Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes.

CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option.

Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes / Preditores da escolha da especialidade Medicina de Família a partir de competências e atitudes de alunos de graduação

ABSTRACT: CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option.

RESUMO CONTEXTO E OBJETIVO: Um clima frio para a atenção primária na academia médica constitui uma barreira para escolher Medicina de Família (MF) como opção de carreira. Este estudo foi concebido para determinar se o conhecimento e as atitudes dos estudantes de medicina em relação à MF predizem a escolha da carreira. TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado em duas faculdades de medicina. MÉTODOS: Depois de terem completado um curso de Cuidados Primários na Faculdade de Medicina de Albacete, em 2005-2006, 81 alunos do segundo ano foram convidados a responder a um questionário. No seu sexto ano (2009-2010), 79 estudantes de Albacete assim como 42 de Sevilha, tomados como coorte não exposta, foram convidados a responder também. Todos eles foram investigados sobre a escolha da especialidade em 2011. RESULTADOS: Em Albacete, 79 e 76 estudantes responderam no segundo e sexto anos, respectivamente, e 26 em Sevilha. Depois de terem concluído o curso de cuidados primários, 69,3% disseram que gostariam de se tornar médicos de família. Esta percentagem diminuiu para 40,3% no final da graduação (P < 0,0001). No sexto ano, as atitudes com relação à MF pioraram, mas estas foram significativamente mais favoráveis do que as de Sevilla. Apenas 12 alunos escolheram a MF; eles obtiveram pontuação significativamente piores no exame do que seus pares (P < 0,0001). CONCLUSÃO: Na Faculdade de Medicina de Albacete, a opinião dos alunos sobre a MF ao longo da graduação piorou; contudo ainda era melhor que as dos estudantes de Sevilha. Em qualquer caso, MF foi opção minoritária.

[Choice of Family Medicine at the exams for Spanish resident doctors in 2011 and 2013]. / Elección de Medicina Familiar en los exámenes para médicos residentes españoles de 2011 y 2013.

BACKGROUND: Family Medicine (FM) is regarded as one of the specialities less interesting to those who choose for resident physicians (MIR) in Spain. Our objective is to know the priority given to the choice of FM in 2011 and 2013 MIR exams, and what factors might be associated with this choice. METHODS: We obtained information on the website of the Ministry of Health for the graduates who could choose a speciality (11552 y 9182). The variables analyzed were: number obtained in the opposition, sex, speciality chosen, chosen city, medical school where they studied (for 117 and 155 students of a previous cohort study). We calculated the probability of choice of FM in relation to the order number in the exam and the other variables (Kaplan-Meier). RESULTS: 1963 and 1772 chose FM, respectively in 2011 and 2013. The median of the order number to choose FM was 7894 (95%CI:7720-8068) and 6561 (95%CI:6442-6680). There were gender differences, as women chose FM with fewer number and a higher proportion (p<0.00001). CONCLUSIONS: Graduates enrolled in the MIR exam have not special preference for FM. Women show a greater interest in this speciality.

Introducción: la Medicina Familiar (MF) está considerada entre las especialidades que menos interesan a quienes optan por ser médicos internos residentes (MIR) en España. Nuestro objetivo es describir la prioridad concedida a la elección de MF en las convocatorias MIR 2011 y 2013, y qué factores podrían estar asociados con esta elección. Métodos: de la web del Ministerio de Sanidad de España se obtuvo información de los opositores que optaron a plaza (11552 y 9182). Las variables analizadas han sido: número obtenido en la oposición, sexo, especialidad elegida, ciudad elegida, facultad donde estudiaron (para 117 y 155 en un estudio de cohorte previo). Se calculó la probabilidad de elección de MF en relación con el número de orden en la oposición y otras variables (Kaplan-Meier). Resultados: la MF fue elegida por 1963 y 1772, respectivamente en 2011 y 2013. La mediana del número en la oposición para elegir MF fue 7894 (IC 95 % 7720-8068) y 6561 (IC 95 % 6442-6680). Existían diferencias por sexo: las mujeres elegían MF con menor número y en mayor proporción (p < 0.00001). Conclusiones: los opositores MIR no tienen una especial preferencia por la MF. Las mujeres muestran un mayor interés por esta especialidad.

