Adverse Effects in Patients with Intellectual and Developmental Disabilities Hospitalized at the University Clinical Hospital.

(1) Background: Providing the patient with the health care they need in a personalized and appropriate manner and without adverse effects (AEs) is a part of quality of care and patient safety. The aim of this applied research project was the assessment of AEs as a clinical risk in patients with high social vulnerability such as persons with intellectual and developmental disabilities (PwIDD). (2) Methods: A retrospective epidemiological cohort study was performed on exposed and unexposed groups (the control group) in order to estimate the incidence of AEs in PwIDDs and assess their importance for this category of patients. (3) Results: AEs were observed with a frequency of 30.4% (95% CI) in the PwIDD exposed group, with significant differences to the unexposed group (p = 0.009). No differences were observed with regards to gender. Age was as a marker of care risk, with the highest incidence of AEs in the group of 60-69 years. (4) Conclusions: PwIDDs have a high risk of suffering AEs while receiving health care assistance due to their high social and clinical vulnerability. Health care practitioners must therefore be aware of these results and keep these observations in mind in order to carry out personalized, preventive, competent, effective, and safe medical care.

Therapeutic and Preventive Efficacy of an Intervention on Workers in a Back School.

Back pain and its ailments are the main cause of absenteeism and sick leave. Furthermore, the cause of pain and disability in a large number of workers is unknown, and treatments are not effective in controlling it. For this reason, the Back Schools (BSs) provide theoretical and practical training to workers so that they can acquire knowledge and skills that will allow them to adequately manage their back problems, enabling them to recover their autonomy and prevent relapses. The aim of the study is to analyse the efficacy of a BS by means of the evaluation of pain and disability scales in workers in different sectors and in construction. The most important clinical benefits obtained after the intervention of a BS are the reduction of pain and disability. Statistically significant and clinically relevant results have been observed between the initial assessment and the 6-month review. BS has been shown to be effective in reducing low back and neck pain and disability during the first 6 months of follow-up. Construction workers have pain and disability rates at the overall mean and with improvements between the initial assessment and the 6-month review. Their rates of improvement are clinically more relevant than for the overall population analysed.

Female sexual dysfunction associated with idiopathic cerebellar ataxia: A case report.

BACKGROUND: Cerebellar ataxia affects individuals in reproductive age. To date, few clinical cases of cerebellar ataxia and involvement of the cerebellum in sexual response were reported. We report a case of a woman that need to restore skills related for execution of sexual activity and coordination of movements during sexual intercourse. CASE PRESENTATION: We present a case of idiopathic cerebellar ataxia in a 25-year-old woman who was referred for sexual health consultation. The patient complained of sexual problems as follows: "I forgot the behaviors that I should adopt in a sexual encounter, and I know what to do only after paying attention to my movements." The history of sexual behavior indicated that this patient presented a "romantic love" model. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reports that this condition involves anorgasmia disorder and female sexual arousal disorder. In addition, there was a loss of automatism and coordination of movements in the pelvis and lower extremities. The patient's condition improved with occupational and physical therapy combined with rehabilitation therapy based on cognitive behavioral criteria for sexual therapy. CONCLUSIONS: The case evolved from the romantic-affective model to a realistic model. The patient reported being comfortable during sexual intercourse and could explain her sexual needs to her partner. She managed to coordinate lower limb and pelvic movements, but did not reach an orgasm. Moreover, vaginal lubrication occurred with a time lag of 15-30 min after the end of sexual intercourse or masturbation.

Educación inclusiva en Medicina: una experiencia formativa sobre personas con discapacidad / Inclusive education in Medicine: Awareness health care for persons with disabilities

