Squamous cell carcinoma and basal cell carcinoma of the lips: 25 years of experience in a northeast Brazilian population.

BACKGROUND: The lips are the transition zone between the facial skin and the oral mucosa and are the site of alterations related to a broad spectrum of etiologies. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most prevalent neoplasms affecting lips. This study evaluated the demographic and clinicopathological features of the SCC and BCC in the lip. MATERIAL AND METHODS: A retrospective cross-sectional descriptive study (1994-2019) was carried out. Demographic and clinicopathologic data were collected from a hospital's dermatological service and an oncologic hospital. The data were submitted to descriptive analysis and Pearson's chi-square and Fisher's exact tests (p ≤ 0.05). RESULTS: 417 medical records were analyzed, of which 323 corresponded to SCC (77.5%) and 94 to BCC (22.5%). SCC showed more frequency in males (58.8%) and BCC in females (54.3%). The lower lip was significantly affected in male patients (p < 0.0001) and by both neoplasms (70.6% and 56.4%, respectively; p = 0.014). SCC and BCC were mainly treated with surgery (88.3% and 93.2%, respectively). Surgical margin was frequently negative in SCC and BCC (87%; 72.3%, respectively), and no recurrence was observed in 79.9% of SCC and 69.1% of BCC cases. CONCLUSIONS: SCC was more frequent in male patients, while BCC showed more frequency in female patients. Both neoplasms mainly affect the lower lip. Understanding the epidemiological profile of these lesions in the lip, as well as their etiology and clinical features, is fundamental for appropriate clinical conduct and the creation and/or amplification of preventive measures.

La actividad física en la enfermedad de Parkinson: identificación de los responsables de su prescripción, hábitos e impacto en la calidad de vida, y de la gravedad de la enfermedad / Physical activity in Parkinson’s disease: examining prescription sources, patterns, and the influence of quality of life and disease severity

Introducción: Escasas investigaciones han explorado la influencia de la calidad de vida (CV) y la gravedad de la enfermedad en la actividad física (AF) en pacientes con enfermedad de Parkinson (EP), así como las fuentes de prescripción de AF y consejos para esta población. Este estudio tiene como objetivo ampliar el conocimiento científico sobre estos temas. Pacientes y métodos: Se entrevistó personalmente a 211 pacientes con EP para recopilar datos sobre los niveles de AF con el International Physical Activity Questionnaire-Short Form y la CV con el Parkinson’s Disease Questionnaire-8. Un cuestionario ad hoc recopiló información sobre la gravedad de la enfermedad (etapas de Hoehn y Yahr), los comportamientos de AF y las recomendaciones de AF. Resultados: Se encontraron asociaciones débiles, pero significativas, entre los niveles de AF, la gravedad de la enfermedad (r = –0,218; p = 0,004) y la CV (r = –0,244; p = 0,001). La mayoría de los participantes (85%) recibió asesoramiento sobre AF, principalmente de neurólogos, ya sea en el momento del diagnóstico (52%) o poco después (28%). Antes del inicio de la EP, ~86% participaba en AF, lo que disminuyó al 66% después del diagnóstico. Aproximadamente el 78% informó sobre cambios en la AF, incluida una reducción en la frecuencia (18,4%) y la duración (32,8%), y la caminata era la actividad principal. Conclusiones: La gravedad de la enfermedad y la CV afectan significativamente a los niveles de AF en pacientes con EP. El diagnóstico se asocia con una disminución en la frecuencia y la duración de la AF, y la caminata es la actividad preferida. Los neurólogos aconsejan principalmente sobre AF a las personas con EP. (AU)

