Comparing wildlife habitat suitability models based on expert opinion with camera trap detections.

Expert knowledge is used in the development of wildlife habitat suitability models (HSMs) for management and conservation decisions. However, the consistency of such models has been questioned. Focusing on 1 method for elicitation, the analytic hierarchy process, we generated expert-based HSMs for 4 felid species: 2 forest specialists (ocelot [Leopardus pardalis] and margay [Leopardus wiedii]) and 2 habitat generalist species (Pampas cat [Leopardus colocola] and puma [Puma concolor]). Using these HSMs, species detections from camera-trap surveys, and generalized linear models, we assessed the effect of study species and expert attributes on the correspondence between expert models and camera-trap detections. We also examined whether aggregation of participant responses and iterative feedback improved model performance. We ran 160 HSMs and found that models for specialist species showed higher correspondence with camera-trap detections (AUC [area under the receiver operating characteristic curve] >0.7) than those for generalists (AUC < 0.7). Model correspondence increased as participant years of experience in the study area increased, but only for the understudied generalist species, Pampas cat (ß = 0.024 [SE 0.007]). No other participant attribute was associated with model correspondence. Feedback and revision of models improved model correspondence, and aggregating judgments across multiple participants improved correspondence only for specialist species. The average correspondence of aggregated judgments increased as group size increased but leveled off after 5 experts for all species. Our results suggest that correspondence between expert models and empirical surveys increases as habitat specialization increases. We encourage inclusion of participants knowledgeable of the study area and model validation for expert-based modeling of understudied and generalist species.

Comparación entre los modelos de idoneidad de hábitat basados en la opinión de expertos y la detecciones con cámaras trampa Resumen El conocimiento de expertos se usa en el desarrollo de modelos de idoneidad de hábitat (MIH) para la gestión y la toma de decisiones en conservación. Sin embargo, se ha cuestionado la coherencia de dichos modelos. Utilizamos un solo método, el proceso de jerarquización analítica, para generar MIH para cuatro felinos: dos especies especialistas de bosque (Leopardus pardalis y L. wiedii)) y dos generalistas de hábitat (Leopardus colocola y Puma concolor). Usamos estos MIH, la detección de las especies mediante censos de cámaras trampa y modelos lineales generalizados, para analizar el efecto de dichas especies y las características de los expertos sobre la correspondencia entre los modelos expertos y las detecciones con cámaras trampa. También analizamos si la agregación de las respuestas de los participantes y la retroalimentación iterativa mejoran el desempeño del modelo. Analizamos 160 MIH y encontramos que los modelos para las especies especialistas mostraron una correspondencia mayor con las detecciones de cámarastrampa (ABC [área bajo la curva de la característica operante receptora] >0.7) para las especies generalistas (ABC < 0.7). La correspondencia del modelo incrementó conforme incrementaron los años de experiencia de los participantes en el área de estudio, pero sólo para Leopardus colocola, una especie generalista y poco estudiada (ß = 0.024 [SE 0.007]). Ninguna otra característica de los participantes se asoció con la correspondencia del modelo. La retroalimentación y la revisión de los modelos aumentaron la correspondencia y la agregación de opiniones de múltiples participantes aumentó la correspondencia sólo para las especies especialistas. La correspondencia promedio de las opiniones agregadas incrementó conforme creció el tamaño grupal, aunque se niveló después de cinco expertos para todas las especies. Nuestros resultados sugieren que la correspondencia entre los modelos de expertos y las evaluaciones empíricos incrementan conforme aumenta la especialización del hábitat. Promovemos la inclusión de participantes conocedores del área de estudio y la validación del modelo para el modelado de expertos de especies generalistas y poco estudiadas.

Joint position statement of the Societat Catalana de Digestologia and the Societat Catalana de Radiologia on gastroenterologist-led ultrasound in Catalonia. / Documento de posicionamiento de la Societat Catalana de Digestologia y la Societat Catalana de Radiologia: ecografía para especialistas en enfermedad digestiva en Catalunya.

