María Fernández-Prada

Acute and chronic stress increase salivary cortisol: a study in the real-life setting of a national examination undertaken by medical graduates

Abstract Spanish medical graduates who apply for a medical specialty training position (MIR) must take an examination that will shape their future personal and professional lives. Preparation for the test represents an important stressor that persists for several months. The aim of this study was to elucidate the stress pattern of this group and evaluate possible changes in the circadian rhythm of cortisol release in medical graduates preparing for this test. A repeated-measures longitudinal study was performed, measuring the salivary cortisol concentrations in 36 medical graduates (13 males and 23 females; mean age of 24.2 years) on five sampling days. Five cortisol samples were collected from 07:00 to 21:00 h in order to monitor changes in the circadian rhythm. On all sampling days (except on the day of the official examination), anxiety and psychological stress were evaluated with the Spanish versions of the State-Trait Anxiety Inventory (STAI) and the Perceived Stress Scale (PSS). During the study period, participants showed higher levels of anxiety than the Spanish reference population as well as a progressive increase in self-perceived stress. A significant increase in salivary cortisol concentration was observed in both chronic (study and examination preparation) and acute (examinations) situations. Our results suggest that the cortisol awakening response (CAR) may be a good indicator of anticipatory stress but is unaffected by long-term examination preparation. Comparison of results between the official examination day and the mock examination days yielded evidence that learning may modulate the behavior of the hypothalamic–pituitary–adrenal axis.

Calidad de vida relacionada con la salud en una muestra de médicos internos residentes que realizan guardias en un Servicio de Urgencias: una perspectiva de género

BACKGROUND The high emotional burden of physicians working in emergency departments may affect their quality of life perception. AIM To evaluate health related quality of life among resident physicians performing shifts at an emergency department. MATERIAL AND METHODS Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. RESULTS Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. CONCLUSIONS Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.Background: The high emotional burden of physicians working in emergency departments may affect their quality of life perception Aim: To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Material and methods: Seventy one physicians aged 26 ± 2 years (47 women), working as residents in an emergency department, answered the short version of the SF-36 survey. This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Results: Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Conclusions: Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

Cuestionario para evaluar en médicos conductas, conocimientos y actitudes sobre la higiene de manos

OBJECTIVE Valid and reliable instruments to measure aspects of hand hygiene are needed to determine the current situation and impact of training among health professionals. The main objective of this study was to describe the development of a questionnaire on hand hygiene among health professionals and to analyze the properties of this instrument. METHOD A questionnaire was designed and implemented between January 2010 and March 2011 at the Hospital Clínico San Cecilio (Granada, Spain). The final questionnaire consisted of 44 items that assessed provider behavior before and after contact with the patient, declarative knowledge, and attitudes to hand hygiene. The questionnaire was administered to 113 health professionals. RESULTS A factor analysis was performed. Data were obtained that supported the unidimensionality of the instrument with a general convergence value that explained 39.289% of the total variance and a Cronbachs alpha of 0.784 for the established elements. Significant differences were found in hand hygiene behavior before and after contact with the patient (t=-8,991, p <0.001). Declarative knowledge and attitudes significantly predicted behavior. CONCLUSIONS The questionnaire shows high internal consistency, reliability, and validity and is thus a valid tool to assess behavior, knowledge and attitudes related to hand hygiene in health professionals. This instrument also detects deficiencies in basic knowledge.

Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty

The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day) and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training) of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC) (p < 0.006). This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001). According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.

Prevención de la infección de sitio quirúrgico: análisis y revisión narrativa de las guías de práctica clínica

Surgical site infection is one of the most prevalent healthcare-associated infections and presents a considerable morbidity. The aim of this comprehensive narrative review is to describe the evidence and grade of recommendation of the preventive measures developed in the three phases of the surgical process (preoperative, perioperative and postoperative phases), as well as coincidences and divergences between selected Clinical Practice Guidelines (CPG). Four preventive measures were recommended with similar high grade evidence in all CPG: Hair removal, antibiotic prophylaxis, surgical site preparation and normothermia. However, critical points, new preventive measures and bundle implementations by surgical process are under discussion. These results represent a significant progress toward improving programs to prevent surgical site infection and they should be taken into account for improved future interventions in this area.