Conocimientos sobre violencia de género de la población que consulta en Atención Primaria / Knowledge of gender-based violence in the population seen in Primary Care

Objetivo: Determinar conocimientos y actitudes hacia la violencia de género de la población consultante en Atención Primaria y su relación con factores sociodemográficos y experiencias personales.DiseñoEstudio descriptivo transversal.EmplazamientoCentros de Salud urbanos.ParticipantesPacientes ≥ 18 años que acuden a consulta de Atención Primaria.Mediciones principalesSe utilizó un cuestionario que incluía preguntas relativas a conocimientos, actitudes y experiencias vividas en relación con la violencia de género y en el ámbito doméstico, y que también recogía edad, sexo, nivel de estudios, estado civil y detección de experiencias personales de violencia de género mediante la versión corta del Woman Abuse Screening Tool (WAST).ResultadosRespondieron 673 personas, de 18-86 años, con un 68% de mujeres. Solo un 18,2% tenía un adecuado conocimiento sobre quién se considera que ejerce la violencia de género. La mitad de los participantes consideraban que la violencia de género incluía lesiones físicas, psicológicas, cohibición de libertad y violación. A través de un análisis de regresión logística se encontró una asociación independiente con el conocimiento de la respuesta correcta sobre qué es la violencia de género del estado civil, siendo menos probable en los casados con respecto a los viudos (OR: 0,28; IC 95%: 0,11-0,72) considerar que la violencia de género implica lesión física (OR: 2,55; IC 95%: 1,28-5,08), pero no lesiones psicológicas (OR: 0,52; IC 95%: 0,28-0,96), y no dar la respuesta correcta sobre qué es la violencia doméstica (OR: 0,06; IC 95%: 0,03-0,12).ConclusionesExiste una gran dispersión en las respuestas con relación a qué consideran los pacientes que es la violencia de género y qué aspectos abarca(AU)

Objective: To determine the knowledge and attitudes towards gender-based violence in the Primary Care patient population and their relationship with sociodemographic factors and personal experience.DesignA descriptive, cross-sectional study.SettingUrban Health Centres.ParticipantsPatients ≥18 years-old who were seen in a Primary Care clinic.Materials and methodA questionnaire was used that included questions associated with knowledge, attitudes and experience of gender-based violence in the domestic environment. Variables such as, age, sex, education level, marital state were recorded, as well as the detection of personal experiences of Gender-Based Violence using the short Woman Abuse Screening Tool (WAST).ResultsA total of 673 people, from 18- 86 years, responded, of which 68% were women. Only 18.2% had sufficient knowledge on who is considered to exercise gender-based violence. Half of the participants believed that gender-based violence included physical and psychological injuries, inhibition of freedom and rape. In the logistic regression analysis an independent relationship was found with the knowledge of the correct response on what is gender-based violence by marital state, being less likely in married people as regards widowers (OR: 0.28; CI 95%: 0.11-0.72), to consider that gender-based violence involves physical injury (OR: 2.55; CI 95%: 1.28-5.08), but not psychological injury (OR: 0.52; CI 95%: 0.28-0.96), and not giving the correct response on what is domestic violence (OR:0.06; CI 95%: 0.03-0.12).ConclusionsThere is a wide variation in the results as regards what patients believe gender-based violence is and what aspects it covers(AU)

[Knowledge of gender-based violence in the population seen in primary care]. / Conocimientos sobre violencia de género de la población que consulta en Atención Primaria.

OBJECTIVE: To determine the knowledge and attitudes towards gender-based violence in the Primary Care patient population and their relationship with sociodemographic factors and personal experience. DESIGN: A descriptive, cross-sectional study. SETTING: Urban Health Centres. PARTICIPANTS: Patients ≥18 years-old who were seen in a Primary Care clinic. MATERIALS AND METHOD: A questionnaire was used that included questions associated with knowledge, attitudes and experience of gender-based violence in the domestic environment. Variables such as, age, sex, education level, marital state were recorded, as well as the detection of personal experiences of Gender-Based Violence using the short Woman Abuse Screening Tool (WAST). RESULTS: A total of 673 people, from 18-86 years, responded, of which 68% were women. Only 18.2% had sufficient knowledge on who is considered to exercise gender-based violence. Half of the participants believed that gender-based violence included physical and psychological injuries, inhibition of freedom and rape. In the logistic regression analysis an independent relationship was found with the knowledge of the correct response on what is gender-based violence by marital state, being less likely in married people as regards widowers (OR: 0.28; CI 95%: 0.11-0.72), to consider that gender-based violence involves physical injury (OR: 2.55; CI 95%: 1.28-5.08), but not psychological injury (OR: 0.52; CI 95%: 0.28-0.96), and not giving the correct response on what is domestic violence (OR:0.06; CI 95%: 0.03-0.12). CONCLUSIONS: There is a wide variation in the results as regards what patients believe gender-based violence is and what aspects it covers.