Over recent years, ultrasonography has been used increasingly in various medical specialties and is now an indispensable diagnostic tool. In gastroenterology, bedside or point-of-care ultrasound allows the early diagnosis and monitoring of multiple intraabdominal conditions. Ultrasound guidance is also highly useful in certain therapeutic procedures, increasing procedural safety. Ultrasound is a non-invasive technique but has the drawback of being very operator dependent. Therefore, it is necessary to ensure that the professionals who perform ultrasonography have a sufficient level of training in the technique. In Catalonia, abdominal ultrasound is usually carried out by radiologists and has not yet been incorporated as an investigation performed by gastroenterologists. In view of this, the Societat Catalana de Radiologia and the Societat Catalana de Digestologia judged it necessary to develop a consensus framework document on ultrasound use and training for gastroenterologists. The document establishes the suggested format for training, the appropriate indications, the minimum material requirements and appropriate documentation of the procedure to ensure that gastroenterologist-performed ultrasound is useful and safe.

Los médicos especialistas en México.

INTRODUCCIÓN: No hay datos recientes en México sobre el estado de los médicos especialistas que permitan diseñar políticas de formación y empleo de los recursos humanos para la salud. OBJETIVO: Analizar el estado actual de los médicos especialistas en México: número, distribución (geográfica, por sexo y especialidad), vigencia de la certificación (por sexo y especialidad) y tasa de especialistas por 100 000 habitantes. MÉTODO: estudio transversal descriptivo. Se consultaron múltiples fuentes disponibles en México: consejos, asociaciones, colegios, instituciones hospitalarias, universidades y otros. RESULTADOS: Se contabilizaron 147 910 especialistas para una población de 123 518 272 habitantes; 69 % contaba con certificación vigente de la especialidad. Se obtuvo una tasa de 119 especialistas por 100 000 habitantes; 54.2 % se encontraba en la Ciudad de México, Estado México, Jalisco y Nuevo León. En promedio había 1.7 especialistas varones por cada mujer. CONCLUSIONES: El número de especialistas es inferior al recomendado internacionalmente e insuficiente para cubrir las necesidades en salud del país. La distribución por género está cambiando hacia una más equitativa. Los especialistas están agrupados mayormente en zonas urbanas. Es el primer censo de especialistas con base en el número comprobable de médicos, que permitirá el diseño de políticas de planificación de recursos humanos en salud. INTRODUCTION: There are no recent data in Mexico about the state of medical specialists that allow the design of policies for training and use of human resources for health. OBJECTIVE: To analyze the current state of medical specialists in Mexico: number, distribution (geographical, by gender and specialty), certification validity (by gender and specialty) and the rate of specialists per 100 000 population. METHOD: Cross-sectional, descriptive study. Multiple sources available in Mexico were consulted: councils, associations, schools, hospital institutions, universities, and others. RESULTS: A total of 147,910 specialists were counted for a total population of 123,518,272 inhabitants; 69 % had current specialty certification. A rate of 119 specialists per 100 000 population was obtained; 54.2 % are in Mexico City and in the States of Mexico, Jalisco and Nuevo León. On average, there are 1.7 male specialists per female specialist. CONCLUSIONS: The number of specialists is lower than that internationally recommended and insufficient to cover the health needs of the country. Gender distribution is shifting towards a more equitable one. Specialists are mainly grouped in urban areas. This is the first census of specialists based on total verifiable number of physicians, which will allow the design of policies for human resources planning in health.

Risk of local extinction of Odonata freshwater habitat generalists and specialists.

Understanding the risk of a local extinction in a single population relative to the habitat requirements of a species is important in both theoretical and applied ecology. Local extinction risk depends on several factors, such as habitat requirements, range size of species, and habitat quality. We studied the local extinctions among 31 dragonfly and damselfly species from 1930 to 1975 and from 1995 to 2003 in Central Finland. We tested whether habitat specialists had a higher local extinction rate than generalist species. Approximately 30% of the local dragonfly and damselfly populations were extirpated during the 2 study periods. The size of the geographical range of the species was negatively related to extinction rate of the local populations. In contrast to our prediction, the specialist species had lower local extinction rates than the generalist species, probably because generalist species occurred in both low- and high-quality habitat. Our results are consistent with source-sink theory.

