Entorno psicosocial y estrés en trabajadores sanitarios de la sanidad pública: diferencias entre atención primaria y hospitalaria / Psychosocial stress environment and health workers in public health: Differences between primary and hospital care

OBJETIVOS: Describir el entorno psicosocial de los profesionales sanitarios de la sanidad pública en atención primaria y hospitalaria, compararlo con el de la población asalariada española y valorar el efecto de los factores de riesgos psicosociales sobre síntomas relacionados con el estrés percibido. DISEÑO: Estudio observacional transversal, con muestreo aleatorio estratificado. Emplazamiento: Trabajadores de atención sanitaria de la provincia de Granada, distribuidos en 5 centros hospitalarios y 4 distritos sanitarios. PARTICIPANTES: Se invitó a 738 empleados (personal facultativo y de enfermería) del Servicio Andaluz de Salud (SAS). MEDICIONES PRINCIPALES: Cuestionario CopSoQ/Istas21, desarrollado para el análisis del ambiente psicosocial en el trabajo de forma multidimensional. Los síntomas de estrés se midieron con el cuestionario Stress Profile. RESULTADOS: La tasa de respuesta fue del 67,5%. En comparación con la población laboral española, nuestra muestra mostró altos niveles de exigencias psicológicas cognitivas, emocionales y sensoriales, posibilidades de desarrollo personal y sentido de su trabajo. El personal facultativo de atención primaria es el que presenta un ambiente psicosocial más desfavorable, aunque todos los grupos mostraron niveles elevados de síntomas relacionados con el estrés percibido. El análisis multivariante mostró que las variables asociadas con el estrés percibido fueron menor edad y posibilidades de relación social, el conflicto de rol, y mayores exigencias psicológicas emocionales e inseguridad en el trabajo. CONCLUSIONES: Nuestros hallazgos muestran que el ambiente psicosocial de los trabajadores sanitarios difiere del de la población asalariada española, siendo más desfavorable en el colectivo de facultativos/as de atención primaria

OBJECTIVE: To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. DESIGN: Cross-sectional study with stratified random sampling. SETTING: Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. PARTICIPANTS: A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. MAIN MEASUREMENTS: CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. RESULTS: The response rate was 67.5%.compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. CONCLUSIONS: Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners

[Psychosocial stress environment and health workers in public health: Differences between primary and hospital care]. / Entorno psicosocial y estrés en trabajadores sanitarios de la sanidad pública: diferencias entre atención primaria y hospitalaria.

OBJECTIVE: To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. DESIGN: Cross-sectional study with stratified random sampling. SETTING: Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. PARTICIPANTS: A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. MAIN MEASUREMENTS: CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. RESULTS: The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. CONCLUSIONS: Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners.

Mapa bibliométrico de la investigación realizada en atención primaria en España durante el periodo 2008-2012 / Bibliometric map of research done in primary care in Spain during the period 2008-2012

OBJETIVO: Describir la producción científica española de atención primaria durante el periodo 2008-2012. DISEÑO: Estudio observacional bibliométrico. Emplazamiento: Producción científica española de atención primaria. Participantes: Las unidades de estudio fueron las publicaciones indexadas en Medline. Mediciones principales: En cada registro se obtuvo revista, año de publicación, primer/último autor, centro de trabajo y comunidad autónoma. Posteriormente los artículos fueron clasificados según su contenido o área de investigación. El factor de impacto fue obtenido a partir de la base de análisis bibliométrico Journal Citation Reports. RESULTADOS: Mediante criterios de búsqueda fueron seleccionados 1.048 documentos. El índice de transitoriedad fue del 62,6%. La producción se incrementó desde 170 documentos en 2008 hasta 291 en 2012. La mayoría (65,7%) procedían de centros de salud, observándose un incremento significativo (p = 0,01) de los originados en unidades/institutos de investigación (5,9% en 2008; 12,0% en 2012). El 61,6% se clasificaron como «aspectos clínicos». El 22,5% fueron publicados en la revista Atención Primaria, el 80,5% en revistas con factor de impacto y el 33,49% en revistas extranjeras, siendo esta proporción superior (p < 0,001) en unidades/institutos de investigación (70,5% vs. 29,8%). En relación con el número de habitantes (documentos/100.000 hab.), las comunidades más productivas fueron Cataluña (4,1), Castilla-La Mancha (3,6), Aragón (3,4) y Navarra (3,4). CONCLUSIONES: En las publicaciones de atención primaria existe gran diversidad tanto en áreas de investigación como en las revistas donde se publican. La mayoría proceden de centros de salud, tratan aspectos clínicos y se publican en revistas españolas. Se observan diferencias en el volumen de producción científica entre comunidades autónomas

