[Relationship between emotional intelligence and burnout syndrome in Primary Healthcare doctors]

AIM

The purpose of this study is to analyse the relationship between emotional intelligence (EI) and burnout syndrome (BOS) in doctors in Primary Health Care.

MATERIAL AND METHODS

Cross-sectional descriptive study.

SETTING

All healthcare centres and clinics in Asturias.

PARTICIPANTS

Doctors of Primary Health Care who are active.

INTERVENTION

In April 2018, an anonymous self-administered questionnaire was sent to all concerned. It included sociodemographic data, employment data, and TMMS-24 (EI) and MBI (BOS) validated scales.

VARIABLES

BOS as a dependent variable. Three dimensions of EI, age, sex, marital status, number of children, form of training, contract type, time worked, on-call hours, number of patients per day, quota, rural or urban setting, healthcare area, relationship with nursing/hospital, and teaching as independent variables.

STATISTICAL ANALYSIS

Bayesian inference.

RESULTS

A total of 647 questionnaires were sent, and 374 subjects took part in the study (response rate: 57.8%). The subsequent distribution of BOS prevalence was 64.5% [95% credibility index: 59.7-69.2]. BOS was associated with 3 dimensions of the EI, and to have higher social skills decreased the risk of presenting with BOS. Age, contract type, urban setting, and number of patients per day tended to increase the odds of prevalence of BOS. Having children or being a guardian tended to decrease the odds of prevalence.

CONCLUSIONS

The high level of BOS in Primary Health Care doctors should be pointed out, with more than one out of 2 doctors having burnout. Therefore, we suggest looking into how emotional skills are achieved, and also how to improve working conditions in Primary Health Care.

[Analysis of the healthcare of the paediatric population by General Practitioners in a Continuous Care Point]

OBJECTIVE

The main objective of this study is to analyse the management of paediatric emergencies by Family Doctors in Primary Care. The secondary objective is to determine the appropriateness of hospital referrals.

MATERIAL AND METHODS

A retrospective, observational, and descriptive study was performed. An analysis was carried out on the visits made by children less than 14years-old during one year in continued care opening hours in a basic health area, after single-stage cluster random sampling of 45days.

RESULTS

A total of 447 emergency consultations were made by paediatric patients with a mean age of 6.83years (SD=3.82). Almost all (92.8%) the emergency consultations made by children less than 14years were resolved in situ. The referral rate to hospitals was 7.2% (95%CI: 4.9-10). Just over half (56%: 95%CI: 37.7-73.6) of the children referred had some type of hospital intervention (tests, treatments, assessments by other non-paediatric specialists, observation and or admission).

CONCLUSIONS

The referral rate was 7.2%, which is in the upper limit of that found in other studies. Just over half of the children required some type of intervention, which could be considered as justified referrals. Furthermore, good agreement was found (Kappa index=0.778) between the diagnosis from Primary Care and the final diagnosis by paediatricians, inferring that the diagnosis made on paediatric patients by Family Doctors are correct.

[Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners]

AIM

To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage.

MATERIAL AND METHODS

Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated.

RESULTS

The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor.

CONCLUSIONS

The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening.

[A case-control study of the influence of the smoking behaviour in multiple sclerosis]

INTRODUCTION

Several epidemiological studies have demonstrated that there is a genetic factor of susceptibility in Multiple Sclerosis (MS) and that the environmental factors play an important important role in their development. Smoking is among the environment factors studied. In fact, several studies have established a relationship between smoking and multiple sclerosis, although most of them did not find significant results or found that these were contradictory.

OBJECTIVE

To evaluate the influence of the smoking habit on the risk of suffering MS.

METHODS

This was a case-control matched study with 138 patients diagnosed of MS according to the McDonald criteria who were paired with the same number of controls of the same gender, residents in the same city and having the same age +/-2 years. Demographic data, smoking status (never, always smokers, ex-smokers), Kurtzke disability status scale (EDSS) and type of MS were collected.

