Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65.

AIM: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Adults over 65 years of age with T2DM treated at the Madrid Primary Care Service. MAIN MEASUREMENTS: Data collection: Electronic Health Record database. VARIABLES: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. RESULTS: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15-13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86-16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04-12.02). CONCLUSIONS: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.

[Ramadan and diabetes mellitus in adult muslim population].

Background: Although sick people are exempted from performing Ramadan, it is estimated that approximately 50 million people with diabetes mellitus (DM) fast during this month. Objective: To explore the relationship between Ramadan and DM in adult Muslim population as well as management and recommendations from literature related with this issue. Method: A narrative review was carried out in PubMed, Cochrane and Cuiden, databases, using controlled and free language for the period 2009-2014, and language filters (Spanish and English). Content analysis of selected documents in order to find emerging thematic categories was conducted. Results: The results have been organized into five thematic categories: the desire for Ramadan; changes that occur in the body by fasting; complications from fasting; control of DM during fasting; knowledge of healthcare professional. Conclusion: Those believers who wish to take part in Ramadan and suffering DM, have to go to their health care professional before performing because, although people with good control can perform the fast, the treatment must be individualized, considering the composition and amount of food they are going to eat.

Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain.

The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models.

Advancing migration and health research by examining return migration.

This essay offers an analysis of research on return migration and health by adopting the social determinants of health (SDH) framework proposed by the WHO. Specifically, we argue that the SDH are implicated in the decision to migrate, stay or return, which in itself also contributes to social health inequities. Most theoretical frameworks developed to study migration have predominantly considered primary migration movements. The lack of a fluid consideration of the migration phenomenon has a direct impact on our understanding of the relationship between migration and health. In this essay, we, first, address the challenges of defining and studying return and its implications for health research. Second, we propose to use the WHO's SDH framework to understand how social factors shape migrants' health, influence the decision to return and can contribute to health inequalities. The conceptual approach developed in this paper can help design future studies on the health of return migrants, fostering interdisciplinary collaborations to investigate how social factors are embodied, giving rise to health inequities in society that are intricately linked to the migration experience.

Financial toxicity in allogeneic haematopoietic stem cell transplant patients from a social determinants of health perspective.

PURPOSE: Financial toxicity (FT) refers to the subjective perception of financial distress resulting from objective economic strain due to illness, exerting a detrimental influence on health outcomes. This study aimed to describe FT among allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients within a public health framework, employing a social determinants of health approach. METHODS: A multi-centre cross-sectional study involving adult allo-HSCT patients was conducted across three public hospitals in Madrid. FT was assessed using a validated COST scale (range 0-44; lower scores indicating higher FT). Patient-administered paper/online questionnaires were utilized to collect data on sociodemographic, socioeconomic, clinical, and healthcare access variables. Descriptive, non-parametric univariate statistical analysis and multiple linear regression models were performed. RESULTS: Sixty-six patients, with a mean age: 52.5 years (SD: 11.5), 50% women, 28.7% displaced to Madrid for HSCT, and 71.4% lacking financial support were included. The median FT score was 20 points (IQR 12-27.25). Independent factors associated with higher FT included being females (Coef = -3.26; p = 0.079), perceived income loss after HSCT (Coef = -6.81; p < 0.001) and a monthly household income of ≤1000 € compared to 1001-2500€ (Coef = 8.29; p = 0.005) or >2500 € (Coef = 15.75; p < 0.001). CONCLUSIONS: Despite the limited sample size, our findings underscore the presence of financial toxicity among allo-HSCT patients, shaped by social determinants of health. Recognizing and addressing FT within the HSCT process is essential to mitigate social inequalities in health.

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

AIM: To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. DESIGN: Cross-sectional, analytical, observational study. PARTICIPANTS AND CONTEXT: Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. MAIN MEASUREMENTS: Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. RESULTS: There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. CONCLUSIONS: The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results.

[Current epidemiological overview of the most frequent cancers in Spain. Implications for nursing care]. / Cánceres mas frecuentes en España. Panorama epidemiológico actual.

