Spanish Physicians Research Articles

Historical Views of Spiritism and Mediumship in Spain, 1880-1930

Little is known by non-Spanish speakers about the history of Spiritism and psychical research in Spain. Standard English-language sources such as Frank Podmore’s Modern Spiritualism (1902) and Arthur Conan Doyle’s The History of Spiritualism (1926) do not cover developments in that country.1 There is a useful historical outline of the topic in philosopher and educator Mario Méndez Bejarano’s Historia de la Filosofía en España Hasta el Siglo XX (n.d., Chapter 17, Part 14). Much of relevance can be found in the new historiography about the subject in Spain which, like that in some other countries, has grown in recent decades.2 Other recent studies have included psychical research as well. Particularly useful are the essays compiled by Annette Mülberger (2016) in Los Límites de la Ciencia: Espiritismo, Hipnotismo y el Estudio de los Fenómenos Paranormales (1850–1930), and articles about such topics as the attitudes and approaches of specific investigators (Vilaplana Traviera & Mülberger, 2003), turning tables (González de Pablo, 2006), and prominent clairvoyance studies (Mülberger & Balltondre, 2013). Andrea Graus, the author of the book reviewed here, has also made various significant contributions.
 Graus, a historian at the Centre Alexandre Koyré, has published various articles about mediumistic investigations, and the ideas of Spanish physicians (e.g., Graus, 2015, 2016). This work has been expanded in the book reviewed here, Ciencia y Espiritismo en España, 1880–1930 (see Figure 1).

Management of prediabetes from the perspective of Spanish physicians and community pharmacists: Detecta2 study

IntroductionPrediabetes is a high-risk state for diabetes. The study aims to describe routine clinical practice and the views of physicians and pharmacists on prediabetes management. Materials and methodsAn observational, descriptive, cross-sectional study was conducted using a structured questionnaire. ResultsA total of 410 physicians and 393 pharmacists completed the questionnaire. Self-adherence to clinical practice guidelines (CPGs) was reported by 51.5% and 23.2% of physicians and pharmacists, respectively. Less than 60% of participants defined prediabetes according to main CPG. Regarding the use of screening strategies to detect prediabetes (physicians: 96%; pharmacists: 42.1%), reports indicate the opportunistic strategy is widely employed (≥75%) whereas systematic screening is unusual (<20%). Changes in lifestyle were deemed essential by almost all participants (≥95%), but in clinical practice only 58.3% of healthcare centers and 28.0% of pharmacies were found to provide awareness-raising/instruction. The role of pharmacists in the prevention of prediabetes/diabetes was judged useful by most participants. ConclusionsUse of CPG, systematic prediabetes screening strategies, and specific strategies for patient education are scarce. The support of community pharmacists in prediabetes management was well valued. Therefore, it is crucial that the lines of action followed by both physicians and pharmacists align with each other and with the CPG.

Factors Affecting the Success of Step-up Therapy in Patients With Moderate-Severe Asthma: A Real-Life Study.

Introduction: Clinical practice guidelines recommend regular adjustment of treatment to achieve control of asthma. A step-up approach based on the degree of disease control should be followed. Objective: To perform a real-life analysis of the factors that affect the success or failure of this therapeutic strategy and of the criteria applied by clinicians when applying a step-up approach in a representative sample of patients diagnosed with moderate-severe asthma. We performed a multicenter retrospective cohort study involving 226 Spanish specialist physicians (98 allergologists, 127 pulmonologists, and 1 family physician). We included 1254 patients (787 women) diagnosed with moderate-severe asthma who underwent step-up therapy during 2016. Step-up was successful in 44% of cases. The factors associated with success were presence of <2 comorbid conditions, lower grade of severity and therapy step before modification, absence of exacerbations during the previous year, fewer daytime/nighttime symptoms, and limitation in activities, as well as type of inhaled corticosteroid/ long-acting β₂-agonist combination after modification, lower body mass index, and higher fractional exhaled nitric oxide. An early increase in the maintenance dose once a lack of control was detected (≤3 months, >3 to ≤6 months, >6 to ≤12 months) was more likely to be successful. The factors that determine whether or not this therapeutic strategy manages to control asthma are time since onset of clinical impairment, previous grade of severity, number of comorbid conditions, previous exacerbations, and frequency of symptoms.