FUNDAMENTO: La educación inclusiva universitaria trata de transformar y mejorar el rol competencial de los futuros médicos en relación con las personas con discapacidad (PcD), grupo poblacional vulnerable y prevalente que necesita una atención de calidad para hacer efectivo su derecho a la salud. OBJETIVO: Analizar y valorar la sensibilización y la formación de una experiencia desarrollada en Medicina en relación con la atención integral a las PcD. MÉTODO: Se ha realizado un estudio de intervención, tipo antes y después, sin grupo control, en 120 alumnos del grado de Medicina. RESULTADOS: Los estudiantes perciben que falta de formación en este tema y son conscientes de su rol sanitario y social en la reducción de desigualdades en las PcD. Entre los conocimientos profesionales que mejoran con la intervención, de manera significativa, están los relacionados con los derechos de las PcD, los factores de riesgo, el grado de discapacidad, el diseño universal, las medidas de acción positiva y las adaptaciones curriculares asociadas a la educación inclusiva. En relación con las competencias que deben ser adquiridas, se debe destacar su sensibilización sobre la necesidad de habilidades sociales y de comunicación, y la capacidad para emitir informes médicos sobre la incapacitación. CONCLUSIÓN: La intervención formativa se muestra efectiva en relación con la sensibilización sobre la importancia del rol del médico en relación con los pacientes con discapacidad y, en consecuencia, se valoran los conocimientos y competencias necesarias para conseguir una mejor atención sanitaria

BACKGROUND: Inclusive higher education aims to transform and improve the competence role of the future doctors in relation to people with disabilities (PwD), a vulnerable and prevalent population group which needs Quality Care to fulfil the right to health. AIM: To analyse and assess the awareness and training received of an experience developed in the School of Medicine related to the comprehensive care for PwD. METHOD: A before- and after-intervention, with no control group, of 120 students enrolled in the School of Medicine. RESULTS: Students perceive a lack of training on this topic and are aware of their health and social role to reduce inequalities in PwD. The professional knowledge that significantly improved with the intervention are the related with the rights of PwD, risk factors, degree of disability, universal design, positive action measures, and curriculum adaptations. As regards to the competences that must be acquired, the awareness of social and communications skills needed should be noted, as well as the ability to issue medical reports about disability. CONCLUSION: The training intervention is effective in terms of awareness about the importance of the medical role related to PwD, and consequently, the knowledge and skills needed to achieve a better Health Care are assessed

Do health and social support and personal autonomy have an influence on the health-related quality of life of individuals with intellectual disability?

BACKGROUND: The aim of this study was to assess the relation between perceived social support and personal autonomy of individuals with intellectual disabilities and Health-Related Quality of Life. METHODS: A cross-sectional study with a multicentre sample was carried out including 162 institutionalized individuals with intellectual disability. The measurement tool was a structured questionnaire with sociodemographic variables, and three scales: Functional Independence Measure(FIM) scale, Duke-UNC Functional Social Support Questionnaire, and SF-36 Health Survey, which were completed during an individual/family interview. RESULTS: The perception of received social support is high on all 11 items of the Duke-UNC questionnaire, with an average of 3.45 for item-1 and 4.85 for item-11, which represents a total perceived support of an average 47.98 points (±SD7.30) (normal support). The Mental-Health component is rated worse than Physical-Health (67.41 vs. 71.74). The average rates for the different dimensions range from 57.34 points for Social-Functioning (the lowest rating) to 79.61 points for Bodily-Pain (highest rating). A multiple linear regression analysis reveals that the dimensions of Physical-Functioning (p < 0.001), Role-Physical (p = 0.016) and Bodily-Pain (p = 0.022), which are elements of the Physical-Health component, are independent predictive variables with the Degree of Autonomy (FIM) as a dependent variable. Social-Support (Duke-UNC) as a dependent variable is determined by the dimensions of Vitality (p = 0.014), Role-Emotional (p = 0.001) and Mental-Health (p < 0.001), which are part of the Mental-Health component and act as independent predictive variables. CONCLUSIONS: Individuals with intellectual disability and a higher degree of personal autonomy determined by institutional and family support report better Health and Quality of Life.

¿La información sobre automedicación disponible en internet reúne criterios de calidad? / Does the information about self-medication available in the internet meet standards of quality? / A informação sobre automedicação disponível em internet reúne critérios de qualidade?

