Resumen Introducción El enfoque de la salud basado en los derechos humanos (ESBDH) en la educación médica exige una formación eficiente y en condiciones favorables para la formación de médicos, sin embargo, se han documentado quejas por errores médicos en donde se involucran a estudiantes de medicina, afectando la protección del derecho a la salud en usuarios y médicos en formación. Objetivo Identificar los factores atribuibles a la ocurrencia de errores médicos (diagnóstico-terapéuticos) auto percibidos por falta de supervisión académica o falta de competencias clínicas en residentes médicos, adscritos a unidades hospitalarias del estado de Veracruz, México. Método Se utilizaron datos generados por el Observatorio de Educación Médica y Derechos Humanos (OBEME) de la Universidad Veracruzana, considerando los derechos a la educación, a la salud y al trabajo de residentes médicos de especialidad clínica del ciclo académico 2019-2020. Se desarrolló un estudio epidemiológico de prevalencias analítico y se estimó la Tasa de Error Médico (TEM). Resultados Se determinaron factores asociados en la ocurrencia e incremento de la TEM en 764 médicos residentes: la falta de supervisión de las actividades, número de horas semanales trabajadas, tipo de adscripción hospitalaria, tipo de especialidad y edad. Las condiciones del derecho al trabajo digno incrementaron el riesgo en hasta siete veces cuando tomaron decisiones médicas sin supervisión, así como el incremento de riesgo ante un trato discriminatorio. El error médico se presenta de manera diferenciada para hombres y mujeres en algunos de los factores analizados. Conclusiones El error médico disminuye cuando es mayor la garantía del respeto a los derechos analizados. Con base en el ESBDH se establece que, para disminuir el error médico cometido por médicos residentes, es fundamental respetar sus derechos. Finalmente, se sugiere la incorporación de la perspectiva de género en el análisis e intervención para mejoras de la educación médica.

Abstract Introduction The Human Rights-Based Approach to Health (HRBAH) in medical education requires efficient training and favorable conditions in order to train doctors. However, complaints about medical errors involving residents have been documented, so protecting the right to health of users and residents has been affected. Objective This paper aims to identify the factors related to self-perceived medical errors (diagnostic-therapeutic), risk and protection factors that occur due to lack of academic monitoring or because specialty medical residents, assigned to medical units in the state of Veracruz, Mexico, during the 2019-2020 academic year, lack of clinical skills. Method We used data collected by the Observatory of Medical Education and Human Rights of Universidad Veracruzana, in which the right to education, the right to health and the right to work in medical students, particularly those from both clinical specialty and 2019-2020 academic year, are considered. We conducted an analytic prevalence epidemiological study, for which we elaborated the Rate of Medical Errors (RME). Results The following factor were determined with the occurrence and increase of RME in 764 medical residents: lack of supervision of activities, number of weekly hours worked, type of hospital affiliation, type of specialty and the age, was observed. The conditions for the right to decent work increased the risk up to seven times when medical decisions were made without the supervision of the person in charge, as well as the increased risk for discriminatory treatment. Medical error is presented differently for men and women in some of the factors analyzed. Conclusion Medical errors decrease when the guarantee of the rights analyzed is greater. From the HRBAH perspective, it is essential to respect the right to education, work, and a decent life of medical residents in order to reduce medical errors. Finally, the incorporation of the gender perspective in the analysis and intervention for improvements in medical education is suggested.

Resumen Objetivo: Describir el desarrollo de intervenciones comunitarias virtuales en el marco de intervenciones de salud pública, como estrategia didáctica en educación universitaria desde un enfoque constructivista para su posterior implementación en momentos donde estas iniciativas no puedan ser llevadas presencialmente. Método: El estudiantado desarrolló intervenciones virtuales en los temas de vacunación, asma, depresión y fibromialgia, temas asignados por el equipo docente. El desarrollo de las intervenciones se basó en los 10 servicios esenciales de la salud pública y bajo la premisa de la participación de la comunidad o actantes con interés. Se trabajaron seis fases: descripción de la comunidad, identificación del problema, propuesta de un plan de acción, desarrollo de intervenciones, desarrollo de un plan de mercadeo y evaluación de intervenciones. Para identificar el problema se indagó sobre inquietudes y necesidades mediante entrevistas a personas relacionadas con cada tema, esto para determinar temas recurrentes. Los aspectos en los que la población participante coincidió fueron considerados como el problema a trabajar. Resultados: Las intervenciones desarrolladas fueron principalmente charlas, talleres y campañas educativas virtuales, las cuales se llevaron a cabo mediante infografías, pósteres y redes sociales. Conclusiones: Las actividades del curso pudieron adaptarse a la virtualidad con bastante facilidad, lo que podría significar un replanteamiento de la modalidad del curso. El uso de la virtualidad para el desarrollo de intervenciones de salud en la comunidad es un recurso que facilita a la población el acceso a la educación sanitaria, especialmente a aquella que vive en lugares alejados; constituye una forma de dotar a las personas de herramientas digitales para el autocuidado de la salud.

Abstract Objective: To describe the development of virtual community interventions within the framework of public health interventions in community pharmacies, as a didactic strategy in university education from a constructivist approach for its subsequent implementation at times when these initiatives cannot be carried out face to face. Method: The students developed virtual interventions in communities or specific population groups on the topics of vaccination, asthma, depression, and fibromyalgia, previously chosen by the professors. The interventions were developed in accord with the 10 essential services in public health and with the mandatory participation of the community or interested stakeholders; interventions consisted of six phases: description of the community, problem identification, proposal of an action plan, construction of the interventions, marketing plan development, and the evaluation of interventions. To identify the problem, students conducted interviews on people familiar with each assigned topic, to identify common needs or concerns. These common needs or concerns were considered the aspects on which the participating population agreed were considered as the problem to work on. Results: The interventions developed were mainly talks, workshops, and virtual educational campaigns through infographics, posters, and social networks. Conclusions: The activities of the course were easily adapted to the virtuality, which could mean a reconsideration of the course modality. The use of virtuality for the development of health interventions in the community is an important resource that facilitates access to health education for the population especially for those who live in rural or remote areas. It constitutes a way of providing people with digital tools for self-care in health.

Abstract Objective To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. Method The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. Results 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). Conclusions This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.

Resumen Objetivo Evaluar el impacto del Plan de Promoción de la Autonomía Personal y Prevención de la Dependencia de Andalucía (2016-2020) en 13 organismos públicos participantes tras su primer año, y analizar la usabilidad y la fiabilidad de la escala de evaluación del impacto que se ha empleado. Método El Plan aborda la promoción de la autonomía personal y la prevención de la discapacidad y la dependencia con un enfoque multisectorial. Se estructura en líneas, objetivos y actuaciones que han sido evaluadas mediante la escala Adoption Impact Ladder (AIL). El análisis de la validez simple, la viabilidad y la fiabilidad de la escala se ha realizado en 30 actuaciones evaluadas por 20 expertos de la Administración pública y un evaluador externo independiente. Resultados En 2017 se pusieron en marcha 176 actuaciones y programas del Plan. Se han implementado el 67,2% de las actuaciones propuestas y solo uno de los 16 objetivos no se ha asociado a actuaciones ejecutadas en el primer año. Siete de los 15 objetivos ejecutados fueron enteramente multisectoriales, involucrando a tres o más consejerías. La validez simple, la viabilidad y la fiabilidad interexaminadores de la escala AIL fueron buenas (κ: 0,72). Conclusiones El Plan ha proporcionado un marco novedoso para coordinar un amplio rango de políticas y actuaciones en la Administración pública de Andalucía. Por primera vez se presenta un análisis del impacto multisectorial que proporciona una guía efectiva para el seguimiento, la planificación y el establecimiento de prioridades públicas en salud, servicios sociales y atención a personas mayores y personas con discapacidad.

Abstract Objective To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. Method The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. Results 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). Conclusions This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.

Resumen Objetivo Evaluar el impacto del Plan de Promoción de la Autonomía Personal y Prevención de la Dependencia de Andalucía (2016-2020) en 13 organismos públicos participantes tras su primer año, y analizar la usabilidad y la fiabilidad de la escala de evaluación del impacto que se ha empleado. Método El Plan aborda la promoción de la autonomía personal y la prevención de la discapacidad y la dependencia con un enfoque multisectorial. Se estructura en líneas, objetivos y actuaciones que han sido evaluadas mediante la escala Adoption Impact Ladder (AIL). El análisis de la validez simple, la viabilidad y la fiabilidad de la escala se ha realizado en 30 actuaciones evaluadas por 20 expertos de la Administración pública y un evaluador externo independiente. Resultados En 2017 se pusieron en marcha 176 actuaciones y programas del Plan. Se han implementado el 67,2% de las actuaciones propuestas y solo uno de los 16 objetivos no se ha asociado a actuaciones ejecutadas en el primer año. Siete de los 15 objetivos ejecutados fueron enteramente multisectoriales, involucrando a tres o más consejerías. La validez simple, la viabilidad y la fiabilidad interexaminadores de la escala AIL fueron buenas (κ: 0,72). Conclusiones El Plan ha proporcionado un marco novedoso para coordinar un amplio rango de políticas y actuaciones en la Administración pública de Andalucía. Por primera vez se presenta un análisis del impacto multisectorial que proporciona una guía efectiva para el seguimiento, la planificación y el establecimiento de prioridades públicas en salud, servicios sociales y atención a personas mayores y personas con discapacidad.

Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the “gold standard” for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the “Correct use of bone densitometry in clinical practice in Chilean population”. Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.