[What do medical students think about functional neurological disorders?] / ¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales?

INTRODUCTION: Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree. PATIENTS AND METHODS: We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities. RESULTS: A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term 'psychosomatic' was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training. CONCLUSIONS: Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.

TITLE: ¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales?Introducción. Los trastornos neurológicos funcionales (TNF) son un motivo de consulta frecuente en neurología. Sin embargo, la formación específica sobre estos trastornos durante la formación universitaria y el período de residencia es limitada. En este estudio se evalúan los conocimientos, la actitud y la exposición de los estudiantes de Medicina a los TNF antes de terminar el grado de Medicina. Sujetos y métodos. Realizamos una encuesta de 15 ítems para explorar la comprensión, la exposición y las actitudes hacia los TNF entre los estudiantes de Medicina de sexto año en cuatro universidades españolas. Resultados. Devolvieron la encuesta 118 estudiantes (edad media 23,6 ± 1,2 años; 71,2%, mujeres). De ellos, 88 (74,6%) conocían el concepto de TNF y 78 (66,1%) los habían estudiado en las clases de psiquiatría. El 54,1% de los estudiantes eligió el término 'psicosomático' como el más adecuado para referirse a estos trastornos, y 111 (94,1%) creían que una historia de abuso sexual o físico era común entre los pacientes con TNF. Cincuenta y siete estudiantes (48,3%) asumieron que el diagnóstico de TNF era mayoritariamente un diagnóstico clínico de exclusión y 63 (53,4%) señalaron que el manejo se realiza únicamente desde psiquiatría. Ciento un estudiantes (85,6%) consideraron que una formación adecuada sobre los TNF es un aspecto importante de su formación médica. Conclusiones. Los estudiantes de Medicina son conscientes de la existencia de los TNF, pero la terminología preferida por ellos, así como los factores etiológicos percibidos, reflejan que la visión histórica acerca de estos trastornos está aún arraigada. Los estudiantes de Medicina consideran que deberían recibir una educación adecuada sobre los TNF como parte de su formación por parte de los especialistas en neurología y psiquiatría.

¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales? / What do medical students think about functional neurological disorders?

Introducción: Los trastornos neurológicos funcionales (TNF) son un motivo de consulta frecuente en neurología. Sin embargo, la formación específica sobre estos trastornos durante la formación universitaria y el período de residencia es limitada. En este estudio se evalúan los conocimientos, la actitud y la exposición de los estudiantes de Medicina a los TNF antes de terminar el grado de Medicina. Sujetos y métodos: Realizamos una encuesta de 15 ítems para explorar la comprensión, la exposición y las actitudes hacia los TNF entre los estudiantes de Medicina de sexto año en cuatro universidades españolas. Resultados: Devolvieron la encuesta 118 estudiantes (edad media 23,6 ± 1,2 años; 71,2%, mujeres). De ellos, 88 (74,6%) conocían el concepto de TNF y 78 (66,1%) los habían estudiado en las clases de psiquiatría. El 54,1% de los estudiantes eligió el término ‘psicosomático’ como el más adecuado para referirse a estos trastornos, y 111 (94,1%) creían que una historia de abuso sexual o físico era común entre los pacientes con TNF. Cincuenta y siete estudiantes (48,3%) asumieron que el diagnóstico de TNF era mayoritariamente un diagnóstico clínico de exclusión y 63 (53,4%) señalaron que el manejo se realiza únicamente desde psiquiatría. Ciento un estudiantes (85,6%) consideraron que una formación adecuada sobre los TNF es un aspecto importante de su formación médica. Conclusiones: Los estudiantes de Medicina son conscientes de la existencia de los TNF, pero la terminología preferida por ellos, así como los factores etiológicos percibidos, reflejan que la visión histórica acerca de estos trastornos está aún arraigada. Los estudiantes de Medicina consideran que deberían recibir una educación adecuada sobre los TNF como parte de su formación por parte de los especialistas en neurología y psiquiatría.(AU)

Introduction: Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree. Patients and methods: We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities. Results: A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term ‘psychosomatic’ was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training. Conclusions: Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.(AU)

Prevalence of ectoparasitic arthropods on wild animals and cattle in the Las Merindades area (Burgos, Spain).

This paper reports the prevalence of ectoparasitic arthropods in sampled groups of wild (n = 128; 16 species) and domestic (n = 69; 3 species) animals in the Las Merindades area of the Province of Burgos, Spain. The study revealed that wild animals were more infested and with a wider variety of ectoparasites than domestic animals. The parasitic prevalence was 67% for wild animals and 48% for livestock. In this way, 39% of animals were infected by ticks. Ixodes ricinus and Ixodes hexagonus were the most prevalent species whereas Dermacentor reticulatus showed affinity for the fox and wolf. The overall prevalence of parasitisation by fleas was 27%. Ctenophthalmus spp. showed the wider range host in wild animals, while Pulex irritans was the most frequent specie found. The parasitic prevalences by lice (Trichodectes melis, Trichodectes canis and Trichodectes mustelae) and by mite (Neotrombicula spp., Laelaps agilis and Sarcoptes scabiei) were 4% and 12%, respectively. In both cases only wild animals were found parasited.

The seroprevalence of human infection with Rickettsia slovaca, in an area of northern Spain.

An epidemiological survey was undertaken to explore human exposure to Rickettsia slovaca in two provinces of northern Spain. When IFAT were used to test 200 members of the general population for antibodies to rickettsiae of the spotted-fever group, six (3.3%) were found positive, presumably, since Dermacentor is one of the most common genera of human-biting tick in the study area, for antibodies to R. slovaca. Thirty-one (16.9%) of an additional 183 subjects who presented shortly after being bitten by ticks were also found seropositive. The difference in seroprevalence between the general and the tick-bitten populations was significant. Subject gender had no influence on seroprevalence in either population, although, in the tick-bitten group, age and occupation did have a significant influence on the prevalence recorded. Immunoblotting was used to confirm the presence of antibodies in the five subjects, all from the tick-bitten group, found to have acute infections. Three D. marginatus ticks obtained from three of these acute cases were found PCR-positive for R. slovaca DNA.

