The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain.

PURPOSE: The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence. METHODS: A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners' adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted. RESULTS: Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life. CONCLUSION: These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substance-dependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.

Social class and mental health: testing exploitation as a relational determinant of depression.

This study tests whether social class exploitation operates as a relational mechanism that generates mental health inequalities in the nursing home industry. We ask, does social class exploitation (i.e., the acquisition of economic benefits from the labor of those who are dominated) have a systematic and predictable impact on depression among nursing assistants? Using cross-sectional data from 868 nursing assistants employed in 50 nursing homes in three U.S. states, we measure social class exploitation as "ownership type" (private for-profit, private not-for-profit, and public) and "managerial domination" (labor relations violations, perceptions of labor-management conflict). Depression is assessed using the original and revised versions of the Center for Epidemiologic Studies Depression Scale (CES-D and CESD-R). Using two-level logistic regressions, we find that private for-profit ownership and higher managerial domination are predictive of depression among nursing assistants even after adjustment for potential confounders and mediators. Our findings confirm the theoretical and empirical value of applying a social class approach to understanding how mental health inequalities are generated through exploitative mechanisms. Ownership type and managerial domination appear to affect depression through social relations that generate mental health inequalities through the process of acquiring profits, controlling production, supervising and monitoring labor, and enforcing disciplinary sanctions.

[Prevalence of mental health problems and their association with socioeconomic, work and health variables: Findings from the Spain National Health Survey]. / Prevalencia de problemas de salud mental y su asociación con variables socioeconómicas, de trabajo y salud: resultados de la Encuesta Nacional de Salud de España.

The aim of this study is to determine the prevalence of people with mental health problems in Spain and their association with socioeconomic, health and work variables. This is a cross-sectional study with data from the National Health Survey of Spain including 29,476 non-institutionalized people between 16 and 64 years of age. The screening instrument of mental health problems used is the General Health Questionnaire (GHQ-12). Descriptive analyses were performed, and logistic regression was used to verify the association between the prevalence of mental health problems and independent variables, by calculating odds ratios (OR) and the confidence interval. The prevalence of mental health problems is higher in women (24.6%) than in men (14.7%). The variables associated with an increased prevalence of mental health problems are being separated or divorced, being an immigrant from a developing country (men OR 1.3; women OR 1.5), having little social support (men OR 3.6; women OR 3.3), being unemployed or on sick leave, having chronic diseases, and being restricted or severely restricted in one's daily activities because of a health problem (men OR 7.5; women OR 7.1). These results allow the identification of the most vulnerable population groups and may be useful to design interventions.

[Fortalezas y fragilidades en la implantación de la prueba rápida para VIH en un centro especializado en Brasil]. / Strengths and weaknesses of rapid Hiv test implementation in a specialized center in Brazil.

OBJECTIVE: To analyze how health professionals and health service users assess counseling on Rapid HIV test, as well as its implementation, which started in Brazil in 2010, focusing on positive aspects, barriers, and limitations, and analyzing possible meanings that are given to STD and HIV/AIDS. METHOD: Qualitative, exploratory, and descriptive research. Semi-structured interviews were administered to 27 service users and 14 health care professionals; a thematic analysis of the interviews was performed. The study was carried out in one of the first Counseling and Testing Centers (CTC) designed to implement Rapid HIV tests in Porto Alegre, Brazil. RESULTS: Positive aspects of Rapid HIV testing implementation included a reduced waiting time for obtaining the test results, better assistance provision, an increase in the number of service hours, personalized pre- and post-tests, and better prepared health care professionals regarding health care during counseling. Limitations included beliefs about the effectiveness of Rapid HIV testing, physical structure, bad publicity on this technology, and poor health care capacity. Likewise, there are some who oppose this type of test, since they believe rapid tests may not be effective. CONCLUSIONS: Integrating the perspectives of health care professionals and users on this policy will favor future rapid test implementations in other CTCs, and increase health care access possibilities.

OBJETIVO: Analizar cómo los profesionales y usuarios de un servicio de salud evalúan el asesoramiento y las implementaciones de pruebas rápidas de VIH, que comenzaron en 2010, destacando aspectos positivos, barreras y limitaciones, e investigando los posibles sentidos y significados asignados a las EST/VIH/SIDA. MÉTODO: Es una investigación cualitativa, exploratoria y descriptiva. Se realizaron entrevistas semi dirigidas con 27 usuarios de servicios y 15 profesionales de la salud, analizadas con el análisis temático. El estudio se realizó en uno de los primeros Centros de Asesoramiento y Pruebas (CTC) a implementar pruebas rápidas de VIH para todos los usuarios, en Porto Alegre, Brasil. RESULTADOS: Aspectos positivos de la implementación de pruebas rápidas de VIH: disminución del tiempo de espera de los resultados, mejor resolución de asistencia, expansión de las horas de servicio, pruebas pre y post personalizadas, y competencia en el enfoque de atención realizada por profesionales de la salud durante el asesoramiento. Limitaciones: creencias sobre la eficacia de la prueba rápida de VIH, la estructura física, la mala publicidad de la prueba rápida y poca capacidad de asistencia. Hay algunas oposiciones a la tecnología, debido a la creencia de que las pruebas rápidas pueden no ser efectivas. CONCLUSIONES: La integración de las perspectivas de los profesionales y usuarios de atención médica para esta política beneficiará las futuras implementaciones de pruebas rápidas en otros Centros de asesoramiento e incrementar el acceso a los servicios de salud.