Introduction: Limited research has explored the influence of quality of life (QoL) and disease severity on physical activity (PA) in Parkinson’s disease (PD) patients, and the sources of PA prescription and advice for this population. This study aims to expand scientific knowledge on these topics. Patients and methods: Two-hundred eleven PD patients were personally interviewed to collect data on PA levels using the International Physical Activity Questionnaire-Short Form and QoL using the Parkinson’s Disease Questionnaire-8. An ad hoc questionnaire gathered information on disease severity (Hoehn and Yahr stages), PA behaviors, and PA recommendations. Results: Weak but significant associations were found between PA levels, disease severity (r: –0.218; p = 0.004), and QoL (r: –0.244; p = 0.001). Most participants (85%) received PA counselling, predominantly from neurologists, either at diagnosis (52%) or shortly after (28%). Before PD onset, ~86% engaged in PA, decreasing to 66% post-diagnosis. Approximately 78% reported changes in PA, including reduced frequency (18.4%) and duration (32.8%), with walking as the primary activity. Conclusions: Disease severity and QoL significantly affect PA levels in PD patients. Diagnosis is associated with decreased PA frequency and duration, and walking is the preferred activity. Neurologists primarily provide PA advice.(AU)

Physical activity in Parkinson's disease: examining prescription sources, patterns, and the influence of quality of life and disease severity. / La actividad física en la enfermedad de Parkinson: identificación de los responsables de su prescripción, hábitos e impacto en la calidad de vida, y de la gravedad de la enfermedad.

INTRODUCTION: Limited research has explored the influence of quality of life (QoL) and disease severity on physical activity (PA) in Parkinson's disease (PD) patients, and the sources of PA prescription and advice for this population. This study aims to expand scientific knowledge on these topics. PATIENTS AND METHODS: Two-hundred eleven PD patients were personally interviewed to collect data on PA levels using the International Physical Activity Questionnaire-Short Form and QoL using the Parkinson's Disease Questionnaire-8. An ad hoc questionnaire gathered information on disease severity (Hoehn and Yahr stages), PA behaviors, and PA recommendations. RESULTS: Weak but significant associations were found between PA levels, disease severity (r: -0.218; p = 0.004), and QoL (r: -0.244; p = 0.001). Most participants (85%) received PA counselling, predominantly from neurologists, either at diagnosis (52%) or shortly after (28%). Before PD onset, ~86% engaged in PA, decreasing to 66% post-diagnosis. Approximately 78% reported changes in PA, including reduced frequency (18.4%) and duration (32.8%), with walking as the primary activity. CONCLUSIONS: Disease severity and QoL significantly affect PA levels in PD patients. Diagnosis is associated with decreased PA frequency and duration, and walking is the preferred activity. Neurologists primarily provide PA advice.

TITLE: La actividad física en la enfermedad de Parkinson: identificación de los responsables de su prescripción, hábitos e impacto en la calidad de vida, y de la gravedad de la enfermedad.Introducción. Escasas investigaciones han explorado la influencia de la calidad de vida (CV) y la gravedad de la enfermedad en la actividad física (AF) en pacientes con enfermedad de Parkinson (EP), así como las fuentes de prescripción de AF y consejos para esta población. Este estudio tiene como objetivo ampliar el conocimiento científico sobre estos temas. Pacientes y métodos. Se entrevistó personalmente a 211 pacientes con EP para recopilar datos sobre los niveles de AF con el International Physical Activity Questionnaire-Short Form y la CV con el Parkinson's Disease Questionnaire-8. Un cuestionario ad hoc recopiló información sobre la gravedad de la enfermedad (etapas de Hoehn y Yahr), los comportamientos de AF y las recomendaciones de AF. Resultados. Se encontraron asociaciones débiles, pero significativas, entre los niveles de AF, la gravedad de la enfermedad (r = ­0,218; p = 0,004) y la CV (r = ­0,244; p = 0,001). La mayoría de los participantes (85%) recibió asesoramiento sobre AF, principalmente de neurólogos, ya sea en el momento del diagnóstico (52%) o poco después (28%). Antes del inicio de la EP, ~86% participaba en AF, lo que disminuyó al 66% después del diagnóstico. Aproximadamente el 78% informó sobre cambios en la AF, incluida una reducción en la frecuencia (18,4%) y la duración (32,8%), y la caminata era la actividad principal. Conclusiones. La gravedad de la enfermedad y la CV afectan significativamente a los niveles de AF en pacientes con EP. El diagnóstico se asocia con una disminución en la frecuencia y la duración de la AF, y la caminata es la actividad preferida. Los neurólogos aconsejan principalmente sobre AF a las personas con EP.

