[Adult learning, professional autonomy and individual commitment]. / Formación de adultos, autonomía profesional y compromiso individual.

DEVELOPMENT: The concept of 'andragogy' is the basis of the adult education which is different from pedagogy in several aspects, particularly in the autonomy of the adult learner in choosing the educational programmes and the methodologies and sites in where learning occurs. This happens very often in the worksite. The professionals have to learn permanently during their active lives in order to maintain their competence updated. In this sense, continuing education correlates with continuing professional development, which is an attempt to enlarge the traditional domains of continuing education. Continuing education must be clearly differentiated from formal education, which is a requirement for granting professional degrees or titles. Very often it arises from the changing health needs and for this reason is necessary to avoid the institutionalization of continuing education programmes. CONCLUSION: Professional associations should be actively involved in providing and accrediting continuing education-continuing professional development programmes, because this involvement is an essential component of the professionals' self-regulation in the context of the current medical professionalism ideology.

Formación de adultos, autonomía profesional y compromiso individual / Adult learning, professional autonomy and individual commitment

La formación de adultos tiene sus raíces conceptuales en la noción de ‘andragogía’ y se diferencia dela pedagogía en múltiples aspectos, el más relevante de los cuales es la autonomía en la selección de lo que se quiere aprender y en la forma y momento en que se hace, y generalmente ocurre en el lugar de trabajo. El profesional debe aprender en todo momento a lo largo de su vida, como una manera de mantener actualizada su competencia. Y en este punto entronca con lo que hoy en día se denomina desarrollo profesional continuo, en un intento de ensanchar los límites tradicionales de la formación médica continuada. Ésta, por su parte, debe diferenciarse claramente de la formación reglada, que permite obtener titulaciones exigibles y con frecuencia surge al compás de las necesidades cambiantes del momento. Por ello, debe huirse de su institucionalización y mantener su carácter oportunista, como elemento genuino. Conclusión. Las asociaciones profesionales deben involucrarse más activamente en la provisión y la acreditación de la formación médica continuada-desarrollo profesionalcontinuo, como un componente esencial de su autorregulación que emana del ideario del profesionalismo médico actual

The concept of ‘andragogy’ is the basis of the adult education which is different from pedagogy inseveral aspects, particularly in the autonomy of the adult learner in choosing the educational programmes and the methodologies and sites in where learning occurs. This happens very often in the worksite. The professionals have to learn permanently during their active lives in order to maintain their competence updated. In this sense, continuing educationcorrelates with continuing professional development, which is an attempt to enlarge the traditional domains of continuing education. Continuing education must be clearly differentiated from formal education, which is a requirement for granting professional degrees or titles. Very often it arises from the changing health needs and for this reason is necessary to avoid theinstitutionalization of continuing education programmes. Conclusion. Professional associations should be actively involved in providing and accrediting continuing education-continuing professional development programmes, because this involvementis an essential component of the professionals’ self-regulation in the context of the current medical professionalism ideology

¿De quién es responsabilidad la formación continuada de los médicos? / Who is responsible for doctors’ continuing medical education?

No disponible

Tabaco, presión arterial y riesgo cardiovascular / Tabacco, blood pressure and cardiovascular risk

La hipertensión arterial (HTA) y el tabaquismo son dos condiciones crónicas altamente prevalentes, afectando a más del 30 por ciento de la población adulta, cada una de ellas por separado y hasta al 5 por ciento como mínimo su asociación. El riesgo cardiovascular derivado de su existencia es muy elevado, siendo la HTA el principal factor de riesgo en la mayoría de países del mundo y el tabaquismo la principal causa de muerte evitable. De ello se deriva un altísimo coste sanitario y social. Los diversos componentes del tabaco y del humo del tabaco actúan a distintos niveles del organismo, originando alteraciones fisiopatológicas que explican las complicaciones derivadas, mayormente la aceleración del proceso arterioscleroso y las alteraciones vasculares y endoteliales observadas en el fumador, la propia elevación tensional, las alteraciones hemorreológicas y del sistema de coagulación y diversas alteraciones endocrinas hemodinámicas. Todas ellas subyacen en el desencadenamiento de la enfermedad coronaria y cerebrovascular, las dos principales complicaciones cardiovasculares de la HTA potenciadas por el tabaquismo. El tratamiento del hipertenso fumador no difiere sustancialmente del hipertenso en general; la única especificidad estriba en la necesidad de estimularle a abandonar el hábito tabáquico y ayudarle en su consecución, utilizando las estrategias de soporte psicológico y los fármacos actualmente disponibles (diversas modalidades de reemplazamiento nicotínico y bupropion esencialmente) (AU)

Cómo implicar más activamente al médico en la prevención y control del tabaquismo. Papel de las organizaciones científico-profesionales / How to more actively involve physicians in the prevention and control of cigarette smoking. Role of scientific-professional organizations

