Study of the Psychometric Properties of the Spanish Version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA).

BACKGROUND: The early detection of moral distress requires a validated and reliable instrument. The aim of this study was to carry out an advanced analysis of the psychometric properties of the moral distress scale for health professionals (MMD-HP-SPA) by performing a validation of the construct and its internal and external reliability. METHODS: We performed a multicentre cross-sectional study in health professionals belonging to the Andalusian public health system. Construct validity was performed by exploratory (n = 300) and confirmatory (n = 275) factor analysis (EFA/CFA) in different subgroups; we also analysed the internal consistency and temporal reliability of the scale. RESULTS: 384 doctors and 191 nurses took part in the survey. The overall mean for moral distress was 128.5 (SD = 70.9), 95% CI [122.7-134.3], and it was higher in nurses at 140.5 (SD = 74.9) than in doctors at 122.5 (SD = 68.1), F = 8.37 p < 0.01. The EFA produced a model of five components which accounted for 54.8% of the variance of the model. The CFA achieved a goodness of fit of Chi2 = 972.4; AIC = 1144.3; RMSEA = 0.086; CFI = 0.844; TLI = 0.828; NFI = 0.785. CONCLUSIONS: The MMD-HP-SPA scale has solid construct validity, excellent internal consistency, optimal temporal reliability, and underlying dimensions which effectively explore the causes of moral distress in health professionals, thus guaranteeing its use in hospital and community settings.

Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain.

BACKGROUND: The COVID-19 pandemic outbreak has severely affected healthcare organizations worldwide, and the provision of palliative care (PC) to cancer patients has been no exception. The aim of this paper was to analyse the levels of health care provided by the Clinical Management Unit for PC in Córdoba (Spain) for cancer patients. METHOD: a retrospective cohort study was conducted. It analyzed the PC internal management database including all cancer patients treated in the period of 2018-2021. RESULTS: 1967 cases were studied. There was a drop in cancer cases (p = 0.008), deaths at the PC hospital (p < 0.001), and referrals from primary care (p < 0.001). However, there was a rise in highly complex clinical situations (p = 0.020) and in ECOG performance status scores of 3-4 (p < 0.001). The pandemic was not shown to be a risk factor for survival in the PC program (0.99 [0.82-1.20]; p = 0.931). However, being female (p = 0.005), being older and having a high Karnofsky Performance Status (KPS) score (p < 0.001) could be indicators of a longer stay. CONCLUSION: The COVID-19 pandemic has presented a challenge in the management of patients requiring PC and has highlighted the urgent needs of the healthcare system if it is to continue providing a level of care which meets the needs of patients and their families.

Programa piloto de tratamiento psicológico grupal en duelo complicado / A Pilot program of group psychological treatment in complicated grief

Objetivo: evaluar la efectividad de un programa piloto de tratamiento psicológico en duelo complicado. Método: se realizó una terapia grupal de duelo complicado en 20 sesiones, con frecuencia quincenal. Las participantes fueron 6 mujeres que recibían tratamiento psicológico en la Unidad de Gestión Clínica de Cuidados Paliativos. El grupo era homogéneo en cuanto a gravedad, tipo de proceso y tiempo del fallecimiento. Se las evalúo antes, durante y después de la intervención mediante escalas psicométricas: el Inventario de Duelo Complicado, la Escala de Ansiedad Depresión Hospitalaria y la Escala de Desesperanza de Beck. Resultados: se encontraron mejorías significativas en sintomatología de duelo y síntomas de depresión desde línea base al postratamiento de depresión, cuatro de los seis participantes estaban asintomáticos en postratamiento. Conclusiones: la intervención grupal puede ser eficaz para el duelo complicado (AU)

Objective: To evaluate the effectiveness of a pilot program of psychological treatment in complicated grief. Material and Method: A group therapy of complicated grief carried out in 20 sessions, with biweekly frequency. The participants were 6 women received psychological treatment in the Palliative Care Unit. The group was homogeneous in terms of severity, type of process and chronology of the loss. They have been evaluated before, during and after the intervention with the following psychometric scales: Inventory of Complicated Grief, Hospital Anxiety Depression Scale and Beck Hopelessness Scale. Results: Significant improvements in complicated grief and depression symptoms were found from baseline to depression posttreatment, four of the six participants were asymptomatic at posttreatment. Conclusions: group intervention can be effective for complicated grief.Keywords: Complicated grief, group therapy, tasks of mourning, emotional support (AU)

Análisis de la duración de los períodos de incapacidad temporal por procesos en Andalucía. Factores asociados / Analysis of the length of sick leave in Andalusia. Associated factors