Sources of psychological distress among primary care physicians during the COVID-19 pandemic's first wave in Spain: a cross-sectional study.

The COVID-19 pandemic is affecting people worldwide. In Spain, the first wave was especially severe. This study aimed to identify sources and levels of distress among Spanish primary care physicians (PCPs) during the first wave of the pandemic (April 2020). A cross-sectional study was conducted using a survey that included sociodemographic data, a description of working conditions related to distress [such as gaps in training in protective measures, cleaning, and hygiene procedures in work setting, unavailability of personal protective equipments (PPEs) and COVID-19 RT-PCR test, and lack of staff due to be infected] and a validated scale, the 'Self-applied Acute Stress Scale' (EASE). The survey was answered by a non-probability sampling of PCPs working in family healthcare centres from different regions of Spain. Analysis of variance and multivariate linear regression analysis were performed. In all, out of 518 PCP participants, 123 (23.7%) obtained high psychological distress scores. Only half of them had received information about the appropriate use of PPE. PCP characteristics associated with higher levels of distress include female gender [1.69; 95% confidence interval (CI) 0.54, 2.84]; lack of training in protective measures (1.96; 95% CI 0.94, 2.99); unavailable COVID-19 RT-PCR for health care workers after quarantine or COVID-19 treatment (-0.77 (-1.52, -0.02). Reinforcing disinfection of the work environment (P < 0.05), availability of PPEs (P < 0.05), and no healthcare professional was infected (P < 0.05) were related to the lowest distress score. A better understanding of the sources of distress among PCPs could prevent its effect on future outbreaks.

Palliative care undergraduate education: Do medical and nursing students need more skills in ethical and legal issues?

This study aimed to analyze the schools that teach ethical and legal aspects within the subject of palliative care in the degrees of medicine and nursing in Spain. Material and Methods: Descriptive Analysis of the palliative care subject and their ethical and legal curricular competencies in the Spanish Nursing and Physicians undergraduate. The training received in legal ethical aspects related to palliative care was compared with the criteria established by the European Association for Palliative Care (EAPC). Data sources: The National Conference of Nursing Deans, The National Conference of Spanish Medical Faculty Deans and The Ministry of Science, Innovation, and Universities databases were searched. Results: Twenty-one universities have an undergraduate in medicine with palliative care in their curricular training explicitly. The degree in nursing is present in fifty-six universities, palliative care is present in 62.5% of the cases. The degrees of nursing and medicine receive approximately the same level of training in ethical and legal aspects of palliative care. Conclusion: The specific training received in ethical and legal issues of palliative care must be improved in medical and nursing to meet the EAPC levels.

Characterization of Burnout Among Spanish Family Physicians Treating Fibromyalgia Patients: The EPIFFAC Study

Burnout among physicians has increased, affecting not only doctors but also the quality of patient care. Treating challenging disorders, such as fibromyalgia, may increase the risk of feeling burned out. Health care of fibromyalgia patients is increasingly being assigned to family physicians. Therefore, we described the demographic characteristics, work contexts, component burnout scores (exhaustion, depersonalization, and personal accomplishment), and perceptions of fibromyalgia care of Spanish family medicine physicians with high and low levels of burnout. We then evaluated which of these variables were associated with having high or low levels of burnout. This cross-sectional study assessed 506 family physicians recruited from the Spanish Society of Family Physicians and randomly selected from Primary Health Care Centers. The subgrouping of family physicians based on their burnout scores was assessed by cluster analysis. Variables showing statistically significant differences between clusters and significance below 0.25 in univariate logistic regressions were assessed by multivariate logistic regression analysis. Family physicians reporting higher burnout scores (25%) felt that fibromyalgia patients on sick leave increased their workload, reported no support from nurses in the treatment of fibromyalgia patients, and had a more negative impression of fibromyalgia patients. One-quarter of family physicians reported feeling exhausted, detached from fibromyalgia patients, or less professionally accomplished. Several personal characteristics and contextual variables increased burnout. Several interventions to modify these variables and, thus, protect family physicians treating fibromyalgia from burnout are suggested.

