[Attitudes and values of the medical internal residents who have chosen the specialty of family and community medicine: A health model adapted to the new times]. / Actitudes y valores de los residentes de Medicina de Familia y Comunitaria: un modelo sanitario adaptado a los nuevos tiempos.

OBJECTIVE: To analyze the views that medical internal residents (MIR), who have chosen the specialty of family and community medicine (MFC), have about training and professional practice, and analyzing the differences in views between them and the rest of the MIR specialties. MATERIAL AND METHODS: On-line survey with the medical residents who began their residential training period in Andalusia in 2008. A factorial analysis of principal components was conducted using the variables of opinion on professional and training issues and training in order to group them into meaningful dimensions, and then a ANOVA to see the differences between them. RESULTS: Three dimensions, that summarize the MFC resident's opinions about their residential training, were obtained. MFC residents have a more positive view of the resident training system, and give more importance to the general aspects of medical practice. CONCLUSIONS: Health policies are currently positioned with the patient at the center of the system and emphasises not only the biological issues but also social issues (prevention, education, treating common diseases, and groups with major problems, etc.). According to the results, the MIR-MFC are more in line with these values, and this might be indicative of a better adaptation to this new culture of the system.

Actitudes y valores de los residentes de Medicina de Familia y Comunitaria: un modelo sanitario adaptado a los nuevos tiempos / Attitudes and values of the medical internal residents who have chosen the specialty of family and community medicine: a health model adapted to the new times

Objetivo. Analizar la visión que tienen de su formación y práctica profesional los médicos internos residentes (MIR) que han elegido la especialidad de medicina de familia y comunitaria (MFC) frente al resto de residentes de otras especialidades, para ver las diferencias entre ambos y sus implicaciones para el sistema. Material y métodos. Encuesta online a MIR que comenzaron su formación residencial en Andalucía en 2008. Se realizó un análisis factorial de los componentes principales a partir de variables de opinión sobre aspectos profesionales y formativos con el fin de agruparlas en dimensiones y posteriormente un ANOVA para observar las diferencias entre los 2 grupos estudiados con respecto a dichas dimensiones. Resultados. Se obtuvieron 3 dimensiones que resumen las opiniones de los residentes sobre su formación residencial. Los residentes de MFC tienen una visión más positiva del sistema de formación y le dan más importancia a cuestiones generales de la práctica médica respecto a los residentes de otras especialidades. Conclusiones. Actualmente las políticas sanitarias posicionan al ciudadano como eje del sistema y ponen el acento no solo en cuestiones biológicas sino también en otras de carácter social (prevención, educación, atención de enfermedades comunes y de colectivos con mayores problemas, etc.). A tenor de los resultados los MIR-MFC parecen estar más en consonancia con estos valores, lo cual puede ser indicativo de una mejor adaptación a esta nueva cultura organizativa (AU)

Objective. To analyze the views that medical internal residents (MIR), who have chosen the specialty of family and community medicine (MFC), have about training and professional practice, and analyzing the differences in views between them and the rest of the MIR specialties. Material and methods. On-line survey with the medical residents who began their residential training period in Andalusia in 2008. A factorial analysis of principal components was conducted using the variables of opinion on professional and training issues and training in order to group them into meaningful dimensions, and then a ANOVA to see the differences between them. Results. Three dimensions, that summarize the MFC resident´s opinions about their residential training, were obtained. MFC residents have a more positive view of the resident training system, and give more importance to the general aspects of medical practice. Conclusions. Health policies are currently positioned with the patient at the center of the system and emphasises not only the biological issues but also social issues (prevention, education, treating common diseases, and groups with major problems, etc.). According to the results, the MIR-MFC are more in line with these values, and this might be indicative of a better adaptation to this new culture of the system (AU)

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Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: “la buena sufridora” / Analysis of rejection of epidural analgesia during labor in Andalusian women: “the silent sufferer”

Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral...(AU)

Introduction: Knowledge and use of epidural analgesia has become increasingly wides preadin Spain over the last 20 years. In Andalusia (southern Spain), expectant mother shave the right to choose this analgesic technique during labor and delivery, an option that depends solely on the physical or health status of the mother or the availability of the resources at the hospital at the time of childbirth. Preference is determined by two interrelated factors. Firstly, a cognitive component, which is influenced by the values, perceptions and culture of the mother and, secondly, a behavioral component, i.e., the acceptance or rejection of the technique, which will depend not only on the motives determining the choice, but on the possibility of choosing epidural analgesia as well as the above-mentioned conditioning factors. Objective: To determine the characteristics of women in Andalusia who refuse epidural anaesthesia during labor, even when this analgesic technique is readily available to them. Material and methods: Annual surveys on user satisfaction with hospital care in Andalusia conducted from 2000-2007 were used, specifically data provided by women who gave birth in public hospitals in Andalusia. Based on these data, a hierarchical segmentation analysis was conducted to determine the profile of women who refused this analgesic technique. Results: Educational level, income and employment status played a significant role in rejection of epidural anaesthesia during labor. Conclusions: The social, economic and cultural factors underlying rejection, that is, the profile of women who reject epidural analgesia, is consistent with the paradigm of the “traditional woman” (characterized by limited income, low educational level and mainly occupied by housework) studied by other authors...(AU)

Prevalence and clinical characteristics of HIV type 1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006: GESIDA 48/05 study.

End-stage renal diseases (ESRD) are becoming more frequent in HIV-infected patients. In Europe there is little information about HIV-infected patients on dialysis. A cross-sectional multicenter survey in 328 Spanish dialysis units was conducted in 2006. Information from 14,876 patients in dialysis was obtained (81.6% of the Spanish dialysis population). Eighty-one were HIV infected (0.54%; 95% CI, 0.43-0.67), 60 were on hemodialysis, and 21 were on peritoneal dialysis. The mean (range) age was 45 (28-73) years. Seventy-two percent were men and 33% were former drug users. The mean (range) time of HIV infection was 11 (1-27) years and time on dialysis was 4.6 (0.4-25) years. ESRD was due to glomerulonephritis (36%) and diabetes (15%). HIV-associated nephropathy was not reported. Eighty-five percent were on HAART, 76.5% had a CD4 T cell count above 200 cells, and 73% had undetectable viral load. Thirty-nine percent of patients met criteria for inclusion on the renal transplant (RT) waiting list but only 12% were included. Sixty-one percent had HCV coinfection. HCV-coinfected patients had a longer history of HIV, more previous AIDS events, parenteral transmission as the most common risk factor for acquiring HIV infection, and less access to the RT waiting list (p < 0.05). The prevalence of HIV infection in Spanish dialysis units in 2006 was 0.54% HCV coinfection was very frequent (61%) and the percentage of patients included on the Spanish RT waiting list was low (12%).