El estudio tiene por objetivo analizar la calidad de la información en relación con la automedicación en las páginas web de internet y estimar si se cumplen criterios de calidad. Para conseguir dicho propósitose efectuó un estudio observacional tipo transversal basado en la valoración de 15 páginas web institucionales relacionadas con la automedicación y que fueron seleccionadas aleatoriamente para ser revisadas por 59 usuarios habituales de internet como herramienta fundamental en su trabajo profesional. Como instrumento de medida se utilizó un cuestionario elaborado específicamente para este trabajo de investigación. El 66 % de los usuarios del estudio confirmaron la existencia de información sobre automedicación en dichas web. De acuerdo con las observaciones realizadas por los usuarios -la mayor parte de páginas web con información sobre automedicación- en 9 (60 %) se cumplen criterios de calidad en un 70-75 %. Las variables mejor evaluadas han sido la actualización de la información, la responsabilidad y la accesibilidad. Las peor evaluadas han sido la arquitectura de la información y la existencia de acreditación o sello de calidad en la web. La calidad de las web analizadas es aceptable, pero mejorable en accesibilidad universal, acreditación y/o certificación. Las web mejor valoradas globalmente han sido la del Ministerio de Sanidad, Política Social e Igualdad de España y la de la Organización Mundial de la Salud.

The study aims at analyzing the quality of information on self-medication in Internet websites and assess whether quality criteria are met. In view of this, an observational cross-sectional study was carried out as based on the assessment of 15 institutional websites related to self-medication and randomly chosen for review by 59 regular internet users as a fundamental tool in their professional work. A survey developed specifically for this research was conducted. The 66 % of this study's users confirmed the existence of information on self-medication in these websites. According to the observations made by users -most web pages with information about self-medication- in 9 (60 %), standards of quality are met in 70-75 %. The best assessed variables have been updating of information, responsibility and accessibility. The worst assessed ones have been the information architecture and the existence of accreditation or quality seal on the Web. The quality of the websites analyzed is acceptable, but improvable regarding universal accessibility, accreditation and/or certification. The Webs best rated globally have been the Ministry of Health's, Social Policy and Equality's of Spain and the World Health Organization's.

O estudo tem por objetivo analisar a qualidade da informação em relação com a automedicação nas páginas webs de internet e estimar se são cumprido critérios de qualidade. Para conseguir o referido propósito foi efetuado um estudo observacional tipo transversal baseado na valoração de 15 páginas webs institucionais relacionadas com a automedicação e que foram seleccionadas aleatoriamente para ser revistas por 59 usuários habituais de internet como ferramenta fundamental no seu trabalho profissional. Como instrumento de medida foi utilizado um inquérito elaborado especificamente para este trabalho de investigação. O 66 % dos usuários do estudo confirmaram a existência de informação sobre automedicação nas referidas webs. De acordo com as observações realizadas pelos usuários -a maior parte de páginas webs com informação sobre automedicação- em 9 (60 %) são cumpridos critérios de qualidade em um 70-75 %. As variáveis melhor avaliadas têm sido a actualização da informação, a responsabilidade a acessibilidade. As pior avaliadas têm sido a arquitetura da informação e a existência de acreditação ou selo de qualidade na web. A qualidade das webs analisadas é aceitável, mas melhorável em acessibilidade universal, acreditação e/ou certificação As webs melhor valoradas globalmente têm sido a do Ministério de Sanidade, Política Social e Igualdade (MSPS) da Espanha e a da Organização Mundial da Saúde.

Association between Occupational Exposure to Wood Dust and Cancer: A Systematic Review and Meta-Analysis.

OBJECTIVE: To perform a systematic review to analyze the association between occupational exposure to wood dust and cancer. METHODS: A systematic literature search of entries made in the MEDLINE-PubMed database between 1957 and 2013 was conducted to identify studies that had assessed the relationship between occupational exposure to wood dust and different types of cancer. A meta-analysis of selected case-control and cohort studies was subsequently performed. RESULTS: A total of 114 studies were identified and 70 were selected for review. Of these, 42 studies focused on the relationship between wood dust and nasal cancer (n = 22), lung cancer (n = 11), and other types of cancer (n = 9). Low-to-moderate quality evidence that wood dust acts as a carcinogen was obtained, and a stronger association between wood dust and nasal adenocarcinoma was observed. A lesser association between wood dust exposure and lung cancer was also observed. Several studies suggested that there is a relationship between wood dust and the onset of other cancers, although there was no evidence to establish an association. A meta-analysis that included four case-controls studies showed that workers exposed to wood dust exhibited higher rates of nasal adenocarcinoma than other workers (odds ratio = 10.28; 95% confidence interval: 5.92 and 17.85; P<0,0001), although a large degree of heterogeneity was found. CONCLUSIONS: Low-to-moderate quality evidence supports a causal association between cancer and occupational exposure to wood dust, and this association was stronger for nasal adenocarcinoma than for lung cancer. There was no evidence of an association between wood dust exposure and the other cancers examined.