The current situation of tutoring in specialised training in otorhinolaryngology-head and neck surgery in Spain. Where are we? Where do we want to go?

BACKGROUND AND OBJECTIVE: There is great heterogeneity in the methodology and evaluation in specialized health training (SHT) in otorhinolaryngology in our country. The figure of the resident tutor is the cornerstone on which the ESF system is based and the regulation and recognition of this figure varies. This article aims to take a snapshot of the current situation of the ESF in Spain and to describe the activity of tutors. MATERIALS AND METHODS: During the month of September 2023, a survey was sent in a Google Forms® format through the Spanish Society of Otolaryngology and Head and Neck Surgery. The survey consisted of 8 multiple-choice questions and 4 questions in which they were asked to rank a series of 5 weaknesses, threats, opportunities and strengths selected by the authors, in order to perform a SWOT analysis. RESULTS: A total of 103 responses were obtained, of which 81 corresponded to accredited tutors. 63% of the tutors indicated that they did not have enough time to carry out their teaching work and 48% did not carry out a regular assessment of their residents. 64% of the tutors believe that the quality of otorhinolaryngology training in Spain is good and 61% are satisfied with their job as tutors. The main weakness was the short duration of the training programme, and the pressure of care was found to be the main threat. An experienced training system was considered the main strength and the creation of a national network of tutors was seen as an opportunity for improvement. CONCLUSIONS: The creation of a common and transversal otorhinolaryngology training pathway for all accredited centres and the creation of a network of mentors and residents are necessary to address the problems of SHT. The role of the tutor must be recognised and reinforced to improve specialist training.

Prevalence of Burnout Syndrome and Associated Variables in Mexican Medical Specialists.

OBJECTIVE: To determine the prevalence of burnout syndrome and the associated variables in medical specialists in Mexico. METHODS: Observational, descriptive and cross-sectional study, by means of a census of 540 medical specialists from three Regional Hospitals. Using their identification card and self-administered Maslach Burnout Inventory-Human Services questionnaire, descriptive statistics and inferential analysis were performed using SPSS 15.0 and Epi-infoV6.1. RESULTS: There was a 90.0% response in the specialists studied. Burnout was detected in 45.9%. There were significant differences in variables: being female; under 40 years of age; without a stable partner, and less than 15 years together; a working couple; childless; clinical specialty; less than 10 years of professional and current employment, and accumulated work day. A negative correlation was found in burnout with emotional exhaustion, and with depersonalisation. It was positive with a lack of personal fulfilment at work. CONCLUSIONS: Burnout is common (45.9%) in specialist physicians. The average levels of the subscales are close to normal. Emotional exhaustion and depersonalisation behave inversely proportional to the total score of the syndrome, and directly proportional to the lack of personal fulfilment in the work with burnout.

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.

Prevalence of Burnout Syndrome and Associated Variables in Mexican Medical Specialists. / Prevalencia del síndrome de agotamiento profesional (burnout) y variables asociadas en médicos especialistas.

OBJECTIVE: To determine the prevalence of burnout syndrome and the associated variables in medical specialists in Mexico. METHODS: Observational, descriptive and cross-sectional study, by means of a census of 540 medical specialists from three Regional Hospitals. Using their identification card and self-administered Maslach Burnout Inventory-Human Services questionnaire, descriptive statistics and inferential analysis were performed using SPSS 15.0 and Epi-infoV6.1. RESULTS: There was a 90.0% response in the specialists studied. Burnout was detected in 45.9%. There were significant differences in variables: being female; under 40 years of age; without a stable partner, and less than 15 years together; a working couple; childless; clinical specialty; less than 10 years of professional and current employment, and accumulated work day. A negative correlation was found in burnout with emotional exhaustion, and with depersonalisation. It was positive with a lack of personal fulfilment at work. CONCLUSIONS: Burnout is common (45.9%) in specialist physicians. The average levels of the subscales are close to normal. Emotional exhaustion and depersonalisation behave inversely proportional to the total score of the syndrome, and directly proportional to the lack of personal fulfilment in the work with burnout.