This article is to describe the epidemiological situation of cancer and prevention strategies, particularly related to the work of nurses (primary prevention and early detection), focusing primarily on lung cancer (LC), breast (BC) and colorectal (CRC). 98,046 cancer deaths occurred in Spain in 2006, which is the leading cause of death in our country. The main action of prevention for the LC is based on smoking cessation, the main risk factor (relative risk (RR) from 10 to 30) beside radon and asbestos exposures. Basically the prevention for the BC is based on early detection, mammography remains the ultimate test because it reduces mortality, and must be done along period between 50 and 70 years old with a two-year interval. CRC mortality is reduced by 16% due to early detection test based on fecal occult blood (TsOH), but it's necessary to insist on changes in lifestyle (diet and exercise) as primary prevention strategies, and in breast cancer too. One of the most effective ways to reduce the impact of cancer today is the prevention, which is carried out mainly by the nurses.

Non-pharmaceutical interventions during COVID-19 in the UK and Spain: a rapid realist review.

The paper is located at the crossroads of two modern intellectual movements. The first, evidence-based policy, seeks to locate vital information that will inform and improve key policy decisions on such matters as population health, social welfare, and human wellbeing. The second, complexity theory, describes the nature of the social world and perceives human action as persistently adaptive and social institutions as incessantly self-transformative. The first assumes that policies and programmes can achieve sufficient control to meet specific and measurable objectives. The second assumes that social actions are sufficiently capricious so that the society never conforms to anyone's plans - even those of the most powerful. The unparalleled resources committed to control the unprecedented attack of the COVID-19 pandemic are the epitome of complexity. The long struggle to contain the virus thus constitutes an ideal test bed to investigate this paradigmatic split. The paper undertakes this mission - focusing specifically on the effectiveness non-pharmaceutical interventions and examining evidence from the UK and Spain.

Recruiting Participants in Vulnerable Situations: A Qualitative Evaluation of the Recruitment Process in the EFFICHRONIC Study.

In recent years, stakeholder involvement in research has become a central element of responsible research. The EFFICHRONIC project reflects these principles and aims to reduce the burden of chronic diseases and increase the sustainability of the healthcare system through the implementation of an evidence-based chronic disease prevention and self-management programme. The qualitative study presented here is part of EFFICHRONIC and aims to explore and understand the recruitment strategies implemented in the participating countries (Spain, UK, Netherlands, Italy, and France). Semi-structured interviews were conducted with the country coordinators (purposive sampling of the five coordinators responsible for the recruitment strategy), and a coding and synthesis process was used to conduct a thematic analysis. The analysis resulted in five main categories: (1) Stakeholder recruitment strategies. (2) Facilitators to recruitment. (3) Barriers to recruitment. (4) Strategies developed to address recruitment challenges. (5) Lessons learned. From a collaborative approach to the co-production process, recruitment has helped to build a wide network and new relationships with local actors, explore and learn about the social world, step out of the comfort zone of health institutions, combine a wide variety of strategies, and innovate by taking into account the institutional and cultural contexts of each country.

Nurses competence in the reporting of medication-related incidents: An intervention study.

OBJECTIVES: Less than 5% of all harmful medicine-related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs. DESIGN: One-group pre-test-posttest design. SETTING: Tertiary, public, teaching hospital in Spain. PARTICIPANTS: A total of 139 RNs responded to pre- and postintervention questionnaires constituting the paired sample subjected to analysis. INTERVENTION: A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes. MAIN OUTCOME MEASURES: Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34-170 points) by means of an electronic questionnaire. RESULTS: A statistically significant 7.96-point increase in OC from baseline to the final measurement was obtained (CI: 5.05-10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06-9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no-harm MI postintervention compared to 4.4% pre-intervention (p < .001). A one-point increase in OC improved the probability of becoming reporter by 2.9% and a one-point increase in skills by 6.4%. CONCLUSION: MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no-harm MIs reported.

[Uncovering infertility: the experience of women undergoing assisted reproductive technologies.] / Descubrir la infertilidad: la experiencia de mujeres sometidas a técnicas de reproducción asistida.

