ABSTRACT
INTRODUCCIÓN Y OBJETIVOS: La empatía es la capacidad de transmitir comprensión hacia las emociones de otros individuos. La empatía de los profesionales sanitarios se ha asociado a mejores resultados clínicos y de relación con el paciente. El objetivo del estudio era conocer el nivel de empatía de los estudiantes de Medicina, y su evolución después de recibir un curso sobre Entrevista Clínica y Comunicación. MÉTODOS: Estudio longitudinal prospectivo con intervención (módulo de Comunicación y Entrevista Clínica de un mes de duración) y sin grupo control. La empatía se midió con el cuestionario Índice de Reactividad Interpersonal (IRI) que tiene 2 dimensiones cognitivas (toma de perspectiva y fantasía) y 2 emocionales (preocupación empática y distrés personal). La empatía percibida se obtuvo mediante autoevaluación del 0 al 10. RESULTADOS: Participaron 136 alumnos, un 72% eran mujeres, con una edad media de 20,3 años. La empatía percibida correlacionó con las dimensiones del IRI, excepto con distrés personal. Después de la intervención educativa se observaron incrementos en los hombres en toma de perspectiva (de 16,5 a 17,8; p = 0,005) y en las mujeres en fantasía (de 15,5 a 16,7; p = 0,001), con aumento en ambos sexos de la empatía percibida autoevaluada (de 6,9 a 7,4 en hombres; p = 0,009 y de 7,4 a 7,8 en mujeres; p < 0,001). No se modificaron las dimensiones emocionales de empatía. CONCLUSIONES: Los estudiantes de Medicina no perciben dentro de la empatía el componente de distrés personal, y después de la formación se incrementaron los niveles de empatía cognitiva y percibida
INTRODUCTION AND OBJECTIVES: Empathy is the capacity to place oneself in another's position and understand his/her emotions. Empathy of health professionals has been associated with better clinical outcomes and relationship with the patients. The aim of the study is to define the level of empathy of Medical students and how does it evolve after following a one-month Clinical Interview and Communication training module. METHODS: The study is a non-control prospective longitudinal study. Second year Medical students have followed Clinical interview and Communication training module during one month. Empathy has been measured through the Interpersonal Reactivity Index (IRI) questionnaire that has 2 cognitive (perspective taking and fantasy) and 2 emotional (empathic concern and personal distress) dimensions. The perceived empathy was self-assessed using a 1-10 points scale. RESULTS: A sample of 136 students participated on this study (72% women, mean age 20.3 years). The perceived empathy correlates with the size of IRI, except personal distress. Post training intervention scores showed a significant increase in perspective taking dimension among men (from 16.5 to 17.8; P=.005) and fantasy among women (from15.5 to 16.7; P=.001), while self-assessed empathy increased in both sexes (from 6.9 to 7.4 in men; P=.009 and from 7.4 to 7.8 in women; P<.001). CONCLUSIONS: Medical students don't perceive personal distress as an empathy component. After receiving clinical interview and training module, cognitive and perceived empathy were significantly increased
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Empathy/classification , Education, Medical/trends , Educational Measurement/methods , Psychometrics/methods , Communication , Students, Medical/psychology , Prospective Studies , Self-Assessment , Physician-Patient Relations , Controlled Before-After Studies/statistics & numerical dataABSTRACT
BACKGROUND: The recommendation of screening with ankle brachial index (ABI) in asymptomatic individuals is controversial. The aims of the present study were to develop and validate a pre-screening test to select candidates for ABI measurement in the Spanish population 50-79 years old, and to compare its predictive capacity to current Inter-Society Consensus (ISC) screening criteria. METHODS AND RESULTS: Two population-based cross-sectional studies were used to develop (n = 4046) and validate (n = 3285) a regression model to predict ABI < 0.9. The validation dataset was also used to compare the model's predictive capacity to that of ISC screening criteria. The best model to predict ABI < 0.9 included age, sex, smoking, pulse pressure and diabetes. Assessment of discrimination and calibration in the validation dataset demonstrated a good fit (AUC: 0.76 [95% CI 0.73-0.79] and Hosmer-Lemeshow test: χ(2): 10.73 (df = 6), p-value = 0.097). Predictions (probability cut-off value of 4.1) presented better specificity and positive likelihood ratio than the ABI screening criteria of the ISC guidelines, and similar sensitivity. This resulted in fewer patients screened per diagnosis of ABI < 0.9 (10.6 vs. 8.75) and a lower proportion of the population aged 50-79 years candidate to ABI screening (63.3% vs. 55.0%). CONCLUSION: This model provides accurate ABI < 0.9 risk estimates for ages 50-79, with a better predictive capacity than that of ISC criteria. Its use could reduce possible harms and unnecessary work-ups of ABI screening as a risk stratification strategy in primary prevention of peripheral vascular disease.
Subject(s)
Ankle Brachial Index , Mass Screening/methods , Peripheral Arterial Disease/diagnosis , Aged , Asymptomatic Diseases , Chi-Square Distribution , Female , Humans , Logistic Models , Male , Middle Aged , Patient Selection , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/prevention & control , Practice Guidelines as Topic , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Risk Assessment , Risk Factors , SpainABSTRACT
BACKGROUND: High prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain. DESIGN: Comparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain. METHODS: An electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age. RESULTS: A total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol >3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiovascular risk factors. In 1995, 2000 and 2005, low-density lipoprotein cholesterol decreased in both men and women: 4.05-3.91-3.55 mmol/l (156-151-137 mg/dl) and 3.84-3.81-3.40 mmol/l (148-147-131 mg/dl), respectively. Increases were observed in lipid-lowering drug use (5.7-6.3-9.6% in men and 4.0-5.8-8.0% in women), controlled hypertension (14.8-35.4-37.7% in men and 21.3-36.9-45.0% in women); (all P-trends <0.01), and obesity (greatest for men: 17.5-26.0-22.7%, P-trends=0.020). Prevalence of myocardial infarction or possibly abnormal Q waves in electrocardiogram also increased significantly (3.9-4.7-6.4%, P-trends=0.018). CONCLUSIONS: The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs.
Subject(s)
Cardiovascular Diseases/epidemiology , Adult , Aged , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Spain/epidemiology , Time FactorsABSTRACT
Se realizó un estudio longitudinal, retrospectivo y comparativo en el Hospital General Tacuba del ISSSTE, durante el periodo comprendido del 1 de julio de 1995 al 30 de junio de 1996, con la finalidad de determinar la sensibilidad y la especificidad de los diagnósticos obtenidos por medio de cánula de Novak y el legrado biopsia fraccionado comparándolos con el resultado obtenido en la pieza de histerectomía. De 194 histerectomías realizadas en este periodo, se excluyeron 69 pacientes por lo que el grupo final fue de 125 pacientes. Se correlacionaron los resultados de ambos métodos con el estudio histopatológico de la pieza quirúrgica. Se encontró para la biopsia tomada por cánula de Novak una especificidad y una sensibilidad de 75 por ciento, y para el legrado biopsia fraccionado una sensibilidad de 63.26 por ciento y una especificidad de 65.3 por ciento, ambas diferencias son no significativas para la sensibilidad ni para la especificidad entre ambos métodos (p>0.01). Se tuvo un menor rango de error cuando se trataba de endometrio proliferativo o secretor, no así cuando existía hiperplasia simple o con atipia. Concluimos que ambos métodos son igualmente útiles para el estudio de la patología endometrial.
