Medicina familiar y comunitaria: la especialidad más elegida en el MIR / Family and community medicine: The most chosen specialty in the MIR

Medicina Familiar y Comunitaria es la especialidad más ofertada y elegida en el MIR, sin embargo, cada año se cuestiona su atractivo debido que no se ocupan todas las plazas ofertadas y un determinado número de médicos residentes desisten de continuar en dicha especialidad una vez iniciada. En este contexto algunas de las propuestas que se plantean para abordar el problema se centran en incrementar la oferta cuando los hechos muestran que el reto está en actuar sobre la demanda haciendo más atractiva la especialidad y su ámbito de ejercicio profesional. Se procede a analizar este problema y sus condicionantes abriendo el foco del análisis a 4 elementos que pueden estar influyendo en el mismo: los aspectos vocacionales de los graduados en medicina que acuden a la especialización, las características del programa de la especialidad y de las unidades docentes en las que se lleva a cabo la formación, la presencia de la medicina de familia en la universidad como elemento clave para el conocimiento y la afección a dicha especialidad desde el grado y finalmente la situación de la atención primaria, como espacio en el que se materializa la formación y lugar prioritario de desempeño profesional de los futuros especialistas. (AU)

Family and Community Medicine is the most offered and chosen specialty in the MIR (Spanish medical residency examination), however, every year its attractiveness is questioned due to not all offered positions being filled and a certain number of resident doctors deciding not to continue in this specialty once started. In this context, some of the proposals to address the problem focus on increasing the supply when the facts show that the challenge lies in addressing the demand by making the specialty and its professional scope more attractive. The problem and its determinants are analyzed in this context by focusing on four elements that may be influencing it: the vocational aspects of medical graduates who pursue specialization, the characteristics of the specialty program and the teaching units where training is carried out, the presence of family medicine in the university as a key element for knowledge and affinity to this specialty from undergraduate studies, and finally, the situation of primary care as the space where training is materialized and the priority setting for the professional practice of future specialists. (AU)

[Family and community medicine: The most chosen specialty in the MIR]. / Medicina familiar y comunitaria: la especialidad más elegida en el MIR.

Family and Community Medicine is the most offered and chosen specialty in the MIR (Spanish medical residency examination), however, every year its attractiveness is questioned due to not all offered positions being filled and a certain number of resident doctors deciding not to continue in this specialty once started. In this context, some of the proposals to address the problem focus on increasing the supply when the facts show that the challenge lies in addressing the demand by making the specialty and its professional scope more attractive. The problem and its determinants are analyzed in this context by focusing on four elements that may be influencing it: the vocational aspects of medical graduates who pursue specialization, the characteristics of the specialty program and the teaching units where training is carried out, the presence of family medicine in the university as a key element for knowledge and affinity to this specialty from undergraduate studies, and finally, the situation of primary care as the space where training is materialized and the priority setting for the professional practice of future specialists.

Long-Term Feeding of Dairy Goats with 40% Artichoke by-Product Silage Preserves Milk Yield, Nutritional Composition and Animal Health Status.

The aim of this work is to study the effect of 40% inclusion of artichoke by-product silage (AB) in dairy goat diets on milk yield, composition and animal health status during a full lactation period compared to an isoenergetic and isoproteic mixed ration based on alfalfa hay and a cereal and legume mixture. Milk yield was not affected by the dietary treatments, and neither was body weight. AB treatment reduced whey protein (0.38 vs. 0.42%, p < 0.05) and milk urea concentrations (687 vs. 773 mg/L, respectively, p < 0.001), and did not affect total true protein (3.22 vs. 3.24% p > 0.05) or other macro-composition variables. AB treatment showed higher milk concentrations of Ca (p < 0.05), Mn (p < 0.01), Cu (p < 0.01) and Zn (p < 0.001) compared to the control group (C). Slight differences were observed in milk fatty acid profile without any negative effects (p > 0.05) on the blood cholesterol and glucose of goats. The AB group reduced blood urea due to its high dietary total phenol content. However, it had a positive effect on ß-hydroxybutyrate (p < 0.05) and nonesterified fatty acids (p > 0.05). It was concluded that 40% artichoke by-product inclusion in dairy goat feed for the whole lactation period (23 weeks) is a sustainable solution, reducing feeding cost by 12.5% per kg of dry matter, contributing to a better circular economy without any negative repercussions on the productivity and health of Murciano-Granadina dairy goats.