OBJECTIVE: Infertility is a huge reproductive health problem in developed countries. The aim was to understand the infertility experience of women who have undergone assisted reproduction technologies. METHODS: Qualitative study using Grounded Theory. Through intentional sampling and theoretical sampling, 20 women who had undergone Assisted Reproduction Technologies in public hospitals and specialized private clinics in Spain were selected. Data were collected using semi-structured interviews and were analysed using the principles of Grounded Theory: initial coding and focused coding, memo writing, theoretical sampling and constant comparative method. RESULTS: "Uncovering infertility: unveiling the unknown" is the core category that explains the process which women go through. Four subcategories emerged and describe the temporal process from seeking pregnancy to reception and coping with the infertility diagnosis: "Seeking for a vital desire: being mothers/fathers", "Suspecting infertility: the absence of the natural", "In search of a diagnosis: knowing and understanding the problem" and "The impact of diagnosis: a vital grief". CONCLUSIONS: Uncovering infertility is a process that has an impact on the different areas of women's lives. This process produces different emotions and feelings such as guilt, frustration, sadness or anger. This process could be easier if women have the support of their partner, their social environment and if they share their problem with women who have the same situation.

OBJETIVO: La infertilidad es uno de los grandes problemas de salud reproductiva en los países desarrollados. El objetivo de este estudio fue comprender la experiencia vivida de la infertilidad por mujeres que se han sometido a técnicas de reproducción asistida. METODOS: Estudio cualitativo de Teoría Fundamentada. Mediante muestreo intencional y muestreo teórico se seleccionaron 20 mujeres que habían sido sometidas a técnicas de reproducción asistida tanto en hospitales públicos como en clínicas privadas especializadas en España. La técnica de recogida de los datos fue la entrevista semiestructurada. El análisis siguió los procedimientos de la Teoría Fundamentada: codificación inicial y focalizada, escritura de memos analíticos, muestreo teórico y método de comparación constante. RESULTADOS: "Descubrir la infertilidad: desvelar lo desconocido" es la categoría principal que explica el proceso que viven las mujeres. Emergieron cuatro subcategorías que describen el proceso temporal desde el inicio de la búsqueda de embarazo hasta la recepción y afrontamiento del diagnóstico de infertilidad: "Buscar un deseo vital: ser madres/padres", "Sospechar la infertilidad: la ausencia de lo natural", "En busca de un diagnóstico: conocer y comprender el problema" y "El impacto del diagnóstico: un duelo vital". CONCLUSIONES: Descubrir la infertilidad es un proceso que afecta a los distintos ámbitos de la vida de las mujeres y en el que aparecen emociones y sentimientos como culpa, frustración, tristeza o rabia. Este proceso puede estar facilitado cuando se tiene el apoyo de su pareja, el entorno y se comparte el problema con mujeres que tienen su misma situación.

Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol.

INTRODUCTION: Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS: A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION: Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER: CRD42020147655.

Bayesian spatio-temporal models for mapping TB mortality risk and its relationship with social inequities in a region from Brazilian Legal Amazon.

BACKGROUND: Reducing TB mortality is a great challenge in Brazil due to its territorial extension, cultural variations and economic and political crises, which impact the health system. This study aimed to estimate in space and time the risk of TB mortality and test its relationship with social inequities. METHODS: This was an ecological study that included deaths from TB between 2006 and 2016 in Cuiabá, Brazilian Legal Amazon. Bayesian models based on the integrated nested Laplace approximation approach were used to estimate spatio-temporal RRs. RRs for TB mortality were obtained according to the covariables representative of social inequities. RESULTS: The risk of TB mortality was stable between 2006 and 2016 and high-risk areas were identified throughout the municipality studied. Regarding social inequities, income was an important factor associated with TB mortality risk, as an increase of 1 SD in income resulted in a 35.4% (RR 0.646; CI 95% 0.476 to 0.837) decrease in risk. CONCLUSIONS: The results provided evidence of areas with higher TB mortality risks that have persisted over time and are related to social inequities. Advancing social policies and protections in these areas will contribute to achieving the WHO's End TB strategy.

[Reference population values of the Spanish version of the COOP/WONCA charts of quality of life in an urban adult population]. / Valores poblacionales de referencia de la versión española de las viñetas COOP/WONCA de calidad de vida en población adulta urbana.