Dysautonomia and small fiber neuropathy in post-COVID condition and Chronic Fatigue Syndrome.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and post-COVID condition can present similarities such as fatigue, brain fog, autonomic and neuropathic symptoms. METHODS: The study included 87 patients with post-COVID condition, 50 patients with ME/CFS, and 50 healthy controls (HC). The hemodynamic autonomic function was evaluated using the deep breathing technique, Valsalva maneuver, and Tilt test. The presence of autonomic and sensory small fiber neuropathy (SFN) was assessed with the Sudoscan and with heat and cold evoked potentials, respectively. Finally, a complete neuropsychological evaluation was performed. The objective of this study was to analyze and compare the autonomic and neuropathic symptoms in post-COVID condition with ME/CFS, and HC, as well as, analyze the relationship of these symptoms with cognition and fatigue. RESULTS: Statistically significant differences were found between groups in heart rate using the Kruskal-Wallis test (H), with ME/CFS group presenting the highest (H = 18.3; p ≤ .001). The Postural Orthostatic Tachycardia Syndrome (POTS), and pathological values in palms on the Sudoscan were found in 31% and 34% of ME/CFS, and 13.8% and 19.5% of post-COVID patients, respectively. Concerning evoked potentials, statistically significant differences were found in response latency to heat stimuli between groups (H = 23.6; p ≤ .01). Latency was highest in ME/CFS, and lowest in HC. Regarding cognition, lower parasympathetic activation was associated with worse cognitive performance. CONCLUSIONS: Both syndromes were characterized by inappropriate tachycardia at rest, with a high percentage of patients with POTS. The prolonged latencies for heat stimuli suggested damage to unmyelinated fibers. The higher proportion of patients with pathological results for upper extremities on the Sudoscan suggested a non-length-dependent SFN.

Aumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19 / Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians

Introducción El burnout es un síndrome psicosocial causado por situaciones estresantes en el ámbito laboral. Afecta al 30-60% de los profesionales médicos. El objetivo de este estudio es realizar un análisis comparativo de su frecuencia antes y después del brote de la COVID-19 en los médicos adjuntos de Medicina Interna españoles. Métodos Se enviaron encuestas por correo electrónico y redes sociales integradas con el Maslach Burnout Inventory a los miembros de la Sociedad Española de Medicina Interna en 2019 y 2020. Resultados Se ha observado un aumento no significativo de burnout (38,0% vs. 34,4%). Sin embargo, sí se constata un aumento en la baja realización personal (66,4% vs. 33,6%; p=0,002), dimensión asociada a la prevención de la morbilidad psiquiátrica, además de otras dos: la fatiga emocional y la despersonalización, que pueden afectar negativamente a la atención del paciente. Conclusiones Es esencial abordar este síndrome individual e institucionalmente (AU)

Introduction Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30% to 60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. Methods Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. Results A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p=0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. Conclusions It is essential to address this syndrome individually and institutionally (AU)

Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians.

INTRODUCTION: Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30%-60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. METHODS: Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. RESULTS: A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p = 0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. CONCLUSIONS: It is essential to address this syndrome individually and institutionally.

[Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians]. / Aumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19.

Introduction: Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30% to 60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. Methods: Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. Results: A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p = 0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. Conclusions: It is essential to address this syndrome individually and institutionally.

Mucocutaneous diseases with manifestations in the head and neck region: 24 years of experience in a Dermatology service.

BACKGROUND: This study aimed to evaluate the clinicopathological features of mucocutaneous diseases with manifestation in the head and neck region. MATERIAL AND METHODS: A retrospective analysis of a dermatology reference center database was carried out. Over 24 years. Clinicopathological data were collected from medical records and the data was analyzed by descriptive statistics. RESULTS: A total of 11.538 medical records were analyzed, being 152 cases of mucocutaneous diseases with manifestations in the head and neck region. Cutaneous lupus erythematosus was the most prevalent diagnosis (66.4%). Face (44.1%), females (79.6%), and patients with 45 years mean age were the most common features. In the oral cavity, the most affected region was the buccal mucosa (37.5%). CONCLUSIONS: Mucocutaneous diseases with head and neck manifestation were rare in the sample analyzed (1.3%), with cutaneous lupus erythematosus and lichen planus being the most common lesions in this region.