RESULTS

Out of a total of 138 MS patients (93 women, 43 men), 110 had relapsing-remitting MS, 20 secondary progressive MS and 7 primary progressive MS. Most of the patients were smokers and ex-smokers (63%). In the control group, only the 41,3% were smokers/ex-smokers. Moreover, the age of onset for smoking was earlier in the case group.

CONCLUSION

Being a smoker/ex-smoker implies a 27% greater risk of developing MS compared to those who have never smoked. This risk is statistically significant for women but not for men due to the low number of them in the sample.

[Prevalence and duration of breastfeeding in Asturias]

OBJECTIVE

To estimate the prevalence and duration of breastfeeding, and factors associated with them, in Asturias (Spain).

METHODS

A cross-sectional study was carried out. A stratified random sample of 453 infants was drawn on a population of 4,326 infants aged 0-8 months at the time of the study. Sociodemographic data, and information on pre- and perinatal care were obtained through a telephone survey in which mothers were also asked whether they were breastfeeding on the day of the telephone call. A univariate logistic regression model was used to estimate the prevalence curve of breastfeeding according to infant age, and multiple logistic regression was used to determine the associations between the prevalence and covariates. The discontinuity index (DI) and the cumulative breastfeeding index (CBI) were also estimated as indicators of duration.

RESULTS

A total of 418 telephone calls were made. The prevalence of initial exclusive breastfeeding was 51.4% (95% CI: 46.6-56.2%) which decreased to 14.9% at day 90 and to 8.7% at day 120. The DIs were 28.6% at day 30 and 71% at day 90. In the multivariate analysis the prevalence of exclusive breastfeeding was higher among mothers living in a rural or suburban area (OR = 5.69 and OR = 3.55, respectively), than among those living in urban areas. The prevalence was also higher among mothers with a university degree (OR = 3.90; 95% CI: 1.77-8.58), and among those who had been seen by a midwife during pregnancy (OR = 2.13; 95% CI: 1.04-4.38). A negative correlation was found between exclusive breastfeeding and the newborn having received food supplements during the first hours after birth (OR = 0.43; 95% CI: 0.20-0.95).

CONCLUSIONS

The prevalence of breastfeeding in Asturias, and especially its duration, is much lower than that recommended by the World Health Organization. Mothers living in urban areas do not follow the most appropriate patterns of breastfeeding.

[Anorexic behavior in a population of high-school students of a health area]

OBJECTIVES

To calculate the prevalence of eating attitudes which determine eating disorders and their relationship to social, personal and cultural variables.

DESIGN

Prevalence study.

PARTICIPANTS

Centres of secondary education. Gijón Health Area (Asturias). Secondary school students (n = 17,000) selected by multi-stage stratified sampling.

MEASUREMENTS AND MAIN RESULTS

The self-filled questionnaire included: social and personal variables, and Eating Attitudes Test 26 (anorexic conduct defined as scores = 20). Women also filled in the "Questionnaire on Influences on the Aesthetic Model of the Body" (CIMEC-26). There were 860 valid questionnaires, with 50% women. There was 12.8% prevalence of anorexic attitudes among women (95% CI, 9-16.5), and 1.8% among men (CI, 0.8-2.8). In the group with anorexic attitudes, 87.3% were women, with mean age 16.4; 88.3% lived in a city; 84% were in middle and middle-to-low social classes; 92% were studying their bachillerato; 28.5% attended private schools; 27% undertook activities related to having a thin body; 18.3% had separated parents; 27% had mothers working outside the home; 39.7% saw themselves as fat; and 81% wished to slim. The following variables showed statistically significant differences with the normal population: sex (OR = 7.7; 95% CI, 4.5-13.4), separated parents (OR = 1.9; CI, 1.4-2.8), undertaking activities relating to having a thin body (OR = 3.7; CI, 2.7-5.2); thinking oneself fat (OR = 4.7; CI, 3.1-7.1) and wishing to slim (OR = 7.2; CI, 4.6-11.2). 94.5% of women with disordered conduct showed a disorder on the CIMEC-26.