BACKGROUND AND OBJECTIVE: We intended to obtain reference population values of the COOP/WONCA charts of health-related quality of life (HRQOL) among a Spanish urban adult population. MATERIAL AND METHOD: Cross sectional study based on data from the Survey of Health of the City of Madrid 2005. 7341 adults were selected by biphasic cluster sampling. The variable HRQOL was measured through COOP/WONCA charts of quality of life (9 dimensions), culturally validated for Spanish people. Other variables included age, sex, marital status, and social class, zone of origin and level of education. Statistical treatment included descriptive statistics for the dimensions and summation of HRQOL, significance tests (Kruskal-Wallis, Mann-Whitney, ANOVA), analysis of internal consistency and correlation. RESULTS: Highest mean values were found in the dimensions Changes in the State of Health, Health Status, Physical Form and Social Support. The average value of the dimensions and the summation of HRQOL increased significantly with age, and in parallel to a lowering of the social class and depending on the country of origin (higher in native people). They were also higher in women. The alpha of Cronbach for the questionnaire was 0.77. CONCLUSIONS: Reference population values were obtained for a Spanish urban adult population according to sex, age, social class and status of native or immigrant people. All ratings increased with age and were highest in women. The availability of benchmarks values contribute to the score' interpretation, which would ease the systematic use of tools of self-assessed health in clinical practice.

[Aging in a methadone maintenance program. A perspective from the framework of social determinants of health]. / Envejecer en un programa de mantenimiento con metadona. Una perspectiva desde el marco de los determinantes sociales de la salud.

OBJECTIVE: People on methadone treatment have increased their life expectancy, aging prematurely with comorbidities. The objective of this study was to know the sociodemographic and clinical profile of these people in the Center for Addiction Care in the district of Latina (belonging to Madrid Salud), as well as the perception of the influence of the treatment on their aging. The Social Determinants of Health Model was used as a framework. METHODS: A mixed methodology was used in two phases: a quantitative one, to describe the sociodemographic and clinical characteristics of the study population; and another qualitative one, through semi-structured interviews to an intentional sample, to explore the history of life and the perception of future needs regarding the health of the participants. RESULTS: The results highlighted that the average age of the sample was 48.28 years, that they were mostly men (81.25%), of Spanish origin, with a low level of education and economics and with a medium stay in treatment with methadone of ± 13 years. An increase in mental pathologies was found the more years they had been in the program, as well as, at a lower age of onset in consumption, the presence of HIV and Hepatitis C virus increased. In their speeches it was found that the social determinants of Health have conditioned its vital history. CONCLUSIONS: Both consumption and methadone contribute to its stigmatization, not favoring its normalized inclusion in society and determining a high state of vulnerability. This increases as age does, not receive adequate resources to meet their future needs.

OBJETIVO: Las personas en tratamiento con metadona han aumentado su esperanza de vida, envejeciendo de una forma prematura con comorbilidades. El objetivo de este estudio fue conocer el perfil sociodemográfico y clínico de estas personas en el Centro de Atención a las Adicciones del distrito de Latina (perteneciente a Madrid Salud), así como la percepción de la influencia del tratamiento en su envejecimiento. Se tuvo como marco el Modelo de los Determinantes Sociales de Salud. METODOS: Se utilizó una metodología mixta en dos fases: una cuantitativa, para describir las características sociodemográficas y clínicas de la población de estudio; y otra cualitativa, mediante entrevistas semiestructuradas a una muestra intencional, para explorar el historial de vida y la percepción de necesidades futuras respecto de la salud de los participantes. RESULTADOS: En los resultados destacó que la edad media de la muestra era de 48,28 años, que eran en su mayoría hombres (81,25%), de origen español, con un nivel de estudios y económico bajos y con una estancia media en tratamiento con metadona de ±13 años. Se encontró un aumento de patologías mentales cuantos más años llevaban en el programa, así como que, a menor edad de inicio en el consumo, aumentaba la presencia de VIH y virus de la Hepatitis C. En sus discursos se halló que los determinantes sociales de la salud han condicionado su historia vital. CONCLUSIONES: Tanto el consumo como la metadona contribuyen a su estigmatización, no favoreciendo su inclusión normalizada en la sociedad y determinando un estado elevado de vulnerabilidad. Ésta aumenta a medida que lo hace su edad, no recibiendo los recursos adecuados para atender a sus futuras necesidades.