Effect of the Onset of Intramammary Infection on the Electrical Conductivity of Ewe's Milk and Study of Various Algorithms for Its On-Line Detection.

The aim of this study was to determine the effect of the onset of intramammary infection (IMI) on the electrical conductivity (EC) of ewe milk and assess the detection capability of various algorithms based on daily glandular milk EC measurement. An experiment was carried out with 26 Manchega sheep located at the farm of the Miguel Hernández University, Elche, Spain. The variables in milk from the gland (production, EC) were monitored daily for 2 weeks during the morning and evening milking; once infection was established in the gland, the variables were measured for a further 4 weeks. In addition, the SCC, sodium, potassium, chloride and milk macro-compositions were analysed. The sensitivity, specificity and positive and negative predictive values for IMI detection of different algorithms were calculated using the EC variable. It was observed that the onset of IMI resulted in an increase in SCC and a significant decrease in yield, and EC rose significantly when infection occurred bilaterally. The best results for IMI detection were obtained with the algorithm that detected deviations greater than 3σ of the conductivity ratio between collateral glands with respect to a moving average calculated with a time horizon of 10 days (50% sensitivity and 100% specificity).

El nuevo programa de la especialidad de medicina familiar y comunitaria: una oportunidad que no se debe perder / The new program of the Family and Community Medicine specialty: An opportunity not to be missed

El programa formativo de la especialidad de medicina familiar y comunitaria (MFyC), vigente desde 2005, se encuentra en proceso de revisión y actualización. Este artículo hace aportaciones para profundizar en los contenidos específicos de la especialidad que orienten hacia un desarrollo competencial más significativo.Se plantea, para llevar a cabo una formación orientada a los valores, realizar el despliegue de la función valores y propiciar la creación de espacios asistenciales en los que la experiencia cotidiana de esos valores sea posible.Se propone establecer una escala de valores en la que los 2 valores esenciales del médico de familia sean, por este orden, el compromiso con la persona, en singular, y el compromiso con el conjunto de las personas a su cargo, en plural. A su vez se propone la reorganización del mapa de competencias en torno a 5 integradores competenciales o metacompetencias: el método clínico centrado en el paciente, la gestión clínica de base poblacional, la atención primaria orientada a la comunidad, la promoción de la salud o salud comunitaria basada en activos y la investigación en el ámbito familiar y comunitario.(AU)

The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development.To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible.It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.(AU)

[The new program of the Family and Community Medicine specialty: An opportunity not to be missed]. / El nuevo programa de la especialidad de medicina familiar y comunitaria: una oportunidad que no se debe perder.

The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development. To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible. It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.

Optimal Parameters to Milk Murciano-Granadina Goats in Mid and Low-Line Milking Parlours.