Professional burnout syndrome in specialist surgeons: prevalence and risk factors.

BACKGROUND: Medical surgeons specialists are exposed to risk factors, the most frequent being those of the psychosocial type, where burnout syndrome is included due to the type of exposure and diversification of their activities as a member of the health team and the legal and socio-labor repercussions. OBJECTIVE: To determine the prevalence and risk factors of burnout in medical surgeons. METHOD: Observational, descriptive and cross-sectional study in 296 specialists. The data was processed descriptively and inferentially with the support of the SPSS 15.0 and Epi-infoV6.1 program. RESULTS: There was a response in 92.5% of the interviewees and the burnout was found in 40.2%. Significant differences were detected in age under 40 years, not having a stable partner, and < 15 years with your partner, being a medical oncologist, having < 10 years of professional seniority and in the workplace. CONCLUSIONS: Burnout is frequent (40.2%), as risk factors are, being: woman; under 40 years old; not having a stable partner, under 15 years with her and not working this, without children; surgical medical oncologist; < 10 years of professional seniority and job position, night shift; definitive hiring; not having another job and more than 4 h in it. The involvement of the subscales behaves like the syndrome. There was a negative correlation with burnout between emotional exhaustion and depersonalization, and positive with lack of personal fulfillment at work.

ANTECEDENTES: Los médicos cirujanos especialistas están expuestos a factores de riesgo, siendo los más frecuentes los de tipo psicosocial, incluyendo el síndrome de desgaste profesional (burnout) por el tipo de exposición y la diversificación de sus actividades como miembros del equipo de salud, y las repercusiones jurídicas y sociolaborales. OBJETIVO: Determinar la prevalencia y los factores de riesgo del burnout en médicos cirujanos especialistas. MÉTODO: Estudio observacional, descriptivo y transversal, en 296 especialistas. Los datos se procesaron descriptivamente y de manera inferencial con apoyo de los programas SPSS 15.0 y Epi-infoV6.1. RESULTADOS: Hubo respuesta en el 92.5% de los entrevistados y el burnout se encontró en el 40.2%. Se detectaron diferencias significativas en edad menor de 40 años, no tener pareja estable o menos de 15 años con pareja, ser médico oncólogo quirúrgico, y tener menos de 10 años de antigüedad profesional o en puesto de trabajo. CONCLUSIONES: El burnout es frecuente (40.2%) y como factores de riesgo están ser mujer, ser menor de 40 años, no tener pareja estable o menos de 15 años con pareja y que esta no trabaje, no tener hijos, ser médico oncólogo quirúrgico, tener menos de 10 años de antigüedad profesional o en puesto de trabajo, trabajar en turno nocturno, tener contratación definitiva, no tener otro trabajo y trabajar más de 4 horas en él. La afectación de las subescalas se comporta como el síndrome. Hubo correlación negativa con el burnout entre agotamiento emocional y despersonalización, y positiva con falta de realización personal en el trabajo.

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.

BACKGROUND: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. METHODS: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. RESULTS: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. CONCLUSIONS: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

Influence of previous experience on the benefits of laparoscopic surgical training based on simulation. / Influencia de la experiencia previa en los beneficios del entrenamiento quirúrgico laparoscópico basado en la simulación.

INTRODUCTION: Surgical training based on simulation seeks the acquisition of skills in novice participants and ongoing sill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyse their results depending on their level and previous experience. METHODS: The students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analysed. Manual side-to-side intestinal anastomoses with porcine 'ex vivo' viscera were performed in a laparoscopic endotrainer. The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared. RESULTS: We analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists (p<.001). In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, p=.59), which presented improvement without statistical significance. CONCLUSIONS: The group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.