Flexibilidad en las pautas take home de metadona en los CAD de Madrid Salud durante la pandemia de Covid-19 / Flexibility in the methadone take home guidelines in the CAD of Madrid Salud during the Covid-19 pandemic

El objetivo del estudio fue examinar qué cambios se realizaron en los horarios de dispensación y las pautas take home de metadona solución oral y comprimidos, en los siete Centros de Atención a las Adicciones (CAD) de Madrid Salud, a raíz del estado de emergencia y a lo largo de un año posterior a su entrada. Se realizó un estudio descriptivo longitudinal, obteniendo los datos de la revisión de los informes elaborados por la unidad de farmacia, encargada del suministro y control de la metadona, en tres momentos: febrero de 2020 y marzo de 2021, para las pautas de metadona quincenal; y además en noviembre de 2020 para las de tratamiento con metasedín. Se realizó un análisis de estadística descriptiva, calculándose frecuencias absolutas y relativas, así como el porcentaje de variación entre el primer momento y el último momento de medición. En todos los centros se redujeron los días de dispensación. Las pautas quincenales take home de solución de metadona aumentaron más del 50% en todos los centros, manteniéndose un año después un incremento total del 97%. Las personas en tratamiento de mantenimiento con Metasedín se incrementaron en un 45,3%. Las restricciones de movilidad debido al confinamiento por Covid-19 obligaron a flexibilizar y ampliar el take home. La buena respuesta de las personas en tratamiento ha favorecido el mantenimiento de los cambios, lo que ayuda a la normalización de un tratamiento estigmatizado. (AU)

The objective of the study was to examine the changes made in the dispensing schedules and oral solution methadone take home doses and tablets, in the seven Addiction Care Centers (CAD) of Madrid Salud, because of the state of emergency, and which ones remain one year later. A longitudinal descriptive study was conducted, obtaining the data from the review of the reports prepared by the pharmacy unit, responsible for supply and control of methadone, at three times: February 2020 and March 2021, for the two weeks methadone doses; in addition, people treated with Metasedín were included in November 2020. A descriptive statistical analysis was performed, calculating absolute and relative frequencies, as well as the percentage of variation between the first moment and the last moment of measurement. Dispensing days were reduced in all centers. Two weeks methadone solution take home doses increased by more than 50% in all centers, maintaining a total increase of 97% one year later. People in Metasedín maintenance treatment increased by 45.3%. Mobility restrictions due to confinement by Covid-19 forced to make more flexible and expand the take home. The good response of people in treatment has favored maintaining the changes, which helps to normalize a stigmatized treatment. (AU)

Intersectorality and social participation as coping policies for health inequities-worldwide.

OBJECTIVE: To determine the impact that intersectoral policies and social participation, implemented worldwide, have had on the modification of the social determinants for health and on the reduction of social health inequities. METHOD: A scoping review of the literature published in the period 2005-2015 was performed. The literature search was conducted on PubMed and Scielo databases. Two researchers reviewed each document. Data were analysed according to the intersectoral action and social participation variables and according to the theoretical frameworks of the Social Determinants Model of the Commission on Social Determinants of Health (CSDH) and the theoretical constructs of Social Capital (SC) and Life Course (LC). RESULTS: Out of 45 documents likely to be selected for final review, all of them based on title and abstract, 20 documents were eventually picked out and analysed; most them (n = 8) were conducted in all Latin America and Latin America's countries. Twelve documents reported intersectoral action associated with social participation in partnership with different institutions. Regarding theoretical frameworks, most of studies (n = 8) used CSDH and SC. In relation to health outcomes, the studies showed mainly: increased access to health and education, follow-up of pregnant women, increasing in prenatal examinations, reduction in malnutrition/child mortality, reduction in extreme poverty/hunger; reduction in epidemics/tuberculosis, control of alcohol/drug consumption, promotion of health/mental as well as basic sanitation improvements. CONCLUSIONS: Intersectoral and social participation experiences studied yielded positive outcomes regarding health status and quality of life in the communities in which such experiences were implemented.

