Impact of COVID-19 on mental health of health care workers in Spain: a mix-methods study.

BACKGROUND: Spain's lockdown measures couldn't prevent the severe impact of the COVID-19 first wave, leading to high infections, deaths, and strain on healthcare workers (HCWs). This study aimed to explore the mental health impact on HCWs in the Balearic Islands during the initial months of the pandemic, the influencing factors, and the experiences of those in a COVID-19 environment. METHODS: Using a mixed-methods approach, the study encompassed quantitative and qualitative elements. Cross-sectional survey data from April to June 2020 comprised HCWs who were emailed invitations. The survey covered demographics, work, clinical and COVID-19 variables, along with psychological distress and PTSD symptoms, using validated measures. Additionally, semi-structured interviews with HCWs offered qualitative insights. RESULTS: Three hundred thirty-six HCWs averaging 46.8 years, mainly women (79.2%), primarily nurses in primary care with over 10 years of experience. Anxiety symptoms were reported by 28.8%, 65.1% noted worsened sleep quality, and 27.7% increased psychoactive drug usage. Psychological distress affected 55.2%, while 27.9% exhibited PTSD symptoms. Gender, age, experience, COVID-19 patient contact, and workload correlated with distress, PTSD symptoms, sleep quality, and psychoactive drug usage. Interviews uncovered discomfort sources, such as fear of infection and lack of control, leading to coping strategies like information avoidance and seeking support. LIMITATIONS: Static cross-sectional design, non-probabilistic sample, and telephone interviews affecting non-verbal cues, with interviews conducted during early pandemic lockdown. CONCLUSIONS: HCWs faced significant psychological distress during the pandemic's first wave, underscoring the necessity for robust support and resources to counteract its impact on mental health.

Survivorship care plans in Spain: A need that cannot be postponed.

In Spain, as around the world, the number of cancer survivors is increasing. There were an estimated 500,000 cancer survivors in 2010. In spite of recognition that Survivorship Care Plans (SCPs) are needed, their implementation in Spain has been slower than in other countries and only in very recent years some small initiatives have been carried out. This editorial addresses the difficulties to implement SCPs in the Spanish Health Services and which are the opportunities that favour a scenario in which PCPs and oncologists can offer a real patient-centred care to cancer survivors.

Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care.

BACKGROUND: Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence. AIMS: To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use. METHOD: A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months. RESULTS: At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03-4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04-4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability. CONCLUSIONS: Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.

"Self pop-out": agency enhances self-recognition in visual search.

In real-life situations, we are often required to recognize our own movements among movements originating from other people. In social situations, these movements are often correlated (for example, when dancing or walking with others) adding considerable difficulty to self-recognition. Studies from visual search have shown that visual attention can selectively highlight specific features to make them more salient. Here, we used a novel visual search task employing virtual reality and motion tracking to test whether visual attention can use efferent information to enhance self-recognition of one's movements among four or six moving avatars. Active movements compared to passive movements allowed faster recognition of the avatar moving like the subject. Critically, search slopes were flat for the active condition but increased for passive movements, suggesting efficient search for active movements. In a second experiment, we tested the effects of using the participants' own movements temporally delayed as distractors in a self-recognition discrimination task. We replicated the results of the first experiment with more rapid self-recognition during active trials. Importantly, temporally delayed distractors increased reaction times despite being more perceptually different than the spatial distractors. The findings demonstrate the importance of agency in self-recognition and self-other discrimination from movement in social settings.

Treatment of chronic diabetic foot ulcers with bemiparin: a randomized, triple-blind, placebo-controlled, clinical trial.

AIMS: To assess the efficacy and safety of bemiparin in the treatment of chronic diabetic foot ulcers. METHODS: A triple-blind, parallel, randomized, placebo-controlled trial. Patients aged > 18 years, [corrected] with diabetes for at least 3 years, and with a foot ulcer persisting for > 3 months were selected from 39 Spanish centres. Bemiparin 3500 IU/day for 10 days, followed by 2500 IU/day for up to 3 months plus standard care for ulcers, was compared with placebo plus standard care for ulcers for 3 months. The primary efficacy end-point was ulcer improvement, defined as an objective decrease in ulcer area of >or= 50%, measured by digital photography and ImageJ software, and/or any decrease in Wagner's ulcer grade at 3 months. RESULTS: Ulcer improvement rates were 70.3% (26 of 37 patients) in the bemiparin group and 45.5% (15 of 33 patients) in the placebo group [absolute difference 24.8; 95% confidence interval (CI) 2.3, 47.3; P = 0.035] (number needed to treat 4; 95% CI 2, 43). Complete healing rates at 3 months were similar in both groups (35.1% vs. 33.3%; P = 0.874), as were the number of adverse events. CONCLUSIONS: Bemiparin is more effective than placebo in the management of diabetic foot ulcers and has few side-effects.