OBJECTIVE: To describe the Spanish scientific production of primary care during 2008-2012. DESIGN: Observational study bibliometric. Setting: Spanish scientific production in primary care. Participants: The study focused on publications indexed in Medline. Main measurements: In each record was obtained journal, year of publication, first/last author, workplace and autonomous community. Later, articles were classified according to their content or areas of research. The impact factor was obtained from the basis of bibliometric analysis Journal Citation Reports. RESULTS: Using search criteria, were selected 1,048 documents. The transiency rate was 62.6%. Production increased from 170 papers in 2008 to 291 in 2012. Most (65.7%) came from health centers, but we observed a significant increase (P = .01) of the articles from units or research institutes (5.9% in 2008, 12.0% in 2012). Of the total, 61.6% were classified as «clinical aspects», 22.5% were published in the journal Atención Primaria, 80.5% in journals with impact factor and 33.49% in foreign journals, being higher this proportion (P < .001) in units or research institutes (70.5% vs. 29.8%). In relation to population (articles/100.000 inhab.), the most productive communities were Cataluña (4.1), Castilla-La Mancha (3.6), Aragón (3.4) and Navarra (3.4). CONCLUSIONS: In primary care publications there is great diversity in both research areas such as in journals where published. Most are from health centers, treat clinical aspects and published in Spanish journals. Differences in the volume of scientific production between regions are observed

[Bibliometric map of research done in primary care in Spain during the period 2008-2012]. / Mapa bibliométrico de la investigación realizada en atención primaria en España durante el periodo 2008-2012.

OBJECTIVE: To describe the Spanish scientific production of primary care during 2008-2012. DESIGN: Observational study bibliometric. SETTING: Spanish scientific production in primary care. PARTICIPANTS: The study focused on publications indexed in Medline. MAIN MEASUREMENTS: In each record was obtained journal, year of publication, first/last author, workplace and autonomous community. Later, articles were classified according to their content or areas of research. The impact factor was obtained from the basis of bibliometric analysis Journal Citation Reports. RESULTS: Using search criteria, were selected 1,048 documents. The transiency rate was 62.6%. Production increased from 170 papers in 2008 to 291 in 2012. Most (65.7%) came from health centers, but we observed a significant increase (P=.01) of the articles from units or research institutes (5.9% in 2008, 12.0% in 2012). Of the total, 61.6% were classified as «clinical aspects¼, 22.5% were published in the journal Atención Primaria, 80.5% in journals with impact factor and 33.49% in foreign journals, being higher this proportion (P<.001) in units or research institutes (70.5% vs. 29.8%). In relation to population (articles/100.000 inhab.), the most productive communities were Cataluña (4.1), Castilla-La Mancha (3.6), Aragón (3.4) and Navarra (3.4). CONCLUSIONS: In primary care publications there is great diversity in both research areas such as in journals where published. Most are from health centers, treat clinical aspects and published in Spanish journals. Differences in the volume of scientific production between regions are observed.

Development and validation of a risk model for prediction of hazardous alcohol consumption in general practice attendees: the predictAL study.

