[Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors]. / Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos.

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. MAIN MEASUREMENT: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations.

[Gender analysis of the Spanish Fertility Survey 2018]. / Análisis con perspectiva de género de la Encuesta de Fecundidad 2018 en España.

OBJECTIVE: To analyze the language and content of the questionnaire used in the Fertility Survey 2018, from a gender perspective. METHOD: Qualitative design based on a content analysis of the questionnaire used in the Fertility Survey 2018. Methodological recommendations and guides for gender-sensitive statistics were used, together with the comparison established with the Generations and Gender Survey. The categories of analysis were: language, sexual division of labor and fertility. The analysis procedure included the checklist and the incorporation of emerging variables specifically related to gender inequalities and biases. RESULTS: The questionnaire uses with some inclusive language, but maintains the generic use of masculine gender, reproduces gender stereotypes and uses male-female binomials as a single concept. It offers a limited perspective on sexual division of domestic and care labor, horizontal and vertical segregation in the workplace, gender differences between the access and control of resources. In relation to fertility, it reproduces gender inequalities and biases that build a normalized and idealized vision on having children, do not reflect the differential impact of pregnancy and parenting on women's health and prioritize the biological dimension of motherhood and fatherhood. CONCLUSIONS: The Spanish Fertility Survey needs to improve its gender sensitivity, reflect the heterogeneous biological, socio-economic and structural dimensions of fertility and explore deeper into the differential elements that generate inequalities and gender biases.

Psychological impact of COVID-19 pandemic in Western frontline healthcare professionals. A systematic review. / Impacto psicológico de la COVID-19 en profesionales sanitarios de primera línea en el ámbito occidental. Una revisión sistemática.

The aim of this study was to assess the psychological impact among healthcare workers who stand in the frontline of the SARS-CoV-2 crisis and to compare it with the rest of healthcare professionals, by means of a systematic review of Western publications. The systematic review was carried out in PubMed, Scopus and Web of Science databases and 12 descriptive studies were reviewed. The European and American quantitative studies reported moderate and high levels of stress, anxiety, depression, sleep disturbance and burnout, with diverse coping strategies and more frequent and intense symptoms among women and nurses, without conclusive results by age. In the first line of assistance the psychological impact was greater than in the rest of the health professionals and in the Asian area. It is necessary to go deeper into the emotional experiences and professional needs for emotional support in order to design effective interventions for protection and help.

[Women's emotional accounts of induced abortion]. / Experiencias emocionales en la interrupción voluntaria del embarazo.

OBJECTIVE: To explore women's emotional accounts of induced abortion, analyzing qualitative scientific publications. METHOD: Qualitative systematic review of 19 studies published in PubMed, Science Direct and Scopus from 2010 onwards. The articles based on qualitative research design were revised using inductive content analysis. RESULTS: The analysis identified three main themes regarding women's emotional experiences: access to abortion, emotional impact during medical assistance, and individual, relational and sociocultural determinants. The studies showed the variability in women's emotional accounts, mainly determined by the following factors: Access and waiting times, health system, type of intervention, degree of awareness and participation regarding the use of technical and medical technologies, interaction with health professionals, and specificity of individual, relational and sociocultural context. The main emotional difficulties were related to the ethical conflict, the decision-making, the relation with the social and health system and stigma. As main facilitating aspects, women highlighted autonomy in decision-making and emotional support, while barriers referred to social rejection and negative messages perceived from the political, social and health system. CONCLUSIONS: The emotional accounts around induced abortion depend on individual and relational factors, as well as on health assistance, all mediated by gender inequalities and bias. Improvements in health assistance refer to an integral and individualized attention, adapted to women's needs.

Psychological impact of COVID-19 pandemic in Western frontline healthcare professionals. A systematic review.