[Estimation of the prevalence of attention deficit hyperactivity disorder among the standard population on the island of Majorca]. / Estimación de la prevalencia del trastorno por déficit de atención e hiperactividad en población normal de la isla de Mallorca.

AIM: To determine the rate of prevalence of attention-deficit/ hyperactivity disorder (ADHD) in children of school age (6-11 years) in the Island of Mallorca. SUBJECTS AND METHODS: The epidemiological study was conducted using a community sample extracted by means of multi-stage stratified sampling according to areas (rural, city and touristy) and schooling (public, private and concerted) and consisted in 1,509 children of both sexes. The ADHD Rating Scales-IV (ADHD RS-IV) for home and school setting were used to collect data. The optimal approach to do a diagnostic evaluation, according with the literature, was using a cut-off point of 90 centil. RESULTS: The estimated prevalence of ADHD was 4.57% (CI at 99%: 3.0-5.8%) and we also obtained 1.26% for the hyperactive subtype, 1.06% for the disattentional subtype, and 2.25% for the combined subtype. Contrary to what was expected, prevalence was higher for females but no statistically significant. There were no statistically significant differences between levels, schools or areas. CONCLUSIONS: The estimates for prevalence found in this study are consistent with those reported in the literature (between 3-5%). Using the ADHD rating scale which has different cut-off point regarding age, sex and setting and the fact that it was a poblational based study could explain the higher prevalence in the females. We propose a normalization of the scales in our area in other to confirm our findings.

Changing motor perception by sensorimotor conflicts and body ownership.

Experimentally induced sensorimotor conflicts can result in a loss of the feeling of control over a movement (sense of agency). These findings are typically interpreted in terms of a forward model in which the predicted sensory consequences of the movement are compared with the observed sensory consequences. In the present study we investigated whether a mismatch between movements and their observed sensory consequences does not only result in a reduced feeling of agency, but may affect motor perception as well. Visual feedback of participants' finger movements was manipulated using virtual reality to be anatomically congruent or incongruent to the performed movement. Participants made a motor perception judgment (i.e. which finger did you move?) or a visual perceptual judgment (i.e. which finger did you see moving?). Subjective measures of agency and body ownership were also collected. Seeing movements that were visually incongruent to the performed movement resulted in a lower accuracy for motor perception judgments, but not visual perceptual judgments. This effect was modified by rotating the virtual hand (Exp.2), but not by passively induced movements (Exp.3). Hence, sensorimotor conflicts can modulate the perception of one's motor actions, causing viewed "alien actions" to be felt as one's own.

Terminal cancer. duration and prediction of survival time.

The duration of the terminal period of cancer allows us to determine its prevalence, which is necessary to plan palliative care services. Clinical prediction of survival influences access to palliative care and the healthcare approach to be adopted. The objective of this study was to determine the duration of the terminal period, the prognostic ability of healthcare professionals to predict this terminal period and the factors that can improve the prognostic accuracy. In the island of Mallorca, Spain, we followed 200 cancer patients at the inception of the terminal period. Twenty-one symptoms, quality of life, prognosis and duration of survival were measured. Using a Cox regression model, a predictive survival model was built. Median duration was 59 days; 95% confidence interval (CI)=49-69 days, mean=99 days. The oncologists were accurate in their predictions (+/-1/3 duration) in 25.7% of cases, the nurses in 21.5% of cases and the family physicians in 21.7% of cases. Errors of overestimation occurred 2.86-4.14 times more frequently than underestimation. In the final model, in addition to clinical prognosis (P=0.0094), asthenia (P=0.0257) and the Hebrew Rehabilitation Centre for Aged Quality of Life (HRCA-QL) Index (P=0.0002) were shown to be independent predictors of survival. In this study, the estimated duration of the terminal period was greater than that reported in a series of palliative care programmes, and survival was overestimated. Oncologists could estimate prognosis more accurately if they also take into account asthenia and HRCA-QL Index.