Prevalence and severity of urinary incontinence among male and female competitors and recreational CrossFit® practitioners.

OBJECTIVE: This study aimed to determine the prevalence, severity and type of urinary incontinence (UI) in female and male CrossFit® practitioners. STUDY DESIGN: The study design is an online cross-sectional survey distributed to CrossFit® practitioners across all Spanish regions. The questionnaire included categorical questions related to CrossFit® practice, multiple-choice questions to determine the exercises performed during reported UI symptoms, and The International Consultation on Incontinence Questionnaire Short-Form questionnaire items. RESULTS: Five hundred seventy-one practitioners (34.0 ± 8.37 years, Body Mass Index 24.20 ± 3.34 kg/m2) met inclusion criteria and completed the survey. There were and 316 females and 255 males. Around 45 % of women and 6 % of men reported having UI (p < 0.001). The severity of UI mainly was slight (30.3 % women, 3.5 % men) and moderate (11.7 % women, 2.3 % men) (p < 0.001). Stress and urgent UI were the most prevalent types among women (36 %) and men (5 %) (p < 0.001). CONCLUSIONS: This study found that UI is relatively common among female CrossFit® practitioners, especially in repetitive jumps. The practitioners' profile (amateur/competitor) does not affect the prevalence or severity of UI. Male athletes can also experience urine leakage while performing CrossFit®, although its prevalence is much lower when compared to female practitioners.

Historical and future naturalization of Magallana gigas in the Galician coast in a context of climate change.

Magallana gigas is a naturalized species on the north coast of Galicia (Rías Altas, Northwest Iberian Peninsula), where it was unintentionally introduced. In recent decades, a greater abundance of M. gigas has been observed on the Galician coast, expanding towards the south, reaching the Artabro Gulf (Rías Centrales, NW Galician coast), probably due to ocean warming. Although this species has been cultivated in the Rías Baixas since the early 1990s and spawning has been reported, recruitment was never observed, which is likely due to the cold water upwelled during the spawning months. The future rise in seawater temperature may favor the naturalization of the non-indigenous species M. gigas southwards, in the Rías Baixas. Thermally, the Ría de Arousa seems to be the most favorable estuary for the future settlement of M. gigas, which may occur in the next decades. The extent of thermally favorable zones within estuaries is projected to increase rapidly by mid-century, and reaching 100 % of the estuarine area by the end of the century. As has already happened in other areas of the world, the expansion and naturalization of the Pacific oyster on the Galician coast will likely affect the native communities and economic activities, making it necessary to implement monitoring and management strategies to mitigate its effect.

Effects of exercise training on obesity-related parameters in people with intellectual disabilities: systematic review and meta-analysis.

BACKGROUND: Efforts to synthesise existing knowledge concerning the effects of exercise interventions on obesity (i.e. changes in body weight and composition) have been made, but scientific evidence in this matter is still limited. This systematic review and meta-analysis aims to identify and critically analyse the best available evidence regarding the use of physical exercise as a strategy to attenuate obesity through its effects on adiposity-related anthropometric parameters in people with intellectual disability (ID). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed using PubMed, Scopus, SPORTDiscus, CINAHL and the Cochrane Library through specific keywords up to July 2020. The search adhered to the population, intervention, comparison and outcome strategy. Randomised controlled trials addressing the effects of the exercise intervention on adiposity-related anthropometric parameters (body mass index, waist circumference, waist-hip ratio, fat percentage or body weight) in children, adolescents and adults with ID were included. The methodological quality of the studies found was evaluated through the PEDro scale. RESULTS: A total of nine investigations with children and/or adolescents (10-19 years) and 10 investigations with adults (18-70 years) were selected, mostly experiencing mild and moderate ID. Methodological quality was fair in 13 of these publications, good in five and excellent in one. Seventeen trials reported comparable baseline and post-intervention data for the intervention and control groups and were included in the meta-analysis. In nine studies, the intervention group performed a cardiovascular training programme. Five papers described a combined training programme. Two trials executed whole-body vibration training programmes, and one publication proposed balance training as the primary intervention. According to the meta-analysis results, the reviewed studies proposed exercise modalities that, in comparison with the activities performed by the participants' in the respective control groups, did not have a greater impact on the variables assessed. CONCLUSIONS: While physical exercise can contribute to adiposity-related anthropometric parameters in people with mild and moderate ID, these findings show that exercise alone is not sufficient to manage obesity in this population. Multicomponent interventions appear to be the best choice when they incorporate dietary deficit, physical activity increase and behaviour change strategies. Finding the most effective modality of physical exercise can only aid weight loss interventions. Future research would benefit from comparing the effects of different exercise modalities within the framework of a multicomponent weight management intervention.

