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La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.

Variations in clinical practice in clinical psychology may involve, among other aspects, the type of treatment, the waiting time to receive it, and its duration. There have been few studies that have examined the variability in mental health care in Spain. The objective of this study has been to describe the variability in the assistance responses of Clinical Psychologist in Mental Health Center and hospital outpatient consultations in the Community of Madrid, through a survey reported by clinical psychologists, and to analyze factors that may be related to this variability. 120 responses were obtained, 36% of SERMAS clinical psychologists. The risk of poor mental health in the health area was related to a longer waiting list for clinical psychology and with the completion of therapy groups. The mean income of the health area and the professional's years of experience were also associated with a greater probability of carrying out groups of psychotherapy. The private management of the public devices was associated with a shorter time for first consultation and subsequent appointments and a longer time delay between appointments. The factors related to the organizational offer are the ones that most influence the healthcare variables examined. The implications of these results are discussed. La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.

La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.

Desde 2018 los Centros de Atención Primaria (AP) del Servicio Madrileño de Salud (SERMAS) ofrecen atención psicológica especializada. Se analizan indicadores asistenciales informados por 17 de los 21 facultativos/as de psicología clínica que trabajan en AP y sus propuestas para ampliar la cartera de servicios, a través de una encuesta online en 2022. El tiempo medio de espera para primera consulta fue de 30 días. El número medio de pacientes nuevos semanales fue de 20, 7 pacientes diarios en individual y 5 grupos de terapia a la semana. La carga media por profesional se encontraba en 318 pacientes. El 35% cambiarían de trabajo. Quedan múltiples retos en el desarrollo de la atención psicológica especializada en este nivel como aumentar la ratio de psicólogos/as clínicos/as, diversificar la cartera de servicios, coordinación y trabajo en equipo, turnos de trabajo y reducir la sobrecarga asistencial.

Pain is one of the most persistent symptoms after cancer treatment. The central nervous system can erroneously stay in its alarm phase, altering the pain experience of patients who have cancer. Pain neuroscience education (PNE) with multimodal approaches may benefit these patients. This protocol aims to determine the effectiveness of a PNE tool on pain, physical function and quality of life, as a supplement to a multimodal rehabilitation (MR) program in patients who had breast cancer (BC). An 8-week double-blinded randomized controlled trial will be conducted, including 72 participants who had BC and who have persistent pain, randomized into three groups: PNE program + MR program, traditional biomedical information + MR program and control group. The PNE program will include educational content that participants will learn through a mobile app and the MR program will include a concurrent exercise program and manual therapy. The primary outcome will be the perceived pain assessed using the Visual Analogue Scale and secondary outcomes are others related to pain, physical function and quality of life. All outcomes will be evaluated at baseline, at the end of the intervention and 6 months after the end of intervention. The proposed study may help BC patients with persistent pain improve their pain experience, quality of life and provide for more adaptive pain-coping strategies. This protocol could propose an action guide to implement different integral approaches for the treatment of sequelae. This treatment option could be offered to this patient profile and it could be easily implemented in the healthcare systems due to its low costs.

Introduction: This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical–practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations. Materials and Methods: This was a quasi-experimental pre–post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Marañón Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020–2021 and 2021–2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives. Results: Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020–2021 academic year and 80.6% of students in the 2021–2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical–practical knowledge (improvement mean = 1.38 and 1.21 in 2020–2021 and 2021–2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points. Conclusions: Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.

Background: This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology. Methods: Two independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used. Results: In total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction. Conclusions: The QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.

Background: Rheumatoid arthritis (RA) is the most common inflammatory rheumatic disease. RA symptoms make the disease disabling and strongly impact the quality of life of patients. Among the available forms of treatment, balneotherapy seems to be one of the most common forms of nonpharmacological treatment for rheumatic disease. The aim was to explore the effectiveness of balneotherapy for improving the quality of life of patients with RA. Methods: Pubmed, Scopus, Web of Science and The Cochrane library were searched for randomized or clinical controlled trials published in English or Spanish until May 2021. Risk of bias of included articles were assessed using the Cochrane tool. A total 535 records were retrieved, and seven met the inclusion criteria. All the included studies showed statistically significant improvements in the quality of life of patients who received balneotherapy treatment despite differences in treatment administration. Sessions should be approximately 20 min long and use natural mineral waters enriched with elements, or mud, at a water temperature between 35–38 °C. Conclusions: Balneotherapy benefits the quality of life of people with RA. The obtained results show positive effects for both mineral bathing and immersion in sand or mud on the quality of life of people who suffer from RA.

Objetivo: Determinar los estilos de vida en trabajadores del sector informal. Materiales y Métodos: Estudio transversal realizado en 2101 trabajadores informales de diferentes ciudades y municipios de la región caribe colombiana. Se evaluaron las características sociodemográficas y laborales de los sujetos de estudio. Se aplicó el cuestionario FANTASTICO para medir los estilos de vida relacionados con la salud. Resultados: Los resultados del estudio muestran que la mayoría de la población corresponde al género masculino. La media de la edad de los sujetos fue 41,4±12,8 años, con un rango entre 18 y 90 años. Al analizar el estilo de vida relacionado con la salud, se observó que los trabajadores informales tienen niveles bajos de actividad física, patrones de alimentación inadecuados y bajo control de la salud en general. Conclusiones: De los resultados se recomienda fomentar la formación de los trabajadores informales que le permitan ampliar sus posibilidades de oferta laborales, así de esta manera, mejorar sus ingresos económicos y nivel educativo que es claramente un limitante para su estilo de vida relacionado con la salud.

We report on the large-scale synthesis of highly oriented ultrathin MoO3 layers using a simple and low-cost atmospheric pressure by van der Waals epitaxy growth on muscovite mica substrates. By this method we are able to synthetize high quality centimeter-scale MoO3 crystals with thicknesses ranging from 1.4 nm (two layers) up to a few nanometers. The crystals can be easily transferred to an arbitrary substrate (such as SiO2) by a deterministic transfer method and extensively characterized to demonstrate the high quality of the resulting crystal. We also study the electronic band structure of the material by density functional theory calculations. Interestingly, the calculations demonstrate that bulk MoO3 has a rather weak electronic interlayer interaction and thus it presents a monolayer-like band structure. Finally, we demonstrate the potential of this synthesis method for optoelectronic applications by fabricating large-area field-effect devices (10 micrometers by 110 micrometers in lateral dimensions), finding responsivities of 30 mA/W for a laser power density of 13 mW/cm2 in the UV region of the spectrum and also as an electron acceptor in a MoS2-based field-effect transistor.