[Knowledge, beliefs and attitudes of the female population towards cancer in Mallorca]. / Conocimientos, creencias y actitudes de la población femenina de Mallorca respecto al cáncer.

BACKGROUND: To analyze the knowledge of the facts on the part of the female population of Mallorca with regard to the causes of cancer, the beliefs regarding diagnosis and treatment and their attitude toward prevention. METHODS: A descriptive cross-section study of a random population sample (n = 124) of women within the 40-69 age range. The questionnaire includes socio-demographic variables, risk factors, early warning symptoms and beliefs regarding diagnosis and treatment and attitudes toward prevention. RESULTS: Cigarette smoking (92.7%; CI:88.1-97.3) and drinking alcoholic (85.7%; CI:79.4-92.0) are the most well-identified causes. Also the presence of a lump in the breast (92.6%; CI:87.9-97.2) and changes in a mole or wart on the skin (89.7%; CI:84.2-95.2%). The underestimate the role of the diet (44.4%; CI:35.1-53.8) and overestimate the environmental factors. The knowledge and use of self-examination procedures on the breast are associated directly with the degree of education (p < 0.05). Most believe that early diagnosis improves the prognosis (IC:94.2-99.5) and that treatment is beneficial (85.2%; CI:78.5-91.9). They consider surgery to be the most highly effective method, and in the event of any doubt they would first see their primary care physician (41.9%; CI:33.2-50.6). It is mainly older women having a low level of completed schooling who get their information regarding cancer above all from the television (43.5%; CI:34.8-52.3). Worthy of special mention is the very small impact of health care personal as a source of information (6.5%; CI:2.1-10.8). CONCLUSIONS: A major knowledge of the facts exists regarding the causes and warning signs, although some misconceptions do exist. In view of future prevention campaigns, educational measures addressed mainly to older women having a low level of completed schooling should be carried out.

Urinary incontinence in Mallorcan women: prevalence and quality of life.

GOALS: To estimate the prevalence, age distribution, impact on quality of life and type of urinary incontinence (UI) in women over 30 years in Mallorca (Spain). MATERIAL AND METHODS: Cross-sectional descriptive study on a randomized sample of 673 women in the health district affiliated to Son Llàtzer Hospital and the 14 Community Health Centres on its area of influence. Following an invitation to participate in the study, women were interviewed twice by their Community Nurse, through the phone and face-to-face. Every interview comprised the completion of the Spanish versions of the ICIQ-SF and EuroQol-5D questionnaires. Prevalence, type and severity (ICIQ-SF) of UI, previous health history and quality of life of women suffering from and free from UI were all estimated. RESULTS: 24% (CI 95%=20.9-27.5%) of women suffered from UI and prevalence increased significantly with age. Most frequently identified type of UI was stress incontinence (45%) followed by mixed incontinence (29%), urge incontinence (19.4%) and continuous incontinence (6.5%). For women suffering from UI, ICIQ-SF mean total score was 9.2, 25.2% of these suffering from moderate to severe UI. Women suffering from mixed or continuous UI scored highest at ICIQ-SF. Women suffering from UI showed worse quality of life in every dimension of EuroQol-5D. Quality of life was especially poor for women suffering from mixed or continuous UI. CONCLUSIONS: One in four women suffers from UI. UI prevalence increases with age. Half of identified women suffered from stress UI. A fourth of identified incontinences were described as moderate to severe. Women suffering from UI showed worse quality of life.

[Triple-blind clinical trial with placebo control to evaluate the efficacy of a heparin of low molecular weight (bemiparin) for treating slow-responding ulcers in diabetic foot in primary care]. / Ensayo clínico, controlado con placebo, triple ciego, para evaluar la eficacia de una heparina de bajo peso molecular (bemiparina) en el tratamiento de las úlceras tórpidas del pie diabético, en atención primaria.

