Abstract Starting from the observation that Pierre Klossowski not only theoretically privileged the role of the image, but constantly drew in and among his philosophical-literary writings, our proposal will be developed from a graphic choice that enables the analysis of certain sketches on Nietzsche. We will proceed as if his reflections on Nietzsche were drawings that figuratively emerge from his own hands and texts, in the manner of effective and primordial discursive illustrations. Our analysis procedure will follow the following structure: After a brief introductory note on the manner, we will operationalize his writings - Approximation Note - we will consider several Klossowskian graphs related to his explicit readings on Nietzsche and collected in the form of Three images redrawn from Nietzsche, chosen as figures of the current analysis: 1. The gods; 2. The circle; and 3. The triangles. In this way, we intend to open another path that allows us to take a detour or a singular path that considers Er, a figure in detours, privileging, in this manner, a figurative detail that, in our view, enables the reinforcement of the presential image of this mythological character, Er, in Plato's, Nietzsche's, and Klossowski's perspectives. In this form, we will analyze: 1. Er in Plato's Republic X; 2. Er in Nietzsche's textual traces; and 3. Er in traces drawn by Klossowski. We will end our journey with A brief sketch of distancing.

Resumo Partindo da constatação que Pierre Klossowski não somente privilegiou teoricamente o papel da imagem, mas desenhou constantemente em e entre seus escritos filosóficos-literários, nossa proposta será desenvolvida a partir de uma escolha gráfica que possibilite a análise de determinados esboços sobre Nietzsche. Procederemos como se suas reflexões sobre Nietzsche fossem desenhos que emergissem figurativamente de suas próprias mãos e textos, ao modo de efetivas e primordiais ilustrações discursivas. Nosso procedimento de análise seguirá a seguinte estrutura: após uma breve nota introdutória sobre a maneira como operacionalizaremos seus escritos, Nota de Aproximação, consideraremos diversas grafias klossowskianas relacionadas com suas leituras explícitas sobre Nietzsche e recolhidas na forma de Três imagens redesenhadas a partir de Nietzsche, escolhendo como figuras desta análise: 1. Os deuses; 2. O círculo; e 3. Os triângulos. Dessa forma, pretendemos abrir um outro caminho que possibilite realizar um desvio ou percurso singular que considere Er, uma figura em desvios, privilegiando, desse modo, um detalhe figurativo que, ao nosso ver, possibilita o reforço da imagem presencial desse personagem mitológico, Er, nas perspectivas de Platão, Nietzsche e Klossowski. Sendo assim, analisaremos: 1. Er na República X de Platão; 2. Er em vestígios textuais de Nietzsche; e 3. Er em traços desenhados por Klossowski. Finalizaremos este nosso percurso com Um breve esboço de distanciamento.

Resumen Objetivo: establecer una metodología predictiva de aplicación clínica de recuentos de CD4+ en rangos de interés clínico a partir del recuento absoluto de leucocitos. Metodología: a partir de los valores secuenciales de leucocitos y linfocitos CD4+ de 9 pacientes, se observaron patrones matemáticos que posteriormente fueron aplicados en un estudio ciego con 71 casos para confirmar su capacidad predictiva, midiendo porcentajes de especificidad y sensibilidad. Resultados: se determinaron cinco patrones matemáticos que predicen en el 99% de los casos los distintos recuentos de CD4+ a partir de recuentos de leucocitos con valores de especificidad y sensibilidad del 99%. Conclusiones: los patrones matemáticos encontrados entre recuento de leucocitos y CD4+ sugieren que este fenómeno prácticamente es determinista.

Abstract Objective: To establish a predictive methodology of CD4+ counts for clinical application in ranges of clinical interest based on the absolute leukocyte count. Methodology: From sequential values of leukocytes and CD4+ lymphocytes of nine patients, mathematical patterns were observed and applied in a blind study with 71 cases to confirm their predictive capacity, measuring percentages of specificity and sensitivity. Results: Five mathematical patterns were determined that predict 99% of the cases in which CD4+ counts are obtained from leukocyte counts with specificity and sensitivity values of 99%. Conclusions: The mathematical patterns found between leukocytes and CD4 counts suggest that this phenomenon is practically deterministic.

