Differences in the baseline characteristics, management and outcomes of patients with hip fractures depending on their pre-fracture place of residence: the Spanish National Hip Fracture Registry (RNFC) cohort.

PURPOSE: One in four hip fracture patients comes from an aged care facility. This study aimed to compare the characteristics of these subjects with their community-dwelling counterparts at baseline, during hospitalization and 1-month post-fracture. METHODS: We analyzed data from a cohort of older adults admitted with hip fractures to 75 Spanish hospitals, collected prospectively in the Spanish National Hip Fracture Registry between 2016 and 2018. We classified participants according to pre-fracture residence: community dwellers vs. aged care facilities residents. We collected demographic records at baseline, along with variables relating to in-hospital evolution and discharge to geriatric rehabilitation units. Patients or relatives were interviewed at 1-month follow-up. RESULTS: Out of 18,262 patients, 4,422 (24.2%) lived in aged care facilities. Aged care facilities residents were older (median age: 89 vs. 86 years), less mobile (inability to walk independently: 20.8% vs. 9.4%) and had more cognitive impairment (Pfeiffer's SPMSQ > 3, 75.3% vs. 34.8%). They were more likely to receive conservative treatment (5.4% vs. 2.0%) and less likely to be mobilized early (58.2% vs. 63.0%). At discharge, they received less vitamin D supplements (68.5% vs. 72.4%), less anti-osteoporotic medication (29.3% vs. 44.3%), and were referred to geriatric rehabilitation units less frequently (5.4% vs. 27.5%). One-month post-fracture, 45% of aged care facilities residents compared to 28% of community dwellers experienced a severe gait decline. Aged care facilities residents had a higher one-month mortality (10.6% vs. 6.8%). CONCLUSION: Hip fracture patients from aged care facilities are more vulnerable than their community-dwelling peers and are managed differently both during hospitalization and at discharge. Gait decline is disproportionately higher among those admitted from aged care.

Medical students' perceptions and attitudes about family practice: a qualitative research synthesis.

BACKGROUND: During the last decade medical students from most Western countries have shown little interest in family practice. Understanding the factors that influence medical students to choose family medicine is crucial. OBJECTIVE: To systematically review and synthesize published evidence about medical students' attitudes and perceptions towards family practice. METHODS: A qualitative systematic review. The literature search was undertaken in July 2010 in PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Social Science Citation Index (SSCI), and ProQuest Dissertations & Theses. Two authors independently selected the studies for their inclusion and assessed their quality. The selected studies were thoroughly read. Key themes and categories were identified. A matrix was created for allowing the comparison of each theme across studies. RESULTS: Ten studies were finally included. Seven broad themes were identified across them: 1) Scope and context of practice was a broad theme comprising linked sub-themes: perception of a varied specialty, broad practice, holistic perspective and flexibility that allows having a family; 2) Lower interest or intellectually less challenging: treating common disease, repetitive, quasi administrative job; 3) Influence of role models, either positive and negative, and society: negative comments from other professionals, peers and family; 4) Lower prestige; 5) Poor remuneration; 6) Medical school influences, being important both the length and quality of the exposure; 7) Post graduate training, where the shorter duration and the lower intensity were perceived as positive aspects. After identifying these seven key themes, were also looked into patterns in the distribution of these themes among studies. CONCLUSIONS: Our qualitative review provides a comprehensive picture of medical students' attitudes towards family practice in the available literature. In general, although some students find family medicine appealing, it is regarded as a career of low interest and prestige. More research is needed on the influence of role models, medical school and post graduate training.

Medical student attitudes towards family medicine in Spain: a statewide analysis.

BACKGROUND: Family and community medicine (FM) became a recognized specialty in Spain in 1978; however, most medical schools in Spain still lack mandatory core courses in FM. In order to explore the perceptions, expectations and level of information amongst medical students in Spain in relation to FM and PC, and the training in these areas in the curriculum of the Medical Schools, a survey was developed to be administered in medical schools every two years. This article presents data from the first questionnaire administration. METHODS: The study population was all first-, third-, and fifth-year students (2009-2010) in 22 participating medical schools in Spain (of 27 total). The 83-item survey had three sections: personal data, FM training, professional practice expectations, and preferences). Chi-squared test or analyses of variance were used, as appropriate. RESULTS: We had a 41.8% response rate (n = 5299/12924); 89.8% considered the social role of FM to be essential, while only 20% believed the specialty was well respected within the medical profession. The appeal of FM increased with years of study, independent of student characteristics or medical school attended. Among third and fifth-year students, 54.6% said their specialty preferences had changed during medical school; 73.6% felt that FM specialists should teach FM courses, and 83.3% thought that FM rotations in primary care centres were useful. CONCLUSIONS: Students valued the social role of FM more highly than its scientific standing. The vast majority believe that FM training should be mandatory. Only 25% of first-year students have clear preferences for a specialization. Interest in FM increases moderately over their years of study. Working conditions in FM have decisive influence in choosing a specialty.