Acercar la Medicina de Familia al estudiante: una tarea de todos / Bringing family medicine to the student: A job for everyone

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Experiencias en relación con la Violencia de Género de la población que consulta en Atención Primaria / Experience in gender violence in the general population within the Primary Care setting

Objetivo. Conocer la prevalencia de violencia de género padecida por la población consultante en Atención Primaria y su relación con factores sociodemográficos y otras experiencias personales. Diseño. Estudio observacional, descriptivo, transversal. Emplazamiento. Centros de Salud urbanos. Participantes. Pacientes de 18 o más años que acuden a consulta de Atención Primaria. Mediciones principales. Se utilizó un cuestionario diseñado ad hoc, que incluía preguntas relativas a las experiencias vividas en relación con la violencia de género y en el ámbito doméstico, junto a la versión corta del Woman Abuse Screening Tool (WAST). También recogía edad, sexo, nivel de estudios y estado civil, así como conocimientos y actitudes con respecto a este tema. Resultados. Respondieron al cuestionario 673 personas. De las 662 personas que respondieron a la pregunta sobre si ha sufrido algún tipo de violencia en sus relaciones sentimentales, 76 dieron una respuesta afirmativa (11,48%; IC 95%: 8,98-13,98%). Esta respuesta era más probable encontrarla en viudos y separados (p<0,00001), mientras que entre los más jóvenes predominaba el no haber sufrido violencia (p=0,01), sin diferencias para otras variables sociodemográficas. Mediante regresión logística, la edad fue la única variable asociada independiente con haber sufrido violencia de género (OR: 1,02; IC95%: 1,005-1,036). Para el test WAST se obtuvieron 560 respuestas, de las que un 12,0 % (IC95%: 9,2-14,7%) fueron positivas. La concordancia entre la respuesta a la pregunta sobre si ha sufrido algún tipo de violencia en sus relaciones sentimentales y el resultado del WAST fue muy baja (Kappa: 0,153; IC 95%: 0,038-0,243). A la pregunta “¿qué ha hecho?” (en caso de violencia en alguna relación sentimental), la respuesta más frecuente es alejarse del agresor. Hasta un 42,1% de los participantes decía conocer a alguna persona que hubiera padecido violencia de género. Conclusiones. Existe un contacto frecuente de las personas que acuden a consulta de atención primaria con la violencia de género, siendo considerable el número de personas que afirman haber sufrido maltrato (AU)

Objectives. To determine the prevalence of gender violence in the general population in the primary care setting and its association with sociodemographic factors and other personal experience. Design. Cross-sectional, observational, descriptive study. Setting. Urban primary care centres. Participants. Patients aged 18 years or over who attended the Primary Care centre. Main measurements. An ad hoc designed questionnaire that included questions on experience of domestic violence and the short version of the Woman Abuse Screening Tool (WAST), were used. Sociodemographic variables and knowledge and attitudes towards gender violence were also collected. Results: A total of 673 persons responded to the questionnaires. Of the 662 subjects who answered the question on whether they had suffered any type of abuse by their partner, 75 answered affirmatively (11.48%; 95% CI: 8.98-13.98%). This response was more probable in widowed or separated subjects (p<0.00001). Amongst young people there was a predominance of not having suffered abuse (p=0.01). There were no differences regarding the other sociodemographic variables. Logistic regression analysis revealed that age was the only variable that demonstrated an independent association with having suffered gender violence (OR: 1.02; 95% CI: 1.005 – 1.036). A total of 560 responses were obtained in the WAST questionnaire and 12.0% were positive (95% CI; 9.2 – 14.7%). Its concordance with the question on history of domestic violence was very low (Kappa: 0.153; 95% CI: 0.038-0.243). In the case of previous abuse, in answer to the question “What did you do? the most frequent response was to get away from the aggressor. Up to 42.1% said they knew someone who was a victim of gender violence. Conclusions. In the primary care setting there is frequent contact with persons suffering gender violence. There are a considerable number of persons who admit to being abused (AU)

