RESUMEN Fundamentos: Una Atención Primaria fuerte tiene efectos beneficiosos para la salud. El atributo de la misma con mayores beneficios es la longitudinalidad, que requiere de estabilidad laboral para poder producirse. Además, la Atención Primaria se enfrenta a una crisis por el número de jubilaciones que espera. Conseguir la permanencia de los profesionales jóvenes en Atención Primaria podría contribuir a mejorar la longitudinalidad y al recambio generacional de los profesionales. Por ello, en este estudio se exploraron los motivos que influyen en el abandono de la Medicina Familiar y Comunitaria entre jóvenes médicos y médicas de familia. Métodos: Se realizó un estudio cualitativo descriptivo-interpretativo en Granada y Madrid durante 2022. Mediante un muestreo intencionado por bola de nieve se reclutaron jóvenes médicos y médicas de familia que habían abandonado su trabajo, a los que se realizaron entrevistas en profundidad, además de un grupo triangular. La información se codificó de forma inductiva y se analizó según el método de análisis de contenido temático. Resultados: Los jóvenes médicos y médicas de familia abandonaban la Medicina Familiar y Comunitaria por la frustración de no poder ejercer como les gustaría, por insatisfacción laboral y por una visión pesimista de su futuro como trabajadores/as. La decisión de abandonar de estos jóvenes profesionales se vio favorecido por el empeoramiento de las condiciones laborales tras la pandemia y sus valores respecto al trabajo. Conclusiones: La decisión de jóvenes médicos y médicas de familia de abandonar la Medicina Familiar y Comunitaria es compleja. Para contribuir a su permanencia es necesario mejorar sus condiciones laborales y represtigiar la especialidad.

ABSTRACT Background: A strong Primary Care has beneficial health effects. Its more beneficial attribute is longitudinality, which requires job stability in order to occur. In addition, Primary Care is facing a crisis due to the number of retirements it expects. The permanence of young professionals in Primary Care could contribute to improve longitudinality and the generational turnover of professionals. Therefore, this study explored the reasons that influence the abandonment of Family Medicine among young family physicians. Methods: A qualitative descriptive-interpretative study was carried out in Granada and Madrid in 2022. By means of purposive snowball sampling, young family physicians who had left their job were recruited, with whom in-depth interviews and a triangular group were carried out. The information was coded inductively and analyzed according to the thematic content analysis method. Results: oung family physicians left Family Medicine due to the frustration of not being able to practice as they would like to, job dissatisfaction and a pessimistic view of their future as workers. The decision to leave by these young professionals had been favored by the worsening of working conditions after the pandemic and by the values they have regarding work. Conclusions: The decision of young family physicians to leave the practice of Family Medicine is complex. To contribute to their permanence in Primary Care, it's necessary to improve their working conditions and increase the prestige of Family Medicine.

RESUMEN Fundamentos: La violencia sexual contra la mujer es uno de los problemas más graves de Salud Pública. Esta no puede erradicarse sin abordar las actitudes sociales que la toleran. El objetivo de este estudio fue evaluar la percepción social sobre el acoso sexual en el ámbito laboral de las personas trabajadoras de un hospital de la Comunidad de Madrid. Métodos: Se realizó un estudio observacional transversal sobre la percepción del acoso sexual laboral en una muestra de trabajadores del Hospital Universitario Severo Ochoa de la Comunidad de Madrid, a través de una encuesta anónima que recogió variables sociodemográficas y la Escala validada de Illinois de Aceptación del Mito del Acoso Sexual (ISHMA). Se realizó un análisis descriptivo de las variables y una comparación de medias con ANOVA. Resultados: La encuesta la completaron 243 trabajadores (23,5% hombres; 44,9% tenía entre 25-35 años). Se encontraron diferencias estadísticamente significativas respecto al género en la puntuación media de la escala ISHMA (p=0,002), presentando lo hombres mayor aceptación de los mitos del acoso sexual (media=2,0974; DT=1,09; n= 57) respecto a las mujeres (media=2,7261; DT=0,68; n=184). No obstante, en el resto de las variables (categoría profesional [p=0,072], tiempo trabajado [p=0,406] y edad [p>0,251]) no se encontraron diferencias estadísticamente significativas. Un 11% de las personas encuestadas consideraba que las mujeres pueden hacer que los hombres dejen de fijarse sexualmente en ellas si estas les piden que dejen de hacerlo. Conclusiones: El porcentaje de trabajadores que rechaza las distintas formas de acoso sexual es alto. Sin embargo, existen algunos mitos sobre acoso sexual que son bastante aceptados.