The aim of this study was to assess the psychological impact among healthcare workers who stand in the frontline of the SARS-CoV-2 crisis and to compare it with the rest of healthcare professionals, by means of a systematic review of Western publications. The systematic review was carried out in PubMed, Scopus and Web of Science databases and 12 descriptive studies were reviewed. The European and American quantitative studies reported moderate and high levels of stress, anxiety, depression, sleep disturbance and burnout, with diverse coping strategies and more frequent and intense symptoms among women and nurses, without conclusive results by age. In the first line of assistance the psychological impact was greater than in the rest of the health professionals and in the Asian area. It is necessary to go deeper into the emotional experiences and professional needs for emotional support in order to design effective interventions for protection and help.

El objetivo de este estudio fue conocer el impacto psicológico entre el personal sanitario de primera línea en la asistencia a pacientes con SARS-CoV-2 y compararlo con el resto de profesionales sanitarios, a través de una revisión sistemática de la producción científica en el ámbito occidental. La revisión se realizó en las bases PubMed, Scopus y Web of Science y se seleccionaron 12 artículos. Los estudios cuantitativos realizados en Europa y EE. UU. refirieron niveles moderados y altos de estrés, ansiedad, depresión, alteración del sueño y burnout, con estrategias de afrontamiento diversas y síntomas más frecuentes e intensos entre mujeres y enfermería, sin resultados concluyentes por edad. En la primera línea de asistencia, el impacto fue mayor que en el resto de profesionales sanitarios y que en el ámbito asiático. Se requiere profundizar en las experiencias emocionales y necesidades profesionales de apoyo emocional, para diseñar intervenciones eficaces de protección y ayuda.

Emotional paths of professional experiences in transplant coordinators. / Rutas emocionales en las experiencias profesionales de los equipos de coordinación de trasplantes.

BACKGROUND AND OBJECTIVE: To look at transplant coordinators' professional narratives and explore their emotional experiences, coping strategies, needs and demands in relation to the donation interview. MATERIALS AND METHODS: Exploratory, transversal, multicenter design, using grounded theory, qualitative approach and content analysis of open-ended questionnaire and semistructured interviews with 22 transplant coordinators from the Andalusian Public Health System. Categories of analysis: Transplant coordination: perceptions, functions, impact and consequences; Positive/gratifying aspects and negative/ difficult aspects; Donation interview; Coping strategies; Needs, demands and suggestions. RESULTS: Transplant coordinators maintain a polarized perspective on their work, which they describe as a challenge and an opportunity. They highlight both their satisfaction and professional commitment as their work difficulties and requirements, which represent stress factors with an impact on professionals' perceptions, life styles, identity or physical and psychical life. Most gratifying work aspects refer to professional excellence, successful transplants and relationship with patients and their families. The donation interview is considered to be the most stressful moment, in response to which coordinators develop different emotional paths, conditioned by their experience, families' response to donation and its interpretation by the health team and professional (self) evaluation. Main professional demands are training strategies, group therapies and institutional support. CONCLUSIONS: The complexity and emotional intensiveness of transplant coordination require special interventions aiming to enable professionals towards an improvement of their emotional heath and management.

[Heroine, but no Superwoman. Evaluation of a peer-training activity for women with breast cancer]. / Heroína, pero no Superwoman. Evaluación de una formación entre iguales para mujeres con cáncer de mama.

OBJECTIVE: To evaluate a peer-training intervention for women with breast cancer, from a gender perspective: to discover the results of the intervention and examine in-depth the personal experiences of patients and health professionals participating in the training activity. METHOD: Mixed method multicentre design completed in 2017 in Andalusia (Spain), with a pre and post evaluation questionnaire with 102 patients, measuring life style, limitations, use of health services, communication with professionals and self-management; and content analysis of semi-structured interviews and focus groups with 21 patient-trainers and 5 health professionals, looking at experiences, needs and suggestions for improvement. RESULTS: The patients described a good general health status, with improvements of: diet quality (7 in pre-test to 7.7 in post-test), limitations for daily life (from 1.93 to 1.64 points), self-efficacy (from 6.46 to 7.42 points). Age, civil status and level of education generated statistically significant differences, with more improvement in more vulnerable social profiles. Participants revealed the benefits of the peer-training at a personal, relational, psycho-emotional and socio-cultural level and expressed how the training changed their experiences around identity-construction and gender roles. The improvement dimensions related to organization, evaluation and continuity. CONCLUSIONS: The peer-training intervention is a positive experience for women's physical, relational and emotional health and, from a gender perspective, it represents an opportunity, at both individual and group level, to negotiate and deconstruct gender roles when living with breast cancer.