Abstract Introduction: The increase in the number of organ transplants and the poor adherence to the treatments after transplant provokes an alert attitude among the nursing professionals and a public health problem. Aim: To know the factors associated with resilience, which influence adherence to treatment, in this case in kidney graft transplantation. Material and Method: A cross-sectional and retrospective descriptive study was carried out in adult population transplanted with functioning graft, from January 2012 to June 2016 with ages between 18 and 70 years, of both sexes, self-sufficient in the treatment management; and transplanted in the Marqués de Valdecilla Hospital. Belonging, as partners, to the Alcer Cantabria Association. Results: The results obtained, although not being significant due to the sample size, demonstrate a positive influence (3% of the variability) of the resilience in the adherence to the treatment. It is shown that there are significant differences in some of the sociodemographic variables such as professional activity, educational level and age. Likewise, there are differences according to the level of tolerance to negative effects and stress. Conclusions: The data reveal a greater risk of non-adherence in the younger age group, so it is necessary to raise awareness of the importance of adherence to treatment. The inverse relationship between low adherence in patients and greater situational control is surprising.

Resumen Introducción: El aumento en el número de trasplantes de órganos y la escasa adherencia a los tratamientos una vez realizado el trasplante suscita una actitud de alerta entre los profesionales de enfermería y un problema de salud pública. Objetivo: Conocer los factores asociados a la resiliencia que influyen sobre la adherencia al tratamiento, en este caso en el trasplante con injerto renal. Material y Método: Estudio descriptivo trasversal y retrospectivo en población adulta trasplantada con injerto funcionante desde enero de 2012 hasta junio de 2016 con edades comprendidas entre 18 y 70 años, de ambos sexos, autosuficientes en el manejo de tratamiento; y trasplantados en el Hospital Marqués de Valdecilla. Pertenecientes, como socios, a la Asociación Alcer Cantabria. Resultados: Los resultados obtenidos, aun no siendo significativos por el tamaño muestral, demuestran una influencia positiva (3% de la variabilidad) de la resiliencia en la adherencia al tratamiento. Se demuestran que existen diferencias significativas en alguna de las variables sociodemográficas como la actividad profesional, nivel de estudios y edad. Así mismo, se encuentran diferencias según el nivel de tolerancia a los efectos negativos y estrés. Conclusiones: Los datos revelan mayor riesgo de no adherencia en el grupo de menor edad, por lo que resulta necesario sensibilizar de la importancia de la adherencia al tratamiento. Sorprende la relación inversa entre baja adherencia en pacientes y mayor control situacional.

Resumen Introducción: la dimensión fractal estadística ha sido de utilidad para la caracterización de diversos fenómenos, incluyendo la dinámica cardiaca fetal y del adulto, así como comportamientos asociados al sistema inmune. Las Infecciones Asociadas al Cuidado de la Salud son un problema de salud de alta importancia a nivel mundial. Objetivo: establecer el comportamiento fractal estadístico de la frecuencia de aparición de Infecciones Asociadas al Cuidado de la Salud. Material y métodos: Se aplicó la ley de Zipf-Mandelbrot a la distribución de frecuencias de aparición agrupadas por especialidad de Infecciones Asociadas al Cuidado de la Salud en el Hospital Meissen ESE II Nivel, para los años 2011, 2012 y 2013. Se calculó la dimensión fractal estadística para cada año, hallando los rangos en los que se desenvuelve la dinámica en estos años y posteriormente se realizaron simulaciones de estas dinámicas anuales. Resultados: Se observó un comportamiento a escala de la dinámica de aparición de Infecciones Asociadas al Cuidado de la Salud por especialidad, los valores de la dimensión fractal fue de 0,6104, 0,7560 y 0,4332 para los años 2011, 2012 y 2013 respectivamente. Conclusión: La ley de Zipf/Mandelbrot permite caracterizar de forma objetiva y reproducible el comportamiento de la frecuencia de aparición de las Infecciones Asociadas al Cuidado de la Salud en el tiempo; las dimensiones fractales acotadas consecutivas en el tiempo permitirían generar predicciones, constituyendo una herramienta de ayuda para la vigilancia epidemiológica y la clínica.