B-learning training in the certification of causes of death.

INTRODUCTION: An adequate certification of causes of death is essential for Public Health. The objective of this work is to improve the professional competence of medicine students and family doctors with regard to the certification of causes of death according to the international regulations of the WHO. METHODS: Intervention-formation, before and after design, addressed to students of Medicine in their last year (6th year), and Family Doctors and Interns. The blended learning or b-learning program consisted in an on-site seminar-workshop, plus basic information/documentation stored in an on-line platform, together with the preparation of Certificates of Causes of Death based on Clinical Histories of real cases. RESULTS: 308 students participated in the program. We observed an individual improvement in the professional competence in all certifications of death, which was significant in 3 out of 5 cases (it was not significant in a medical-legal case of violent death and the case of a pluripathological chronic patient). The intermediate causes improved in all cases. Most formal aspects of the certification improved with significant changes. In the group of 62 Family Doctors and interns who took part in the program there were improvements in the basic or underlying causes in 4 of the 5 cases and improvements in the formal quality of the assessment, although less significantly than in students, because they started with better basal indexes in their certificates in the Before stage of the study. CONCLUSIONS: Blended learning training has shown to be effective in improving the professional competence, both in students of the Degree of Medicine and in practicing Family Doctors and Interns.

Seguimiento prospectivo de los resultados del tratamiento antituberculoso / Prospective follow-up of results of tuberculosis treatment

Objetivo. Analizar los resultados del tratamiento antituberculoso en un Área de Salud del Sistema Nacional de Salud. Material y Métodos. Estudio de seguimiento prospectivo de pacientes de tuberculosis atendidos en la Atención Hospitalaria del Área de Salud de Salamanca. El período de inclusión de los casos en el estudio fue de 6 meses. La historia clínica constituyó la fuente básica de datos, cuya información se complementó con una entrevista clínica al paciente. Adicionalmente, se emplearon los registros microbiológicos para clasificar los resultados terapéuticos en resultado satisfactorio (RS), resultado potencialmente insatisfactorio (RPI) y fallecimiento. Cumplieron los criterios de inclusión 146 pacientes; fueron entrevistados 108. La edad media fue de 49 años y el 29,6% (32/108) presentaba algún factor social de riesgo (FSR). Resultados. El nivel de RS fue del 55,6% (IC95%: 55,6±9); ancianos jóvenes, vivir en familia y pautas de 6 meses se asociaron con los RS. La proporción de RPI fue del 40,7% (IC95%: 40,7±9); edad adulta, residir en otras provincias, vivir solo, comorbilidad, virus de la inmunodeficiencia humana (VIH), alcoholismo y sociopatía aumentaron la probabilidad de RPI. En la regresión logística, las variables del modelo final para RPI fueron adulto, comorbilidad y FSR, mientras que las condiciones institucionales se asocian a la mortalidad. Conclusiones. La tasa de RS es mejorable. El nivel de RPI está condicionado por las altas tasas de pérdidas, 31,5% (IC95%: 31,5 ± 9), por lo que deben establecerse medidas para su reducción y así mejorar la efectividad del tratamiento global (AU)