Extensión del empleo del criterio de expertos. Validez, consistencia y fiabilidad de los resultados científicos

El criterio (juicio o consulta) de expertos, en las últimas décadas, ha sido ampliamente utilizado en las investigaciones cualitativas, puede decirse que para muchos investigadores constituye la "regla de oro" para validar sus hallazgos. El propósito del artículo consistió en proponer un procedimiento para el procesamiento estadístico de los datos cuando se emplea una extensión del método convencional del criterio de expertos, para establecer la validez, consistencia y fiabilidad en los hallazgos científicos. El mismo fue aplicado en la toma de decisiones de una de las tres dimensiones de la variable de los componentes del ejercicio problémico interdisciplinario del proceso de enseñanza-aprendizaje. En el proceso investigativo se utilizaron métodos empíricos como la revisión de documentos, la encuesta y el criterio de expertos. Los tests estadísticos aplicados arrojaron significación estadística (P < 0.05 hasta P < 0.001) entre las comparaciones y/o asociaciones realizadas. Los hallazgos encontrados demostraron, al aplicar el procedimiento, una aproximación hacia la validez, consistencia y fiabilidad de los resultados científicos.

O julgamento de especialistas (julgamento ou consulta) tem sido, nas últimas décadas, amplamente utilizado em pesquisas qualitativas, indiscutivelmente o "padrão ouro" para muitos pesquisadores validarem suas descobertas. O objetivo do artigo foi propor um procedimento para o processamento estatístico de dados ao usar uma extensão do método convencional de julgamento de especialistas para estabelecer validade, consistência e confiabilidade em descobertas científicas. Ele foi aplicado na tomada de decisão de uma das três dimensões dos componentes variáveis do exercício interdisciplinar de solução de problemas do processo de ensino-aprendizagem. Métodos empíricos, como análise de documentos, pesquisa e julgamento de especialistas, foram usados no processo de pesquisa. Os testes estatísticos aplicados mostraram significância estatística (P < 0,05 a P < 0,001) entre as comparações e/ou associações feitas. Os resultados demonstraram, ao aplicar o procedimento, uma abordagem voltada para a validade, a consistência e a confiabilidade dos resultados científicos.

In recent decades, expert judgment has been widely used in qualitative research, and it can be said that for many researchers it constitutes the "golden rule" for validating their findings. The purpose of the article was to propose a procedure for the statistical processing of data when an extension of the conventional method of expert judgment is used to establish the validity, consistency and reliability of scientific findings. It was applied in the decision making of one of the three dimensions of the variable of the components of the interdisciplinary problem-solving exercise of the teaching-learning process. Empirical methods such as document review, survey and expert judgment were used in the research process. The statistical tests applied showed statistical significance (P < 0.05 to P < 0.001) among the comparisons and/or associations made. The findings found demonstrated, when applying the procedure, an approach towards the validity, consistency and reliability of the scientific results.

Competential development of nurses in the public health system of Andalucía. / Desarrollo competencial de las enfermeras en el sistema sanitario público de Andalucía.

The socio-demographic and epidemiological changes of our environment are characterized by an increase in aging, chronic illness, comorbidities and with it, a progressive escalation of the demand for care. These new demands and expectations of citizenship are accompanied by an evolution of health systems (technological advances, complexity of the healthcare network, limited resources), the need to develop new roles and competence in care, together with the opportunity that full academic development implies: Nursing undergraduate and posgraduate degrees. This is why, at present, it is necessary to reorient care models in order to achieve health care for more agile, efficient and better quality care processes, adapted to the needs and expectations of citizens and to the sustainability of health systems. The Public Health System of Andalusia (SSPA) has developed, in recent decades, different nursing roles that include new competences, with the aim of responding to the needs of citizens. The objective of this article is to present how the competences development framework of nurses has been configured in the SSPA, which also integrates advanced skills in care and advanced practice profiles (Clinical Nurse Specialists and Advanced practice nurses).

The implementation of the Mental Health Nursing Specialty in Andalusia. A community approach. / La implantación de la especialidad de Enfermería de Salud Mental en Andalucía desde un enfoque comunitario.