Recent short-term studies on Murciano-Granadina goats have established that the optimal parameters to set up the milking machines are different according to the milk pipes height. Two groups of 52 fresh goats each were employed in 2 different experiments to confirm during an entire lactation period the best combinations of system vacuum pulsation rate and pulsator ratio in low-line and mid-line milking parlours. The experiment performed in the low-line milking parlour included one group milked with 40 KPa vacuum system level, 90 puls/min pulsation rate and 60/40 pulsation and a second group milked with 38 KPa vacuum system level, 90 puls/min pulsation rate and 60/40 pulsation ratio. The experiment carried out in mid-line included one group milked with 40 KPa vacuum system level, 90 puls/min pulsation rate and 60/40 pulsation ratio and a second group milked with 40 KPa vacuum system level, 120 puls/min pulsation rate and 60/40 pulsation ratio. Variables studied included milking efficiency, milk composition, cortisol, SCC and intramammary infections, teat-end oedema after milking and vacuum dynamics during milking. Considering the results of an entire lactation period, it was confirmed that when milking in mid-line, the combination of 40 KPa system vacuum, 90 cycles/min pulsation rate and 60/40 pulsator ratio showed optimal results of the above-mentioned variables. On the other hand, the use of 40 KPa in a low-line system increased the milk cortisol values (0.34 ± 0.1 vs. 0.44 ± 0.1 ng/mL) without any other advantage. Thus, the recommendation is to use a combination of 38 KPa system vacuum, 90 cycles/min pulsation rate and 60/40 pulsator ratio to enhance animal welfare.

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program.

Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.

Quality and Functional Parameters of Fermented Milk Obtained from Goat Milk Fed with Broccoli and Artichoke Plant By-Products.

Large amount of vegetal by-products are generated during production and processing steps. Introducing silage from vegetable by-products into dairy goat feed would be of great interest from the point of view of reducing costs and supporting the circular economy. The aim of this research was to study the effect of 40% inclusion of silage broccoli by-products and artichoke plant by-products in the diet of Murciano-Granadina goats throughout the lactation to establish milk suitability for fermented milks production. The novelty of this study is the use of milk from goats fed for a long term with a high inclusion of silages from artichoke plant and broccoli by-products, being the first one on broccoli inclusion. Two starter cultures thermophilic (YO-MIXTM300), and, mesophilic (MA400) were used and fermented milks were analyzed at two storage times after fermentation. Fermentation enhances antioxidant properties of fermented milks from all diets (p < 0.05), especially when mesophilic starter cultures are used. The main findings are that long term inclusion of 40% silage from broccoli and artichoke plant by-products in balanced diets of dairy goats yields milk suitable for fermentation by yogurt and cheese cultures, the inclusion of broccoli silage enhances antioxidant properties (p < 0.05), and, the inclusion of plant artichoke enhances fatty acids health indexes (p < 0.05).

Analysis and evaluation of the operational characteristics of a new photodynamic therapy device.

One of the key aspects of photodynamic therapy is the light source that is used to irradiate the lesion to be treated. The devices used must ensure that their emission spectrum matches the absorption spectrum of the photosensitizer, so that treatment radiation is delivered only on the target area, without irradiating healthy tissue at superficial or deep levels. Irradiance values must be adequate in order to avoid thermal damage, exceed the oxygen replenishment rate and avoid long treatment times. Furthermore, the device should be user-friendly, inexpensive, and able to be adapted to different photosensitizers. We have developed an easy-to-use and highly customizable device based on LED technology. Its innovative geometric design allows radiation to be delivered to a small treatment surface, since the LEDs are arranged in three arms, the configuration of which directs their radiation on the treatment point. Different high-power color LEDs are disposed on the arms, and can be independently selected based on the most effective wavelengths for exciting the different photodynamic therapy photosensitizers. We have tested the prototype in 5 different patients (1 actinic keratose, 1 actinic cheilitis, 1 superficial basal cell carcinoma and 2 Bowen's disease) and after 1-2 sessions of total cumulative dose of 25-50 J / cm2, 100% clearance of lesions were obtained. Our device can be used by any professional in the field, whether for medical or research purposes. It facilitates the development of treatment protocols and trials with different photosensitizers.

Terminal Crossbreeding of Murciano-Granadina Goats to Boer Bucks: Effects on Reproductive Performance of Goats and Growth of Kids in Artificial Rearing.

