Percepciones, reflexiones y aprendizajes de estudiantes de Medicina sobre una experiencia de tres años de Educación Basada en la Comunidad / Perceptions, reflections and learnings of Medicine students about a three-year experience of community-based education

Introducción: la Educación Basada en la Comunidad (EBC) representa una estrategia educativa que acerca la formación médica a la práctica real, y promueve una atención médica de mayor aceptabilidad que contempla la esfera social de los procesos de salud/enfermedad y aborda de forma adecuada las necesidades reales de la población. Existen, a la fecha, escasas publicaciones a nivel regional en las cuales los propios estudiantes reflexionen sobre este tipo de experiencias formativas. Objetivos: identificar y comunicar los principales aprendizajes obtenidos de una experiencia de EBC por parte de estudiantes de grado de Medicina. Metodología: se revisaron las sistematizaciones de experiencias confeccionadas por la primera cohorte que completó esta experiencia en el Instituto Universitario del Hospital Italiano de Buenos Aires. Se reflexionó sobre las principales dificultades observadas y los aprendizajes más significativos obtenidos a partir de dicha experiencia. Se establecieron dominios y codificaron los textos de las sistematizaciones generadas durante la cursada. Finalmente, se generó un mapa de conceptos a partir del cual se escribió este artículo. Resultados: esta experiencia tuvo para los estudiantes tres momentos bien definidos: una etapa inicial, caracterizada por incertidumbre y malestar; una intermedia, con aprendizaje estratégico y algo de transformación; y una avanzada, con aprendizaje profundo y situado. Conclusión: es recomendable que a las experiencias de EBC se les asigne el tiempo suficiente en las planificaciones y que finalicen con un proceso de reflexión promovido por el equipo docente. (AU)

Introduction: Community-Based Education (CBE) represents an educational strategy that brings medical training closer to real scenario practice, and promotes medical care of greater acceptability that contemplates the social sphere of health/disease processes and that adequately addresses the real needs of the population. To date, there are few publications at the regional level in which the students themselves reflect on this type of training experience. Objectives: to identify and communicate the main lessons learned from a CBE experience by Medicine-degree students.Methodology: the systematization of experiences made by the first cohort that completed this experience at the Instituto Universitario del Hospital Italiano de Buenos Aires was reviewed. We reflected on the main difficulties observed and the most significant lessons learned from this experience. Domains were established, and the texts of the systematization generated during the course were codified. Then, a concept map was generated from which this work was written. Results: this experience had three well-defined moments for the students: an initial stage, characterized by uncertainty and discomfort; an intermediate one, with strategic learning and some transformation; and an advanced one, with deep and situated learning. Conclusion: it is recommended that EBC experiences are assigned enough time in the planning and that they end with a reflection process promoted by the teaching team. (AU)

Perceived barriers to implementing screening and brief intervention for alcohol consumption by adolescents in hospital emergency department in Spain. / Barreras percibidas contra la implementación en los servicios de urgencias hospitalarios en España de un protocolo de cribado de consumo de alcohol e intervención breve en adolescentes.

BACKGROUND: Screening for alcohol consumption in adolescents is widely justified in the health care field because of the particular vulnerability of this population, which starts drinking alcohol at a very early age and frequently consumes high levels of the same. Hospital emergency departments (ED) could be a good venue to manage early detection and carry out brief intervention (BI) programmes. OBJECTIVES: The aim of this study was to identify perceived barriers for medical staff of three hospitals in Spain to successfully implement a protocol for alcohol detection and BI for minors in the ED. METHODS: Exploratory qualitative analysis using focus groups with semi-structured, flexible and open-ended questions to explore beliefs, attitudes, and barriers perceived by professionals to screening alcohol consumption and implementing BI in adolescents attended at the ED. RESULTS: The main perceived barriers by health professionals were lack of time, work overload, mistrust, lack of validated and simple screening tools, lack of training/awareness and legal concerns about informed consent and confidentiality. CONCLUSIONS: Barriers to screening and intervention in ED are similar to those described previously. It is necessary to improve organization of time allocated for medical consultations, avoid limiting ED resources, motivate staff and provide appropriate training.