Health systems have a responsibility to respond to the new health needs of the population, which are characterized by factors such as aging, chronicity and/or dependency situations and which requires quality and specialized care adapted to different areas where care is provided, care offered by trained and increasingly qualified professionals to improve the health outcomes of the caregivers. In 2016, in Andalusia the regulatory framework by which is created the statutory professional category of nurse/specialists is published, including the specialty of Mental Health Nursing in the Andalusian Health Service. In the field of Mental Health, the development of this normative framework and the definition and occupation of positions, will allow the health system to combine the role of nurse specialist nurses with that of nurses who provide general care, registered nurses, in order to advance in the best response to the health needs of citizens in this area of care. The development of the specialty will be an added value both to improve the health outcomes of people with mental health problems, and to improve the quality of care, efficiency and sustainability of health systems.

Mobbing as a Predictor of Health Risk Behaviours and Seeking Specialist Support in Non-university Teachers / [El acoso psicológico como predictor de conductas de riesgo para la salud y la búsqueda de apoyo especializado en los docentes no universitarios]

The purpose of this study was to investigate whether experiencing mobbing can predict different health risk behaviours, such as smoking, alcohol intake, increased use of medication as a consequence of psychological disorders at work, and the need to seek specialist support in non-university teachers (N = 9,350). The results of the factorial analysis confirmed the one-dimensionality of the scale and its invariance by gender and educational stage. Results for the predictive model showed that the total score on a mobbing scale predicts the increase in both alcohol intake and tobacco use, a greater use of medication as a consequence of psychological or psychosomatic health disorders at work, and the need to seek support from a specialist to overcome some personal crises related to work. Likewise, the consumption of alcohol and tobacco were positively correlated, whereas the search for specialist support was more related to the increase in the use of medication.(AU)

El objetivo del estudio fue investigar si el acoso psicológico predecía conductas de riesgo no saludables en forma de aumento del consumo de tabaco y alcohol y aumento del consumo de medicamentos por trastornos psicológicos asociados al trabajo, así como la búsqueda de apoyo de profesionales en docentes no universitarios (N = 9,350). Un análisis factorial inicial confirmó la unidimensionalidad de la escala de mobbing y su invarianza por género y etapa educativa. Los resultados del modelo predictivo mostraron que la puntuación en acoso predice el aumento de consumo de alcohol y de tabaco y mayor uso de medicamentos debido a problemas de salud psicológicos o psicosomáticos derivados del trabajo, así como la necesidad de buscar apoyo de especialistas para superar crisis personales relacionadas con el trabajo. El aumento del consumo de alcohol y de tabaco correlacionan positivamente. La búsqueda de apoyo especializado está más relacionada con el aumento del uso de medicamentos.(AU)

Survey on the knowledge of cochlear implant indication in the treatment of hearing loss in Spain. / Encuesta sobre el conocimiento en la indicación de implantes cocleares para el tratamiento de la hipoacusia en España.

INTRODUCTION: This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area. MATERIAL AND METHODS: A questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population. RESULTS: A total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed). CONCLUSIONS: The 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.

Percepción de Miedo al COVID-19 en Estomatólogos Generales y Especialistas / Perception of Fear of COVID-19 in General and Specialist Stomatologists

Durante la pandemia por COVID-19, se incrementaron las preocupaciones, la ansiedad y el miedo, especialmente al brindar atención estomatológica. El objetivo de esta investigación fue analizar la percepción del miedo al COVID-19 en estomatólogos generales y especialistas durante la pandemia. Se diseñó un estudio observacional, analítico, unicéntrico y homodémico. Se incluyeron estomatólogos generales y especialistas de cualquier sexo de diversas disciplinas estomatológicas como ortodoncia, endodoncia, cirugía maxilofacial, etc. La muestra estuvo constituida por 72 estomatólogos, 42 de práctica general (58,3 %) y 32 especialistas (41,6 %). Los datos se recolectaron durante marzo a septiembre del 2021. Participaron 72 estomatólogos (M= 39 años, D.E. 10,82). El 69,4 % de la muestra (n =50) fueron mujeres. De acuerdo con el análisis de medias de la escala total, se encontró que los hombres se perciben ligeramente con más miedo al Covid-19 (M=3,09) que las mujeres durante su práctica estomatológica (M=2,78) sin diferencias significativas. La edad impactó en las respuestas, ya que los mayores de 40 años percibieron más miedo M= 3.23 (IC 95%: 2,65-3,81) que el grupo de 20 a 40 años M=2,73 (IC 95%: 2,37-3,09). Los especialistas, también percibieron mayor miedo al COVID-19 contrastados con los estomatólogos de práctica general (M=2,63) vs (M=3,06). Los resultados denotaron que el 36,1 % de los estomatólogos tuvieron miedo al COVID-19. La investigación anterior mostró resultados similares al estudio de Monterrosa-Castro et al. (2020) en médicos generales colombianos en el que el 37,1 % presentó síntomas de miedo al COVID-19 (FCV-19S). El contexto de pandemia, además de la incertidumbre del comportamiento del COVID-19 y la falta de vacunación masiva al momento de levantar los datos, jugaron un papel muy importante en la percepción del miedo al COVID-19. Los especialistas observaron mayor miedo al COVID-19 al igual que el grupo de mayor edad.

