Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Body Mass Index , Habits , Social Isolation , Quarantine , Coronavirus Infections/prevention & control , Epidemiology, DescriptiveSubject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Habits , Pandemics , Social Isolation , Quarantine , Body Mass Index , Coronavirus Infections/prevention & controlABSTRACT
Introduction: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. Goal: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. Design: Descriptive, multicenter, longitudinal (retrospective-prospective). Location: primary care (PC) centers in Oviedo, Asturias (Spain). Participants: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). Variables: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis.Results: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). Discussions: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.(AU)
Introducción: Las ratios del trastorno de déficit de atención e hiperactividad (TDAH) varían entre el 1 y el 20%, dependiendo del tipo de guía diagnóstica utilizada, del test usado en la evaluación, de los factores psicosociales y del profesional a cargo de la evaluación. Objetivo: Describir el proceso actual de evaluación del trastorno por déficit de atención e hiperactividad (TDAH) en la práctica clínica en el sistema público de salud y analizar las variables relacionadas con el diagnóstico final.Diseño: Estudio descriptivo y longitudinal (retrospectivo-prospectivo). Localización: Centros de atención primaria en Oviedo, Asturias (España). Participantes: Se analiza una muestra española de 134 casos clínicos en dos cohortes (2004 y 2009). Variables: Profesional a cargo de la evaluación, test empleados en la evaluación y diagnóstico final. Resultados: El empleo de listas de síntomas y las evaluaciones a cargo de profesionales de atención primaria (AP) y de neuropediatría (NP) muestran una tendencia al alza entre 2004 y 2009. El diagnóstico final de TDAH muestra una baja fiabilidad interprofesional (kappa = 0,39). Conclusiones: El profesional a cargo de la evaluación parece ser una variable relevante para establecer un diagnóstico final. Los criterios de diagnóstico de TDAH no parecen claros. Estos datos sugieren que el diagnóstico de TDAH debe usarse con precaución para garantizar una práctica clínica de calidad al evaluar y tratar los síntomas de TDAH. Las evaluaciones apoyadas por listas de síntomas y realizadas por NP o AP podrían ser factores que contribuyen a una tendencia de diagnóstico excesivo de TDAH.(AU)
Subject(s)
Humans , Diagnosis , Attention Deficit Disorder with Hyperactivity/diagnosis , Symptom Assessment , Child Behavior , Reproducibility of Results , Primary Health Care , Spain , Epidemiology, Descriptive , Retrospective Studies , Prospective Studies , Longitudinal StudiesABSTRACT
INTRODUCTION: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. GOAL: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. DESIGN: Descriptive, multicenter, longitudinal (retrospective-prospective). LOCATION: primary care (PC) centers in Oviedo, Asturias (Spain). PARTICIPANTS: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). VARIABLES: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis. RESULTS: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). DISCUSSIONS: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Attention Deficit Disorder with Hyperactivity/diagnosis , Humans , Prospective Studies , Reproducibility of Results , Retrospective Studies , SpainABSTRACT
En los últimos años diferentes publicaciones e informes alertan de una crisis mundial de recursoshumanos en salud y de un déficit de facultativos especialistas.Las políticas de recursos humanos en salud y su planificación implican adecuar la oferta y demandade médicos, coordinando los subsistemas formativos (pre y postgrado) con el subsistema laboral,y con las políticas sanitarias y las necesidades de salud de los ciudadanos.Deseamos estimar las necesidades de especialistas y conocer el grado de adecuación entre subsistemasformativos y subsistema laboral del sistema sanitario público.Elaboramos un estudio descriptivo transversal y con proyección sobre la plantilla real en la Red deCentros de Utilización Pública (Servicio de Salud del Principado de Asturias, y hospitales sin ánimo delucro), salidas por jubilación, facultativos en período de formación sanitaria especializada y estudiantesde Medicina, considerando la Comunidad Autónoma de Asturias como un sistema cerrado.La tasa de facultativos es superior a la media nacional, con una pirámide envejecida y masculinizada.El índice de reposición es 0,89 (SESPA), indicando que las nuevas contrataciones no están garantizandola reposición de facultativos salientes. En el próximo lustro se jubilarían 315 facultativos especialistas,finalizarían su formación especializada 671 facultativos especialistas y se graduarían 509 médicos.En los próximos 10 años se jubilarían 765 facultativos especialistas, finalizarían su formación especializada1.414 facultativos especialistas y se graduarían unos 1.071 médicos. No existiría déficit generalizadode facultativos, aunque 12 de 48 especialidades médicas sufrirían algún tipo de carencias
In recent years, various publications and reports have warned about a global crisis regardinghuman resources in health and a shortage of medical specialist. The human resources policies in health and planning involve matching supply and demand fordoctors, coordinating training subsystems (pre-and postgraduate) with the working subsystem andwith health policies and the health needs of the public.We have aimed is to estimate needs for specialists and to determine the degree of adequacy betweentraining subsystems and the working subsystem in the public healthcare system, considering theautonomous region of Asturias as a closed system.This is a cross-sectional, descriptive study and projection, on the current staff from the Public CentersNetwork (Health Service of Asturias, and non-profit hospitals), retirements, medical staff undergoingSpecialized Health Training and medical students.Its proportion of doctors is higher than the national average, with an older and male-heavy pyramid.Replacement rate is 0.89 (SESPA), indicating that the new hirings of professionals are not ensuringthe replacement of outgoing medical staff.Within the next five years, 315 medical specialists willhave retired, 671 medical specialists will have finished their specialist training, and 509 doctors will havegraduated. In the next 10 years, 765 medical specialists will have retired, 1,414 medical specialistswill have completed their specialist training, and about 1,071 doctors will have graduated.There willno widespread deficit of medical staff, although 12 out of every 48 medical specialities will suffersome sort of deficiency
