Persons with mental disorders and assisted dying practices in Spain: In response to Ramos et al.

Ramos et al. paper offers a narrative review of Spanish Organic Law 3/2021, which regulates euthanasia, focusing on its application to individuals with mental disorders. Ramos et al. examine the application of legal prerequisites from an ethical-legal perspective to ascertain the conditions under which psychiatric euthanasia might be considered legitimate and compliant with legal stipulations. Nevertheless, it is apparent that the core ethical inquiries linked to this matter have not been exhaustively investigated. The criteria laid out are, in our assessment, still open to further debate and broader deliberation. Our article emphasizes the need for a comprehensive ethical and legal debate in Spain regarding psychiatric euthanasia. Competency assessment is central to the legislation, but there are concerns about the validity of assessment tools and the subjective nature of interviews. Furthermore, defining irreversible suffering in mental health contexts poses challenges. The article advocates for a deeper understanding of the needs of individuals with mental disorders before considering euthanasia and emphasizes the importance of comprehensive care and psychosocial interventions in reducing the desire for euthanasia. Ultimately, it underscores the ethical complexities of euthanasia in mental health and the necessity of prioritizing comprehensive care in addressing these complexities.

Human-Animal Bond Generated in a Brief Animal-Assisted Therapy Intervention in Adolescents with Mental Health Disorders.

BACKGROUND: The human-animal bond is crucial for the proper development of animal-assisted therapy (AAT) sessions. However, in specific cases such as in AAT focused on psychiatric patients who are admitted to acute units, there is only a short period of time available to establish this bond. OBJECTIVES: To assess the degree of HAB generated after two AAT sessions in adolescents admitted to acute psychiatry units. METHODS: A prospective multicenter cohort study aimed at adolescents aged 13 to 17 years admitted to the acute child and adolescent psychiatry unit of three hospitals. INTERVENTION: Two weekly 1 h group sessions of AAT with therapy dogs. MAIN OUTCOME: The Center for the Study of Animal Wellness Pet Bonding Scale Survey (CSAWPB). RESULTS: One hundred and fourteen adolescents participated. A positive perception of the dog was generated, achieving a good level of bonding and attachment. CONCLUSIONS: The results obtained make it possible to affirm that a short period of time is enough to establish a good HAB between patients and therapy dogs. This study aims to contribute to the study of non-pharmacological interventions as a complement to pharmacological treatments in adolescents with mental health disorders.

Veinte años después: prevalencia y evolución del burnout en Pediatría, de 1998-1999 a 2018-2019 / Twenty years after: prevalence and evolution of burnout in pediatrics, from 1998-1999 to 2018-2019

Introducción: el burnout es un síndrome de estrés crónico, descrito como un proceso de cansancio emocional, despersonalización y falta de realización personal. Tiene elevado impacto tanto a nivel personal como en calidad y seguridad asistencial, y su prevalencia es elevada. El presente estudio pretende determinar la prevalencia de este síndrome en pediatras de Lleida, analizar su relación con diversas variables y comparar los resultados actuales con los del estudio previo en 1998. Método: estudio descriptivo transversal observacional, que valora información sociodemográfica y cuestionario de burnout de Maslach. Se comparan los datos con los del estudio de 1998, en el que se recogieron los mismos datos. Resultados: han participado 42 pediatras (64%), 66% de mujeres, edad media de 42,1 años. Un 36% presentaban puntuaciones sugestivas de síndrome burnout en cansancio emocional. No había diferencias respecto a las horas trabajadas, el género, el estado civil ni el lugar de trabajo. Los pediatras con más desgaste profesional presentaban mayor decepción y depresión en relación con el trabajo, así como también mayor presencia de enfermedad física o psíquica. Por otro lado, aquellos que concebían el trabajo como una vocación y disfrutaban de reconocimiento institucional tenían valores más altos de realización personal. Se comparan los datos con los del estudio de 1998 Conclusiones: la prevalencia de desgaste profesional elevado es del 36%. Se confirma la cifra de aproximadamente un tercio de los pediatras con niveles significativos de burnout, que está presente de forma estructural y que requiere de estrategias de abordaje, no solo individual sino también del equipo y de las organizaciones (AU)