Las organizaciones científico-profesionales deben desempeñar un papel mucho más activo en la prevención y control del tabaquismo del que han venido ejerciendo hasta la actualidad. Su actuación debe desarrollarse en tres ámbitos prioritarios: por un lado, en el del desarrollo de una política institucional propia en relación con la prevención y control de la epidemia tabáquica, implantando las recomendaciones nacionales e internacionales y ofreciendo una imagen ejemplar como les corresponde; por otro lado, promoviendo un mayor compromiso de los profesionales que agrupan, mediante la creación de un grupo de trabajo sobre tabaquismo, la evaluación periódica de los aspectos epidemiológicos del tabaquismo entre sus miembros, la promoción de actividades educativas sobre el tabaquismo, la puesta en práctica de programas de ayuda a la cesación entre sus miembros fumadores, la cooperación con los medios de comunicación y la promoción de la investigación científica sobre los diversos aspectos del tabaquismo, y finalmente dichas organizaciones deben contribuir decisivamente al desarrollo e implementación de una política nacional de prevención y control del tabaquismo, conjuntamente con las administraciones sanitarias y otras organizaciones, públicas y privadas, relacionadas con el problema (AU)

El médico y el tabaco / Physician and tobacco

No disponible

Tratamiento antihipertensivo y racionalización del gasto sanitario / Anti-hypertensive treatment and rationalization of health expenditures

No disponible

[Physicians and continuing medical education. The results of a survey carried out in Catalonia]. / Los médicos y la Formación Médica Continuada. Resultados de una encuesta ilevada a cabo en Cataluña.

In order to learn about opinions, behaviours and needs of continuing medical education (CME), a telephone survey was carried out with a random sample of 1,001 physicians of Catalonia. Books and journals (67.7%; IC: 64.8-70.6) are the most frequent training methods used, much more than the courses and seminars (11.5%; IC: 9.5-13.5)--which are used more often by generalists than specialists--and clinical sessions (9.2%; IC 6.6-12.4). A high proportion (59.2%; IC: 56.1-62.2) do CME out of their workplace, specially general practitioners (66%; IC: 61.5-70.5). Most participants (74.7%; IC: 72.0-77.4) consider that the main objective of CME is to increase their level of knowledge. Those who argue that CME should not be mandatory are mainly general practitioners (58.9%; IC: 54.2-63.6) of which a significant number work in private practice (63.5%; IC: 60.5-66.5). 64.7% (IC: 61.8-67.7) are in favour of cost-free CME. The majority, 80% (IC: 77.4-82.4) believe that CME has to be included in the work timetable: of the physicians who support this point, the majority work in hospitals while only a few work in private practice. Some of the achieved findings could be explained by generational, training and work place differences; as well as the increasing bureaucratic elements in the profession.

[Epidemiology of tobacco use in health-science students]. / Epidemiología del tabaquismo en los estudiantes de ciencias de la salud.

The characteristics of tobacco use by students of the Division of Health Sciences of the University of Barcelona have been studied. During the 1988-1989 school year, 382 students were individually interviewed about their use of tobacco by means of a questionnaire routinely used by the Department of Health and Social Security of the Generalitat of Catolonia (Spain), with pertinent modifications for this specific group. These interviews were performed by appropriately trained personnel. Information was also gathered on the influence of university-level studies on smoking habits, the effect of advertising and the efficacy of antitobacco programs and campaigns carried out by the government. The study sample was drawn from lists supplied by the registrars' offices, by means of a random sampling by school (Medicine, Pharmacy, Psychology, Odontology and Nursing). The prevalence of tobacco use was 40.8% (29.8% daily smokers and 11% occasional smokers). These results are similar to those described in the literature, although these values are somewhat higher than those in more developed countries with a longer tradition of resistance to the use of tobacco. It is important to note that studying health sciences does not appear to be a major influence on the student's habits, but that the social and cultural environment is the factor which weighs the most in this respect. In conclusion, to reduce the prevalence of tobacco use in this important group, educational programs must be begun at the pre-university level (secondary school) and changes should be made in the curricula of the health professional so that areas related to tobacco use are more motivational for students.