Potential Survival Benefit for Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation after Nivolumab Therapy for Relapse/Refractory Hodgkin Lymphoma: Real-Life Experience in Spain.

Clinical trials have shown that nivolumab has remarkable activity against relapsed/refractory classical Hodgkin lymphoma (cHL). However, the role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) as consolidation therapy in these patients remains controversial. We performed a retrospective analysis of data from 74 patients treated with nivolumab. The overall response rate was 58% (including 30.6% with complete responses). Treatment-related adverse events were reported in 56.8% of patients (grade ≥3 in 9.4%). The main reasons for nivolumab discontinuation were referral for transplantation (41.7% patients) and disease progression (37.5%). The 2-year overall survival (OS) rate was 52% for the entire series. Ultimately, 39 patients underwent allo-HSCT. The cumulative incidence of grade II-IV acute graft-versus-host disease was 33.3% (grade III-IV in 2 patients). The cumulative incidence of nonrelapse mortality was 13.2%. Among the patients who responded to nivolumab, the 2-year OS and progression-free survival (PFS) were higher in patients who underwent consolidation with allo-HSCT (77.5% versus 42.6% [P = .126] and 73.9% versus 27.2% [P = .025], respectively). Thus, the efficacy and safety of nivolumab were comparable to values reported in previous clinical trials. The percentage of patients who bridged to transplantation was high, indicating a preference for Spanish physicians. These results suggest that consolidation allo-HSCT increases OS and PFS.

Education and information needs for physicians about rare diseases in Spain

BackgroundRare diseases are a priority objective for public health systems. Given its complexity, late and misdiagnoses occur very often which causes mental and physical burden for patients and family. This would be caused, in part, for unprepared clinicians in this field. The aim of this study was to report the training needs and the perceived shortcomings of Spanish physicians of the public health system in the diagnosis, treatment and monitoring of patients with rare diseases.MethodsWe used a descriptive cross-sectional study through an “ad hoc” survey of 26 questions was completed by 132 primary care physicians and 37 specialists during April and May 2018.ResultsLess than a third of the physicians had received training in rare disease during their undergraduate or postgraduate years, and for hospital professionals, they received more training in the postgraduate period.ConclusionPrimary care physicians and specialists showed low training level in rare diseases. An academical and continuous program on rare disease, as well as, multidisciplinary units and high quality practice guidelines are necessary to help to prevention and support clinical decisions and improve quality of care of patients and families.

Survey of Opinion of Spanish Physicians on the Role of Eosinophils in Asthma and Other Diseases

Survey of Opinion of Spanish Physicians on the Role of Eosinophils in Asthma and Other Diseases

PBI79 EXAMINING BIOLOGIC PRESCRIBING BEHAVIOURS AND ATTITUDES OF ATOPIC DERMATITIS SPECIALISTS IN EUROPE

To examine the factors influencing the prescribing of biologics by atopic dermatitis (AD) specialists across EU5 markets (UK/FR/DE/IT/ES). A multi-country multi-centre medical chart-review study of AD patients was conducted among AD specialists to collect de-identified data. Physician screening criteria: specialty duration (3-30 years), patient volume (≥5 moderate/severe AD patients/month). Physicians were recruited from a geographically representative panel. Physicians abstracted patient diagnosis, symptomatology, disease severity, and factors influencing prescribing patterns of 5 consecutive moderate/severe AD patients. In Q1 2019, 258 physicians abstracted 1307 AD patients (mean age:30.2 years, female:47.9%). German physicians reported a significantly higher proportion of AD patients receiving biologic treatment than physicians in the rest of EU5 (UK:35.3%/FR:34.5%/DE:65.6%/IT:37.6%/ES:24.3%, p<0.05). The most frequently cited reasons for not prescribing biologics were – UK: Only use biologics after other options have failed (52.4%), FR/DE/IT: Patient indecision (43.6%/46.8%/40.9%), ES: Concerns about long term safety (39.0%). Spanish physicians, who have the smallest proportion of biologic patients across EU5, were significantly more likely to report a lack of options available than those in Germany (DE:4.8%/ES:23.0%, p<0.05). Consequently, German physicians report fewer barriers to prescribing biologics and are significantly less likely to report cost/funding issues than physicians in the UK, Italy and Spain (UK:27.0%/DE:4.8%/IT:22.7%/ES:34.0%, p<0.05). French physicians are significantly more likely to be satisfied with current non-biologic treatments than Italian and Spanish physicians (FR:29.5%/IT:11.4%/ES:8.0%, p<0.05). When asked about future prescribing intent, Italian physicians were significantly more likely than UK or French physicians to consider prescribing biologics for patients not currently receiving them in the next 6 months (UK:29.2%/FR:26.3%/IT:48.12%, p<0.05). Myriad factors influence prescribing patterns for AD patients across EU5, highlighting the differing attitudes towards prescribing biologics, and how barriers such as access and reimbursement have varying influence across the EU5. It will be prudent to observe how attitudes change as more biologics become available for AD.

Palliative sedation: beliefs and decision-making among Spanish palliative care physicians.

To describe physician attitudes to deep palliative sedation. A nationwide e-survey of Spanish palliative care specialists was performed using vignettes which described patients close to death with intractable symptoms. Sedation levels were defined according to the Richmond Agitation-Sedation Scale. Multivariate analyses were performed to assess the explanatory factors involved in decision-making. Responses of 292 palliative care specialists were analyzed (response rate 40%). Ninety-four percent, 87%, and 81% of the respondents supported the use of palliative sedation in cases of irreversible refractory symptoms as hyperactive delirium and dyspnea at rest secondary to lung cancer and GOLD stage IV COPD; 60% agreed with the use of palliative sedation in cases of existential suffering. Logistic regression analysis found as the explanatory factor in not performing palliative sedation the physicians' belief that sedation therapy constitutes undercover euthanasia (OR = 12, p < 0.01). Around 80% of physicians who decided on palliative sedation chose deep/complete sedation for every vignette; there were no common explanatory factors for decision-making for every vignette. The belief that sedation therapy equates to undercover euthanasia justifies not performing deep sedation in cases of irreversible refractory agitated delirium (OR = 7) and irreversible intractable dyspnea (OR = 6). Physician background in palliative care and sedation were associated with the selection of deep/complete sedation in cases of refractory delirium and cancer-associated dyspnea. Spanish palliative physicians generally agree with the use of deep sedation as a proportionate treatment in dying patients with refractory symptoms. Decision-making is associated with physician beliefs regarding euthanasia and with the physician's background in palliative care and sedation.

The “Palliative Soul”: Music Therapy, End of Life Care, and Humanizing the Patient

This qualitative research project features semi-structured interviews on perspectives of humanistic care with Spanish physicians and therapists who have worked in or are familiar with music therapy and end of life care, disciplines that identify themselves as centering humanistic values in patient care. The purpose of the study was to have the thirteen music therapists and physicians elaborate on their perceptions regarding humanistic patient care and synthesize common elements from their interviews. A grounded theory approach was used to construct and derive themes among interviewees, and a narrative method of analysis was used to highlight salient philosophies of care and moments of conversation with clinicians. Building off of the interviews, this article explores how artistic engagement in end-of-life contexts sets up avenues for spiritual, psychosocial, and medical care. This “palliative soul” approach to patient care illuminates how health professionals may humanize patients at the end of life: leaning in to experiences of suffering with intention and an open ear, approaching patients in anticipation of their potential spiritual, emotional, and psychosocial needs, defining suffering, wellbeing, and effective clinical intervention through the patient’s voice, thinking actively about their own biases and shortcomings in care, and overall seeing the beauty and humanity in people both within and despite their arrival at end-stage disease. Lastly, this article discusses how even outside the context of end of life care, health professionals may broadly adopt the “palliative soul” and incorporate the needs of patients and their relational networks into clinical practice.

Spanish primary care survey on the management of Helicobacter pylori infection and dyspepsia: Information, attitudes, and decisions.

Dyspepsia and Helicobacter pylori are two of the most relevant digestive conditions in primary care. Several consensuses on the subject have been published, but the assimilation/implementation of these guidelines is uncertain. To evaluate the attitudes, perceptions, limitations, and adherence to recommendations of Spanish primary care physicians using an open online survey. Responses were anonymously codified. Estimated margin of error was 3.4%. Responses were weighted by province, gender, age, and type of practice. Survey was performed using the AEG-REDCap platform. A total of 1445 responses, received between December 2017 and April 2018, were analyzed. Women represented 54%, and the average age was 48years; 59% were from urban context, 20% from semi-urban, and 21% from rural; 93% provided public practice. Over 40% had read at least one Maastricht consensus (24% Maastricht V), and 34% had attended a course related to H.pylori. 16% reported no direct access to any validated diagnostic method, only 44% to urea breath test, and 33% did not systematically refer to eradication confirmation test. The first-line treatment of choice was standard triple therapy in 56%, followed by concomitant therapy (28%). Only 20% of physicians had optimal adherence to recommendations. Even though some improvements from guidelines have been partially incorporated, the level of penetration of recommendations is still poor and delayed. To provide optimal primary care, the barriers for implementation, access to diagnostic tests and to continuous medical education, should be removed. Rigorous dissemination, implementation, and evaluation programs are desired in future consensuses.

Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study.

IntroductionPrimary care (PC) professionals' knowledge about alcohol use has been identified as one of the barriers PC providers face in their clinic. Both PC professionals’ level of training and attitude are crucial in the clinical practice regarding alcohol use.ObjectiveTo evaluate the knowledge, attitude, and preventive practices of Spanish PC physicians and nurses towards alcohol use.DesignAn observational, descriptive, cross-sectional, multi-center study.MethodologyLocation: PC centers of the Spanish National Health System (NHS). Participants: PC physicians and nurses selected randomly from health care centers, and by sending an e-mail to semFYC and SEMERGEN members. Healthcare providers completed an online survey on knowledge, attitude, and follow-up recommendations for reducing alcohol intake. A descriptive, bivariate, and multivariate statistical analysis was conducted (p<0.05).ResultsParticipants: 1,760 healthcare providers completed the survey (75.6% [95% CI 73.5–77.6] family physicians; 11.4% [95% CI 9.9–12.9] medical residents; and 12.5% [95% CI 10.9–14.1] nurses), with a mean age of 44.7 (SD 11.24, range: 26–64, 95% CI: 47.2–48.2). Knowledge was higher in family physicians (p<0.001), older professionals (Spearman's r = 0.11, p<0.001), and resident trainers (p<0.001). The PC professional most likely to provide advice for reducing alcohol use was: a nurse (p <0.001), female (p = 0.010), between 46 and 55 years old (p <0.001).ConclusionsPC providers’ knowledge and preventive practices regarding alcohol use are scarce, hence specific training strategies to increase their knowledge and improve their attitude and skills with regard to this health problem should be considered a healthcare policy priority.

Patient satisfaction in the Spanish National Health System

Determine which key indicators of the Spanish National Health Service (NHS) influence patient satisfaction with the Spanish NHS and physicians (family doctors and specialists). The mean for each indicator for each autonomous community, published by the Ministry of Health, Social Services and Equality, corresponding to the years 2005 to 2014, was related to patient satisfaction by means of multiple linear regression. Patient satisfaction with the NHS was ascertained at 57.32%, with general practitioners at 54.45% and specialist doctors at 55.11%. In the three types of satisfaction, the number of specialist doctors, hospital admissions and in-hospital mortality had a positive and significant influence, while the number of surgical interventions had a negative influence. The greater use of computerized tomography equipment and the hospital infection rate had a negative effect on satisfaction with the NHS and with specialist physicians, while the percentage of outpatient surgery had a positive effect. The average hospital stay shows a negative relationship with satisfaction with family doctors and specialists. Health policies should consider an increase in the number of medical specialists, favour ambulatory surgery, facilitate hospital treatment, monitor the effectiveness of surgical interventions, control hospital infections and moderate the prescription of drugs through the use of alternatives in order to increase patient satisfaction.

Nivolumab for Heavily Pretreated Relapsed/Refractory Hodgkin Lymphoma: Real-Life Experience in Spain (Spanish Group of Lymphoma and Bone Marrow Transplantation, GELTAMO)

Background: Nivolumab, an immune checkpoint inhibitor, has been tested in patients with classical Hodgkin lymphoma (cHL) who failed standard treatment options and has demonstrated remarkable activity with acceptable safety profile in clinical trials. After the impressive results of nivolumab phase I study, a significant number of patients were granted early access to nivolumab through a Name Patient Program (NPP) or compassionate use in Spain. Demonstrating that results of nivolumab use in real-life are similar to those in clinical trials is of major clinical relevance.Objective: The aim of this retrospective study was to analyze the efficacy and safety profile of nivolumab for the treatment of relapsed/refractory (RR) cHL in a real-life context.Methods: We retrospectively collected data from 34 GELTAMO centers. Eligible patients included RR cHL patients treated with at least one cycle of nivolumab. The primary end-point was to describe the overall response rate (ORR). Secondary objectives were to assess the complete response rate (CR), safety of nivolumab, and clinical outcomes (overall survival [OS], and progression free survival [PFS]).Results: Between September 2015 and May 2018, 74 patients with RR cHL received nivolumab monotherapy dosed at 3mg/kg once every 2 weeks (97%). The median age was 38 years (range 17-78). Patients have received a median of 4 (1-15) prior therapy lines; all but 2 were previously treated with brentuximab vedotin (97%), and 38 (51%) of them underwent a hematopoietic stem cell transplantation (HSCT) (n=33 autologous, autoHSCT, and n=5 allogeneic, alloHCST). Median number of nivolumab cycles was 8 (1-65). Ten (14%) patients are still on treatment. Reasons for nivolumab discontinuation were disease progression in 23/64 (36%), referral to HSCT in 27/64 (42%), adverse events (AE) in 8/64 (13%), patient or physician's decision in 5/64 (8%), and unknown in 1/64 (1%). Treatment related AE were reported in 42/69 (61%). Half of them (21, 30%) were probably immune related AE: grade 1-2, 67% (cutaneous n=5, hepatitis n=3, hypothyroidism n=3, gastrointestinal n=3, suprarenal insufficiency n=1); grade 3-4, 24% (pneumonitis n=2, hepatitis n=1, encephalitis n=1, hypothyroidism n=1); grade 5, 3% (pneumonitis n=1, Stevens-Johnson syndrome + hepatitis + nephritis n=1). ORR was 58% (CR 21/72 patients, partial response [PR] 21/72). Stable disease (SD) was achieved in 9 patients (13%). After an initial response (4 PR and 3 SD), 7 patients developed lymphoma progression. A total of 40 (54%) patients finally underwent HSCT, 4 autoHSCT and 36 alloHCST. AlloHSCT was performed after a median of 63 days (41-115) and 8 patients received prior salvage therapy. Complications after alloHSCT consisted of non-infectious fever requiring steroid treatment in 13 (36%), acute graft-versus-host disease in 19 (53%) (2 of them grade 3-4, 1 death), hepatic venocclusive disease in 2 (6%, 1 death), and non-infectious pulmonary complications in 2 (6%). Five (14%) patients died due to transplant complications. At the last follow-up, all autoHSCT patients and 23/36 alloHSCT were in CR. The 2-year OS for the whole series (n=74) was 54% (median not reached). After a median follow-up of survivors patients of 12.5 months (1-31), 29 (39%) were alive in CR.Conclusions: Our real-life experience confirms the efficacy of nivolumab in very heavily pretreated cHL patients with an ORR of 58%. The safety profile of our cohort is comparable with that previously reported in clinical trials with manageable side effects and low treatment related mortality. In our study the percentage of patients who bridged to transplantation was significantly higher to that previously reported indicating this preference for Spanish physicians. AlloHSCT post-nivolumab showed encouraging results and toxicity seemed comparable to that previously described with other treatment regimens.Authors thank Bristol Myers Squibb for its support in this study. DisclosuresMartinez:BMS: Research Funding; Takeda: Consultancy. García-Sanz:Janssen: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Takeda: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria; Hospira: Research Funding; Pharmacyclics: Research Funding; Spanish Government: Research Funding; Gilead: Research Funding; Amgen Inc.: Research Funding; Incyte: Consultancy.

Adherence Of Spanish Primary Physicians And Clinical Practise To The Mediterranean Diet.

The primary objective of this study was to explore physicians' adherence to the dietary pattern known as the Mediterranean diet (MD). As a secondary objective we assessed physicians' awareness on the benefits of the MD and of the possibility of prescribing it. Physicians' adherence to the MD was evaluated through the Spanish associations SEMERGEN and CAMFIC, who sent the validated PREDIMED screener to their affiliates. The results reflected a high, medium, low or very low level of adherence depending on total score. The sample was drawn between 2014 and 2016. The second questionnaire evaluated the physicians' knowledge of the MD and their opinion about recommending it. The PREDIMED test was answered by 422 Spanish physicians. In 8 out of 14 questions, more than 50% of the individuals scored only 1 point. However, 3 questions resulted in 1 point being scored by almost all physicians. Thus, on average, 55% of questions obtained 1-point scoring. The second questionnaire was answered by 212 physicians; 70% of them considered themselves to be aware of the benefits of the MD. More than 60% said they could invest 5 min of their time to recommend the MD. Primary care physicians do not show a high level of adherence to the MD and emphasize the need for creating tools to evaluate it in their patients. This research can be useful as both a database and a justification for the creation of a new protocol to help physicians increase their own and their patients' MD adherence.

Antonio Vallejo-Nágera (1889-1960) and Juan Antonio Vallejo-Nágera Botas (1926-1990).

Antonio Vallejo-Nágera (1889-1960) and Juan Antonio Vallejo-Nágera Botas (1926-1990).

Medical Martyrs: Nineteenth-Century Representations of Early Modern Inquisitorial Persecution of Spanish Physicians

Abstract This essay examines the discourse on medicine and the Inquisition in nineteenth-century Spain. It traces how liberal reformers selectively appropriated aspects of the history of Spanish medicine in the service of their contemporary political and scientific agendas, and how in doing so they contributed to the formation of new professional and national identities.

EL PAPEL DEL GÉNERO, LA EDAD, EL NIVEL LABORAL Y LA SEGURIDAD LABORAL EN EL COMPROMISO DE LOS MÉDICOS ESPAÑOLES DE HOSPITALES PÚBLICOS

The purpose of this paper is to examine how the variables of age, gender, job level and job security affect engagement in a knowledge intensive context. Literature shows a lack of research on how these variables facilitate engagement, and our aim is to provide further evidence on this issue. Using a sample of 167 Spanish public physicians, this found that age does not affect engagement, while gender, job level and job security should be considered as demographic engagement determinants.