Objective. The aim of the study was to analyze tuberculosis treatment outcomes in a health area of the National Health System. Material and Methods. Analytical cohort study of tuberculosis’ cases treated in the hospital care of the health area of Salamanca (Spain) 6 months. The clinical record constituted the basic source of data, whose information was complemented by a clinical interview to the patient. The microbiological records were additionally used for classifying the therapeutic outcomes in satisfactory outcome (SO), potentially unsatisfactory outcome (PUO) and death. A total of 146 patients met the inclusion criteria; 108 patients were interviewed. Their average age was 49 years. Out of them, 29.6% (32/108) showed some social risk factor (SRF). Results. The SO level was 55.6% (IC 95%: 55.6±9); the variables associated with the SO were young elderly patients, living in family and patterns of 6 months. The PUO proportion stood at 40.7% (IC 95%: 40.7±9); the variables which increased the PUO probability were adulthood, residing in other provinces, living alone, comorbidity, human immunodeficiency virus (HIV), alcoholism and social maladjustment. The variables included in the final model for PUO in logistic regression were adult, comorbidity and SFR, while the institutional conditions associated the mortality. Conclusions. The SO rates can be improved. The PUO level is conditioned by high loss rates, 31.5% (95% CI: 31.5 ± 9), so measures should be established for reduction and improve the effectiveness of the overall treatment (AU)

Información sobre medicamentos y automedicación en las redes sociales / Information on drugs and self-medication in social networks

Las redes sociales emergen como una de las principales fuentes de información mediante el uso de Internet. Objetivo: valorar la información sanitaria que se utiliza en las redes sociales en relación con los medicamentos y la automedicación. Métodos: se realizó un estudio observacional en Facebook y Twitter durante tres meses para explorar y analizar los comentarios realizados sobre información sanitaria según tres descriptores: salud, enfermedad y medicamentos. Se analizaron 334 comentarios en Facebook y en Twitter, elegidos aleatoriamente de 1 002 extraídos. Resultados: la información sobre medicamentos representa el 20,8 % en Facebook y el 24,15 % en Twitter. Sobre la automedicación supone el 6,9 % y el 8,5 % respectivamente. Los medicamentos más comentados corresponden al sistema nervioso (Grupo N) con 76 (22,7 %) en Facebook y 78 (23,3 %) en Twiter, el grupo más prevalente en ambas redes. Se destacan los mismos subgrupos terapéuticos: N02 (analgésicos), donde es superior Facebook, N06 (psicoanalépticos) y N05 (Psicolépticos). En relación con los medicamentos utilizados en automedicación predomina el grupo N (sistema nervioso) en ambas, pero superior en Facebook. Los grupos que le siguen y que se destacan en todos los casos sobre Twiter son: grupo R (sistema respiratorio), A (sistema digestivo) y M (sistema músculo-esquelético). Los grupos M y R con igual número ocupan el segundo lugar en Twiter. Conclusión: los usuarios de Facebook y Twitter comparten más información sobre medicamentos que sobre automedicación. Las redes sociales, por el momento, se usan prioritariamente para compartir experiencias, resolver dudas y recibir información sobre problemas de salud.

Social networks are one of the main sources of information on the Internet. Objective: evaluate the health information provided by social networks concerning drugs and self-medication. Methods: an observational study was conducted in Facebook and Twitter for three months based on the search terms health, disease and drugs, with the purpose of exploring and analyzing comments on health information. 334 comments were analyzed, randomly selected from the total 1 002 collected. Results: Information on drugs was 20,8 % in Facebook and 24,15 % in Twitter. Information on self-medication was 6,9 % in Facebook and 8,5 % in Twitter. The drugs most commonly commented on were those for the nervous system (Group N) with 76 (22,7 %) comments in Facebook and 78 (23,3 %) in Twitter. This was the prevailing group in both networks. The same therapeutic subgroups stand out in the two networks: N02 (analgesics), higher in Facebook, N06 (psychoanaleptics) and N05 (psycholeptics). As to the drugs used for self-medication, there is a predominance of Group N (nervous system) in both networks, but the prevalence is higher in Facebook. The groups following, all of which stand out in Twitter, are Group R (respiratory system), A (digestive system) and M (musculoskeletal system). Groups M and R rank second in Twitter with the same number of hits. Conclusions: Users of Facebook and Twitter share more information about drugs than about self-medication. Social networks are mostly used to exchange experiences, make inquiries and obtain information about health problems.