Los smartphones en la investigación: la mensajería instantánea como aliado para reducir las bajas experimentales

El permanente avance de la telefonía móvil en la vida diaria puede traducirse en beneficios para los investigadores, especialmente en el campo de la salud1,2. En 2010 ya existían más de 250 millones de smartphones en el mercado global de telefonía móvil y en 2025 se espera que 5.000 millones de personas tengan uno3. Con este exponencial crecimiento, la mayoría de sujetos que participan en investigaciones tienen un teléfono inteligente4 y utilizan de forma habitual programas de mensajería instantánea (Whatsapp®, Blackberry-Messenger®, etc.). La investigación utilizando estos dispositivos es cada vez más frecuente5 y, desde un punto de vista investigador, estas tecnologías pueden ser excelentes aliados5 al mejorar la comunicación generada por los medios tradicionales1. Hay varios motivos para ello: la reducción de gastos derivados de las llamadas telefónicas, del SMS, así como del tiempo dedicado a la puesta en contacto con los sujetos; puede ser una herramienta de anonimato perfecta, asociando un código a un número de teléfono; se tiene constancia del momento en que el sujeto ha leído la información suministrada por el investigador y además permite una mayor cercanía entre el participante y el investigador. Esta aplicación puede utilizarse como complemento a otras estrategias, pero resulta especialmente útil para estudios longitudinales y multicéntricos donde se necesite recordar cualquier información. Como es sabido, en muchas investigaciones una parte de la muestra que se pierde está asociada a la falta de comunicación o a simples olvidos. En nuestra experiencia, empleamos esta tecnología con el objetivo de reducir posibles pérdidas experimentales y mejorar la comunicación investigador-participante. Para ello, se realizó un análisis de la metodología de investigación llevada a cabo en un estudio en el Servicio de Urgencias Externas del Hospital Universitario San Cecilio (Granada, España) en 2012 con 32 médicos residentes (datos no publicados) donde se solicitaba la toma de 6 muestras de saliva a lo largo de 2 días distintos. Para cada una de las 12 recogidas de datos, se les envió un recordatorio mediante un Whatsapp®, llegando a un total de 384 envíos. Esta C (

Cuestionario para evaluar en médicos conductas. conocimientos y actitudes sobre la higiene de manos

OBJECTIVE Valid and reliable instruments to measure aspects of hand hygiene are needed to determine the current situation and impact of training among health professionals. The main objective of this study was to describe the development of a questionnaire on hand hygiene among health professionals and to analyze the properties of this instrument. METHOD A questionnaire was designed and implemented between January 2010 and March 2011 at the Hospital Clínico San Cecilio (Granada, Spain). The final questionnaire consisted of 44 items that assessed provider behavior before and after contact with the patient, declarative knowledge, and attitudes to hand hygiene. The questionnaire was administered to 113 health professionals. RESULTS A factor analysis was performed. Data were obtained that supported the unidimensionality of the instrument with a general convergence value that explained 39.289% of the total variance and a Cronbachs alpha of 0.784 for the established elements. Significant differences were found in hand hygiene behavior before and after contact with the patient (t=-8,991, p <0.001). Declarative knowledge and attitudes significantly predicted behavior. CONCLUSIONS The questionnaire shows high internal consistency, reliability, and validity and is thus a valid tool to assess behavior, knowledge and attitudes related to hand hygiene in health professionals. This instrument also detects deficiencies in basic knowledge.

Evaluación de un taller práctico sobre higiene de manos impartido por estudiantes entrenados

Introduccion. La ensenanza y el aprendizaje de la higiene de manos en el contexto sanitario es una tarea compleja. La intervencion del estudiante como lider de su propia formacion esta muy poco analizada en la bibliografia. El objetivo principal del trabajo es la evaluacion de un taller sobre higiene de manos gestionado, dirigido e impartido, bajo tutela experta, por estudiantes al propio colectivo estudiantil.