Abstract Introduction: The statistical fractal dimension has been useful for the characterization of diverse phenomena, including the fetal and adult cardiac dynamics, as well as the behaviors associated with the immune system. Health Care Associated Infections are a major health problem worldwide. Objective: to establish the statistical fractal behavior of the frequency of occurrence of Health Care Associated Infections. Material and methods: The Zipf-Mandelbrot law was applied to the frequency distribution of occurrences grouped by Health Care Associated Infections in II level at Meissen ESE Hospital for the years 2011, 2012 and 2013. The statistical fractal dimension was calculated for each year, finding the ranges in which the dynamics develops in these years and later simulations of these annual dynamics were carried out. Results: Scale behavior of the dynamics of occurrence of Health Care Associated Infections by specialty was observed; the values of fractal dimension were 0.6104, 0.7560 and 0.4332 for the years 2011, 2012 and 2013 respectively. Conclusion: The law of Zipf / Mandelbrot allows to characterize objectively and reproducibly the behavior of the frequency of occurrence of Health Care Associated Infections over time; the consecutive bounded fractal dimensions over time would allow predictions to be generated, constituting an aid tool for epidemiological and clinical surveillance.

RESUMO A baixa prevalência de demência relatada em comunidades deve ser devida ao emprego de testes de rastreio de baixa sensibilidade e à falta da avaliação por especialistas. OBJETIVO: Estimar a prevalência de comprometimento cognitivo leve (CCL) e demência em adultos com idade superior a 50 anos. MÉTODOS: Um estudo transversal de duas fases realizado por especialistas, avaliando a cognição e os fatores de risco demográficos associados, com 1.235 adultos autônomos da comunidade em Bogotá. Em uma Fase I, foram realizados os testes de rastreio MEEM e MoCA. Na Fase II, após uma ampla bateria neuropsicológica com avaliações neurológicas e psiquiátricas, foi estabelecido um diagnóstico cognitivo por consenso. RESULTADOS: A prevalência encontrada de CCL foi de 34% e de demência, de 23%. CCL foi associado a ensino médio incompleto, OR=1,74 (IC 95%=1,23-2,45) e idade entre 70-79 anos, OR=1,93 (IC 95%=1,47-2,53). Entre os casos de CCL, 73% eram amnésticos. A demência foi associada a ensino fundamental incompleto, OR=8,98 (IC 95%=5,56-14,54), ensino fundamental completo, OR=6,23 (IC 95%=3,70-10,47) e idade superior a oitenta anos, OR=3,49 (IC 95%=2,23-5,44). CONCLUSÃO: A prevalência de demência encontrada é maior do que a relatada em estudos prévios. O baixo nível educacional foi o principal fator de risco para declínio cognitivo e deve ser considerado no planejamento estratégico do nosso sistema de saúde.