Síndrome de burnout en especialistas de medicina interna y factores asociados a su desarrollo / Burnout syndrome in internal medicine specialists and factors associated with its onset

ANTECEDENTES Y OBJETIVOS: El burnout es un síndrome psicosocial que se produce en respuesta a situaciones estresantes durante el desarrollo laboral; afecta a un 30-60% del personal sanitario. El objetivo de este estudio es valorar su frecuencia en los internistas de España y qué factores podrían relacionarse con su aparición. MATERIAL Y MÉTODOS: Se realizó una encuesta sobre las condiciones laborales seguida del Maslach Burnout Inventory y se difundió mediante el registro de correos electrónicos y las redes sociales de la Sociedad Española de Medicina Interna. Se realizó un estudio descriptivo y un análisis univariante y multivariante para valorar qué variables se asociaron con la presencia de síndrome de burnout. RESULTADOS: Contestaron la encuesta 934 internistas, 58,8% mujeres, con una mediana de edad de 40,0 años. Un 55,0% presentaba un grado de cansancio emocional alto, un 61,7% un grado de despersonalización alto y un 58,6% un grado de realización personal bajo. El 33,4% presentaba burnout. El síndrome de burnout se relacionó de forma independiente con la edad (OR 0,96; IC 95% 0,94-0,98), el mal ambiente de trabajo (OR 1,94; IC 95% 1,31-2,82), no ganar suficiente dinero (OR 1,79; IC 95% 1,20-2,67), haber recibido amenazas (OR 1,703; 1,204-2,410) y tener la sensación de no progresar profesionalmente (OR 2,83; IC 95% 1,92-4,17). CONCLUSIONES: El síndrome de burnout afecta al 33,4% de los internistas de España. Su desarrollo se relaciona de forma independiente con la edad, el mal ambiente de trabajo, no tener la sensación de poder progresar profesionalmente, no creer suficiente la retribución económica recibida y haber sufrido amenazas por parte de pacientes o compañeros

BACKGROUND AND OBJECTIVES: Burnout is a psychosocial syndrome caused by stressful working conditions and affects 30-60% of medical personnel. The aim of this study was to assess the burnout rate of Spanish internists and the factors related to its onset. MATERIAL AND METHODS: We conducted a survey of work conditions followed by the Maslach Burnout Inventory, which was disseminated through the email registry and social networks of the Spanish Society of Internal Medicine. We performed a descriptive study and a univariate and multivariate analysis assessing the variables associated with burnout syndrome. RESULTS: A total of 934 internists (58.8% women and a median age of 40.0 years) answered the survey. Some 55.0% of the internists indicated high emotional fatigue, 61.7% indicated a high sense of depersonalisation, and 58.6% indicated low personal fulfilment. Some 33.4% of the interns experienced burnout. Burnout syndrome was independently related to age (OR 0.96; 95% CI 0.94-0.98), poor work environment (OR 1.94; 95% CI 1.31-2.82), insufficient wages (OR 1.79; 95% CI 1.20-2.67), receiving threats (OR 1.703; 95% CI 1.204-2.410) and the feeling of a lack of professional progress (OR 2.83; 95% CI 1.92-4.17). CONCLUSIONS: Burnout syndrome affects 33.4% of internists in Spain, and its onset is independently related with age, poor work environment, a lack of professional progress, insufficient financial remuneration and experiencing threats by patients or colleagues

Physiotherapy for freezing of gait in Parkinson's disease: a systematic review and meta-analysis. / Fisioterapia para la congelación de la marcha en la enfermedad de Parkinson: revisión sistemática y metaanálisis.

