Continuing medical education and continuing medical education accreditation in Spain.

Nearly all Spanish physicians are employed by public or private institutions, and employers are enabling the continuing medical education (CME) of physicians. In view of coexisting CME accreditation systems in Spain, we conclude that a common approach is needed. We recommend establishing formal relationships with American and European systems to ensure consistent accreditation and mutual recognition of CME credits and improvement in accreditation.

[Smoking prevalence in Catalonia (Spain), 1982-1998: a gender perspective]. / Prevalencia del tabaquismo en Cataluña, 1982-1998: una perspectiva de género.

BACKGROUND: We aimed at describing the smoking prevalence trend among the Catalan population (Spain) from 1982 to 1998, based on a gender perspective analysis. SUBJECTS AND METHOD: Data obtained from the surveys carried out by the Catalan Department of Health in 1982, 1986, 1990, 1994 and 1998 were analysed. Variables included were those related to smoking status, number of daily cigarettes, age and sex of the interviewed, type of tobacco smoked, age at which the first experience with smoking took place and smoking duration. Results are presented as proportions with 95% confidence interval and means with standard deviation. RESULTS: Global smoking prevalence in the 15 to 64 year-old population has remained stable between 1982 and 1998 (percentual variability: 1.1%). In 1998, there were 37.5% smokers. In women, the prevalence rate increased by 53.5% during the same period, reaching an overall prevalence of 30.7% in 1998. Among males, there was a 23.8% reduction, reaching an overall prevalence of 44.4%. The decreasing smoking prevalence trend observed among 15 to 24 year-old males and females until 1994 breaks between 1994 and 1998 so that the prevalence in young people increases in this period. In 1998, 26.1% women smoke light tobacco versus 10.4% males; women smoke an average 13.8 (8.8) daily cigarettes versus 19.7 (12.6) in males; mean smoking duration among women is 13.9 (10.1) years, while it is 22.6 (16.0) years among males. CONCLUSIONS: Despite the important reduction of smoking prevalence observed among males, the smoking prevalence rate of the Catalan population remains high. The situation is particularly unfavourable in young people of both sexes and in women, whose smoking habit has specific characteristics.

A brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys.

OBJECTIVE: It is important to perform a routine screening of nicotine dependence in psychiatric patients. The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. The Heavy Smoking Index (HSI) is a briefer measure including only two FTND items (time to first cigarette of day and number of daily cigarettes). In a prior study comparing HSI with FTND, a high HSI (score > or = 4) was a good and briefer alternative for detecting high nicotine dependence. The goals of this study were: (i) to compare the effectiveness of the HSI with the effectiveness of Items 1 and 4 alone for the screening of high nicotine dependence; (ii) to investigate the optimality of 4 as a cut-off score for the HSI so that the HSI can be used as a binary indicator of high nicotine dependence; and (iii) to compare the sensitivity and specificity of four indexes of high nicotine dependence, namely 'High HSI', 'Very Early Smoking', 'Heavy Smoking' and 'High in Either Item'. METHOD: The FTND was administered to 819 current daily smokers from a general population survey. As in a prior study, an FTND score > or = 6 was considered the reference or 'gold standard' test for detecting high nicotine dependence. Receiver-operating characteristic analyses were performed. RESULTS: This new study using more sophisticated statistical methodology verified that a cut-off of 4 for the HSI is appropriate and that the 'high' HSI has good sensitivity and specificity even across different population subclassifications. CONCLUSIONS: With four questions (smoking, daily smoking, time to first cigarette of day and number of daily cigarettes) and minimal calculations, it may be possible to screen whether a smoker has high nicotine dependence. If other studies in other populations and settings verify this finding, this brief measure might be an ideal screening instrument for busy clinicians, epidemiologists developing questionnaires for health surveys and psychiatric researchers.

The effect of age on the relationship of pulse pressure and left ventricular mass in untreated patients with mild to moderate hypertension.

AIM: To study the relationship between left ventricular mass (LMV) and pulse pressure (PP) in mild to moderate hypertensive patients according to age and gender. DESIGN AND METHODS: Two hundred and eleven patients aged 18-65 years, 56% males, with untreated mild to moderate hypertension, were included. A 24-h ambulatory blood pressure (BP) profile was recorded in 204 patients. In 174 of them, an echocardiogram of good quality was obtained. PP was defined as the difference between systolic and diastolic BP. RESULTS: Statistically significant differences were observed in office and ambulatory PP according to the age, with a greater PP among hypertensive subjects younger than 30. Globally, there was a significant correlation between LVM and PP, either with clinical PP (r = 0.17, p = 0.024) or with ambulatory PP (24-h PP: r = 0.18, p = 0.016). When stratifying by age group, the stronger correlations were observed in patients younger than 30. When stratifying by gender, previous results were applicable to men, but, in women, no correlation was observed between PP and LVM in either age group. CONCLUSIONS: an increased PP was observed in hypertensive patients younger than 30 in comparison with middle-aged hypertensive patients. The correlation between LVM and PP was stronger in younger male hypertensive patients, but not in female.

Cardiac damage in hypertensive patients with inverse white coat hypertension. Hospitalet study.