ABSTRACT The low prevalence of dementia described in communities is likely due to the low sensitivity of screening tests and an absence of evaluation by specialists. OBJECTIVE: To estimate the prevalence of mild cognitive impairment (MCI) and dementia in adults older than 50 years. METHODS: A two-phase, cross-sectional study was conducted by specialists to evaluate cognition and associated demographic risk factors in 1,235 independent community-dwelling adults from Bogotá. In Phase I, screening was performed using the MMSE and MoCA tests. In Phase II, after application of a comprehensive neuropsychological battery with neurologic and psychiatric evaluations, a cognitive diagnosis was established by consensus. RESULTS: The prevalence found for MCI was 34% and for dementia was 23%. MCI was associated with incomplete high school, OR=1.74 (95%CI=1.23-2.45), and with an age of 70-79 years, OR=1.93 (95%CI=1.47-2.53). A total of 73% of MCI cases were amnestic. Dementia was associated with incomplete primary education, OR=8.98 (95%CI=5.56-14.54), complete primary education, OR=6.23 (95%CI=3.70-10.47), and age older than eighty years, OR=3.49 (95%CI=2.23-5.44). CONCLUSION: The prevalence of dementia found was greater than the rates reported in previous studies. Low educational level was the main risk factor for cognitive impairment and should be considered in strategic planning for the local health system.

Introducción: la relación entre los factores de riesgo cardiovascular (FRCV) y los factores metabólicos con deterioro cognitivo (DC), definido como deterioro cognitivo leve (DCL) o demencia, es controversial. Objetivo: describir los FRCV y metabólicos relacionados con DC, en una muestra de adultos de Bogotá. Material y métodos: se diseñó un estudio de corte transversal y se evaluó el estado cognitivo en dos fases, en adultos mayores de 50 años, autónomos, no institucionalizados, aplicando pruebas neuropsicológicas y un protocolo de evaluación neuropsiquiátrica. Los FRCV y metabólicos fueron documentados por autoreporte, y se tomaron medidas antropométricas. Resultados: en 1.045 adultos estudiados, el promedio de edad fue de 68 años (DS 8.6), y de educación 8 años (DS 6.0), 76 % fueron mujeres, 56 % presentaba hipertensión arterial (HTA), 40 % dislipidemia, 37 % fueron fumadores, 37 % tenían sobrepeso, 28 % hipotiroidismo, 25 % obesidad, 17 % consumían alcohol y 16 % eran diabéticos. El DCL se asoció con escolaridad de primaria-incompleta OR:1.94 (95 % IC: 1.21- 3.14), primaria-completa OR:1.96 (95 % IC: 1.18- 3.25), bachillerato- incompleto OR:3.01 (95 % IC: 1.80-5.05), bachillerato-completo OR: 2.54 (95 % IC: 1.45- 4.45) y con edad entre 70 y 79 años OR:2.06 (95% IC: 1.32-3.23). La demencia se asoció con escolaridades de primaria-incompleta OR: 11.20 (95 % IC: 4.99- 25.12), primaria-completa OR: 7.91 (95 % IC: 3.44-18.16), bachillerato- incompleto OR: 2.87 (95 % IC: 1.17- 7.01) y con edades entre 70 -79 años OR: 2.82. (95 % IC: 1.37-5.80), o mayores de 80 años OR: 7.68 (95 % IC: 3.49- 16.90) y con sufrir HTA OR: 1.45 (95 % IC: 1.03-2.05). Conclusión: la baja escolaridad, una edad avanzada y sufrir HTA son en su orden los factores más importantes para el desarrollo de la demencia. Los adultos entre 70 y 79 años con bachillerato incompleto, tienen mayor riesgo de DCL.

Introduction: The relationship between some metabolic and cardiovascular risk factors (CVRF) and cognitive impairment (CI) defined as mild cognitive impairment (MCI) and dementia, is controversial. Objective: Describe the cardiovascular and metabolic risk factors that are associated with cognitive impairment in adults from Bogotá. Materials and methods: A cross-sectional study, where the state of cognitive functions (normal, MCI or dementia) was evaluated in two phases, in adults older than 50 years, autonomous, non-institutionalized, using neuropsychological tests and neuropsychiatric protocol. Its cardiovascular and metabolic risk by self-reported history and standardized anthropometric measurements were documented. Results: Of 1045 adults surveyed, the mean age of the group was 68 years(SD 8.6), and the mean education level was 8 years(SD 6.0), 76% were women, 56% had hypertension(HT), 40% dyslipidemia, 37% were smokers, 36% were overweight, 28% presented hypothyroidism, 25% were obese, 17% drank alcohol and 16% were diabetic. MCI was associated with incomplete high school education OR:3.01(95% CI 1.80-5.05) and aged between 70 and 79 years OR:2.06(95%CI 1.32-3.23). Dementia was associated with lower scholarity, incomplete-primary OR:11.20(95%CI 4.99-25.12), complete-primary OR 7.91(95% CI.3.44-18.16), incomplete-high school OR: 2.87(95% CI 1.17-7.01), age over 80 years OR:7.68(95%CI 3.49-16.90); and suffer hypertension OR:1.45(95%CI 1.03- 2.05) Conclusion: Low education, older age and hypertension are in order, the most important risk factors for the development of dementia in our population. Adults between 70 and 79 with incomplete high school have higher risk of MCI.