OBJECTIVES: To establish the degree of efficacy of bemiparin treatment over 3 months in the improvement of slow-responding ulcers in diabetic foot. Also, to evaluate the safety of bemiparin and quality of life and to compare the evolution of retinopathy and nephropathy against placebo. DESIGN: Stage III clinical trial to evaluate efficacy and safety in a new indication of a medicine already on the market, parallel in two branches, randomised, triple-blind, and controlled with placebo. SETTING: Health care centres in Mallorca, Spain. PARTICIPANTS: 42 patients per branch, over 18, with type-1 or 2 DM of over 3 years evolution, and one or more first or second-degree ulcers on the Wagner scale, distal to the knee, that did not heal in three months of health care. Randomised allocation in blocks of four.Interventions. The experimental drug was bemiparin (heparin of low molecular weight), injected subcutaneously at 3500 IU/day for the first 10 days and 2500 IU/day up to 90 days. As control, physiological serum was injected sub-cutaneously in a similar volume for masking. MAIN MEASUREMENTS: An "effect"was defined as a reduction of at least 50% in its surface area and/or a favourable evolution in status to a degree between the control at the start of treatment and at three months. Other measurements included proteinuria, retinography and quality of life (SF-36). Analysis of efficacy through principle of intention to treat.

What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women?

OBJECTIVES: Our aim was to determine the probability of correctly diagnosing urinary tract infections (UTIs) from urinary symptoms and signs, studying their sensitivity, specificity and likelihood ratio (LR) when clinical history, signs and reactive strip test results are taken into account. METHODS: An epidemiological analysis with a diagnostic and clinical orientation was carried out in a primary health care setting. The subjects comprised 343 women > or =14 years of age who consulted their family physician for incident urinary tract symptoms. A guided medical examination was carried out using a check-list formulary, reactive strip test, urine culture and the clinical course of all patients. RESULTS: The pre-test probability of having UTI among patients with incident urinary symptoms is 0.484 [95% confidence interval (CI) 0.431-0.536]. Positive LRs for UTI are: painful voiding 1.31 (95% CI 1.12-1.54), urgency 1.29 (95% CI 1.12-1.50), urinary frequency 1.16 (95% CI 1.06-1.28) and tenesmus 1.16 (95% CI 1.02-1.32). The probability of UTI is reduced by the presence of genital discomfort, dyspareunia, vaginal discharge, positive lumbar fist percussion and perineal discomfort. Nitrites on the urine reactive strip test increase the probability of UTI by >5 times, moderate pyuria increases it by >1.5 times, and the presence of both findings does so by >7 times. CONCLUSIONS: In women with urinary symptoms, a thorough clinical examination, together with performance of a reactive strip test during the office visit, improves the chances of detecting UTI.

[The evaluation of an incentive system for the primary care professionals of Mallorca]. / Valoración de un sistema de incentivos por los profesionales de atención primaria de Mallorca.

OBJECTIVE: To describe the assessment made by Mallorca's primary care professionals of the economic incentives system set up in 1994 and find their opinions of financial incentives and other motivating mechanisms. DESIGN: A descriptive, crossover study. SETTING: Primary care in Mallorca (INSALUD of the Balearics). PARTICIPANTS: All the health professionals and ancillary workers (554) of Mallorca's 24 Health Centres. MEASUREMENTS AND MAIN RESULTS: A self-filled questionnaire was used as a measuring instrument. There was a 74% reply rate. Their assessment of the incentives system used was that the distribution of the incentives was unjust and a cause of tension. However, expectations as to the amount received had been met to a reasonable extent. Self-management was a stronger motivating force than incentives (48.4% vs 13.6%). CONCLUSIONS: The incentives system used displayed certain faults (in distribution and the work atmosphere generated). However, decentralization was shown to be a powerful motivating force. Monitoring professionals' expectations and the fulfillment of them should be integrated into management habits.

[The pharmaceutical prescription: a comparison between the old and the new model of primary health care]. / La prescripción farmacéutica: comparación entre el viejo y nuevo modelo de atención primaria de salud.

The possible influence of the model of primary health care (PHC), the educational background of the physician and the type of contract on pharmaceutical prescription were evaluated. The information was obtained from a sample of 1799 prescriptions, which were representative of the overall prescription of the PHC physicians from the Health Service of Palma de Mallorca. The health center physicians (HC) prescribed less expensive drugs than the classical clinic physicians (CC). The mean prize for HC was 498.98, with SD 418.97, and for CC it was 589.65 with SD 750.25. This difference was significant (p less than 0.0001). There were other significant differences, such as a smaller use of preparations with fixed drug associations (p less than 0.01) and parenteral administration (p less than 0.05) by HC. There were no significant differences in the prescription of cerebral and peripheral vasodilators and drugs for the digestive tract and metabolism considered as doubtful indications.