Introduction: burnout is a chronic stress syndrome, described as a process of emotional exhaustion, depersonalization, and reduced personal accomplishment. It has a high impact both on a personal level and on healthcare quality and safety, and its prevalence is high. The present study aimed to determine the prevalence of this syndrome in paediatricians in Lleida, analyse its association with different variables and compare current results with the results of a previous study conducted in 1998.Method: we conducted a descriptive, cross-sectional observational study analysing sociodemographic data and Maslach burn-out questionnaire scores. We compared these data to the results of the 1998 study, in which the same information was collected.Results: a total of 42 paediatricians (64%) participated in the survey, 66% were female, and the mean age was 42.1 years. Thirty-six percent had scores suggestive of burnout syndrome with emotional exhaustion. There were no differences associated with the number of hours worked, sex, marital status, or the work setting. The paediatricians with the highest level of burnout were more likely to express disappointment and depression in relation to work and or have physical and/or mental illness. On the other hand, respondents who perceived their work as a calling and felt recognised by their organizations had higher scores in the dimension of personal accomplishment. We compared the data of this sample to the data of the 1998 study.Conclusions: We found a high level of burnout in 36% of respondents. The data confirmed that approximately one third of paediatricians have significant levels of burnout, which is a structural problem and therefore must be addressed with strategies not only at the individual level, but also at the level of the team and the institution. (AU)

A pilot study of the efficacy of an adventure therapy programme on borderline personality disorder: A pragmatic controlled clinical trial.

Adventure therapy (AT) is a therapeutic intervention that has demonstrated effectiveness in different populations, but there are no studies on this therapy in borderline personality disorder (BPD). The objective of this study was to assess the response to AT in comparison with treatment as usual (based on cognitive-behavioural therapy) in patients with BPD. Regarding the comparison of the differences post-therapy-pre-therapy between both groups, some metabolic variables improved more in the AT group, with medium-large effect sizes. Almost all psychometric variables evolved better in the AT group, with negligible effects. AT could be considered in BPD treatment because it results in healthier lifestyle habits and increases functionality and quality of life in patients who are prone to self-destruction. © 2021 John Wiley & Sons, Ltd.

Effectiveness of a Mindfulness-Based Programme on Perceived Stress, Psychopathological Symptomatology and Burnout in Medical Students.

OBJECTIVES: Medical students display a high prevalence of psychopathological symptomatology, stress and burnout, which may continue in their time as resident and fully qualified doctors. The aim of this study is to evaluate and compare the effects of a mindfulness-based programme on these variables in an experimental group of medical students who underwent the intervention programme compared to a control group who did not. METHODS: A quasi-experimental study of two independent groups (experimental and control) with two repeated measures (pre and post) was performed. Eight sessions of 2-h duration each were held over the course of 16 weeks. A total of 143 students participated in the study, 68 in the intervention group and 75 in the control group. A sociodemographic questionnaire was administered along with the Symptom Checklist-90-R (SCL-90-R), the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory-Student Survey (MBI-SS). RESULTS: Our study revealed a clear improvement compared to the control group in perceived stress and psychopathological symptomatology, in the Global Severity Index, Positive Symptom Total and the primary symptom dimensions of somatization, obsessive compulsive, interpersonal sensitivity and anxiety of the SCL-90-R. The improvement was significant at both intra- and intergroup level. No impact was found on the level of burnout. CONCLUSIONS: The mindfulness-based programme that was used resulted in an improvement in psychopathological symptomatology and stress, with no effect observed on BO score. This study can contribute to the design of a training programme to promote effective self-care and stress management strategies for both medical students and doctors.

¿Han llegado los millennials a la Facultad de Medicina? Perfil de personalidad de estudiantes de Medicina 1999-2014 / Have millennials arrived at Medical School? Personality profile of medical students 1999- 2014

INTRODUCCIÓN: La formación necesaria de un médico requiere no solo la adquisición de conocimientos y habilidades clínicas, sino también el desarrollo de actitudes y valores, características relacionadas con el perfil de personalidad. El presente estudio se centra en valorar el perfil de personalidad de los estudiantes de Medicina, en relación con variables sociodemográficas y al cambio generacional. MATERIAL Y MÉTODO: Estudio observacional transversal realizado a 675 estudiantes de Medicina, de 1999 a 2014. Se les administró un cuestionario sociodemográfico y el cuestionario NEO-PI-R para valorar el perfil de personalidad. RESULTADOS: En el presente estudio, las puntuaciones medias más altas han sido en la dimensión responsabilidad, seguido de amabilidad y apertura a la experiencia; la más baja ha sido neuroticismo. En relación al género, las mujeres presentan mayores puntuaciones en neuroticismo, extraversión, amabilidad y responsabilidad. Los estudiantes millennials obtuvieron puntuaciones significativamente más altas en las dimensiones de extraversión, amabilidad y responsabilidad. Estos estudiantes son más asertivos, sociables, compasivos, y con mayor tendencia a cumplir con el deber, la organización, el orden y la autodisciplina. Pero se detecta también en este grupo mayor puntuación en ansiedad y rasgos obsesivos, suponiendo un mayor riesgo de estrés y burnout. CONCLUSIONES: Se han encontrado diferencias significativas en los perfiles de personalidad según el género y según la generación, siendo estas congruentes con los perfiles de personalidad descritos en la literatura en la generación millennial