Introducción: en el proceso del diagnóstico neuropsicológico, los instrumentos de tamizaje cognitivo, son una herramienta útil en la identificación de cambios mentales del sujeto, en momentos puntuales o a través del tiempo. Su uso se fundamenta en el análisis psicométrico. Objetivo: determinar el acuerdo inter e intra-observador en el MoCA test y el MMSE, aplicado por profesores y estudiantes en procesos de entrenamiento de tamización cognitiva. Materiales y métodos: a los estudiantes y profesores en entrenamiento en la puntuación del MoCA test y el MMSE, se les presentó un video en dos sesiones, con un intervalo de 5 meses, mostrando el desempeño de dos adultos mayores, respondiendo el MoCA test y el MMSE, previo consentimiento informado. Se compararon los puntajes dados en las dos sesiones por los sujetos en entrenamiento, con los de ellos mismos (intra-observador), usando el coeficiente de concordancia y correlación de Lin(rho) y con los del grupo restante (inter-observador) usando el coeficiente de correlación intra-clase (ICC). Resultados: participaron 46 evaluadores. Se encontró alta confiabilidad inter-observador para el MoCA (ICC=0.86), pero baja para el MMSE (ICC=0.24) y baja confiabilidad intra-observador tanto para el MoCA (rho paciente 1=0.012 y rho paciente 2=0.152) como para el MMSE (rho paciente 1=0.008 y rho paciente 2=0.012). Aunque los puntajes difirieron, las clasificaciones diagnósticas realizadas por los evaluadores fueron similares a las del patrón de oro. Conclusión: la correcta aplicación del test, requiere varios entrenamientos, y aunque hubo pocas diferencias entre los puntajes, los errores cuando se está cerca del punto de corte propuesto, aumentan el riesgo de sesgo.

Introduction: The instruments for screening cognitive functions, applied to subjects in clinical settings and research, are useful for determining if this person has any trouble in cognition or show changes in the time. The usefulness of these instruments is defined with the evaluation of their psychometrics properties. Objective: This study allows to determine the intra and inter-observer agreement, when the MoCA test and MMSE were applied by a group in training process Materials and methods: The study group who attended two training sessions, with an interval of 5 months, scored the MoCA test and MMSE, from two patients which were filmed responding the tests, previous informed consent signature. We compared how close were the scores of participants among themselves by concordance correlation coefficient of Lin (rho) and with those given from the others by intra-class correlation coefficients (ICC). Results: In total, 46 participants were included. Intra-rater reliability was high for MoCA test (ICC = 0.86), but it was poor for MMSE (ICC=0.24). Inter-rater was poor for MoCA test (rho patient 1= 0.012, rho patient 2= 0.152) and MMSE (rho patient 1 = 0.008, rho patient 2 = 0.012). Although the scores between participants and gold standard were different, the diagnoses were similar. Conclusion:The correct scoring of the test, requires several trainings to clinical and research groups, and although they can be found few differences between scores applied by non-expert personnel, if the scores mistakenly given, are close to the cut-of point proposed for each test, the bias increases.