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65 / Factores psicosociales en la adherencia al tratamiento farmacológico y el control de la diabetes mellitus en pacientes mayores de 65 años

Aim: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. Design: Cross-sectional study.Setting and participantsAdults over 65 years of age with T2DM treated at the Madrid Primary Care Service. Main measurements: Data collection: Electronic Health Record database. Variables: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. Results: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15–13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86–16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04–12.02). Conclusions: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.(AU)

Objetivo: Explorar la influencia de los síntomas de ansiedad/depresión y del riesgo social en pacientes mayores de 65 años con diabetes mellitus tipo 2 (DM2), tanto en la no adherencia al tratamiento farmacológico (no AdhT) como en el mal control de la DM2.Diseño: Estudio descriptivo transversal. Emplazamiento y participantesAdultos mayores de 65 años con DM2 atendidos en el Servicio de Atención Primaria de Madrid.Principales mediciones: Recogida de datos: base de datos de historia clínica electrónica. Variables: mal control de T2DM (HBA1c) y no AdhT (prueba de Morisky-Green); principales variables clínicas: síntomas de depresión/ansiedad y riesgo social. Se utilizaron modelos globales de regresión logística multivariante y desagregados por sexo para no AdhT y mal control de DM2. Resultados: Se obtuvieron datos de 884 sujetos. Prevalencia de no AdhT: 4,4%; prevalencia de mal control de DM2: 37,2%. Los modelos de regresión logística multivariante para no AdhT en hombres mostraron un mayor riesgo si tenían síntomas de ansiedad/depresión (OR: 3,88; IC del 95%: 1,15-13,07); y en mujeres, si tenían riesgo social (OR: 5,61; IC del 95%: 1,86-16,94). Los modelos de regresión logística multivariante para el control deficiente de la DM2 en los hombres revelaron un mayor riesgo si no tenían AdhT (OR: 3,53; IC del 95%: 1,04-12,02). Conclusiones: En personas mayores de 65 años con DM2, aunque la no AdhT es baja, la prevalencia de mal control de la DM2 es alta. Los síntomas de depresión o ansiedad son un factor de riesgo de no AdhT en los hombres, mientras que el riesgo social tiene el mismo efecto en las mujeres. La no AdhT en los hombres aumenta el riesgo de un control deficiente de la DM2. Desde una perspectiva de género, es importante detectar problemas de salud social y mental en adultos mayores con diabetes y reforzar estrategias para mejorar su adherencia al tratamiento farmacológico y control glucémico en estos pacientes.(AU)

Design and validation of a questionnaire on nursing competence in the notification of medication incidents. / Diseño y validación de un cuestionario sobre competencia enfermera en la notificación de incidentes por medicamentos.

AIM: To design and perform a face and content validation of a questionnaire to measure the competence of hospital RN to report medication incidents. METHODS: Content and face questionnaire validation descriptive study. A review of the literature was performed for the creation of ítems. A panel of six experts assessed the relevance of the inclusion of each ítem in the questionnaire by calculating the position index; ítems with position index >0.70 were selected. The questionnaire was piloted by 59 RN. Finally, a meeting was convened with experts, in order to reduce the length of the piloted questionnaire through review, discussion and decision by consensus on each item. RESULTS: From the literature review, a battery of 151 ítems grouped into three elements of competence: attitudes, knowledge and skills was created. 52.9% (n=80) of the ítems received a position index > 0.70. The response rate in the pilot study was 40.65%. The median time to complete the questionnaire was 23:35minutes. After reduction by the experts, the final questionnaire comprised 45 ítems grouped into 32 questions. CONCLUSIONS: The NORMA questionnaire, designed to explore the competence of hospital RN to report medication incidents, has adequate face and content validity and is easy to administer, enabling its institutional implementation.

[Meningococcus meningitis nursing intervention from an epidemiological perspective]. / Meningitis meningocócica. Intervención enfermera desde una perspectiva epidemiológica.

Meningitis is an infectious process which can be caused by diverse infectious agents. Among these, Neisseria meningitides or meningococcus is the mot relevant in our environs due to its high degree of incidence and its mortality; especially in recent years, the C sera group is increasing its incidences, particularly in children aged one to four so this type of meningitis has become one of the most preventive types and therefore, treatable from a nursing perspective. It is important to know the epidemiological sequence in order to be able to provide an efficient and effective treatment at every stage of its development.