Introducción: El cribado de consumo de alcohol en menores está ampliamente justificado en el ámbito sanitario por la evidencia epidemiológica de consumo y por la especial vulnerabilidad de este colectivo, que además se inicia a edades muy tempranas e ingiere grandes cantidades. Los servicios de urgencias (ED) podrían ser un entorno donde realizar la detección precoz e implementar una intervención breve (IB) por parte de los profesionales. Objetivo: El objetivo de este estudio es conocer las barreras percibidas por los profesionales sanitarios para implantar con éxito en los servicios de urgencias hospitalarios un protocolo de detección e IB en menores. Material y métodos: Análisis cualitativo exploratorio mediante grupos focales con preguntas semiestructuradas, flexibles y abiertas para conocer las creencias, actitudes y barreras percibidas por los profesionales de los centros donde se desarrollará un proyecto de cribado de consumo de alcohol e IB en adolescentes que acuden a Urgencias. Resultados: Las principales barreras percibidas fueron falta de tiempo, sobrecarga de trabajo, desconfianza en la sinceridad de las respuestas, necesidad de protocolos estandarizados de trabajo, desconocimiento de herramientas de cribado validadas y sencillas, falta de entrenamiento/concienciación y dudas médico-legales sobre el consentimiento informado y la confidencialidad del menor. Conclusiones: Las barreras percibidas para implementar la herramienta de cribado e IB son similares a las descritas por otros autores y sería necesario mejorar la organización de los circuitos asistenciales, no limitar los recursos dedicados a la atención en urgencias y favorecer la motivación y la formación de los profesionales.

Barreras percibidas contra la implementación en los servicios de urgencias hospitalarios en España de un protocolo de cribado de consumo de alcohol e intervención breve en adolescentes / Perceived barriers to implementing screening and brief intervention for alcohol consumption by adolescents in hospital emergency department in Spain

Introducción: El cribado de consumo de alcohol en menores está ampliamente justificado en el ámbito sanitario por la evidencia epidemiológica de consumo y por la especial vulnerabilidad de este colectivo, que además se inicia a edades muy tempranas e ingiere grandes cantidades. Los servicios de urgencias (ED) podrían ser un entorno donde realizar la detección precoz e implementar una intervención breve (IB) por parte de los profesionales. Objetivo: El objetivo de este estudio es conocer las barreras percibidas por los profesionales sanitarios para implantar con éxito en los servicios de urgencias hospitalarios un protocolo de detección e IB en menores. Material y métodos: Análisis cualitativo exploratorio mediante grupos focales con preguntas semiestructuradas, flexibles y abiertas para conocer las creencias, actitudes y barreras percibidas por los profesionales de los centros donde se desarrollará un proyecto de cribado de consumo de alcohol e IB en adolescentes que acuden a Urgencias. Resultados: Las principales barreras percibidas fueron falta de tiempo, sobrecarga de trabajo, desconfianza en la sinceridad de las respuestas, necesidad de protocolos estandarizados de trabajo, desconocimiento de herramientas de cribado validadas y sencillas, falta de entrenamiento/concienciación y dudas médico-legales sobre el consentimiento informado y la confidencialidad del menor. Conclusiones: Las barreras percibidas para implementar la herramienta de cribado e IB son similares a las descritas por otros autores y sería necesario mejorar la organización de los circuitos asistenciales, no limitar los recursos dedicados a la atención en urgencias y favorecer la motivación y la formación de los profesionales

Background: Screening for alcohol consumption in adolescents is widely justified in the health care field because of the particular vulnerability of this population, which starts drinking alcohol at a very early age and frequently consumes high levels of the same. Hospital emergency departments (ED) could be a good venue to manage early detection and carry out brief intervention (BI) programmes. Objectives: The aim of this study was to identify perceived barriers for medical staff of three hospitals in Spain to successfully implement a protocol for alcohol detection and BI for minors in the ED. Methods: Exploratory qualitative analysis using focus groups with semi-structured, flexible and open-ended questions to explore beliefs, attitudes, and barriers perceived by professionals to screening alcohol consumption and implementing BI in adolescents attended at the ED. Results: The main perceived barriers by health professionals were lack of time, work overload, mistrust, lack of validated and simple screening tools, lack of training/awareness and legal concerns about informed consent and confidentiality. Conclusions: Barriers to screening and intervention in ED are similar to those described previously. It is necessary to improve organization of time allocated for medical consultations, avoid limiting ED resources, motivate staff and provide appropriate training

Consenso de seguimiento de pacientes con cáncer de mama de la Sociedad Española de Senología y Patología Mamaria / Consensus document of the Spanish Society of Senology and Breast Disease on the follow-up of patients with breast cancer