INTRODUCTION: Freezing of gait (FOG) is one of the most severe symptoms associated with Parkinson's disease (PD). Physiotherapy treatment could be an effective strategy for treating FOG, but no systematic review has been carried out in this regard. AIM: To identify the characteristics, methodological quality, and main outcomes of the studies that have analyzed the effects of physiotherapy interventions in FOG up to date, by performing a systematic review and a meta-analysis. PATIENTS AND METHODS: Four electronic databases were searched in order to find randomized controlled trials that provided information regarding the effects of any kind of physiotherapy treatment on FOG. The methodological quality of the included investigations was assessed by means of the PEDro scale. RESULTS: Twelve studies were identified for inclusion into the qualitative analysis, with four randomized controlled trials included in the final meta-analysis. The quality of the trials was generally good. Those physiotherapy modalities including cues were more effective for treating FOG than traditional physiotherapy approaches. The meta-analysis indicated that physiotherapy interventions had a significantly greater impact on FOG than control comparisons. CONCLUSIONS: Physiotherapy treatment, especially those modalities including visual and auditory cueing, should be prescribed to PD patients with FOG. Future studies including PD patients with cognitive impairment and FOG objective measurement tools are need to complete the existing scientific evidence.

TITLE: Fisioterapia para la congelación de la marcha en la enfermedad de Parkinson: revisión sistemática y metaanálisis.Introducción. La congelación de la marcha (CDM) es uno de los síntomas más graves asociados con la enfermedad de Parkinson (EP). El tratamiento fisioterapéutico podría ser una estrategia efectiva para su tratamiento, pero no se ha realizado ninguna revisión sistemática al respecto. Objetivo. Identificar las características, la calidad metodológica y los principales resultados de los estudios que han analizado los efectos de las intervenciones fisioterapéuticas en CDM hasta la fecha, mediante la realización de una revisión sistemática y un metaanálisis. Pacientes y métodos. Se realizaron búsquedas en cuatro bases de datos electrónicas para encontrar ensayos controlados aleatorizados que proporcionaran información con respecto a los efectos de cualquier tipo de tratamiento fisioterapéutico sobre la CDM. La calidad metodológica de las investigaciones se evaluó mediante la escala PEDro. Resultados. Se identificaron 12 estudios para su inclusión en el análisis cualitativo y cuatro ensayos controlados aleatorizados se incluyeron en el metaanálisis final. La calidad de los ensayos fue generalmente buena. Las modalidades de fisioterapia que incluían señales fueron más efectivas para tratar la CDM que los enfoques de fisioterapia tradicionales. El meta­análisis indicó que las intervenciones fisioterapéuticas tuvieron un impacto significativamente mayor sobre la CDM que las comparaciones de control. Conclusiones. El tratamiento fisioterapéutico, especialmente las modalidades que incluyen señales visuales y auditivas, debe prescribirse a los pacientes con EP con CDM. Se necesitan estudios futuros que incluyan pacientes con EP con deterioro cognitivo y herramientas de medición objetiva de la CDM para completar la evidencia científica existente.

Burnout syndrome in internal medicine specialists and factors associated with its onset. / Síndrome de burnout en especialistas de medicina interna y factores asociados a su desarrollo.

BACKGROUND AND OBJECTIVES: Burnout is a psychosocial syndrome caused by stressful working conditions and affects 30-60% of medical personnel. The aim of this study was to assess the burnout rate of Spanish internists and the factors related to its onset. MATERIAL AND METHODS: We conducted a survey of work conditions followed by the Maslach Burnout Inventory, which was disseminated through the email registry and social networks of the Spanish Society of Internal Medicine. We performed a descriptive study and a univariate and multivariate analysis assessing the variables associated with burnout syndrome. RESULTS: A total of 934 internists (58.8% women and a median age of 40.0 years) answered the survey. Some 55.0% of the internists indicated high emotional fatigue, 61.7% indicated a high sense of depersonalisation, and 58.6% indicated low personal fulfilment. Some 33.4% of the interns experienced burnout. Burnout syndrome was independently related to age (OR 0.96; 95% CI 0.94-0.98), poor work environment (OR 1.94; 95% CI 1.31-2.82), insufficient wages (OR 1.79; 95% CI 1.20-2.67), receiving threats (OR 1.703; 95% CI 1.204-2.410) and the feeling of a lack of professional progress (OR 2.83; 95% CI 1.92-4.17). CONCLUSIONS: Burnout syndrome affects 33.4% of internists in Spain, and its onset is independently related with age, poor work environment, a lack of professional progress, insufficient financial remuneration and experiencing threats by patients or colleagues.