CONCLUSIONS

There is a high prevalence of eating habits similar to those of patients with anorexia nervosa, which are related to the following variables: being a woman, having separated parents, seeing oneself as fat, desiring to slim and undertaking activities related to having a thin body. We observed no significant differences with the normal population in other social and personal variables. The socially imposed aesthetic model of the body determines anorexic conduct in women.

[Postcoital hormonal contraception: study on the attitudes and prescription of primary care physicians]

OBJECTIVE

To study the understanding, attitudes and practice of primary care doctors in the prescription of hormonal post-coitus interception, along with the social and demographic, educational, legal and ethical variables associated with this prescription.

DESIGN

Cross-sectional descriptive study.

SETTING

Area IV de INSALUD in Asturias.

PARTICIPANTS

Family doctors, excluding locums (n = 178).

MEASUREMENTS AND RESULTS

An anonymous self-administered questionnaire with 33 questions, re-sent once, between November 1999 and February 2000. The association-independence of variables was contrasted through the chi 2 test (a statistically significant association if p < 0.05). 77% responded, 51% of whom were men. Average age was 43 (SD = 6.69), with professional experience of 17 years worked (SD = 6.87). 47% were family doctors and 39% general practitioners. 85% worked in health centres; 46% in urban settings. 71% were catholics, 73% (95% CI: 66%-80%) had been asked on at least one occasion in the previous six months for the post-coitus pill (PCP), with demand greater in the urban environment (83%). 18% considered the PCP an abortion method. 88% said they would prescribe it (95% CI: 82.5%-93.5%), of which 30% (95% CI: 16%-44%) did so according to WHO recommendations. 100% of the "non-prescribers" were catholics.

CONCLUSIONS

Most doctors receive requests for the PCP and prescribe it on demand, though prescription varies with age, categories and, in particular, religious belief. Only a third prescribes according to WHO recommendations.

[Additional question ("is there anything else...?") in primary health care]

OBJECTIVES

To assess in two General Medicine clinics the use of the formula "Was there anything else?" in connection with patients' additional requests and the question's possible association with other variables.

DESIGN

Quasi-experimental.

SETTING

Urban Health Centre.

PATIENTS

Patients from two lists attending over a two-month period, with the exclusion of scheduled patients without appointments.

MEASUREMENTS AND INTERVENTIONS

For one of the months patients were asked: "Was there anything else?" (intervention group) and for the other month, they were not (control group). On each visit variables were recorded: list, doctor (tutor/intern), age, gender, reason for consultation (pathology/burocratic), whether accompanied, waiting time and additional requests (new problems raised at the end of the visit). A bivariant analysis of each of the variables with the variable 'intervention' was made and, after a prior transformation of the variable 'additional requests' into two, was adjusted to a multiple logistic regression model in order to control the confusion.

RESULTS

2,657 attendances were analysed. The variables which were significant for the prediction of additional requests were: intervention, list, age, gender and reason for consultation.

CONCLUSIONS

The intervention of the doctor may generate additional requests, although whether this means that the consultation is better organised remains to be assessed.

[Clinical diagnosis of dementia associated with cortical Lewy bodies]

8 cases of dementia associated with cortical Lewy bodies are dealt with, that were diagnosed in 1993 in examinations for dementia, using the Nottingham's clinical criteria. They make up 15.4% of primary degenerative dementias diagnosed in this examination. All developed a predominantly cortical dementia with variable bradiphrenia and a parkinsonian syndrome which was predominantly of the rigid-bradikinetic type. The dementia established itself rapidly -between 1 and 3 weeks- in 3 cases (37.5%). 50% of patients (4 cases) showed marked psychiatric symptoms. In 2 cases stiffness was predominantly axial and another had supranuclear paralysis of vertical gaze. 3 patients had no tremor, and 2 of the 5 remaining patients showed postural tremor. CT and axial MR images of the encephalon were similar to those observed in dementia of the Alzheimer type. The coronal MR carried out on 3 patients revealed less atrophy of the hypocampus than is normally observed in patients with dementia of the Alzheimer type who are at the same stage of development.