A pesar del aumento en la prevalencia del cáncer de mama, el seguimiento de estas pacientes no está totalmente estandarizado. La Sociedad Española de Senología y Patología Mamaria propuso la elaboración de un documento de consenso sobre el seguimiento que debería proponerse a las pacientes afectas de lesiones de mama in situ e infiltrantes en estadios i-iii, tratadas con intención curativa, una vez finalizados los tratamientos iniciales. En su realización han colaborado profesionales de toda España de distintas especialidades y ámbitos de actuación. Fue presentado en el Primer Congreso Español de la Mama, que se celebró en octubre de 2013 en Madrid, para su refrendo por parte de la Sociedad, y se recogieron las aportaciones de los asistentes a la sala. El objetivo principal del seguimiento es la detección precoz de recurrencias locorregionales y a distancia, de nuevos primarios, y valorar los efectos secundarios de los tratamientos aplicados. Debe también cubrir las necesidades de soporte psicológico, así como la rehabilitación y reinserción sociolaboral posterior y la educación para la salud, corrigiendo hábitos de vida no saludables. No se han descrito diferencias significativas entre el seguimiento minimalista y el intensivo, respecto al índice de recurrencia, la supervivencia global y la calidad de vida. El tipo y los años de seguimiento deberían ser distintos para cada paciente según su riesgo de recidiva y la clasificación molecular de su lesión. Este consenso ha tenido el apoyo de otras sociedades científicas relacionadas con la enfermedad mamaria, asistentes al Primer Congreso Español de la Mama (AU)

Despite the increasing prevalence of breast cancer, there is no standardized protocol for the follow-up of breast cancer survivors. The Spanish Society of Senology and Breast Disease has supported a consensus document on the follow-up of breast cancer survivors, aimed at patients diagnosed with stage i to iii disease and with invasive and intraepithelial (in situ) lesions, and treated with curative intent, after completion of the initial treatment. Practitioners from all over Spain, with different specialities and areas of activity, participated in the drafting in the document. It was presented at the First Spanish Breast Congress (Primer Congreso Español de la Mama), which took place in October 2013, for the Society's approval. Input from the audience was considered. The main aim of follow-up is the early detection of local and distant recurrences, of new primaries, and evaluation of the adverse effects of the therapies applied. Follow-up should also include psychological support, education on healthy habits, rehabilitation, and social and work reintegration. No significant differences between minimalistic and intensive follow-up have been reported regarding recurrence, overall survival, and quality of life. The length, intervals, and intensity of follow-up should be tailored according to each patient's individual risk of relapse and molecular subtype. This consensus document has the support and endorsement of other scientific societies related to breast disease and present at the congress (AU)

Pediatric exposure to drugs of abuse by hair testing: monitoring 15 years of evolution in Spain.

Hair testing is a useful tool to investigate the prevalence of unsuspected chronic exposure to drugs of abuse in pediatric populations and it has been applied to three different cohorts of children from Barcelona, Spain along fifteen years to evaluate eventual changes in this exposure. Children were recruited from three independent studies performed at Hospital del Mar (Barcelona, Spain) and approved by the local Ethics Committee. Hair samples were collected from the first 187 children cohort (around 4 years of age) in 1998, from the second 90 children cohort (1.5-5 years of age) in 2008 and from the third 114 children cohort (5-14 years of age) in 2013. Hair samples were analysed for the presence of opiates, cocaine, amphetamines, and cannabis by validated methodologies using gas or liquid chromatography-mass spectrometry. Familiar sociodemographics and eventual consumption of drugs of abuse by parents, and caregivers were recorded. Hair samples from 24.6% children in 1998 were positive for any drug of abuse (23.0% cocaine), 25.5% in 2008 (23.3% cocaine), and 28.1% in 2013 (20.1% cocaine and 11.4% cannabis). In none of the cohorts, parental sociodemographics were associated with children exposure to drugs of abuse. The results of the three study cohorts demonstrated a significant prevalence of unsuspected pediatric exposure to drugs of abuse which mainly involved cocaine maintained along fifteen years in Barcelona, Spain. We recommend to be aware about unsuspected passive exposure to drugs of abuse in general population and to use general or selected hair screening to disclose exposure to drugs of abuse in children from risky environments to provide the basis for specific social and health interventions.

Transgenerational exposure to environmental tobacco smoke.

Traditionally, nicotine from second hand smoke (SHS), active or passive, has been considered the most prevalent substance of abuse used during pregnancy in industrialized countries. Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and cardiovascular diseases. Tobacco is also a major burden to people who do not smoke. As developing individuals, newborns and children are particularly vulnerable to the negative effects of SHS. In particular, prenatal ETS has adverse consequences during the entire childhood causing an increased risk of abortion, low birth weight, prematurity and/or nicotine withdrawal syndrome. Over the last years, a decreasing trend in smoking habits during pregnancy has occurred, along with the implementation of laws requiring smoke free public and working places. The decrease in the incidence of prenatal tobacco exposure has usually been assessed using maternal questionnaires. In order to diminish bias in self-reporting, objective biomarkers have been developed to evaluate this exposure. The measurement of nicotine and its main metabolite, cotinine, in non-conventional matrices such as cord blood, breast milk, hair or meconium can be used as a non-invasive measurement of prenatal SMS in newborns. The aim of this review is to highlight the prevalence of ETS (prenatal and postnatal) using biomarkers in non-conventional matrices before and after the implementation of smoke free policies and health effects related to this exposure during foetal and/or postnatal life.