ABSTRACT Background: Sexual violence against women is one of the most serious public health problems. Sexual violence cannot be eradicated without addressing the social attitudes that condone it. The objective of this study was to evaluate the social perception of sexual harassment in the workplace of the workers of a hospital in the Comunidad de Madrid. Methods: A cross-sectional observational study was carried out on the perception of workplace sexual harassment in a sample of workers of the Hospital Universitario Severo Ochoa in the Comunidad de Madrid, through an anonymous survey that collected sociodemographic variables and the Illinois Sexual Harassment Myth Acceptance Scale (ISHMA). A descriptive analysis of the variables and a comparison of means with ANOVA were performed. Results: The survey had been completed by 243 employees (23,5% men; 44,9% workers between 25-35 years old). Statistically significant differences were found regarding gender in the average score of the ISHMA scale (p=0.002), with men presenting greater acceptance of the myths of sexual harassment (mean=2.0974; SD=1.09; n=57) compared to women (mean=2.7261; SD=0.68; n=184). However, in the rest of the variables (professional category [p=0.072], time worked [p=0.406] and age [p>0.251]) no statistically significant differences were found. 11% of the people surveyed considered that women can usually stop unrequested sexual attention by simply telling men that their behaviour is not appreciated. Conclusions: The percentage of employees that denies the different forms of sexual harassment is high. However, some myths about sexual harassment are accepted.

Tooth calcification begins during the intrauterine life and is related to the nutritional status of fetus. The purpose of this study was to evaluate the dental calcification status of 15 low-weight human fetuses aged from the 14th to 28th weeks of intrauterine life through radiographic analyses and von Kossa histochemical technique, which is specific to the detection of calcium and other mineral salts in tissues. After dissection of jaws, the mandibles were submitted to lateral and occlusal radiographies. Three mm thick slide sections of jaws samples were stained by conventional and von Kossa methods. As results, radiographic analysis did not exhibit any suggestive image of tooth mineralization, although rudiments of mandibular ossification could be noted. Hematoxilin and eosin sections revealed tooth germs in advanced phases of odontogenesis, but relative delay in tooth development was observed. The von Kossa staining did not show any positivity to the deposition of mineral salts in tooth germs from maxilla and mandible, supporting our findings related to the delay of dental development that was found in studied sample. Hence, we suggest that there is relation between the fetal low-weight and the calcification and maturation status of teeth.

La calcificación del diente comienza durante la vida intrauterina y se relaciona con el estado nutricional del feto. El propósito de este estudio fue evaluar el estado de calcificación dental de 15 fetos humanos de bajo peso entre las 14 y 28 semanas de vida intrauterina mediante análisis radiográficos y técnica histoquímica von Kossa, específica para la detección de calcio y otras sales minerales en los tejidos. Después de su disección, las mandíbulas fueron sometidas a radiografías laterales y oclusales. Secciones de 3 mm de espesor de las mandibulas fueron teñidas con la técnica Von Kossa. El análisis radiográfico no mostró ninguna imagen sugerente de mineralización dentaria, aunque rudimentos de la osificación mandibular podrían tenerse en cuenta. Las secciones de H-E revelaron la presencia de los gérmenes dentarios en las fases avanzadas de odontogénesis, pero con un retraso relativo en el desarrollo normal. La tinción de von Kossa no mostró positividad a la deposición de sales minerales en gérmenes dentarios, lo que apoya nuestros hallazgos relacionados con el retraso de desarrollo dental que se encontró en la muestra estudiada. Se sugiere que existe relación entre el bajo peso del feto y el estado de calcificación y maduración de los dientes.