ObjetivoAnalizar la duración de los periodos de incapacidad temporal (IT) por procesos y sus factores asociados en Andalucía.DiseñoEstudio observacional descriptivo.EmplazamientoAndalucía.ParticipantesSe estudiaron 1.633.405 partes de baja por cualquier contingencia, emitidos por médicos de atención primaria (Servicio Público Salud), del 1 enero de 2002 al 31 diciembre de 2006.Mediciones principalesEstudio descriptivo y análisis bivariante del número de procesos de IT y su duración según sexo, entorno rural y urbano, régimen de la Seguridad Social, diagnóstico y motivo de alta. Se construyó un modelo de regresión lineal múltiple.ResultadosLa tasa de incidencia total de IT ha sido de 15,83 procesos/100 afiliados/año (14,73 en varones y 17,24 en mujeres). Los diagnósticos más frecuentes como motivo de IT fueron lumbago y resfriado común. La media de duración de los procesos de IT en los varones fue inferior a la de las mujeres en 7 días. La mayor parte de los procesos de IT (71,7%) se resuelven en menos de 1 mes. Los procesos de IT que causan mayor duración son: enfermedades endocrinas y trastornos de la inmunidad, neoplasias y trastornos mentales. La duración media de los procesos de IT es superior en el medio rural (45,4) respecto al urbano (36,9). Las variables que predicen la duración de la baja han sido en el modelo sexo, edad y residencia.ConclusionesFactores diferentes del diagnóstico tienen gran influencia en la duración de la IT. Las principales variables que intervienen son la edad, el sexo y el medio rural(AU)

ObjectiveTo analyse the length of sick leave (SL) and its associated factors in Andalusia.DesignDescriptive observational study.SettingAndalusia.ParticipantsA total of 1,633,405 sick leave forms issued from the 1st January 2002 to the 31st of December 2006 for any reason by Primary Health Care doctors in the Public Health Service, were analysed.Main measurementsDescriptive and bivariate analysis of SL health complaints and their length according to gender, rural or urban environment, Social Security scheme, diagnosis and reason for discharge. A model of multiple lineal regression was completed.ResultsThe overall incidence of SL was 15.83 health complaints per 100 Social Security members per year (14.73 in males and 17.24 in women). The most frequent diagnoses for the SL were, lower back pain and the common cold. The mean length of the SL health complaint episodes in men was lower than that of women by 7 days. The majority of the SL health complaints were resolved in less than one month (71.7%). The SL complaints that lasted longer were: endocrine diseases and immune disorders, neoplasms and mental disorders. The mean length of SL is higher in the rural environment (45.4) compared to urban (36.9). The variables that predict the length of sick leave in the model were gender, age and address location.ConclusionsDifferent factors to the diagnosis have a large influence on the length of SL. The main variables that affect this are, age, gender and a rural environment(AU)

Estudio descriptivo de la incapacidad temporal en la provincia de Córdoba / No disponible

La incapacidad temporal (IT) es una situación de infortunio derivada de la alteración de la salud que incapacita temporal y absolutamente para el trabajo habitual o que impide al trabajador el desarrollo de una actividad productiva, cualquiera que fuese su causa. El absentismo laboral es un problema económico, social y sanitario. A pesar de sus repercusiones, la IT es un fenómeno poco estudiado. En este estudio observacional analítico de tipo de cohorte retrospectiva, se evalúa la incidencia de la situación de la Incapacidad Temporal en la provincia de Córdoba durante el período 1995-2002, así como de los factores determinantes de la duración de la IT. La duración de los procesos de IT es debida a factores diferentes al diagnóstico. La mujer presenta en nuestra provincia un mayor nivel de absentismo de IT con respecto al hombre. En el medio rural la duración media de la baja es superior en un 50 % a la del medio urbano a igualdad de causa que origina el proceso de IT

According to the Spanish law, when health's impairment in a worker disables him both in a temporary and absolutely way for the development of his work, or impedes him the development of a productive activity is called temporary disability. It originates the labor absenteeism, which is an economic, social and health problem. In spite of their repercussions, temporary disability is a problem little studied. The present observational study of retrospective cohort, analyze the incidence of the temporary disability in the country of Córdoba (Spain) for the period 1995-2002, as well of the determinant factors in the temporary disability's length. Duration of temporary disability's processes is related to factors different from diagnosis. Women show higher levels of absenteeism than men in temporary disability. For the same health's problem, in rural environments duration of inability is 50% higher that in urban ones