggression. Statistical analysis: measures of central tendency, dispersion and IC 95%. Results One-hundred surveys were conducted in twenty-four doctors, thirty residents, twenty-six nurses, fifteen technicians and five biochemists; 50% women, average age (x): 35, 4 years old (DS±7.9). Sixty-five percent live with their family, 72 %have stable couples and 100 % are heterosexuals. Four percent admitted to leave the guards. Sixty-five percent consider that they were doing someone else’s work, 94 % prefers team work and refers that 50% often receives help from them. Sixty percent have a good relationship with their co-workers and 45 % refers that sometimes their work is valued from their superiors. Seventy-four percent (IC95%64, 27-82, 26) have lived different violence situations in their work environment, 36% one to three times and 11% more than six. The most frequent violence was the Ave (79%)(IC95%69,71-86,51), followed by APs (31%) (IC95%22,13-41,03) and 3% (IC95%0,62-8,52) AFi. The Ave were insults in 74 % of the cases and threats in 36 %, and were daily in 13 % and weekly in 22%. The aggressions were more frequently in the mornings and during visiting hours. The AFi was contusion. The main Aps was humiliation in 53 % of the cases. The main triggered violence was the sociocultural level of the user (51%), followed by prolonged waiting (41%), communication problems (29%), fatigue (15%) and illness severity of the patient (12%). The consequence in the healthcare professionals was emotional stress (69%) manifested by impotence, anger, tears and fear. In 60% of cases the perpetrator were the patient’s relatives and in 31% the patient; and the main reason was the social violence and the problems associated to the health care system. Others agressors were medical doctors (16%) and chiefs (28%). Twenty-five percent of the victims sometimes felt fear. Twenty–three percent of the people who have suffered aggression have thought to change their professional activity because of this and 6% have sometime changed their work because of being exposed to violence. Conclusion Healthcare workers are exposed to a high rate of violence, more frequently to Ave continued with the Aps. The main perpetrators are the patient’s relatives and the principal reason are socioculturals, and linked with health-care system deficiencies. One out of four workers have felt fear and have thought to quit their activity because of violence.Fil: Matile, Carlos Andrés. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Salomón, Susana Elsa. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Suso, Andrea. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Pezzini, Luisa. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Miranda, Raúl. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Carena, José Alberto. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

A critical analysis of the potential for EU Common Agricultural Policy measures to support wild pollinators on farmland

1. Agricultural intensification and associated loss of high‐quality habitats are key drivers of insect pollinator declines. With the aim of decreasing the environmental impact of agriculture, the 2014 EU Common Agricultural Policy (CAP) defined a set of habitat and landscape features (Ecological Focus Areas: EFAs) farmers could select from as a requirement to receive basic farm payments. To inform the post‐2020 CAP, we performed a European‐scale evaluation to determine how different EFA options vary in their potential to support insect pollinators under standard and pollinator‐friendly management, as well as the extent of farmer uptake. 2. A structured Delphi elicitation process engaged 22 experts from 18 European countries to evaluate EFAs options. By considering life cycle requirements of key pollinating taxa (i.e. bumble bees, solitary bees and hoverflies), each option was evaluated for its potential to provide forage, bee nesting sites and hoverfly larval resources. 3. EFA options varied substantially in the resources they were perceived to provide and their effectiveness varied geographically and temporally. For example, field margins provide relatively good forage throughout the season in Southern and Eastern Europe but lacked early‐season forage in Northern and Western Europe. Under standard management, no single EFA option achieved high scores across resource categories and a scarcity of late season forage was perceived. 4. Experts identified substantial opportunities to improve habitat quality by adopting pollinator‐friendly management. Improving management alone was, however, unlikely to ensure that all pollinator resource requirements were met. Our analyses suggest that a combination of poor management, differences in the inherent pollinator habitat quality and uptake bias towards catch crops and nitrogen‐fixing crops severely limit the potential of EFAs to support pollinators in European agricultural landscapes. 5. Policy Implications. To conserve pollinators and help protect pollination services, our expert elicitation highlights the need to create a variety of interconnected, well‐managed habitats that complement each other in the resources they offer. To achieve this the Common Agricultural Policy post‐2020 should take a holistic view to implementation that integrates the different delivery vehicles aimed at protecting biodiversity (e.g. enhanced conditionality, eco‐schemes and agri‐environment and climate measures). To improve habitat quality we recommend an effective monitoring framework with target‐orientated indicators and to facilitate the spatial targeting of options collaboration between land managers should be incentivised

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Sexualidad en el personal de Salud