OBJECTIVE: Medical training not only requires the acquisition of knowledge and clinical skills, but also the development of attitudes and values, characteristics related to the personality profile. The present study focuses on assessing the personality profile of medical students, in relation to sociodemographic variables and generational change. MATERIAL AND METHODS: Cross-sectional observational study performed on 675 medical students,from 1999 to 2014. A sociodemographic questionnaire and the NEO-PI-R questionnaireto assess the personality profile was administrated. RESULTS: In the present study, the highest mean scores were in the responsibility dimension, followed by kindness and openness to the experience. The lowest was neuroticism. As regards gender, women had higher scores in neuroticism, extraversion, kindness, and responsibility. The millennial students obtained significantly higher scores in the dimension of extraversion, kindness, and responsibility. These students are more assertive, sociable, compassionate, and more likely to fulfil their duty, organisation, order, and self-discipline. But this group also has a higher score in anxiety and obsessive traits, assuming an increased risk of stress and burn-out. CONCLUSIONS: Significant differences have been found in the personality profiles between gender and among the millennial medical students, consistent with the personality profiles described in the literature on the millennium generation

The Catalonia Suicide Risk Code: A secondary prevention program for individuals at risk of suicide.

BACKGROUND: Suicide prevention is an emerging priority for public health systems. Here, we present the Catalonia Suicide Risk Code (CSRC), a secondary suicide prevention program that provides a systematic approach to follow-up care for patients at risk. We describe the care pathway of the CSRC and characteristics of the patients enrolled in the program. METHODS: Observational study based on data extracted from the Catalan health care system between the years 2014 and 2019. The following patient-related data were obtained: sociodemographic and clinical characteristics, characteristics of suicidal behaviour, and pathway of care. RESULTS: A total of 12,596 individuals (64.1% women) were screened for suicide risk and 8,403 (66.7%) were subsequently enrolled in the CSRC. Adherence data show that most patients (81.9%) attended a face-to-face appointment and most (67.1%) were successfully contacted by telephone afterwards. Most face-to-face appointments were performed within 10 days of enrolment for adults and 72 h for minors. Psychiatric disorders were significant risk factors for both men and women. Females were significantly more likely to report stressful life events, while males were more likely to report social problems. Compared to men, women were more likely to use poisoning. LIMITATIONS: Adherence to the CSRC care pathway might reflect obstacles to its implementation. Due to the observational study design, it is not possible to determine the effectiveness of the CSRC to reduce suicide re-attempts. CONCLUSIONS: Although the CSRC successfully provided follow-up care for many individuals at high risk of suicide, greater adherence to the CSRC care pathway is needed.

Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors.

Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up.

Design and Validation of an Instrument To Measure a Minor's Maturity When Faced with Health Decisions.

Decision-making capacity in children and adolescents in healthcare requires thorough assessment: the minor's maturity, understanding of the decision, risk of the situation and contextual factors needs to be explored. The intention was to design and validate a test-the Maturtest-to assess the maturity of minors in decision-making processes in healthcare. A reasoning test on moral conflicts for adolescents was designed to infer the degree of maturity of minors applied to decision-making regarding their own health. The test was completed by a sample of 441 adolescents aged from twelve to sixteen, with a corresponding analysis of their psychometric skills to measure feasibility, viability, reliability, validity, and sensitivity to change. Psychometric test results showed viability, reliability, validity, and sensitivity to change. High correlation (correlation index = 0.74) between the test score and the reference method were notable. A high stability was obtained with an intraclass correlation coefficient (r = 0.77). The average response time of the test was twenty-three minutes. This test measures the moral maturity of adolescents. It is presented as an objective, useful, valid, reliable tool, easy to fill out, edit and apply in a healthcare context. It helps to assess the maturity of minors faced with a decision.