Introducción. La geometría fractal caracteriza los objetos irregulares de la naturaleza incluyendo el cuerpo humano. Objetivo. Desarrollar una metodología geométrica que permita diferenciar, en un modelo experimental de restenosis de arterias de porcino, las arterias normales de las patológicas, mediante la aplicación simultánea de la geometría fractal y euclidiana. Materiales y métodos. Para el estudio se tomaron siete (7) imágenes de placas histológicas de arterias normales, y siete (7) de arterias restenosadas, calculando simultáneamente tanto la dimensión fractal de las capas arteriales mediante el método de Box-Counting como el número de cuadros ocupados por las superficies de tres islas o capas arteriales. Posteriormente, se calculó la armonía matemática intrínseca y, finalmente, se establecieron las diferencias entre grupos. Resultados. Los valores del número de cuadros ocupados por la superficie de las siete arterias normales oscilaron entre 27 y 74, y para las restenosadas estuvieron entre 83 y 176; el valor de la dimensión fractal varió entre 0.9241 y 1.2578 para las arterias normales, y para las reestenosadas osciló entre 0.7225 y 1.2937. Conclusión. La metodología desarrollada en el presente trabajo logró diferenciar geométricamente y de manera objetiva las arterias normales de las arterias restenosadas a partir de los espacios de ocupación.

Introduction. Fractal geometry characterizes irregular objects, including the human body. Objective. Develop a geometric method to differentiate, in an experimental model of restenosis in pig arteries, the normal and the pathologic arteries, by the simultaneous use of fractal and Euclidean geometries. Materials and methods. Seven images of histological slides of normal arteries and seven re-stenosed arteries were taken, simultaneously calculating the fractal dimension of the arterial layers -by the use of the Box-Counting method- and the number of squares occupied by the surfaces of three arterial layers. Then, the intrinsic mathematical harmony was calculated and, finally, the differences between the groups were established. Results. The values of the number of squares occupied by the surfaces of the seven normal arteries oscillated between 27 and 74 and the re-stenosed ones oscillated between 83 and 176. The value of the fractal dimension varied between 0.9241 and 1.2578 for the normal arteries and between 0.7225 and 1.2937 for the re-stenosed ones. Conclusion. The methodology developed in this research work could geometrically differentiate, in an objective way, normal and re-stenosed arteries, making the calculations with their occupation spaces as bases.

Introdução. A geometria fractal caracteriza os objetos irregulares da natureza incluindo o corpo humano. Objetivo. Desenvolver uma metodologia geométrica que permita diferenciar, num modelo experimental de estenose de artérias de porcino, as artérias normais das patológicas, mediante a aplicação simultânea da geometria fractal e euclidiana. Materiais e métodos. Para o estudo se tomaram sete (7) imagens de placas histológicas de artérias normais, e sete (7) de artérias estenosadas, calculando simultaneamente tanto a dimensão fractal das capas arteriais mediante o método de Box-Counting como o número de quadros ocupados pelas superfícies de três ilhas ou capas arteriais. Posteriormente, calculou-se a harmonia matemática intrínseca e, finalmente, estabeleceram-se as diferenças entre grupos. Resultados. Os valores do número de quadros ocupados pela superfície das sete artérias normais oscilaram entre 27 e 74, e para as estenosadas estiveram entre 83 e 176; o valor da dimensão fractal variou entre 0.9241 e 1.2578 para as artérias normais, e para as estenosadas oscilou entre 0.7225 e 1.2937. Conclusão. A metodologia desenvolvida no presente trabalho conseguiu diferenciar geometricamente e de maneira objetiva as artérias normais das artérias estenosadas a partir dos espaços de ocupação.