Esquí náutico recreativo en personas con paraplejia: a propósito de tres casos / Recreational Water Skiing In People with Paraplegia: A Study of Three Cases

Objetivos: se analizaron la condición cardiorrespiratoria y la intensidad de esfuerzo durante la práctica recreativa del esquí náutico de slalom. Metodología: participaron tres esquiadores náuticos con paraplejia moderadamente activos. Realizaron un test incremental en un ergómetro de brazos para determinar su VO2pico y los umbrales ventilatorios y completaron 3 sesiones de práctica de esquí náutico, separadas por 48h, registrándose la FC cada 5 s. Resultados: obtuvieron un VO2pico de 22,3 ± 0,6 mL·kg-1·min-1 y los umbrales ventilatorios se analizaron al ~80 y ~50% del VO2pico. La FC media en las sesiones de esquí náutico fue de 111 ppm, lo que representó una intensidad de ~45% de la FC de reserva (FCR), permaneciendo por encima del 40% de la FCR ~12 min. Conclusión: la intensidad moderada de la práctica recreativa de esquí náutico de slalom podría servir para mantener o mejorar la condición cardiorrespiratoria en estas tres personas con paraplejia

Objectives: the cardiorespiratory fitness and the intensity of effort were analyzed during the recreational practice of slalom water skiing. Methodology: three moderately active water skiers with paraplegia participated. They performed an incremental test on an arm ergometer to determine their VO2peak and ventilatory thresholds and completed 3 sessions of water skiing, separated by 48h, where the HR was recorded every 5 s. Results: they obtained a VO2peak of 22.3 ± 0.6 mL·kg-1·min-1 and the ventilatory thresholds were analyzed at ~80 and ~50% of the VO2peak. The average heart rate in the water ski sessions was 111 bpm, which represented an intensity of ~45% of the heart rate reserve (HRR), remaining above 40% of the HRR ~12 min. Conclusion: the moderate intensity of recreational slalom skiing could serve to maintain or improve the cardiorespiratory fitness in these three people with paraplegia

Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo / Fifth-year internal medicine residents in Spain: a survey on education, assessment of competencies and job perspectives

Introducción: la formación de especialistas está basada en la adquisición gradual de conocimientos, habilidades y responsabilidades. El objetivo del estudio es conocer la opinión de los residentes sobre su formación. Material y métodos: estudio descriptivo transversal basado en una encuesta online realizada a los residentes de quinto año durante los meses de febrero y marzo de 2017. Resultados: respondieron la encuesta 194 residentes (62,8% del total); el 62,9% fueron mujeres y el 50% eran menores de 30años, con representación de hospitales de todos los niveles y de las 17 comunidades autónomas. Más del 80% volverían a elegir la especialidad y creen que la duración de la residencia es adecuada; sin embargo, el 76,3% eliminarían alguna de las rotaciones. La mayoría de los residentes desconocen los objetivos de cada rotación y un 37,1% no se han sentido adecuadamente supervisados. Un 82,5% cambiarían el sistema de evaluación y un 68,0% estarían a favor de realizar una prueba de excelencia. La mayoría de residentes han publicado al menos un artículo o realizado una comunicación en un congreso; sin embargo, solo el 27,8% están realizando una tesis doctoral. A pesar de que un 74,7% consideran que van a encontrar empleo, solo un 28,4% tienen una oferta a un mes de finalizar la residencia. Conclusiones: los residentes están satisfechos con la formación recibida, aunque sigue existiendo un déficit en la supervisión y un descontento tanto con la forma de evaluar sus conocimientos como con la precariedad laboral durante los primeros años de especialistas

Background: specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training. Material and methods: this was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017. Results: a total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1month after completing their residence. Conclusions: the residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists

Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación / Getting to know internal medicine mentors: new training requirements