Emotional experiences of health professionals in organ procurement and transplantation. A systematic review. / Vivencias y emociones profesionales en el proceso de donación y trasplantes de órganos. Una revisión sistemática.

INTRODUCTION: The objective was to explore, discuss and synthesize the emotional experiences of health professionals during the process of organ procurement and transplantation. METHODS: A systematic review was made in Medline, Science Direct and the Virtual Library of the Andalusian Public Health System, selecting 16 original articles for inclusion in the review, with qualitative evaluation and narrative synthesis. RESULTS: The results revealed the main use of qualitative methodology, and 4emergent themes were identified: working in organ procurement and transplantation; the transition of professional roles; emotional experiences; and, coping strategies and emotional management. This systematic review revealed the complex and diverse character of professionals' emotional experiences as well as the importance of the interpersonal relationship. CONCLUSIONS: Intense emotional experiences related to the sense of responsibility, the work challenge and coping strategies based on reward searching explained important contradictions and tensions about professional roles and functions, especially during the donation interview.

[Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)]. / Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía.

OBJECTIVE: To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. METHODS: A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. RESULTS: The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. CONCLUSIONS: Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills.

Opiniones de menores residentes en Andalucía (España) sobre temas de salud: Aplicación de un cuestionario por Internet / Opinions of minor children residing in Andalusia (Spain) on health-related topics: An online questionnaire

Objetivo: Analizar opiniones de menores sobre el concepto de salud, centros y profesionales sanitarios así como recomendaciones en forma de consejos sobre promoción de salud. Métodos: Estudio transversal con cuestionario online dirigido a menores de 14 años de edad. Se utilizó una versión adaptada del cuestionario Kid's Hospital, el cual contiene preguntas abiertas y cerradas. Resultados: Contestaron al cuestionario 358 menores, de los cuales 225 fueron niñas (61,3%). La edad media global fue de 9,2(DE 2,61). Asocian buena salud con la ausencia de enfermedad (n=165, 46,1%) y estar en forma (n=151, 42,2%) ; sobre experiencias de la última visita al médico, reconocen el papel de ayuda y mediación de estos profesionales (n=233, 65,1%); destacan la ayuda y la recuperación como lo mejor de la atención, y como lo peor los pinchazos y el dolor padecido. De los consejos emitidos para promoción de salud destacan aquellos sobre alimentación (n=233, 62,3%). Conclusiones: Los cuestionarios online a menores, constituyen una forma útil de recolección de información. Así, estas consultas directas permiten la participación de los niños y niñas o de los menores y proporcionan información útil para adecuar las intervenciones de cara a fomentar la promoción entre iguales, así como sobre sus preferencias en el diseño de intervenciones.

Objective: To analyze opinions of minors regarding the concept of health, health centers, and professionals, as well as providing them with recommendations on health promotion in the form of health promotion advice. Methods: A cross-sectional survey with an online questionnaire aimed to kids below 14. An adapted version of Kid's Hospital questionnaire was utilized, which has both open and closed questions. Results: 358 minors answered the questionnaire, 225 of which were girls (61.3%). The mean global age was 9.2 years (SD 2.61). They associated good health with the absence of illnesses (n=165, 46.1%) and being in shape (n=151, 42.2%). Regarding their experiences about their last doctor's appointment, they acknowledged the aiding and mediation role of these professionals as the best features of the assistance (n=233, 65.1%) and the pain suffered and syringe jabs as the worst ones. They also highlighted healthy eating advice from the health promotion advice given (n=233, 62.3%). Discussion: Online questionnaires for minors are a useful data collection tool. These direct queries allow them to participate and provide useful information to adequate medical interventions in order to develop actions for health promotion, as well as taking their opinions into account when designing interventions.