Introducción: la interpretación patológica de las formas celulares halladas en la citología cervicovaginal es de gran importancia para la prevención del cáncer de cuello uterino. Los métodos más ampliamente utilizados para la evaluación de este examen presentan problemas de reproducibilidad y variabilidad interobservador. Objetivo: hacer medidas fractales y euclidianas para diagnosticar matemáticamente células normales y preneoplásicas del epitelio escamoso del cuello uterino. Metodología: se evaluaron 21 células con diagnósticos de normalidad, ASCUS o LIEBG según el sistema Bethesda. Se establecieron medidas geométricas fractales y euclidianas de tres objetos matemáticos definidos: citoplasma, núcleo y totalidad celular. Se calcularon proporciones matemáticas entre estas medidas con el fin de compararlas con los métodos convencionales de clasificación. Resultados: se encontró que las medidas del borde con la rejilla de 2 pixeles y de la superficie del núcleo celular pudieron diferenciar matemática y objetivamente las células normales y las anormales, clasificadas como ASCUS y LIEBG, cuantificando la gravedad de la lesión. Conclusiones: se estableció una metodología diagnóstica objetiva y reproducible que permite identificar la evolución hacia estados celulares de gravedad con base en medidas fractales y euclidianas simultáneas, estableciendo así el nivel de gravedad de las células ASCUS y LIEBG.

Background: Pathological interpretation of cellular form in cervical cytology is very important for prevention of cervical cancer. The methods most frequently used for assessment of this test have reproducibility and inter-observer variability problems. Objective: To make fractal and Euclidean measurements to mathematically diagnose normal and premalignant cells of cervical squamous epithelium. Methodology: 21 cells with normal, ASCUS or LSIL diagnosis according to the Bethesda system were assessed. Fractal and Euclidean geometric measures of three mathematical objects were calculated: cytoplasm, nucleus and whole cell. Mathematical proportions between these measurements were calculated in order to compare them with conventional classification methods. Results: It was found that the nuclear border measures calculated with the 2-pixel grill and the surface measures could mathematically and objectively differentiate normal cells from the pre-malignant ones (ASCUS and LSIL). Conclusions: An objective and reproducible diagnostic method was developed; it allows to identify the evolution towards malignant cellular states based on simultaneous fractal and Euclidean measures, establishing the severity level of ASCUS and LSIL cells.

Background: The professionals in the medical field are particularly exposed to psychological risk factors which may affect their quality of life. Identification of stress coping strategies and the sources of professional rewards would afford the possibility of implementing preventive measures aimed a moderating the negative effect of these risk factors. The objectives of this study are to identify the stress coping strategies that are used by specialised doctors from six public hospitals of the Valencian Community, and to describe their sources of work reward and job satisfaction. Methods: A qualitative study conducted by means of quasi-structured individual interviews of 47 specialists employed at six public hospitals in the province of Valencia. The interviews were taped and subsequently transcribed. An analysis was made of the substance of the opinions expressed. Results. The coping strategies mentioned most often by the physicians interviewed, analyzed overall, are those focused on the emotions, specifically, disconnecting conduct and seeking social emotional support. However, when confronted with specific stressful factors in daily practice, the strategies most often employed as those focused on the problem. A major part of the physicians surveyed state not having any work reward. Among those who do state finding some aspects gratifying, top mention is made of their salary, personal satisfaction related to being in the medical field being ranked second. Conclusions. Including training related to active stress coping strategies in the professional curriculum of physicians could heighten their personal resources for dealing with stress. Organizational changes should additionally be made to increase their work rewards.