BACKGROUND: Few studies have assessed the relationship between ambulatory blood pressure (BP) and cardiac damage in essential hypertensive patients with inverse white coat hypertension (IWCH). OBJECTIVES: To determine the frequency of IWCH in untreated grade 1-2 hypertension and to assess possible differences in cardiac damage among patients with IWCH, white coat hypertension (WCH) and the rest of patients with grade 1-2 hypertension. PATIENTS AND METHODS: Two hundred and eleven patients with grade 1-2 hypertension were sequentially included. A good quality 24-h ambulatory BP monitoring was obtained in 204 patients (age: 41 +/- 12 years, 56% males). IWCH was defined as a daytime systolic and/or diastolic BP higher than diagnostic office systolic and/or diastolic BP, respectively. WCH was defined as a daytime BP < 135/85 mmHg. A good quality echocardiogram was obtained in 174 patients. We considered left ventricular hypertrophy a left ventricular mass index (LVMI) > or = 125 g/m2. RESULTS: We found IWCH in 29 subjects (14%), and WCH in 68 (33%). Office BP in patients with IWCH was in an intermediate position between WCH and the rest of grade 1-2 hypertension patients. The IWCH patients showed 24-h, daytime and night-time BP higher than the other groups. Left ventricular mass was significantly greater in patients with IWCH than in the other grade 1-2 hypertension patients after adjusting for age, gender, body mass index, smoking and office BP (regression coefficient 28.14, 95%CI: 7.36-48.91). CONCLUSION: IWCH is independently associated with higher values of left ventricular mass in patients with grade 1-2 hypertension.

La acreditación de la Formación Médica Continuada. Hechos y controversias / The accreditation of Continuing Medical Education. Facts and controversies

La acreditación de la formación médica continuada (FMC) tiene como objetivo esencial la mejora de la oferta formativa, por encima de otros objetivos complementarios como servir de guía a los distintos agentes, atestiguar la participación en los programas formativos, orientar la oferta o reconocer la cualificación de los proveedores. De los tres ámbitos tradicionales de la acreditación, la acreditación individual debe separarse claramente, equiparándose a lo que se conoce como revalidación. Los otros dos ámbitos genuinos de acreditación de la FMC son la acreditación de actividades formativas la acreditación de instituciones proveedoras. Los créditos de FMC sirven para tres cometidos fundamentales: la carrera profesional, la revalidación el desarrollo profesional continuo. Adicionalmente, pueden utilizarse para otras finalidades relacionadas con la promoción profesional individual. La situación de la acreditación de la FMC en España esmuí esperanzadora, con dos sistemas de acreditación que disponen de una relativamente larga trayectoria y unas expectativas que lo sitúan en una posición avanzada a nivel europeo (AU)

The main objective of continuing medical education (CME) accreditation is to improve the CME offer, being other additional objectives to serve as orientation of the different agents, to certify the attendance of participants, to orient the CME offer and to recognise the quality of CME providers. Among the three traditional domains of the accreditation, the accreditation of the individuals must be clearly separated and should be identified to revalidation. The other two genuine domains of the CME accreditation are the CME activities accreditation and the CME providing institutions accreditation. The CME credits are useful for three particular professional developments: professional career, revalidation and continuing professional development. Additionally one can use them for other individual promotion purposes. The CME accreditation situation in Spain is currently encouraging, with two accreditation systems actively implemented into practice and with good expectations in the European context (AU)

Retos de la formación médica continuada. Situación actual y perspectivas de futuro en España / No disponible

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El médico del futuro / Physician for the future

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¿Qué opinan los médicos sobre la formación continuada, la evaluación de la competencia y la recertificación? / What do doctors think of continuing education, competence evaluation

Se presentan los resultados de las encuestas llevadas a cabo durante el I Congreso de la Profesión Médica de Cataluña (Sitges, 19-20 de noviembre, 2004), en el que participaron 1.200 médicos, relacionadas con la formación médica continuada (FMC), la evaluación de la competencia (EC) y la recertificación (RC).En lo tocante a la FMC, mayoritariamente opinan que debe ser obligatoria y realizarse en horario laboral y que quienes no la lleven a cabo deben ser advertidos/sancionados. Por lo que se refiere a la EC, prefieren un sistema no punitivo, que esté en manos de las organizaciones profesionales y que se complemente con un registro colegial. A partir de la FMC y la EC, una gran parte opinan que podría introducirse un sistema de recertificación, que contemplara la FMC “remedial” como ayudadle profesional con problemas de (..) (AU)

The main results of the I Congress of the Catalan Medical Profession (Sitges, 19-20 November, 2004)on the subjects of continuing medical education (CME),competence evaluation (CE) and recertification (RC) are presented. Around 1200 physicians participated in it. Most doctors think that CME will be mandatory, provided during work time and with specific warnings/sanctions for physicians who do not participate. As for CE, they prefer a non-punitive system, managed by professional organizations, and complemented by a physicians’ register.CME and CE could facilitate the implementation of a recertification system, in which the remedial CME should be included. The authors conclude that Catalan physicians show an encouraging sense of social accountability and professionalism (AU)

Sobre la regulación de la profesión médica. Situación actual y perspectivas de futuro en España / No disponible

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