During the COVID-19 pandemic, worries, anxiety and fear increased, especially when providing dental care. The objective of this research was to analyze the perception of fear of COVID-19 in general dentists and specialists during the pandemic. An observational, analytical, single center and homodemic study was designed. General stomatologists and specialists of any sex from various dental disciplines such as orthodontics, endodontics, maxillofacial surgery, etc., were included. The sample consisted of 72 dentists, 42 general practice (58.3 %) and 32 specialists (41.6 %). Data was collected from March to September 2021. 72 dentists participated (M= 39 years, S.D. 10.82). 69.4 % of the sample (n = 50) were women. According to the analysis of means of the total scale, it was found that men perceive themselves to be slightly more afraid of Covid-19 (M=3.09) than women during their dental practice (M=2.78) without significant differences. Age had an impact on the responses, since those over 40 years of age perceived more fear M= 3.23 (95% CI: 2.65-3.81) than the group from 20 to 40 years M=2.73 (95% CI: 2.37- 3.09). Specialists also perceived greater fear of COVID-19 compared to general practice dentists (M=2.63) vs (M=3.06). The results denoted that 36.1 % of the dentists were afraid of COVID-19. Previous research showed similar results to the study by Monterrosa-Castro et al. (2020) in Colombian general practitioners in which 37.1 % presented symptoms of fear of COVID-19 (FCV-19S). The pandemic context, in addition to the uncertainty of the behavior of COVID-19 and the lack of mass vaccination at the time of collecting the data, played a very important role in the perception of fear of COVID-19. The specialists observed greater fear of COVID-19 as well as the older group.

Conclusiones de las XII Jornadas del Grupo Avilés sobre Medicina del Deporte / Conclusions of the XII Conference of the Avilés Group on Sports Medicine

El Grupo de Trabajo Avilés surgió en 2009 con el impulso del Consejo Superior de Deportes (CSD) y está formado, entre otros, por representantes de los Centros de Medicina dela Educación Física y el Deporte de todas las comunidades autónomas que cuentan con estas infraestructuras. Como objetivos de este grupo de trabajo figuran la coordinación entre estas estructuras autonómicas de la medicina del deporte, el planteamiento de soluciones comunes a las diferentes problemáticas que sufren cada uno de los centros y el ser un grupo de asesoramiento, en los diferentes ámbitos de la medicina de la educación física y el deporte, para el CSD. Este grupo de trabajo se reúne periódicamente y en su última reunión, celebrada en Miranda de Ebro (Burgos) el 2 y 3 de octubre de 2023, se acordaron una serie de conclusiones, en relación a los beneficios de la actividad física en patologías como la diabetes, el cáncer o las enfermedades neurodegenerativas, la defensa de la Prescripción de Ejercicio Físico como una actuación sanitaria de máxima prioridad, la digitalización de los centros de medicina del deporte y el uso de la inteligencia artificial y la necesidad de crear plazas de formación para especialistas. (AU)

The impact of patients with generalized anxiety disorder in the Brazilian Private Healthcare System: a claim database study with expert's perspective / O impacto de pacientes com transtorno de ansiedade generalizada no Sistema Único de Saúde: um estudo de base de sinistros com a perspectiva de especialistas