La práctica de profesiones relacionadas con la salud se asocia a agotamiento físico y psicológico capaz de producir alteraciones en el plano de la sexualidad. Mediante una encuesta estructurada y anónima se valoró el grado de satisfacción respecto a la calidad de vida sexual y los factores relacionados con esta en médicos, residentes y enfermeros. El 62% afirmó que desde el inicio de la actividad laboral disminuyó la frecuencia y calidad de las relaciones sexuales, primordialmente en residentes (69.3%) (p&lt;0.05) y mujeres (61%), el 33.1% refirió mayor atracción por otras personas y 15% infidelidad. El 71.8% consideró que la frecuencia no era óptima, el 48.6% no estaba satisfecho y el 37.3% que la pareja no estaba conforme con su desempeño sexual. Las mujeres utilizan más pretextos para evitar la relación sexual (22.6 vs. 6.1%), consideran que satisfacen menos a sus parejas (45 vs. 22%) y tienen orgasmos menos frecuentemente (22 vs. 8%) que los hombres (p&lt; 0.05) y estos son más infieles (24.5 vs. 9.7%) (p&lt; 0.05). Los residentes refieren que la frecuencia y calidad sexual disminuyó más con el inicio del trabajo (71.8 vs. 46.7%) (p&lt;0.05), atribuido principalmente al cansancio extremo y se sienten más atraídos por compañeros de trabajo que los médicos de planta (24 vs. 2%) (p&lt;0.05). El cuidado de la salud es un determinante de riesgo de disfunción sexual causado por las demandas y condiciones laborales, que genera un alto grado de estrés y desgaste psicofísico, que conducen a un deterioro de la salud sexual.To evaluate the quality and level of satisfaction of sexual relations for healthcare providers, we studied 142 healthcare workers (staff doctors, residents and nurses) employing a structured and anonymous questionnaire. Ninety three (65.5%) were female, median age 32.9 years (SD±9.2), residents 59.9%, staff doctors 21.1%, nurses 19.01% and 98.6% were heterosexual. Since starting work, 62% reported a diminution in the frequency and quality of sex, mainly in residents (69.3%) (p&lt;0.05) and women’s (61%). Reasons for reduction were excess work (36.4%), extreme exhaustion (68.4%), lack of time (38.6%), desire (25%), disinterest (2.3%) and lack of acceptance of the partner (5.7%). One hundred and two (71.8%) considered the frequency to be sub-optimal and 37.3% felt that their partner was not satisfied. Twenty four (25.8%) of females blamed dyspareunia and 34.4% reduced vaginal lubrication; 12.2% of the males cited erectile dysfunction and 20.4% premature ejaculation. Forty seven (33.1%) felt attracted to persons other than their partner, mainly with to work colleagues (72.3%). Females used more excuses (22.6 vs. 6.1%), felt that they satisfied their partners less (45 vs. 22%), and had orgasms less frequently (22 vs. 8%) and males were significantly more unfaithful (24.5 vs. 9.7%) (p&lt;0.05). The residents experienced a reduction in frequency and quality of sexual relationship and felt more attracted to other work colleagues rather than staff doctors (p&lt;0.05). The practice of health related professions is associated with physical and psychological exhaustion and an uncontrolled stress which produce alterations in the domain of sexuality and deteriorate the sexual health.Fil: Parera, Jorgelina. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Suso, Andrea. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Santolín, Laura. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Clínica MédicaFil: Salomón, Susana Elsa. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Carena, José Alberto. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Urological cancer treatment by a multidisciplinary team throughout the COVID-19 pandemic : what have we learned?

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the COVID-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayedQ4Revista Nacional - IndexadaBN

Oral Anticoagulation in Patients with Chronic Kidney Disease and Non-Valvular Atrial Fibrillation: The FAERC Study

Atrial fibrillation (AF) is the most common arrhythmia in patients with chronic kidney disease (CKD), and its presence is associated with a higher risk of stroke and mortality. Material and Methods: The FAERC study performed a retrospective multicentre analysis of historical cohorts in which data were collected from arrhythmia diagnosis onwards. Results: We analysed a Spanish cohort of 4749 patients with CKD (mean eGFR 33.9 mL/min) followed up in the nephrology clinic, observing a 12.2% prevalence of non-valvular AF. In total, 98.6% of these patients were receiving anticoagulant treatment, mainly with coumarins (79.7%). Using direct-acting oral anticoagulants (DOACs) was associated with fewer cerebrovascular events than using acenocoumarol, but in contrast with other studies, we could not corroborate the association of risk of bleeding, coronary events, or death with a type of anticoagulant prescribed. Conclusions: Atrial fibrillation is highly prevalent in renal patients. Direct-acting anticoagulants seem to be associated with fewer ischemic-embolic complications, with no differences in bleeding, coronary events, or mortality rates

Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)—study protocol

Introduction Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysis This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to &lt;14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7–14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.Ethics and dissemination This study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children’s Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation