A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP). A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used. The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men (p<0.05). A lower educational level, and separation or divorce, were correlated to an increased intensity of pain. Social support, depression and general and oral health also explained part of pain intensity. The regression model established with these variables accounted for 13.3% of the variability of pain (R2 = 0.133). Women suffer more intense pain than men. Perceived health partially explains the variability of the CPI score. However, it is empirically seen that the variables gender, educational level and marital status exert an important and independent influence upon pain intensity.

Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community – the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients’ OHIP-14 score and pain duration, pain intensity, and various sociodemographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p<0.05) was found for gender, age, marital status, chronic pain grade, self-perceived oral health status and pain duration. Conclusions: The analysis of self-perceived oral health status in patients with OP and TMD, as measured by the OHIP-14, showed that oral health is perceived more negatively by women. Moreover, a one-point increase in the Chronic Pain Grade indicator increases the OHIP-14 indicator by 4.6 points, while chronic pain, defined as pain suffered by patients for one year or more, increases the OHIP-14 indicator by 3.2 points.

The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender. To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD. The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a p≥ 0.05 value for the muscle and arthralgia subtypes. The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent. Key words:RDCTMD, axis I, orofacial pain, temporomandibular disorders, gender.

Background: Medical residents play two roles that enter into conflict during their educational period: trainees and workers. This dual role can lead to dissatisfaction among residents that can affect both the quality of the services they provide to citizens and the proper functioning of the health services model itself. Aim: To analyse discrepancies between the preferences and expectations of first-year medical residents and whether these differences affect satisfaction with the residency. Method: A questionnaire was administered on-line to the entire population of first-year medical residents of the Autonomous Community of Andalusia (Spain) in 2008. We performed a means contrast test between the indicator discrepancy (difference between preferences and expectations during the residency as a training or a working period), overall satisfaction with the residency and their relationship to other expectations of medical residents. Results: Respondents showing greater discrepancy have a more negative opinion about the residency. Conclusion: There is a gap between what residents prefer and what they expect from the residency, giving rise to dissatisfaction. This gap must be bridged to improve the quality of training received by these new physicians, their satisfaction and hence the delivery of health services to citizens.

To analyze the association between the OHIP-14 and the different subtypes making up the clinical and psychological axis obtained using the RDC/TMD. 407 patients treated at the TMD unit of the Andalusian Healthcare Service were administered the Spanish version of the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire (RDC/TMD), together with the Oral Health Impact Profile questionnaire (OHIP-14). The degree of association between the patients' score in the OHIP-14 and the clinical and biopsychosocial variables was analyzed through bivariate and multivariate analyses, specifically through linear regression. 89.4% of the treated patients were women, while 10.6% were men, with an average age of 42.08 ± 14.9 years. The mean score and standard deviation for the OHIP-14 was 20.57 ± 10.73. A significant association (p < 0.05) was observed with the following variables: Axis I, jaw disability checklist, depression, somatization, perceived pain duration, and pain interference with activities of daily living. The analysis of the relation between self-perceived health in patients with TMD, as measured by the OHIP-14, showed a R2 of 0.3979, with a higher Beta value for the association between the OHIP and patients with both myofascial pain and arthopathy, jaw disability, depression, a higher pain duration and a higher pain interference with activities of daily living.

La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Las características sociales, económicas y culturales que definen el rechazo, es decir, el “tipo” de mujer que rehúsa la epidural, coinciden con el esquema de “mujer tradicional” estudiado por otros autores (que se caracteriza por tener escasos recursos económicos, nivel educativo bajo y que se dedica, fundamentalmente, a realizar labores domésticas en su propio hogar), lo cual se interpreta en un contexto de universalización de la oferta, como un indicador más de las desigualdades en salud generadas, en esta ocasión, por conductas y valores de género propios de sociedades patriarcalmente concebidas. Knowledge and use of epidural analgesia has become increasingly widespread in Spain over the last 20 years. In Andalusia (southern Spain), expectant mothers have the right to choose this analgesic technique during labor and delivery, an option that depends solely on the physical or health status of the mother or the availability of the resources at the hospital at the time of childbirth. Preference is determined by two interrelated factors. Firstly, a cognitive component, which is influenced by the values, perceptions and culture of the mother and, secondly, a behavioral component, i.e., the acceptance or rejection of the technique, which will depend not only on the motives determining the choice, but on the possibility of choosing epidural analgesia as well as the above-mentioned conditioning factors. To determine the characteristics of women in Andalusia who refuse epidural anaesthesia during labor, even when this analgesic technique is readily available to them. Annual surveys on user satisfaction with hospital care in Andalusia conducted from 2000-2007 were used, specifically data provided by women who gave birth in public hospitals in Andalusia. Based on these data, a hierarchical segmentation analysis was conducted to determine the profile of women who refused this analgesic technique. Educational level, income and employment status played a significant role in rejection of epidural anaesthesia during labor. The social, economic and cultural factors underlying rejection, that is, the profile of women who reject epidural analgesia, is consistent with the paradigm of the “traditional woman” (characterized by limited income, low educational level and mainly occupied by housework) studied by other authors. Given the universal use of this procedure in Andalusia, rejection of epidural analgesia can be interpreted as yet another indicator of inequality in healthcare due, in this case, to gender-related attitudes and values characteristic of patriarchal societies.