¿Limitar o adecuar el esfuerzo terapéutico? / To limit or to adapt the therapeutical effort?

No disponible

Síntomas psicopatológicos, estrés y burnout en estudiantes de medicina / Psychopathological symptoms, stress and burnout among medical students

INTRODUCCIÓN: Diferentes estudios muestran unos elevados niveles de estrés y burnout en médicos y estudiantes de medicina. El objetivo del presente estudio es determinar en los primeros cursos de medicina, en la Facultad de Medicina de Lleida, el grado de estrés percibido por los estudiantes, la sintomatología reportada y el grado de burnout, así como la relación entre estas variables y la posibilidad de detectar estudiantes de alto riesgo. METODOLOGÍA: Estudio transversal con 118 estudiantes (79,7% de segundo curso) de la Facultad de Medicina de la Universidad de Lleida. Se utiliza la escala de estrés percibido Perceived Stress Scale, el cuestionario de 90 síntomas Sympton Checklist-90-R y el cuestionario de burnout académico Maslach Burnout Inventory Student Survey. RESULTADOS: Las puntuaciones en estrés percibido son superiores al baremo, en el cuestionario de 90 síntomas alcanzan valores de una muestra de pacientes psicosomáticos, y un 16,95% igualan o superan la puntuación en el índice de severidad global, correspondiente al baremo de pacientes psiquiátricos. En las escalas de burnout académico se encuentran puntuaciones superiores en Agotamiento e Ineficacia Académica, no en Cinismo. Se han hallado diferencias en función del género. Las 3 variables muestran una correlación entre ellas. CONCLUSIONES: La muestra estudiada presenta unas puntuaciones elevadas en los test administrados. Se aplican puntos de corte que permiten detectar los casos de mayor gravedad en afección, hallándose un porcentaje notable (superior al 15%). Con los resultados obtenidos se propone la necesidad de que desde las facultades de medicina se incluyan programas de prevención, detección y abordaje de dificultades en salud mental, ya sean generales o específicos

INTRODUCTION: Different studies show high levels of stress and burnout in physicians and medical students. The aim of the present study is to determine the degree of stress perceived by the students, the psychopathological symptomatology and the degree of burnout, as well as the relationship between these variables in the first medical courses in the Faculty of Medicine of Lleida, detecting high risk students. METHODOLOGY: A cross-sectional study involving 118 students (79.7% 2nd year) of the Medical Faculty of the University of Lleida. Were assessed in perceived stress (Perceived Stress Scale), symptomatology (Sympton Checklist-90-R) and academic burnout (Maslach Burnout Inventory Student Survey). RESULTS: Perceived stress scores are above the scale. Scores on the symptomatology are at values of a sample of psychosomatic patients, and 16.95% exceed the score corresponding to the scale of psychiatric patients at global severity index. On the scales of academic burnout scores are higher in Exhaustion and Academic Inefficacy, not in Cynicism. In the 3 variables there are differences based on gender. The 3 variables show a correlation between them. CONCLUSIONS: The sample studied had high scores in the administered tests. Cut-off points are used to detect cases of greater severity in pathology, with a notable percentage (greater than 15%). With the results obtained, it is proposed that medical schools should include programs for the prevention, detection and management of mental health difficulties, whether general or specific

Evaluando la enseñanza de la bioética: formando «médicos virtuosos» o solamente médicos con habilidades éticas prácticas / Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills

Objetivo: La bioética se ha incorporado en la formación de las Facultades de Medicina las últimas décadas. Diversos estudios analizan el desarrollo ético-moral de los estudiantes y el efecto de la educación ética, midiendo la evolución del razonamiento moral de Kohlberg (médicos virtuosos), y la sensibilidad ética para resolver casos clínicos (médicos con habilidades éticas). El objetivo del estudio es valorar el impacto de la formación en ética en estas dos variables en nuestro ámbito. Diseño: Estudio observacional transversal. Emplazamiento: Facultad de Medicina, Universidad de Lleida. Participantes: Un total de 175 estudiantes de tercer curso de medicina (78 antes de realizar bioética y 97 después de realizar bioética, en diferentes cursos). Intervención: Formación reglada en bioética. Mediciones principales: Se administra un cuestionario sociodemográfico, el Defining Issue Test de Rest como medida del razonamiento moral, y el Problem Identification Test de Hébert como medida de la sensibilidad ética. Resultados: Se halla una relación consistente y significativa entre razonamiento moral y sensibilidad ética. Las mujeres presentan mayor razonamiento posconvencional, es decir, mayor desarrollo moral. No se aprecian cambios en el estadio de razonamiento moral global de Kohlberg con la formación ética. Sí se incrementa de forma significativa y global la sensibilidad ética, medida en forma de Problem Identification Test. Conclusión: No se hallan diferencias en el desarrollo moral de estudiantes de medicina antes y después de la formación reglada en bioética, pero sí con respecto a las habilidades en resolución de casos. Se plantea si esta mejora es suficiente para formar médicos preparados para los nuevos retos