Attitudes and perceptions of medical students about family medicine in Spain: protocol for a cross-sectional survey.

Background Despite the fact that family medicine (FM) has become established as a specialty in the past 25 years, this has not been reflected in the inclusion of the specialty in the majority of medical schools in Spain. Almost 40% of the students will work in primary care but, in spite of this, most universities do not have an assessed placement as such. There are only specific practice periods in health centres or some student-selected components with little weight in the overall curricula. Objectives To evaluate the attitudes and perceptions of medical students about FM in the health system and their perception about the need for specific training in FM at the undergraduate level. To explore change over time of these attitudes and perceptions and to examine potential predictive factors for change. Finally, we will review what teaching activity in FM is offered across the Spanish schools of medicine. Methods Descriptive cross-sectional survey. Each one of the different analyses will consist of two surveys: one for all the students in the first, third and fifth year of medical school in all the Spanish schools of medicine asking about their knowledge, perceptions and attitudes in relation to primary care and FM. There will be an additional survey for the coordinating faculty of the study in each university about the educational activities related to FM that are carried out in their centres. The repetition of the study every 2 years will allow for an analysis of the evolution of the cohort of students until they receive their degree and the potential predictive factors. Discussion This study will provide useful information for strategic planning decisions, content and educational methodology in medical schools in Spain and elsewhere. It will also help to evaluate the influence of the ongoing changes in FM, locally and at the European level, on the attitudes and perceptions of the students towards FM in Spain.

[Family Medicine and university in Spain: initial reflections from a national research project]. / Medicina de Familia y universidad en España: reflexiones iniciales a partir de un proyecto de investigación estatal.

In 2006, a national research project was initially designed in Spain, with the basic aim of analysing the level of information on Primary Care that is available to medical students, their perception of the role of family medicine in the health system, and professional practice preferences, as well as the opinion expressed on the usefulness and need of specific teaching on primary care and family medicine during undergraduate studies. A questionnaire was prepared for each of the Spanish Faculties of Medicine to gather quantitative and qualitative data on the current situation on the teaching of primary care and family medicine. In this article, we give a short description of the characteristics of the project, the principle data obtained with this first questionnaire and, importantly, the first reflections on the academic situation of Family Medicine in Spain.

Os Sistemas de Informação em Atenção Primária como instrumento de gestão em saúde: análise de experiências na Espanha. / The Systems of Information to Primary Health Care as an instrument of health management: the Spanish experience.

Os Sistemas de Informação em Saúde (SIS) instrumentalizam a sistematização da Atenção Primária à Saúde (APS)nas ações, nas decisões, na reconstrução do modelo assistencial e nos micros e macrosespaços da dimensão do trabalho em saúde. Para construir e gerir o campo da saúde, os SIS passam a ser um instrumento importante como facilitador para seus agentes. Objetivou-se, com este estudo, compreender o papel dos SIS no Sistema de Saúde da Espanha na Comunidade Autônoma de Madri a exemplo da Telecita e Tarjeta Sanitária Individual. Trata-se de um estudo descritivo, exploratório, com abordagem metodológica qualitativa. Realizaram-se entrevistas com oito informantes-chave. Para a análise dos dados utilizou-se análise de conteúdo na modalidade temática. Como resultado tem-se que os sistemas de informação na APS têm uma tendência sistêmico-funcional, sendo necessários processos instituídos e instituintes, com a finalidade de revelar os ruídos presentes, potencializando os SIS como instrumento de gestão. As informações contidas nos sistemas de informações são instrumentos de gestão para o sistema sanitário. Concluiu-se que os exemplos da Espanha têm grande valia no Brasil, porém é necessário aprimorar os sistemas de informações na APS focando na capacitação dos recursos humanos para o planejamento local e utilização dos SIS como instrumento de gestão, a fim de que não sejam subutilizados.