The aim of this work was to improve the growth characteristics of Murciano-Granadina (MG) kids through terminal crossbreeding of MG goats to Boer bucks. Four experiments were carried out, using a total of 354 MG goats, half of which were mated with MG bucks (n = 12) and the other half with Boer bucks (n = 12). The kids were raised in artificial rearing until slaughter weight (9 kg). The birth weight and average daily gain were recorded in crossed kids (n = 197 and 145, respectively) and purebred kids (n = 257 and 169, respectively). Crossed kids presented significant differences (p < 0.001) compared to MG purebred kids in birth weight (+ 24%), mortality in artificial rearing (-37%), average daily gain (+32%) and milk powder conversion rate (-16%). However, the reproductive performance rates of MG goats mated with Boer bucks were slightly worse (pregnancy rate: 78.5% vs. 86.6%, p < 0.05; kidding rate: 62.0% vs. 75.7%; p < 0.01; prolificacy: 1.9 vs. 2.1 kids/parturition), especially when the matings took place in non-breeding season (experiments conducted at latitude 38-39° N). It is concluded that the terminal crossbreeding of MG goats to Boer bucks (those not used to produce replacement kids) could be an interesting option for ethical goat production.

Automatic Prestimulation on Dairy Goats: Milking Efficiency and Teat-End Status.

Experiments carried out in dairy cows show that mechanical stimulation prior to milking offers a good release of oxytocin without involving changes in milk yield or a reduction of the milking time. The objective of the present study was to evaluate the effect of automatic prestimulation on milk fractioning, milking duration and milk flows, teat-end status, and vacuum levels at the short milk tubes and in the pulsation tubes of dairy goats. With this aim, three experiments in Latin square design were developed employing goats in different moments of the lactation: one of them at the onset of lactation, one at mid-lactation, and the last at the end of lactation. Two treatments were tested: milking with a mechanical prestimulation of 300 ppm for a 20-s period and milking without prestimulation. Results showed that prestimulation at the end of lactation showed slightly lower average milk flow (kg/min) values (0.53 ± 0.02 vs. 0.60 ± 0.02; p = 0.03) and lower maximum vacuum level values (Kpa) in the pulsation tubes (27.08 ± 0.15 vs. 39.48 ± 0.25; p < 0.01). No other differences were found in the variables related to milking efficiency or teat-end status in the three experiments carried out.

Effect of Vacuum Level and Pulsation Parameters on Milking Efficiency and Animal Welfare of Murciano-Granadina Goats Milked in Mid-Line and Low-Line Milking Machines.

The Murciano-Granadina goat breed has been described as a slow milking breed. As milking machine parameters can affect milk extraction in terms of yield and time employed, two experiments of one-month duration were performed with 88 goats in Latin square design to find the best combination of these parameters. One of them was carried out in a mid-line milking machine and one in a low-line milking machine. For each of them, two vacuum levels (36 and 40 kPa), two pulsation rates (90 and 120 cycles/min) and two pulsator ratios (50 and 60%) were used and milking efficiency, sanitary status of the mammary gland, milk cortisol, and teat end status were evaluated. Results showed that in milking machines installed in mid- and low-line, the use of 40 kPa system vacuum, 60% pulsator ratio and 90 or 120 cycles/min pulsation rate achieved optimum milking fractioning and efficiency. In the case of low-level milking machines, a similar combination with 36 kPa not only showed worse milking fractioning values, but also provided better values of teat end status and cortisol level.

Long-Term Feeding of Dairy Goats with Broccoli By-Product and Artichoke Plant Silages: Milk Yield, Quality and Composition.

The aim of this experiment was to study the effects of a 40% inclusion of broccoli by-product (BB) and artichoke plant (AP) silages in dairy goat diets on the milk yield, composition and animal health status during a full lactation. Feed consumption was lower in AP and BB animals due to their composition and higher moisture content, and BB animals showed a significant reduction in body weight. Milk from the BB treatment had the highest fat content, total solids and useful dry matter content (5.02, 13.9 and 8.39%, respectively). The Se level was slightly lower in AP and BB animals; however, the milk of these treatments was the lowest in Na and, in the case of BB animals, the richest in Ca (1267 mg/kg). Control and AP milk showed a similar fatty acid profile, although AP had a more beneficial aptitude for human health (lower ratio of n6/n3, 12.5). Plasma components, as metabolic parameters, were adequate for goats. It was concluded that a 40% inclusion of AP is an adequate solution to reduce the cost of feeding without harming the animals' health or performance and to improve the nutritional milk quality. It is necessary to lower the BB level of inclusion to increase feed consumption.