BACKGROUND: Little is known about the risk of progression to hazardous alcohol use in people currently drinking at safe limits. We aimed to develop a prediction model (predictAL) for the development of hazardous drinking in safe drinkers. METHODS: A prospective cohort study of adult general practice attendees in six European countries and Chile followed up over 6 months. We recruited 10,045 attendees between April 2003 to February 2005. 6193 European and 2462 Chilean attendees recorded AUDIT scores below 8 in men and 5 in women at recruitment and were used in modelling risk. 38 risk factors were measured to construct a risk model for the development of hazardous drinking using stepwise logistic regression. The model was corrected for over fitting and tested in an external population. The main outcome was hazardous drinking defined by an AUDIT score ≥8 in men and ≥5 in women. RESULTS: 69.0% of attendees were recruited, of whom 89.5% participated again after six months. The risk factors in the final predictAL model were sex, age, country, baseline AUDIT score, panic syndrome and lifetime alcohol problem. The predictAL model's average c-index across all six European countries was 0.839 (95% CI 0.805, 0.873). The Hedge's g effect size for the difference in log odds of predicted probability between safe drinkers in Europe who subsequently developed hazardous alcohol use and those who did not was 1.38 (95% CI 1.25, 1.51). External validation of the algorithm in Chilean safe drinkers resulted in a c-index of 0.781 (95% CI 0.717, 0.846) and Hedge's g of 0.68 (95% CI 0.57, 0.78). CONCLUSIONS: The predictAL risk model for development of hazardous consumption in safe drinkers compares favourably with risk algorithms for disorders in other medical settings and can be a useful first step in prevention of alcohol misuse.

Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study.

CONTEXT: Strategies for prevention of depression are hindered by lack of evidence about the combined predictive effect of known risk factors. OBJECTIVES: To develop a risk algorithm for onset of major depression. DESIGN: Cohort of adult general practice attendees followed up at 6 and 12 months. We measured 39 known risk factors to construct a risk model for onset of major depression using stepwise logistic regression. We corrected the model for overfitting and tested it in an external population. SETTING: General practices in 6 European countries and in Chile. PARTICIPANTS: In Europe and Chile, 10 045 attendees were recruited April 2003 to February 2005. The algorithm was developed in 5216 European attendees who were not depressed at recruitment and had follow-up data on depression status. It was tested in 1732 patients in Chile who were not depressed at recruitment. Main Outcome Measure DSM-IV major depression. RESULTS: Sixty-six percent of people approached participated, of whom 89.5% participated again at 6 months and 85.9%, at 12 months. Nine of the 10 factors in the risk algorithm were age, sex, educational level achieved, results of lifetime screen for depression, family history of psychological difficulties, physical health and mental health subscale scores on the Short Form 12, unsupported difficulties in paid or unpaid work, and experiences of discrimination. Country was the tenth factor. The algorithm's average C index across countries was 0.790 (95% confidence interval [CI], 0.767-0.813). Effect size for difference in predicted log odds of depression between European attendees who became depressed and those who did not was 1.28 (95% CI, 1.17-1.40). Application of the algorithm in Chilean attendees resulted in a C index of 0.710 (95% CI, 0.670-0.749). CONCLUSION: This first risk algorithm for onset of major depression functions as well as similar risk algorithms for cardiovascular events and may be useful in prevention of depression.

¿Qué hay de cierto en que se puede reducir la utilización de las consultas de los pacientes hiperutilizadores? / No disponible

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Prevalence of common mental disorders in general practice attendees across Europe.

BACKGROUND: There is evidence that the prevalence of common mental disorders varies across Europe. AIMS: To compare prevalence of common mental disorders in general practice attendees in six European countries. METHOD: Unselected attendees to general practices in the UK, Spain, Portugal, Slovenia, Estonia and The Netherlands were assessed for major depression, panic syndrome and other anxiety syndrome. Prevalence of DSM-IV major depression, other anxiety syndrome and panic syndrome was compared between the UK and other countries after taking account of differences in demographic factors and practice consultation rates. RESULTS: Prevalence was estimated in 2,344 men and 4,865 women. The highest prevalence for all disorders occurred in the UK and Spain, and lowest in Slovenia and The Netherlands. Men aged 30-50 and women aged 18-30 had the highest prevalence of major depression; men aged 40-60 had the highest prevalence of anxiety, and men and women aged 40-50 had the highest prevalence of panic syndrome. Demographic factors accounted for the variance between the UK and Spain but otherwise had little impact on the significance of observed country differences. CONCLUSIONS: These results add to the evidence for real differences between European countries in prevalence of psychological disorders and show that the burden of care on general practitioners varies markedly between countries.