Fundamento. Los profesionales de la medicina están particularmente expuestos a factores de riesgo psicosocial que pueden afectar su calidad de vida. La identificación de estrategias de afrontamiento frente al estrés y las fuentes de recompensa profesional permitiría instaurar medidas preventivas tendentes a moderar el efecto negativo de estos factores de riesgo. Los objetivos del presente trabajo son identificar las estrategias de afrontamiento ante el estrés que utilizan los médicos especialistas de seis hospitales públicos de la provincia de Valencia, y describir sus fuentes de recompensa y satisfacción profesional. Métodos. Estudio cualitativo realizado por entrevistas semiestructuradas individuales a 47 médicos especialistas de seis hospitales públicos de la provincia de Valencia. Las entrevistas han sido grabadas en audio y transcritas posteriormente. Se ha realizado un análisis del contenido del discurso. Resultados. Las estrategias de afrontamiento referidas con más frecuencia por los facultativos entrevistados, analizadas de manera general, son las centradas en las emociones y en concreto la desconexión conductual y la búsqueda de apoyo social emocional. Sin embargo, ante factores estresantes puntuales concretos de la práctica diaria, las estrategias más frecuentes son las centradas en el problema. Una parte importante de los médicos entrevistados manifiesta no tener ninguna recompensa laboral. Entre los que sí expresan elementos de recompensa, refieren en primer lugar el salario, seguido de la satisfacción personal por la dedicación a la medicina. Conclusiones. La inclusión de formación sobre estrategias de afrontamiento activo frente al estrés en el currículo profesional de los médicos, podría aumentar sus recursos personales para hacer frente al mismo. Además se deberían instaurar cambios organizacionales que aumenten las recompensas laborales.

Background: The professionals in the medical field are particularly exposed to psychological risk factors which may affect their quality of life. Identification of stress coping strategies and the sources of professional rewards would afford the possibility of implementing preventive measures aimed a moderating the negative effect of these risk factors. The objectives of this study are to identify the stress coping strategies that are used by specialised doctors from six public hospitals of the Valencian Community, and to describe their sources of work reward and job satisfaction. Methods: A qualitative study conducted by means of quasi-structured individual interviews of 47 specialists employed at six public hospitals in the province of Valencia. The interviews were taped and subsequently transcribed. An analysis was made of the substance of the opinions expressed. Results. The coping strategies mentioned most often by the physicians interviewed, analyzed overall, are those focused on the emotions, specifically, disconnecting conduct and seeking social emotional support. However, when confronted with specific stressful factors in daily practice, the strategies most often employed as those focused on the problem. A major part of the physicians surveyed state not having any work reward. Among those who do state finding some aspects gratifying, top mention is made of their salary, personal satisfaction related to being in the medical field being ranked second. Conclusions. Including training related to active stress coping strategies in the professional curriculum of physicians could heighten their personal resources for dealing with stress. Organizational changes should additionally be made to increase their work rewards.

Fundamento. Los profesionales de la medicina están particularmente expuestos a factores de riesgo psicosocial que pueden afectar su calidad de vida. La identificación de estrategias de afrontamiento frente al estrés y las fuentes de recompensa profesional permitiría instaurar medidas preventivas tendentes a moderar el efecto negativo de estos factores de riesgo. Los objetivos del presente trabajo son identificar las estrategias de afrontamiento ante el estrés que utilizan los médicos especialistas de seis hospitales públicos de la provincia de Valencia, y describir sus fuentes de recompensa y satisfacción profesional. Métodos. Estudio cualitativo realizado por entrevistas semiestructuradas individuales a 47 médicos especialistas de seis hospitales públicos de la provincia de Valencia. Las entrevistas han sido grabadas en audio y transcritas posteriormente. Se ha realizado un análisis del contenido del discurso. Resultados. Las estrategias de afrontamiento referidas con más frecuencia por los facultativos entrevistados, analizadas de manera general, son las centradas en las emociones y en concreto la desconexión conductual y la búsqueda de apoyo social emocional. Sin embargo, ante factores estresantes puntuales concretos de la práctica diaria, las estrategias más frecuentes son las centradas en el problema. Una parte importante de los médicos entrevistados manifiesta no tener ninguna recompensa laboral. Entre los que sí expresan elementos de recompensa, refieren en primer lugar el salario, seguido de la satisfacción personal por la dedicación a la medicina. Conclusiones. La inclusión de formación sobre estrategias de afrontamiento activo frente al estrés en el currículo profesional de los médicos, podría aumentar sus recursos personales para hacer frente al mismo. Además se deberían instaurar cambios organizacionales que aumenten las recompensas laborales.