Composition, Mineral and Fatty Acid Profiles of Milk from Goats Fed with Different Proportions of Broccoli and Artichoke Plant By-Products.

In the Mediterranean region, artichoke and broccoli are major crops with a high amount of by-products that can be used as alternative feedstuffs for ruminants, lowering feed costs and enhancing milk sustainability while reducing the environmental impact of dairy production. However, nutritional quality of milk needs to be assured under these production conditions and an optimal inclusion ratio of silages should be determined. This work aimed to evaluate the effect of three inclusion levels (25%, 40%, and 60%) of these silages (artichoke plant, AP, and broccoli by-product, BB) in goat diets on milk yield, composition, and mineral and fatty profiles. Treatments with 60% inclusion of AP and BB presented the lowest milk yield. No differences were found on the milk mineral profile. Inclusion of AP in the animals' diet improved the milk lipid profile from the point of view of human health (AI, TI) compared to BB due to a lower saturated fatty acid content (C12:0, C14:0, and C16:0) and a higher concentration of polyunsaturated fatty acids (PUFA), especially vaccenic acid (C18:1 trans11) and rumenic acid (CLA cis9, trans11), without any differences with the control treatment.

Ensiling Process in Commercial Bales of Horticultural By-products from Artichoke and Broccoli.

Wastes from artichoke and broccoli crops and cannery industries represent an environmental problem. A viable option to this problem is ensiling them for use as ruminants feed. The aim of this study was to characterise the ensiling process of broccoli and artichoke by-products and assess their suitability to be part of the ruminant diet, as well their minimum shelf life. Twenty-one commercial round bale silos (300 kg and 0.64 m3) of each by-product were made. Samples were analysed at days 0, 7, 15, 30, 60, and 200 to determine microbial populations, fermentation metabolites, nutritional components, and phytosanitary residues. Feedstuffs showed good suitability for ensiling, and stabilisation was achieved on day 30. The variables with the greatest significant differences among sampling times were microbial populations and fermentative components. There were no important dry matter losses, and some significant differences were observed in the nutritional composition, especially in crude protein and fibrous fractions, but they were not relevant for the loss of nutritional quality of silages. The phytosanitary residues determined on day 200 were below the maximum residue limits set by European legislation. So, ensiling these by-products in commercial round bale silos is a suitable and profitable technique that allows their preservation for a long time (200 days).

Short-Term Effect of the Inclusion of Silage Artichoke By-Products in Diets of Dairy Goats on Milk Quality.

Artichoke by-products represent a high amount of waste whose removal entails several costs. Moreover, feed is the main cost in a farm. So, including these by-products in ruminant diets would lower feed costs. Two experiments were conducted to evaluate the effect of two levels of inclusion, 12.5% and 25.0%, of two silages of artichoke by-products (artichoke bracts, AB and artichoke plant, AP) in the diet of goats on the milk yield, composition and quality and on the metabolic profile of the animals. AB presented the lowest blood urea content and there were no differences in milk yield in the two experiments. However, with 25.0% of silage by-product in the diet, a higher fat content was observed in AB and of protein in AP, as well as this treatment showing a slightly higher Se content. Regarding the milk lipid profile, milk from 12.5% of AP treatment presented a higher PUFA content. In conclusion, the use of silage artichoke by-products in dairy goat diets does not jeopardise milk yield and quality and health status of animals and, from a nutritional point of view for human health, a slightly better mineral and lipid profile is observed in milk from AP treatments.