Epidemiología del tabaquismo en los estudiantes de ciencias de la salud / Tobacco use in health-science students

Foram estudadas as características do hábito de fumar nos estudantes de ciências da saúde da Universidade de Barcelona. Durante o ano letivo 1988-89 foram entrevistados 382 aluno em relaçäo ao uso do fumo, por meio de questionário rotinamente utilizado por um Departamento daquela Universidade, no qual foram efetuadas modificaçöes pertinentes ao grupo estudado. Foram obtidas informaçöes relacionadas com a influência dos estudos universitários no hábito de fumar, com os efeitos da publicidade e com a eficácia dos programas e das campanhas da luta anti-fumo desenvolvidos pelas administraçöes públicas. A amostra foi obtida a partir das listagens fornecidas pelas diferentes secretarias administrativas, por meio de uma amostragem aleatória estratificada por Faculdades (Medicina, Farmácia, Psicologia, Odontologia e Enfermagem). A prevalência do tabagismo foi de 40,8 por cento (29,8 por cento de fumantes habituais e 11 por cento ocasionais). Os estudos relacionados com a saúde näo parecem influir, de uma forma destacada, no hábito dos estudantes, sendo o meio cultural e social o fator que exerce papel mais determinante nesse sentido. Assinala-se que, para poder diminuir a prevalência do fumo nesse importante grupo, devem-se iniciar programas educativos ao nível de escolarizaçäo pré-universitária (bacharelato unificado polivalente e curso de orientaçäo universitária) e introduzir modificaçöes nos futuros planos de estudo das profissöes sanitárias, de forma a que os conteúdos relacionados com o fumo sejam canais motivadores para os alunos

[Obesity and arterial hypertension. A cross-sectional study of their prevalence in the population of L'Hospitalet de Llobregat]. / Obesidad e hipertensión arterial. Estudio transversal de prevalencia en la población de L'Hospitalet de Llobregat.

A study of the prevalence of arterial hypertension and obesity has been performed in the community of Hospitalet de Llobregat which is an industrial town of 289,000 inhabitants in the vicinity of Barcelona. We have studied a population sample of 801 individuals over the age of 19 years, randomly chosen from the elections lists from 1986, and who were classified according to age and sex. Four hundred and thirty two subjects (54%) had a Quetelet index (QI) of 25 or above. Out of these, 300 (38%) had a QI between 25-30 and 124 (16%) had a QI of 30 or above. Obesity prevalence defined as an QI greater than or = 25 was lower in the youngest group (20-39 years), both in males as in females, with a significant difference p less than 0.05). Arterial hypertension prevalence (SAP greater than 160 and/or DAP greater than 95 mmHg) was 19.8%. When individuals with DAP of 90-94 were included, prevalence was 25.7%. A positive correlation between QI and arterial blood pressure was found in the sample studied as a whole, both for systolic arterial pressure (r = 0.23; p less than 0.001; R2 = 0.053) as for diastolic arterial pressure (r = 0.23; p less than 0.001; R2 = 0.053). Arterial hypertension prevalence (SAP greater than 160 and or DAP greater than 90 mmHg plus those individuals with lower values but were on hypotensive treatment) was higher in obese individuals (QI greater than 25). The difference was statistically significant in males below 60. In females a tendency was observed in women below 40. (p = 0.054).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of arterial hypertension at the Llobregat Hospital. Evolution of the control rate between 1981 and 1987]. / Prevalencia de hipertensión arterial en l'Hospitalet de Llobregat. Evolución de la tasa de control entre 1981 y 1987.

To assess the current prevalence of hypertension (HT) in l'Hospitalet de Llobregat and the evolution of the rate of diagnosis, treatment and control between 1981 and 1987, we carried out a cross sectional study in a census sample of 801 individuals above 19 years old, chosen at random after age and sex stratification. The prevalence of HT, as defined by the WHO classical criteria, was 19.8 +/- 2.7%, and 17% for borderline HT. 122 of the 159 detected hypertensives (76.7%) were known hypertensives, 96 (60.6%) received antihypertensive therapy and 58 (36.4%) had their blood pressure values under control [systolic blood pressure (SBP) less than 160 mmHg and diastolic blood pressure (DBP) less than 95 mmHg]. If individuals with DBP between 90 and 94 mmHg were included as hypertensives, the number of the latter increased to 206 (25.8%). 144 of these (69.9%) were known hypertensives, 97 (47%) were receiving antihypertensive therapy and 51 (24.7%) had their BP values under control (SBP less than 160 mmHg and DBP less than 90 mmHg). The general practitioner had diagnosed HT in 59% of known hypertensives, and was treating the disease on a regular basis in 61%. This value in higher than that found in 1981 (44%, p less than 0.05). In the comparative analysis with the previous study carried out in this town, a significant increase in the rate of detection (47% in 1981 and 76% in 1987, p less than 0.01) and control of HT (7.5% and 36.4%, respectively; p less than 0.01) were found.

[Prevalence of arterial hypertension in the rural population of Catalonia]. / Prevalencia de hipertensión arterial en la población rural de Cataluña.

The arterial blood pressure and hypertension data obtained from an epidemiological study of endemic goiter in the rural population of Catalonia was analyzed. The prevalence of hypertension is of 25.1 +/- 2.16%, existing a predominance of women over men. The distribution of the arterial pressure values according to sex are presented, as well as the relationship between arterial blood pressure, weight and obesity.