The Health System Information (HSI) is relevant to the tool development in Primary Health Care relating actions, decisionmaking, in the rebuilding of the health care system. Furthermore it is related to the micro and macro working spaces process. To develop and manage the health care the HSI became and important instrument to make things easy to its diligent. According to this, the aim of the present study was to comprehend the function of the HSI in the Spanish Health System at the Madri community as example of Telecita and Targeta Sanitária Individual. This is a descriptive, exploratory study with a qualitative approach. Semi-structured interviews with eight information gatekeepers were carried out. The Content Analysis toward Theme category was used. As result we observed that the HSI in the Primary Health Care has a systemic and functional trend, which makes necessary the development of firmed and infirmed processes. This has the object to reveal current and actual work noises, which increase the HSI as a management tool. The HSI indoor information is management tools of a sanitary public health system. We concluded that the Spanish example is very useful for the Brazilian health system but it is necessary to boost the HSI at the primary health care to human resources training in a local planning and to the HIS use as an instrument of health management in order to not make it underused.

[Prevalence of frailty in an elderly Spanish urban population. Relationship with comorbidity and disability]. / Prevalencia de fragilidad en una población urbana de mayores de 65 años y su relación con comorbilidad y discapacidad.

AIM: To estimate prevalence of frailty, by Fried criteria, in a Spanish urban old population, and to analyse relationship with comorbidity and disability. POPULATION: Aged ≥ 65 living in Peñagrande area (Fuencarral district in Madrid, Spain). DESIGN: Cross-sectional study. Baseline evaluation of "Cohort of Peñagrande" established in 814 person. MEASUREMENTS: Frailty was defined by the presence of ≥ 3 of the following criteria: unintentional weight loss, weakness (grip strength), exhaustion, low walking speed, and low physical activity. Age, gender, marital status, educational level, global income at home, comorbidity and disability were measured. A descriptive bivariate and multivariate analysis was performed and ponderated by age and gender in study population. Association was estimated by Odds Ratio and confidence intervals (OR, IC 95%). RESULTS: 73,3% participated (N=814), 48,6% were men and the median age was 76 [71-83]. The estimated prevalence of frailty in the study population was 10,3% (IC95%: 8,2-12,5): 8,1% male and 11,9% female (p=0.084). Frailty was associated with aged ≥ 85 (OR=3,61; IC95%: 1,26-10,29), low educational level (OR=1,71; IC95%: 1,01-2,90), comorbidity (OR=1,27; IC95%:1,03-1,56 by each process) and disability (OR=15,61; IC95%: 8,88-27,45). CONCLUSIONS: Prevalence of frailty in an elderly spanish population is similar to international studies. In our environment first beneficiary population for frailty detection is constituted by people aged ≥ 85, and those with comorbidity and low educational level.

The Hearing-Dependent Daily Activities Scale to evaluate impact of hearing loss in older people.

PURPOSE: We wanted to design and validate the Hearing-Dependent Daily Activities (HDDA) Scale as a means of identifying the impact of hearing loss in older persons by measuring capacity to carry out hearing-dependent activities. METHODS: We undertook a cross-sectional, observational study to validate a scale administered during a personal interview with 1,160 participants aged 65 years and older. When using the instrument to identify patients with hearing impairment, sensitivity and specificity were determined using an audiogram with Ventry and Weinstein criteria as the criterion standard. Standardized audiometries were performed blindly, without knowledge of results of the HDDA Scale. RESULTS: According to the criterion standard, 506 participants had hearing impairment (43.6%; 95% confidence interval [CI], 40.8%-46.5%). The HDDA scale showed high internal consistency (Cronbach's alpha =0.91). Regarding hearing impairment criteria, the HDDA scale obtained a sensitivity of 80.0% (95% CI, 76.3%-83.3%) and a specificity of 70.2% (95% CI, 66.5%-73.5%). CONCLUSIONS: The HDDA scale constitutes a clinically useful instrument for identifying the impact of hearing loss on daily life in the elderly, a condition frequently overlooked during routine medical check-ups. This tool has acceptable psychometric properties and high internal consistency.