Epidemiological study of Rickettsia typhi infection in two provinces of the north of Spain: analysis of sera from the general population and sheep.

Data relating to Rickettsia typhi infection in Spain are scarce. A serological survey of 383 serum samples (184 males, 199 females) from the general population and 120 sera from sheep were studied by immunofluorescence assay (IFA). The human serum samples were collected from the general population of Palencia and Burgos provinces, and sheep serum samples were collected from Palencia province. Of the 383 human serum samples studied, 29 were positive for antibodies against R. typhi (7.5%) No statistical differences were found according to age, sex, origin (rural vs. urban) or geographic distribution, but a significant difference was observed related to occupation. In addition, 69 serums were found positives for R. typhi in sheep samples (57.5%). Our results indicated the circulation of R. typhi infectious for humans and sheep in Palencia and Burgos provinces. This study indicates that sheep may be infected with R. typhi, and that animals can, therefore be used as indicators of the presence of this organism.

Rickettsia typhi infection in wild rodents from central Spain.

When sera from 218 rodents captured in two provinces of central Spain were tested, by indirect immunofluorescence, for antibodies to Rickettsia typhi, 46 (21.1%) were found to be positive, at titres between 1:20 and 1:320. The seropositives included rodents of each of the five species collected: Mus musculus, Mus spretus, Apodemus sylvaticus, Rattus rattus and Rattus norvegicus. Rickettsia typhi infection appears to be common and widespread among the rodents of central Spain.

A sero-epidemiological study of Rickettsia typhi infection in dogs from Soria province, central Spain.

Data relating to Rickettsia typhi infection in Spain are scarce. The seroprevalence of canine infection with this species has now been investigated, in dogs from the central province of Soria. The results of indirect immunofluorescence assays indicated that nine (12.3%) of the 73 dogs checked were carrying antibodies against R. typhi. The gender, age and breed of the dog, and whether it was used for hunting, shepherding, guarding or simply as a pet, apparently had no significant affect on the probability of it being seropositive. Being infested with fleas or having a history of such infestation was, however, significantly associated with seropositivity. The present results confirm that dogs may be infected with R. typhi and indicate their potential usefulness as sentinels in epidemiological studies of the pathogen. The results of wide-scale, serological studies of dogs may allow the geographical distribution of R. typhi to be mapped relatively simply.

Serological study of hantavirus in man in the Autonomous Community of Madrid, Spain.

Data relating to hantavirus infection in Spain are scarce and limited to rural areas. The aim of this work was to study the seroprevalence of hantavirus infection in the Autonomous Community of Madrid (ACM), a region containing both rural and urban populations in different ecological settings. Sera from 3852 individuals (1849 male, 2003 female) were screened by indirect inmunofluorescence, with Vero E6 cells infected with Puumala, Hantaan and Seoul viruses as antigens. Screen-positive results were confirmed by Western blot with recombinant Seoul virus nucleocapsid protein as antigen. Antibodies against hantavirus were detected in 12 sera (0.31%). No statistical differences were found according to sex and age. The highest prevalence was found in the southeastern area, significantly higher than the central and north-western areas. The most frequent serological pattern was reactivity against all three viruses used (33.3% of all positive sera). Therefore, this study confirms the presence of hantavirus infection in the ACM, including for the first time an urban area of Spain, but with the highest prevalence in a rural area. Serological evidence suggests that there is more than one circulating serotype.

¿Un nuevo caso de enfermedad por hantavirus en España? / No disponible

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Prevalence of antibodies to Rickettsia typhi in an area of the center of Spain.

It was the aim of the present work to evaluate Rickettsia typhi antibody prevalence in 'Comunidad Autónoma de Madrid' (CAM), an area in the centre of Spain. A total of 640 serum samples from the general population were tested by an indirect immunofluorescence assay. Specific R. typhi antibodies were found in 44 (6.8%) of the samples. The present survey results demonstrate the occurrence of R. typhi human infections in this area.

Appropriateness of admissions and hospitalization days in an acute-care teaching hospital.

A cross-sectional study was made of the appropriateness of admissions and hospitalization days in an high-technology, acute-care teaching hospital. This 952-bed institution with 31 hospital services is a reference center for the metropolitan area of Barcelona. A systematic random sampling (1:11) of the registers of hospital discharges was carried out during the months of January, February and March 1991 (n = 7,142) excluding discharges from the pediatric, obstetrics and psychiatric departments. A retrospective analysis was made of 639 patients' medical records using the Appropriateness Evaluation Protocol (AEP). The rate of inappropriate hospital admissions was 9.1% (58/639) (95% confidence interval: 6.9-11.5). Inappropriate admissions were primarily attributable to hospitalizations for diagnostic and/or therapeutic services that could have been rendered on an ambulatory basis (70.7% of cases). Overall 29.2% of hospitalization days (1,963/6,731) were inappropriate (95% confidence interval: 28.1-30.3). Inappropriate admissions to hospital, an optimizable health care planning and a conservative physician's attitude (postponed discharge) were the most frequent reasons for unnecessary days of care. The interrater reliability in the use AEP criteria for appropriateness of admission showed a kappa index of 0.5 and that for appropriateness of hospitalization days 0.67. In summary, instruments, such as the AEP protocol, that allow us to determine which patients can be attended at other levels of the health care system and which levels are the most appropriate, are key elements in improving the appropriateness of hospital use in public health care systems.