Os enxertos com a artéria radial foram utilizados há mais de 20 anos e praticamente abandonados após constatação de elevadas taxas de oclusão ou estenose em estudos pós-operatórios. Mais recentemente, seu emprego foi reiniciado associado ao uso dos bloqueadores dos canais de cálcio. Nos últimos 6 meses, em 30 pacientes realizamos 31 enxertos aorto-coronários com a artéria radial. Concomitantemente, a artéria torácica interna esquerda foi empregada em todos (100%) os pacientes, a artéria torácica interna direita em 9 (30%) pacientes e em 24 (80%) também foram realizadas pontes de veia safena. A média de enxertos por paciente foi de 3,5.0 enxerto de artéria radial foi realizado para a artéria diagonal em 10 (33,3%) pacientes, artéria circunflexa em 8 (26,6%), artéria coronária direita em 8 (26,6%), artéria diagonalis em 4 (13,3%) e artéria interventricular anterior em 1 (3,3%). Quatorze (46,6%) pacientes tinham antecedentes de infarto do miocárdio e em 2 (6,6%) tratava-se de reoperação. Em 3 pacientes realizou-se a endarterectomia coronária e uma dessas artérias recebeu enxerto com artéria radial. A artéria radial esquerda foi utilizada em 28 (93,4%) pacientes e a direita em 2 (6,6%). A artéria radial foi anastomosada à aorta ascendente como enxerto livre, diretamente com sutura contínua de Polipropileno 7-0. Completada a anastomose, a pinça da aorta era removida, para avaliação do fluxo sangüíneo através da artéria radial. Todos os pacientes receberam nifedipina no intra e no pós-operatório, quando se associou o AAS. O calibre da artéria radial variou de 2,5 mm a 3,75 mm e nenhum paciente apresentou sinais de isquemia ou outras alterações na mão. Não houve mortalidade nesta série, nem complicações per-operatórias conseqüentes ao uso do enxerto. O cateterismo precoce, antes da alta hospitalar, foi realizado em 7 (23,3%) pacientes e em todos o enxerto encontrava-se pérvio e sem espasmo (um deles para a artéria submetida a endarterectomia). A artéria radial parece constituir uma alternativa de grande importância na revascularização do miocárdio, especialmente após o advento dos bloqueadores dos canais de cálcio. Entretanto, é necessário maior número de estudos e o seguimento a longo prazo dos pacientes, para conclusões definitivas.

The radial artery (RA) was used as a conduit for coronary artery bypass many years ago. Some years later, the graft was abandoned due to of a high incidence of narrowing or occlusion. The advent of new antispastic drugs led us to reinvestigate the use of the RA for coronary artery bypass grafting. Since May 1994,30 patients underwent myocardial revascularization using 31 RA grafts (1 patient received 2 grafts) at our Service. The left internal thoracic artery (LITA) was concomitantly used in all (100%) patients, the right internal thoracic artery (RITA) in 9 (30%) patients and a saphenous vein graft in 24 (80%) cases. A mean of 3.5 graft per patient was performed. The RA was anastomosed to the diagonal (n=10/33,3%), circunflex (n=8/26.6%), right coronary (n=8/26.6%), diagonalis (n=4/13.3%) and anterior interventricular artery (n=1/3.3%). Two (6.6%) patients presented for redo coronary surgery and 14 (46%) had prior myocardial infarction. Two patients underwent associated ventricular aneurismectomy and 3 coronary endarterectomy. The left RA was used in 28 (93.4%) patients, and the right RA in the 2 (6.6%) remaining. The RA was used as a free graft. The proximal end of the RA was directly anastomosed to the ascending aorta using a 7-0 Polypropylene suture. After complete, the aortic clamp was removed and the blood flow throught the RA was tested. The distal anastomosis was then performed using a running 7-0 Polypropylene suture. All patientes received diltiazem started intraoperatively and continued at the follow-up period, when the AAS was associated. There was no mortality in this series. Angiographic controls were obtained in 7 (23.3%) patients before the Hospital discharge, with all patent grafts without any abnormality. We have not observed any ischemic symptoms of the hand in this series. We believe that the RA is a valuable alternative procedure to the myocardial revascularization, specially after the advent of new antispastic drugs. However, a larger study including late control angiograms is still required to establish definitive conclusions.