Valoración de los estudiantes sobre su formación en la Facultad de Medicina / Valuation of the students about his formation in the Faculty of Medicine

Conocer y analizar la valoración y las opiniones que tienen los alumnos de sexto curso de medicina sobre el proceso de enseñanza-aprendizaje en su facultad. Sujetos y métodos. Se realiza un estudio transversal a partir de los datos primarios aportados por una encuesta que se aplica a 225 alumnos de sexto de medicina. Resultados. Del total de encuestados, 208 alumnos (95%; IC 95% = 95 ± 3) no se consideran formados para ejercer la medicina y 214 (96%; IC 95% = 96 ± 3) no se encuentran capacitados para ejercerla. La calidad global de la formación recibida en el pregrado es valorada por el 55% (IC 95% = 55 ± 7) de los alumnos con una puntuación media de 3 en una escala de 1 a 5. Se valora positivamente la formación teórica y negativamente las habilidades clínicas, sociales y de comunicación, las actitudes y los aspectos relacionados con la gestión. Para 169 alumnos, un 75% (IC 95% = 75 ± 6), la prueba MIR ha condicionado la formación, tanto en contenidos (70%; IC 95% = 70 ± 3) como en metodología (58%; IC 95% = 58 ± 6). Conclusiones. Globalmente, existe una evolución positiva entre 1999 y 2008-2010. Los resultados de este trabajo ponen de manifiesto la necesidad de introducir cambios en el proceso de enseñanza-aprendizaje de la medicina que mejoren la formación efectiva y la satisfacción (AU)

To know and to analyze the knowledge and opinions that have the pupils of sixth year of medicine on the education learning of the master. Subjects and methods. A transversal study is realized from the primary information contributed by a survey that is applied to 225 pupils of sixth degree of Medicine. Results. Of the whole of polled pupils, 208 (95%; 95% CI = 95 ± 3) is not considered to be formed to exercise the Medicine, and 214 (96%; 95% CI = 96 ± 3) is not qualified to exercise the Medicine. The global quality of the formation received in the pregrade is valued by 55% (95% CI = 55 ± 7) of the pupils by an average score of 3 for a scale of 1-5. With regard to the formative components, the theoretical formation is valued very positively and negatively the clinical and social skills and the communication, the attitudes and the aspects related to the management. The MIR test has determined as methodology. For 169 pupils (75%; 95% CI = 75 ± 6), the MIR test has determined formation so much contained (70%; 95% CI = 70 ± 3) as methodology (58%; 95% CI = 58 ± 6). Conclusions. Globally, a positive evolution exists between 1999 and 2008-2010. The results of this work reveal the need to introduce changes in the process of education learning of the Medicine that the effective formation and satisfaction improve (AU)

Metodología de investigación en Salud Laboral / Research methodology in occupational health

El objetivo de este artículo es dar a conocer los principales diseños utilizados en investigación aplicada, clínica o de Salud Laboral. Se analiza su estructura básica y el proceso llevado a cabo en un proyecto de investigación. Se describen los métodos de investigación, sus utilidades, su interpretación y su aplicación práctica en relación con la obtención de información fiable y válida que permita una lectura crítica de la comunicación científica, generalmente artículos científicos. La calidad, validez y fiabilidad de la información generada por un trabajo de investigación determinado dependen del diseño y metodología y del proceso llevado a cabo por el equipo de investigación. Su utilidad fundamental es generar evidencias científicas necesarias e imprescindibles para la toma de decisiones, adecuadas y pertinentes, en relación con la prevención, atención y rehabilitación de las personas que padecen enfermedades relacionadas con el trabajo, enfermedades profesionales o accidentes laborales. También, constituye una herramienta imprescindible en el Desarrollo Profesional Continuo, siendo el elemento determinante del autoaprendizaje a través de la lectura crítica de los artículos científicos (AU)

The aim of this article is to present the main designs used in applied and clinical research or occupational health. We analyze the basic structure and the process conducted in a research project. The article describes the research methods, usefulness, interpretation and practical application in relation with obtaining reliable and valid information for a critical reading of scientific communication, scientific articles generally. The quality, validity and reliability of the information generated by a research depend on the design and methodology and the process carried out by the research team. The fundamental usefulness of this article is to generate scientific evidence, necessary and essential to make appropriate decisions in relation with the prevention, care and rehabilitation of people with work related diseases, occupational diseases or accidents. Also, it is essential in Continuing Professional Development, remain the key element of self-learning through critical reading of scientific articles (AU)