This study describes the healthcare resource use and costs associated with anxiety assessing claim database outcomes and expert opinion from the perspective of the Brazilian Private Healthcare System. A retrospective analysis of the Orizon database was conducted, containing claims data of anxiety patients reported in Private Healthcare Systems (2015-2017) according to the ICD-10 code (F40 or F41 and their subtypes). Further, a 3-hour online meeting brought together five anxiety and Health Insurance Companies experts to discuss their perspectives. The total cost of the 18,069 patients identified in the database was BRL 490 million: related to medical appointments (2%), exams (16%), emergency room (5%), and others (77%). The mean number of appointments was 5.1 in a 4-year period, performed by 61% of the patients. Approximately 2,595 visits were made to psychiatrists by 923 patients, and 95% underwent at least one examination (100.6 examinations per patient, on average). The identification of anxiety patients and their corresponding burden is challenging to estimate. The higher impact is related to the frequency of healthcare use before the diagnosis than the treatment itself. These outcomes may help plan and implement adequate healthcare programs for patients with anxiety.

Este estudo descreve o uso de recursos de saúde e os custos relacionados à ansiedade associando resultados de uma base de dados administrativa e opinião de especialistas na perspectiva do Sistema Privado de Saúde Brasileiro. Foi realizada uma análise retrospectiva da base de dados da Orizon de pacientes com ansiedade em atendimento hospitalizar ou ambulatorial no Sistema Privado de Saúde (2015 - 2017) com o código CID-10 (F40 ou F41 e os seus subtipos), adicionalmente promovemos uma reunião online de 3 horas com cinco especialistas em ansiedade e em seguros de saúde para discutir as suas perspectivas. O custo total dos 18.069 pacientes identificados no banco de dados foi de R$ 490 milhões, relacionados a consultas médicas (2%), exames (16%), pronto-socorro (5%) e outros (77%). A média de consultas foi de 5,1 em um período de 4 anos, realizadas por 61% dos pacientes. Aproximadamente 2.595 visitas foram feitas a psiquiatras por 923 pacientes, e 95% realizaram pelo menos um exame (média de 100,6 exames por paciente. É desafiador identificar e estimar o impacto da doença no Sistema Privado de Saúde Brasileiro. O impacto maior está relacionado à frequência de uso de serviços de saúde antes do diagnóstico, em comparação com o próprio tratamento. Esses resultados podem ajudar a planejar e implementar programas de saúde adequados para pacientes com ansiedade.

Variables, indicadores y criterios de evaluación del servicio médico como escenario de formación de especialistas

La calidad de la educación de posgrado concebida estratégicamente como la integración de la pertinencia social y la excelencia académica, deviene esencial en la gestión de las instituciones docente-asistenciales del sector salud. Sus múltiples dimensiones deben ser contextualizadas y son susceptibles de análisis y perfeccionamiento en cada servicio médico donde se desarrolla el proceso de formación de especialistas. Se utilizaron métodos teóricos y empíricos, para la identificación de las dificultades y la elaboración de la nueva propuesta. Se obtuvieron criterios sobre los servicios médicos como escenarios de formación, en los que se identificaron los problemas relativos a la actividad de posgrado. La propuesta consideró las directrices estratégicas, la población objeto de atención y los diferentes ámbitos temporales y espaciales identificados, con lo que pretende el fortalecimiento y desarrollo de la formación de posgrado en las Universidades de Ciencias Médicas en Cuba.

The quality of postgraduate education, strategically conceived as the integration of social relevance and academic excellence, becomes essential in the management of teaching-assistance institutions in the health sector. Its multiple dimensions must be contextualized and are susceptible to analysis and improvement in each medical service where the specialist formation process takes place. Theoretical and empirical methods were used, for the identification of the difficulties and the elaboration of the new proposal. Criteria on medical services were obtained as training scenarios, in which problems related to postgraduate activity were identified. The objective of the work is to expose a proposal of variables, indicators and evaluation criteria in the service as a scenario the specialist's formation. The proposal was considered the strategic guidelines, the target population and the different temporal and spatial areas identified, with which it intends to strengthen and develop postgraduate training in the Medical Sciences Universities in Cuba.