Introducción y objetivos: los tutores son los responsables de planificar el aprendizaje de los residentes. El objetivo de este trabajo es conocer la situación de los tutores de Medicina Interna en España y detectar áreas de mejora que puedan facilitar su trabajo. Material y métodos: encuestas online a tutores de Medicina Interna de mayo a julio de 2017 con análisis posterior de los datos. Resultados: respondieron 110 tutores, de 13 comunidades autónomas y hospitales de todos los niveles con docencia en Medicina Interna. Sesenta y tres fueron hombres (57,3%), la media de edad fue de 48 años y tenían una experiencia como tutores de 8,5 años. En el 88,2% de los casos se respeta la ratio de cinco residentes por tutor; un 46% piensa que debería disminuirse esta ratio para optimizar su labor. Un tercio había sido elegido por el responsable del servicio y el 30% nunca ha realizado cursos sobre formación. La entrevista tutor-residentes es utilizada por la mayoría de los tutores (96,4%) como herramienta de comunicación. En relación a las rotaciones, la cuarta parte no son planificadas por los tutores y, solo la mitad, contacta con los centros donde los residentes realizan las rotaciones externas. El 61% cree que no se realiza bien la evaluación de residentes, con muy escasa utilización de las nuevas herramientas de evaluación. Conclusiones: disminuir la ratio tutor/residente y la formación en técnicas de evaluación y desarrollo del aprendizaje podría mejorar la calidad de la tutorización

Introduction and objectives: mentors are responsible for planning the residents' learning. The aim of this study was to determine the situation of internal medicine mentors in Spain and detect areas of improvement that can facilitate their work. Material and methods: online surveys were sent to internal medicine mentors from May to July 2017, the results of which were subsequently analysed. Results: a total of 110 mentors from 13 autonomous communities and from hospitals of all levels with courses in internal medicine responded to the survey. Of these mentors, 63 were men (57.3%), and the mean age was 48 years. The mean experience as mentors was 8.5 years. Some 88.2% of the cases had a ratio of 5 residents to 1 mentor; 46% of the mentors believed this ratio should be decreased to optimize their work. A third of the mentors were chosen by the heads of the department, and 30% had not previously taken courses on training. The mentor-resident interview was used by most mentors (96.4%) as a communication tool. A quarter of the rotations were not planned by the mentors, and only half had contact with the centres where the residents performed the external rotations. Sixty-one percent of the mentors were of the opinion that resident assessments were not conducted properly, with very little use of the new assessment tools. Conclusions: reducing the mentor-resident ratio and adding training in assessment techniques and learning development could improve the quality of the mentoring

Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus.

OBJECTIVE: The objective of this report is to analyse retinal changes over a five-year period, assessed by spectral domain-optical coherence tomography (SD-OCT), in patients from the Lupus-Cruces cohort treated with hydroxychloroquine (HCQ). METHODS: SD-OCT screening was performed annually between 2012 and 2017. Average macular thickness (AMT), ganglion cell layer thickness (GCLT) and qualitative data of retinal pigment epithelium (RPE) and external retina (ExtR) were collected prospectively. We compared data from 2012 (first) and 2017 (second) SD-OCT. RESULTS: We studied 110 patients and 195 eyes. No cases of HCQ toxicity were detected. At the time of the second SD-OCT, 99% patients had taken a daily dose of HCQ ≤5 mg/kg/day. The median time on HCQ was 133 months. The mean AMT and GCLT were significantly lower in both eyes at the second SD-OCT; however, all the differences were clinically insignificant at less than 1%. Qualitative analysis of RPE and ExtR showed no significant changes. Similar results were found among patients with risk factors for retinopathy. The comparison of patients with and without risk factors showed no differences. CONCLUSIONS: This study shows clinically irrelevant retinal changes in an SLE cohort on HCQ treatment over a five-year follow-up. Our findings support the safety of long-term HCQ at doses ≤5 mg/kg/day.

Fifth-year internal medicine residents in Spain: A survey on education, assessment of competencies and job perspectives. / Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo.

BACKGROUND: Specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training. MATERIAL AND METHODS: This was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017. RESULTS: A total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1month after completing their residence. CONCLUSIONS: The residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists.