[25 years of laparoscopic surgery in Spain]. / 25 años de cirugía laparoscópica en España.

INTRODUCTION: The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. MATERIAL AND METHODS: During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. RESULTS: The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. CONCLUSIONS: Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement.

Characteristics of professionalism of specialists and advantages of multidisciplinary teams in thyroid cancer: results of a national opinion survey. / Características de profesionalidad de los especialistas y ventajas de los equipos multidisciplinares en cáncer de tiroides: resultados de una encuesta de opinión nacional.

INTRODUCTION: The opinion of professionals about multidisciplinary teams (MDT) in thyroid cancer has not been studied in Spain. This study was intended to ascertain the opinion of specialists about the characteristics of the professionals and the advantages provided by these teams. METHODS: A survey was designed to assess the opinion about the characteristics of professionalism and the advantages of MDT for patients, professionals, and the health care system. The survey was posted online from November 15, 2017 to February 15, 2018. RESULTS: A total of 226 surveys were evaluated. The ability for teamwork was considered the most important characteristic to be met by professionals by 37.2% of respondents, while scientific competence was the most important indicator of professionalism for 37.6%. More than two thirds of specialists felt that MDTs improve the choice of treatments and diagnostic procedures, decrease clinical variability, facilitate implementation of clinical guidelines, improve ongoing training, and increase patient satisfaction and hospital prestige. The degree of agreement with the advantages of MDTs was significantly higher among specialists who had a MDT at their hospitals. CONCLUSIONS: The overall opinion of professionals on the MDT model is highly favorable. Hospital managers and health care authorities should take these facts into account in order to encourage and support implementation of these teams.

[Professionalism: Values and competences in specialized medical training]. / Profesionalismo: valores y competencias en formación sanitaria especializada.

OBJECTIVE: To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks. METHODS: A tailor-made questionnaire aimed at healthcare professionals in 9health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10). RESULTS: A total of 287 professionals participated, which included 97% tutors (n=59), 38% residents (n=61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females. CONCLUSION: Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care.

La opinión pública colombiana sobre el acuerdo de paz 2016-2020: punitivismo, desconfianza y ostracismo / Colombian public opinion on the 2016-2020 peace agreement: punitivism, distrust and ostracism / Opinião pública colombiana sobre o acordo de paz de 2016-2020: punitivismo, desconfiança e ostracismo

Después de varias décadas de conflicto armado en Colombia, el Gobierno colombiano y las Farc-EP firmaron, en 2016, el Acuerdo Final para la terminación del conflicto y la construcción de una paz estable y duradera. No obstante, este acuerdo no fue refrendado por la ciudadanía, en un plebiscito celebrado ese mismo año. En 2018, ganó las elecciones presidenciales un candidato que prometió cambiar las condiciones del Acuerdos Final y modificar uno de sus principales instrumentos: la Jurisdicción Especial para la Paz (JEP). En ese contexto esta investigación se pregunta: ¿cuál es la opinión de los colombianos sobre el Acuerdo Final y la JEP? La investigación indaga en las opiniones de los colombianos a través de un análisis estadístico comparativo de tres encuestas de opinión de 2016, 2018 y 2020. Los resultados detallan los cambios actitudinales ocurridos en esos años, como la disminución del rechazo frontal a los Acuerdos de Paz y el leve incremento de las posibilidades de reintegración de los excombatientes a la vida civil. También, expone algunas reticencias al cambio, como la desconfianza persistente, la reafirmación del rechazo al indulto de los excombatientes (punitivismo) y a su participación política (ostracismo).

After several decades of armed conflict in Colombia, the Colombian Government and the Farc-EP signed, in 2016, the Final Agreement for the termination of the conflict and the construction of a stable and lasting peace. However, this agreement was not endorsed by the citizenry, in a plebiscite held that same year. In 2018, the presidential elections were won by a candidate who promised to change the conditions of the Final Agreement and to modify one of its main instruments: the Special Jurisdiction for Peace (JEP). In this context, this research asks: what is the opinion of Colombians on the Final Agreement and the SJP? The research inquiries into the opinions of Colombians through a comparative statistical analysis of three opinion polls from 2016, 2018 and 2020. The results detail the attitudinal changes that occurred in those years, such as the decrease in the frontal rejection of the Peace Accords and the slight increase in the possibilities of reintegration of ex-combatants to civilian life. It also exposes some reluctance to change, such as persistent distrust, the reaffirmation of the rejection of pardoning ex-combatants (punitivism) and their political participation (ostracism).

Após várias décadas de conflito armado na Colômbia, o governo colombiano e as FARC-EP assinaram, em 2016, o Acordo Final para o fim do conflito e a construção de uma paz estável e duradoura. Entretanto, este acordo não foi endossado pelos cidadãos em um plebiscito realizado no mesmo ano. Em 2018, as eleições presidenciais foram ganhas por um candidato que prometeu mudar as condições do Acordo Final e modificar um de seus principais instrumentos: a Jurisdição Especial para a Paz (JEP). Neste contexto, esta pesquisa pergunta: qual é a opinião dos colombianos sobre o Acordo Final e o SJP? A pesquisa investiga as opiniões dos colombianos através de uma análise estatística comparativa de três pesquisas de opinião de 2016, 2018 e 2020. Os resultados detalham as mudanças de atitude que ocorreram nesses anos, tais como a diminuição da rejeição direta dos Acordos de Paz e o leve aumento das possibilidades de reintegração de ex-combatentes na vida civil. Também expõe alguma relutância em mudar, como a desconfiança persistente, a reafirmação da rejeição do perdão de ex-combatentes (punitivismo) e de sua participação política (ostracismo).

Mujeres deportistas: poca visibilidad y mucho estereotipo / Mulehres esportistas: baixa visibilidade e muito estereótipo / Sportswomen: low visibility and largely stereotyped

En el artículo se analiza la opinión ciudadana sobre la imagen de las mujeres deportistas en relación con la de los hombres deportistas en el Territorio Histórico de Gipuzkoa (País Vasco, España). En los últimos años, por una parte, se constata un avance significativo en laparidad de la práctica deportiva y, por otra parte, se observa un alto rendimiento deportivo de las mujeres deportistas que se ha hecho visible en la medida que han tenido la oportunidad de demostrarlo. Sin embargo, los medios de comunicación siguen ofreciendo a menudo una imagen estereotipada de las mujeres deportistas reproducida luego en la opinión pública. El artículo muestra los resultados de una encuesta realizada a la población guipuzcoana sobre la visibilidad/invisibilidad de las mujeres deportistas y los estereotipos asociados a su imagen. Los resultados indican que todavía, y a pesar de diferentes esfuerzos, las mujeres deportistas son poco visibles para la población. Tanto la notoriedad espontánea como la asistida de las mujeres deportistas es muy inferior a la de los hombres deportistas. La poca visibilidad se añade a otro problema, la perdurabilidad de los estereotipos. Se confirma la tendencia a incidir en cuestiones ligadas al aspecto físico, así como la atribución de diferentes valores según el sexo del deportista. A pesar de todo, se ha identificado una predisposición favorable hacia el consumo de deporte practicado por mujeres. En definitiva, se observan algunos pasos en la dirección hacia la paridad, pero el reto sigue aún vigente. (AU)

The article analyzes the public opinion on the image of sportswomen in relation to that of sportsmen in the Historical Territory of Gipuzkoa (Basque Country, Spain).In recent years, on the one hand, there has been a significant advance in the parity of sports practice and, on the other hand, a high sports performance of female athletes has been observed, which has become visible to the extent that they have had the opportunity to prove it. However, the media often continue to offer a stereotypical image of female athletes later reproduced in public opinion. The article shows the results of a survey carried out among the population of Gipuzkoa on the visibility / invisibility of sportswomen and the stereotypes associated with their image. The results indicate that still, and despite different efforts, female athletes are not very visible to the population. Both the spontaneous and assisted notoriety of female athletes is much lower than that of male athletes. Low visibility adds to another problem, the persistence of stereotypes. The tendency to influence issues related to physical appearance is confirmed, as well as the attribution of different values according to the athlete's sex. Despite everything, a favorable predisposition towards the consumption of sports practiced by women has been identified. In short, there are some steps towards parity, but the challenge remains. (AU)

O artigo analisa a opinião pública sobre a imagem das esportistas mulehres em relação à dos esportistas homens no Território Histórico de Gipuzkoa (País Basco, Espanha). Nos últimos anos, por um lado, houve um avançosignificativo na paridade da prática esportiva e, por outro lado, observou-se um alto desempenho esportivo das atletas femininas, que se tornou visível na medida em que tiveram o oportunidade de provar isso. No entanto, a mídia muitas vezes continua a oferecer uma imagem estereotipada de atletas femininas posteriormente reproduzida na opinião pública. O artigo apresenta os resultados de uma pesquisa realizada junto à população gipuzkoana sobre a visibilidade / invisibilidade das esportistas e os estereótipos associados à sua imagem. Os resultados indicam que ainda, e apesar dos esforços diferenciados, as atletas femininas não são muito visíveis para a população. Tanto a notoriedade espontânea quanto a assistida de atletas do sexo feminino é muito menor do que a dos atletas do sexo masculino. A baixa visibilidade aumenta outro problema, a persistência de estereótipos. Confirma-se a tendência de influenciar questões relacionadas à aparência física, bem como a atribuição de valores diferenciados de acordo com osexo do atleta. Apesar de tudo, identificou-se uma predisposição favorável ao consumo de esportes praticados por mulheres. Em suma, existem alguns passos em direção à paridade, mas o desafio ainda está em vigor. (AU)

[Geriatric post-graduate training: Current recommendations and opinion of the trainees]. / Formación especializada en geriatría: normativa actual y opinión de los residentes.

OBJECTIVE: To evaluate the level of compliance with the official curriculum residence programme by geriatrics trainees, and to analyse their level of satisfaction. MATERIAL AND METHODS: A questionnaire was developed including these sections: trainee filiation, and questions related to their clinical training, academic formation, research training, satisfaction, and other comments. The survey was performed in Survey Monkey and sent to a geriatric trainee per hospital in March 2014. The results were collected between March and April of 2014. RESULTS: Responses were received from 41% of the trainees of 23 Geriatric Teaching Units. Rates of over 95% were observed as regards clinical rotations in the basic period, while in the specific period these percentages varied between 34% and 69%, probably because some of the trainees had not yet arrived at the period in which these rotations are programmed. An external rotation could be performed by 83% of the trainees, and 90% do the recommended number of shifts. The mean number of instruction sessions per week was 2.3, and the number of meetings with the tutor was 2.5 times per year. The median number of presentations in congresses was 3.7 per trainee, with 0.2 publications during training. Each trainee attended 1.2 national meetings, 0.3 European meetings, and 0.1 American. Most of the trainees (85%) were satisfied or very satisfied with their training. CONCLUSIONS: Geriatrics curricula for trainees are followed in the basic aspects, but not so much in the specific ones. The average level satisfaction of the trainees is very high. The recommended training activities within the specific department (sessions, etc.) are not always fulfilled. The research activity, evaluated by publications and presentations at meetings, is low. Following these data, reflection and the establishment of improvements are required in Geriatrics training at post-graduate level.

Projeto Mais Médicos na saúde indígena: reflexões a partir de uma pesquisa de opinião / More Doctors Project in indigenous health: reflections from an opinion survey / Proyecto Más Médicos en la salud indígena: reflexiones a partir de una encuesta de opinión

O estudo tem como objetivo contribuir com a análise da implementação do "Projeto Mais Médicos para o Brasil", nos Distritos Sanitários Especiais Indígenas, com dados produzidos por pesquisa de opinião desenvolvida em comunidades assistidas por médicos do projeto. A presente análise trouxe um recorte dos dados produzidos pelo questionário aplicado às comunidades indígenas assistidas e comparados com o universo geral da pesquisa aplicada em municípios. O estudo identifica um incremento significativo no quantitativo de médicos trabalhando na saúde indígena, uma percepção positiva quanto à satisfação com o projeto e aponta uma relação não excludente entre o acesso aos serviços biomédicos e o uso de práticas terapêuticas indígenas. Demonstra, ainda, a necessidade de se ampliarem as pesquisas sobre as consequências do Programa Mais Médicos, especialmente de cunho qualitativo e etnográfico.

The study aims to contribute to the analysis of the implementation of the Project More Doctors for Brazil in the Indigenous Special Health Districts, with data produced by opinion research developed in communities that are served by Project's physicians. The present analysis presents a set of data produced by a questionnaire applied to indigenous communities and then compared with the general universe of the same research in municipalities. The study identifies a significant increase in the number of physicians working in indigenous health, a positive perception of satisfaction with the project pointing out a non-exclusive relationship between access to biomedical services and the use of indigenous therapeutic practices. It also demonstrates the need to expand research on the consequences of the More Doctors Program, especially on qualitative and ethnographic bases.

El objetivo del estudio es contribuir con el análisis de la implementación del Proyecto Más Médicos para Brasil, en los Distritos Especiales Indígenas, con datos obtenidos por encuesta de opinión desarrollada en comunidades asistidas por médicos del proyecto. Este análisis proporcionó un recorte de los datos obtenidos por el cuestionario aplicado en las comunidades indígenas asistidas y comparados con el universo general de la encuesta realizada en los municipios. El estudio identifica un aumento significativo en la cantidad de médicos trabajando en la salud indígena, una percepción positiva en lo que se refiere a la satisfacción el proyecto y señala una relación no excluyente entre el acceso a los servicios biomédicos y el uso de prácticas terapéuticas indígenas. También demuestra la necesidad de ampliar las investigaciones sobre las consecuencias del Programa Más Médicos, especialmente de cuño cualitativo y etnográfico.

Una encuesta sobre biomarcadores y diagnóstico precoz de la enfermedad de Alzheimer / A survey on biomarkers and early diagnosis in Alzheimer's disease

Ante el uso potencial de biomarcadores para el diagnóstico temprano de la enfermedad de Alzheimer (EA), nuevos dilemas éticos y de comunicación aparecen en la práctica clínica cotidiana. El objetivo de este trabajo fue conocer la opinión de profesionales de la salud (PS) y del público en general (PG) sobre la realización de técnicas diagnósticas tempranas en la EA utilizando marcadores biológicos, aun a sabiendas que hasta ahora la enfermedad es incurable. Se confeccionó una encuesta en Internet con respuesta múltiple en dos versiones: una para PS y otra para el PG. Se invitó a participar a los encuestados a través de un sistema legal de envíos masivos de correo electrónico, utilizando direcciones recolectadas en la base de datos del CEMIC. Se analizaron 1503 respuestas: 807 grupo PS y 696 grupo PG. La mayoría de los encuestados (84.7%) prefirió la opción de realizar el diagnóstico temprano de la EA aun conociendo la falta de tratamiento curativo. El 45.1% del grupo PG vs. el 26.8% del grupo PS respondió que no cree que se genere un dilema de comunicación ni ético en los médicos al informar el diagnóstico de la enfermedad. El grupo PS mostró mayor divergencia en las opiniones que el PG. Estos resultados podrían indicar una nueva dinámica en la relación médico-paciente, mostrando al PG con una posición activa y favorable frente al uso de los biomarcadores para el diagnóstico temprano de la EA.

Given the potential use of biomarkers in the diagnosis of Alzheimer’s disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) and general public (GP) on the implementation of early diagnostic techniques in AD and the use of biomarkers for this purpose. A survey with multiple choice answers was elaborated in two versions: one for HP and the other for GP. Respondents were invited to participate through a system of mass mailing e-mail; e-mail addresses were collected from CEMIC database. A total of 1503 answers were analyzed: 807 HP and 696 GP. Most respondents, 84.7%, preferred the option of early diagnosis of AD even knowing the lack of curative treatment. Forty five percent of GP and 26.8% of HP replied that there is no ethical dilemma in the use of biomarkers and that no communication or ethical dilemma is generated to physicians when informing the diagnosis of the disease. The HP group showed more divergence in the views than the GP group. These results may indicate a change in the physician-patient relationship, showing the GP group with an active and supportive position towards the use of biomarkers for early diagnosis of AD.