Objective: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. Design: Observational cross-sectional study. Site: Faculty of Medicine, University of Lleida. Participants: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. Intervention: Bioethics course. Main measurements: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. Results: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. Conclusion: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges

[Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills]. / Evaluando la enseñanza de la bioética: formando «médicos virtuosos¼ o solamente médicos con habilidades éticas prácticas.

OBJECTIVE: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. DESIGN: Observational cross-sectional study. SITE: Faculty of Medicine, University of Lleida. PARTICIPANTS: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. INTERVENTION: Bioethics course. MAIN MEASUREMENTS: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. RESULTS: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. CONCLUSION: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges.

The effect of depressive symptoms on cognition in patients with fibromyalgia.

BACKGROUND: Fibromyalgia (FM) patients frequently complain of cognitive problems, but it remains unclear whether these cognitive complaints can be attributed to a dysfunction of the central nervous system or if they can be explained by other factors associated with the disease, such as depression, anxiety and sleep dysfunction. METHODS: One hundred and ten patients with FM were compared with thirty-three patients diagnosed with a depressive disorder (DD) and fifty healthy controls (HC). Several measures of attention and executive functions were used to make these comparisons and the patients were also asked to complete questionnaires on depression, anxiety and sleep quality. Univariate analyses of covariance (ANCOVA) were performed to identify and control confounders and multiple linear models were used to examine the effects of fibromyalgia and depression on cognitive measures. RESULTS: FM and HC differed significantly with respect to depression, anxiety and sleep dysfunction, whereas FM and DD did not differ in terms of symptoms of depression and anxiety. However, FM was associated with a worse quality of sleep than DD. Comparisons of cognitive performance between groups showed that short-term and working memory and inattention measures were only associated with symptoms of depression, whereas selective attention was associated with both depression and fibromyalgia, and processing speed, cognitive flexibility and inhibitory control showed a significant interaction between depression and fibromyalgia. Moreover, cognitive flexibility and inhibition abilities were specifically associated with FM. CONCLUSION: FM patients show a cluster of cognitive impairment in the attentional and executive domains, although some of the symptoms observed could be explained by the severity of the symptoms of depression, while others seem to depend on the effects of fibromyalgia. Implications of the findings for the understanding and management of cognitive impairment of FM patients are discussed.

Pediatria i salut mental infantojuvenil: claus per millorar en l'abordatge dels pacients / Pediatría y salud mental infantojuvenil / Pediatrics and child and adolescent mental health: Keys to Keys to improving care

Fonament: En les darreres dècades s'ha produït un notable increment en la demanda d'atenció en l'àmbit de salut mental infantojuvenil. Es detecta, a la vegada, una formació escassa o irregular. Objectiu: Descriure les competències del pediatre en salut mental infantil i identificar-ne les àrees d'intervenció. Mètode: Revisió bibliogràfica. Resultats: L'Associació Americana de Pediatria descriu sis àrees competencials que cal assolir en pediatria: pràctica basada en sistemes per millorar la base organitzativa i econòmica de l'assistència i la pràctica clínica; assistència dels pacients; coneixements mèdics; aprenentatge i millora basats en la pràctica clínica; habilitats interpersonals i de comunicació, i professionalitat. Les limitacions més importants per desenvolupar-les serien la manca de formació i de temps. Les àrees identificades son: promoció d'una bona salut mental, prevenció de trastorns, detecció precoç i abordatge de trastorns concrets. Conclusió: És necessari concretar l'àrea de coneixement de pediatre en salut mental infantil, definint bé les competències necessàries i les funcions que cal desenvolupar

Fundamento: En las últimas décadas se ha producido un notable incremento en la demanda de atención en el ámbito de salud mental infantojuvenil. Se detecta, a la vez, una escasa o irregular formación. Objetivo: Describir las competencias del pediatra en salud mental infantil e identificar sus áreas de intervención. Método: Revisión bibliográfica. Resultados: La Asociación Americana de Pediatría describe seis áreas competenciales en pediatría: práctica basada en sistemas para mejorar la base organizativa y económica de la asistencia y la práctica clínica; asistencia de los pacientes; conocimientos médicos; aprendizaje y mejora basados en la práctica clínica; habilidades interpersonales y de comunicación, y profesionalidad. Las limitaciones más importantes para desarrollarlas serían la falta de formación y de tiempo. Las áreas identificadas son: promoción de una buena salud mental, prevención de trastornos, detección precoz y abordaje de trastornos concretos. Conclusión: Es necesario concretar el área de conocimiento del pediatra en salud mental infantil, definiendo bien las competencias necesarias y las funciones a desarrollar

Background: Over the last decades there has been a marked increase in the demand for care in the field of child and adolescent mental health. However, training and education in this field is limited and irregular. Objective: To describe the competencies of the pediatrician in childhood mental health and identify the areas of intervention. Method: Bibliographic review. Results: The American Pediatric Association describes six competency areas to be achieved in pediatrics: system-based practice to improve the organizational and economic basis of clinical assistance and practice, patient care, medical knowledge, practicebased learning and improvement, interpersonal skills, and communication and professionalism. The most important limitations for developing those competencies are the lack of training and time. The identified areas for intervention are: promotion of good mental health, prevention, early detection, and treatment of specific disorders. Conclusion: It is necessary to specify the pediatrician's knowledge in child and adolescent mental health, defining well the required competencies to be developed

Mental disorders in chronic obstructive pulmonary diseases.

PURPOSE: Anxiety and depression are underdiagnosed in chronic obstructive pulmonary disease (COPD) patients. Few studies have tried to identify their association with hospitalization (severe exacerbation). The objective of this study was to determine whether the anxiety/depression was associated with severe exacerbation. DESIGN AND METHODS: A prospective cohort study, based on a sample of 512 patients diagnosed with COPD originating from primary care in a rural area in Lleida (Spain) and monitored between November 1, 2012 and October 31, 2014. For each patient, variables of interest were recorded; they were administered the HADS (Hospital Anxiety and Depression Scale) test to determine the possible presence of anxiety/depression, and its association with severe exacerbation was analyzed using a logistic regression model. FINDINGS: Initially, the prevalence of anxiety/depression was 15.6%. The incidence of global hospitalization in the first year was 8.2% and 11.3% in the second year. In patients with anxiety/depression, it increased to 17.5% in the first year and 18.8% in the second year. In the multivariate regression model, the diagnosis of anxiety/depression almost doubled the risk of hospitalization (OR = 1.94) (p < .041). PRACTICE IMPLICATIONS: Anxiety and depression are associated with an increased risk of hospitalization. Intervention studies are needed to evaluate the effects of anxiety/depression in the hospitalization.

Empathy and burnout of emergency professionals of a health region: A cross-sectional study.

The objective of this study is to assess the association between levels of empathy and burnout of emergency professionals in all the assistance levels.A cross-sectional observational study was conducted in the health region of Lleida and the Pyrenees with 100 professionals from the field of Urgency. Participation reached 40.8%. Empathy and burnout were measured using the Spanish versions of the Jefferson Scale of Physician Empathy (JSPE) and Maslach Burnout Inventory (MBI) respectively. The total MBI score and its 3 dimensions (emotional exhaustion, depersonalization, and personal accomplishment) were analyzed. The JSPE and MBI scores were categorized into tertiles that were identified as "low," "moderate," and "high" levels.The median (interquartile range) was 112 (102-123) and 37 (27-53.5) for the JSPE and MBI scores respectively. Professionals with high burnout (MBI≥47) showed the lowest levels of empathy, that is, JSPE score of 105 (98-114); those with moderate burnout (31≤MBI < 47) had a JSPE score of 114 (104.5-120.5); and those with low burnout (MBI < 31) had a JSPE score of 120.5 (105.8-127.2). In addition, the highest levels of empathy were associated with the lowest levels of burnout, especially in depersonalization, and to a lesser extent in personal accomplishment. There were no differences in empathy and burnout for any of the other study variables.Our findings suggest that the empathy of emergency professionals is associated with burnout. Hence, reducing professional burnout could help keep emergency professionals' empathy levels high, which in turn would ensure a better quality of care. Nevertheless, it would be necessary to carry out prospective studies to describe the profiles of burnout and empathy as well as their association and evolution.