La red de investigación en actividades preventivas y promoción de la salud: un reto para la atención primaria / The network of research info preventive activities and health promotion: a challenge for primary care

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Dudar de la actividad del profesional: un tópico en las reflexiones sobre la demanda asistencial en atención primaria. Réplica / Doubting professionals' activity: a cliché in reflections on primary care case-loads. Response

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Demanda inducida por el profesional: aplicaciones de la teoría económica a la práctica clínica / Doctor-induced demand: applications of economic theory in clinical practice

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[The dimensions of the organisational climate as seen by general practitioners]. / Las dimensiones del clima organizacional percibidas por los médicos de familia.

OBJECTIVE: To create and validate a tool to assess the organizational climate (OC) perceived by general practitioners (GP). DESIGN: Descriptive, cross-sectional, and multi-site, study. SETTING: Health centres (HC) in Jaén and Málaga province Spain. PARTICIPANTS: Random sample of 38 HCs and 387 GPs. MAIN MEASUREMENTS: A self-administered questionnaire in March 2001, with the personal variables of sex, age, graduation date, specialty, kind of contract, time worked in primary care teams, time in current job, list size, case load, tutor of residents and academic qualification. HC variables: urban/rural, team structure, accreditation for teaching residents, service portfolio, out-patient care, and an OC scale of 40 Likert-like questions. We analysed the content validity of the scale by factorial analysis; and its reliability, by Cronbach's alpha and corrected scale-item correlation coefficients. RESULTS: Reply rate was 89.8%, 71% of the GPs were male, mean age was 44, 76% had tenure, and 37% were specialists in family medicine and 28% tutors, 17% with 3rd-year residents, 9% with doctors; 50% of HCs were rural and the mean team structure had 13 GPs and 4 paediatricians. We obtained 12 factors that explained 60% of variance, and 7 factors with reliability coefficients >0.50. We made an OC-positive scale (alpha=.82) with the dimensions for team-work, cohesion and social life; and another OC-negative scale (alpha=.78) composed of team conflict, perceived team failure, excess autonomy, authoritarian management, and GP-nurse tension. CONCLUSIONS: We found a questionnaire with good validity and reliability, which was useful for evaluating the OC perceived by GPs.

Las dimensiones del clima organizacional percibidas por los médicos de familia

Objetivo. Crear y validar un instrumento para medir el clima organizacional percibido por los médicos que trabajan en atención primaria. Diseño. Estudio descriptivo, transversal y multicéntrico. Emplazamiento. Equipos básicos de atención primaria (EBAP) de las provincias de Málaga y Jaén. Participantes. Muestra aleatoria de 38 EBAP y 387 médicos de familia (MF). Mediciones principales. Cuestionario auto administrado em marzo de 2001 con variables personales: sexo, edad, año de licenciatura, especialidad, tipo de adscripción-contrato, tiempo de trabajo en equipos de atención primaria y tiempo en la paza actual, población asignada, frecuentación, tutor de residentes y grado de doctor; variables del centro: distribución urbano/rural, composición del equipo, acreditación docente para el sistema MIR, cartera de servicios y dispensación de cuidados, y escala de clima organizacional (CO) con 40 preguntas de tipo Likert. Analizamos la validez de contenido de la escalade CO mediante un análisis factorial, la fiabilidad de los factores con el alfa de Cronsbach y los coeficientes de correlación ítem-escala corregidos. Resultados. Tasa de respuesta del 89,8 por ciento; el 71 por ciento de los médicos eran varones, con 44 años de media; un 76 por ciento, propietario; un 37 por ciento especialista MIR en medicina familiar; un 28 por ciento tutor acreditado; un 17 por ciento médico residente y un 90 por ciento, doctor. De los EBAP, 50 por ciento eran urbanos, con 13 MF y 4 pediatras de media. Obtuvimos 12 factores que explican el 60 por ciento de la varianza, y quedan 7 con coeficientes de fiabilidad > 0,50. Construimos una escala de CO positivo (alfa=0,82) con las dimensiones trabajo en equipo, cohesión y vida social, y otra de CO negativo (alfa=0,78) integrada por conflicto en equipo, percepción de fracaso, exceso de autonomía, dirección autoritaria y tensión médico-enfermera. Conclusiones. Cuestionario con validez de contenido y buena fiabilidad, útil para evaluar el CO percibido por los MF en atención primaria.(AU)