Cinco preguntas clave en la gripe: una revisión de guías / Five key questions on flu: a review of the guidelines

La gripe es una enfermedad infecciosa aguda provocada por el virus de la influenza A, B y C, que afecta principalmente al aparato respiratorio, se transmite con gran facilidad por secreciones y objetos contaminados, presenta riesgo potencial de complicaciones, especialmente en grupos susceptibles, y es una de las causas más frecuentes de absentismo laboral. Con el objetivo de actualizar el abordaje del síndrome gripal y recopilar información que ayude al clínico en la toma de decisiones, revisamos las recomendaciones presentadas en diferentes guías de práctica clínica. Realizamos una búsqueda en las bases bibliográficas habitualmente utilizadas en el ámbito internacional seleccionando las que sustentan sus recomendaciones en niveles de evidencia y han sido actualizadas en los tres últimos años. Decidimos incluir otras guías que no mencionan niveles de evidencia pero están avaladas por sociedades científicas o instituciones de prestigio internacional. Comparamos las recomendaciones presentadas en cinco aspectos clave: diagnóstico, manejo en los centros sanitarios, tratamiento, consejos e información a la población y vacunación (AU)

Flu is an acute infectious disease caused by the viruses A, B and C. It mainly affects the respiratory system and is easily transmitted by secretions and contaminated objects. It has a potential risk of complications, especially in susceptible groups, and is one of the most common causes of work absenteeism. With the aim of updating flu management and collecting information that will help the doctor in decision making, we reviewed the recommendations given in different clinical practice guidelines. We searched the bibliographical databases commonly used internationally and chose those guidelines that based their recommendations on levels of evidence and that had been updated in the last three years. We decided to include other guidelines that do not mention levels of evidence but that are endorsed by internationally renowned scientific societies or institutions. We compared the recommendations given according to five key elements: diagnosis, management in health centres, treatment, advice and information to the general public and vaccination (AU)

Revisión clínica del tratamiento de los Trastornos de Ansiedad / Clinical review of the treatment of Anxiet y Disorders

La ansiedad es patológica cuando se produce ante estímulos inadecuados o inexistentes, o cuando éstos existen o son adecuados, pero la intensidad y/o la duración de la respuesta supera los límites adaptativos. Es el síntoma común de un conjunto de cuadros clasificados como trastornos de ansiedad. Nos ocuparemos en la presente revisión de los más frecuentes y con mayor trascendencia en la calidad de vida de los pacientes. Revisamos las pruebas actualmente disponibles sobre efectividad y seguridad de las opciones terapéuticas utilizadas para el abordaje del trastorno de angustia, el trastorno de ansiedad generalizado, la fobia social y simple o específica y el nivel asistencial más eficiente para su tratamiento. Se trata de una revisión de la bibliografía seleccionada (guías basadas en la evidencia y revisiones sistemáticas y clínicas), considerando básicamente la validez y consistencia de los estudios, importancia de los resultados y su aplicabilidad. Los grados de recomendación se fundamentan en los niveles de evidencia existentes (AU)

Anxiety is pathological when it is produced in the absence of stimuli or with inadequate stimuli, or when stimuli do exist and are appropriate but the intensity and duration of the response exceed adaptive limits. This is the common symptom of a group of disorders classified as anxiety disorders. In this review, we focus on the most frequent of these and those with the greatest repercussions on the patients’ quality of life. We review currently available tests of efficacy and safety of the therapeutic options available to treat panic attacks, generalised anxiety disorder, specific or simple social phobia and the most efficient healthcare levels for their treatment. This paper reviews the literature selected (evidence-based guidelines and systematic and clinical reviews), basically considering the validity and consistency of the studies, the importance of the results and their applicability. The recommendations are based on existing levels of evidence (AU)