"No somos estadísticas "- la prueba rapida del VIH y la consejería de los representantes de las personas LGBT

Resumen El objetivo del estudio fue analizar cómo representantes de Organizaciones No Gubernamentales (ONG) de colectivos LGBT perciben las estrategias de inclusión de la prueba rápida para VIH/aids, sífilis y hepatitis virales en la escena LGBT de Porto Alegre. Fue un estudio cualitativo en el cual se entrevistaron 4 representantes de ONG de colectivos LGBT de la ciudad y analizadas mediante análisis crítico del discurso. Los resultados indican una preocupación de los entrevistados con las estrategias de cuidado que se construyen con la prueba y que tanto se relacionan con perespectivas de derechos humanos. Así, se construye una tensión que tienen como telón de fondo relaciones entre Estado, movimientos LGBT y VIH. Ignorar cuestiones políticas que permean estas relaciones despolitiza una historia en la que los mayores avances en términos de prevención y enfrentamiento de VIH pasaron por una respuesta conjunta entre diferentes actores sociales. Construir nuevos espacios de discusión puede propiciar que nuevas estrategias colectivas sean pensadas en el enfrentamiento de la epidemia, del prejuicio y del estigma.

Resumo O objetivo do estudo é analisar como representantes de ONGs LGBT percebem as estratégias de inclusão do teste rápido para HIV/aids, sífilis e hepatites virais na cena LGBT de Porto Alegre. Trata-se de um estudo qualitativo no qual foram entrevistados 4 representantes de ONGs LGBT da cidade, analisadas mediante análise crítica do discurso. Os resultados apontam para uma preocupação dos entrevistados com as estratégias de cuidado que se constroem com o teste e o quanto elas dialogam perespectivas de direitos humanos. Assim se constroem tensionamentos que tem como pano de fundo relações entre Estado, movimentos LGBT e HIV. Ignorar questões políticas que permeiam estas relações despolitiza uma história na qual os maiores avanços em termos de prevenção e enfrentamento passaram por uma resposta conjunta entre diferentes atores sociais. Construir novos espaços de discussão pode propiciar que novas estratégias coletivas sejam pensadas no enfrentamento da epidemia, do preconceito e do estigma.

Abstract This study was aim to analyze how representatives of LGBT NGOs perceive strategies about the inclusion of the rapid test for HIV/aids, syphilis and viral hepatitis in the LGBT scenario of Porto Alegre. It is a qualitative study in which 4 representatives were interviewed, and the interviews were analyzed through a critical analysis of discourse. The results point to a concern of the interviewees with the care strategies that are built with the test and how much they dialogue with human rights. This leads to tensions that have as a background the relations between State, LGBT movements and HIV. Ignoring political issues that permeate these relations depoliticizes a history in which the greatest advances in terms of prevention and confrontation have gone through a united response between different social actors. Building new spaces for discussion can allow new collective strategies to be considered in coping with the epidemic, prejudice and stigma.

Impacto de la implementación de la prueba rápida del VIH/ITS en un centro de atención especializada en Brasil / Impact of the Implementation of the Rapid HIV/STI Test in a Specialized Care Center in Brazil / Impacto da implementação de teste rápido do VIH/ITS em um centro de atenção especializada no Brasil

Resumen Objetivo: evaluar el impacto de la implementación de la consejería y prueba rápida del VIH e infecciones de transmisión sexual en un centro especializado de consejería y diagnóstico de VIH (CE). Método: estudio analítico con un grupo de intervención y un grupo control en el cual fueron comparadas las medias mensuales de las pruebas y consejerías realizadas entre un centro especializado que implementó la prueba rápida de VIH para todos los pacientes (CE caso) y otro centro especializado que utiliza la modalidad tradicional de la prueba (diagnóstico en treinta días) (CE control). Resultados: el CE (caso) tuvo un aumento significativo en el número de pruebas realizadas entre los dos periodos. En el CE (caso) hubo una disminución en la proporción de personas de la población general que se hicieron la prueba y un aumento en las personas más vulnerables al VIH. Conclusiones: la implementación de la prueba rápida tuvo un impacto positivo en el número de pruebas realizadas y también en el acceso a las personas en situación de vulnerabilidad.

Abstract Objective: to evaluate the impact of the implementation of counseling and rapid testing of HIV and sexually transmitted infections in a specialized HIV counseling and diagnosis center (CE). Method: analytical study with an intervention group and a control group; a comparison was established between the monthly means of tests and counseling sessions performed in a specialized center that implemented the HIV rapid test for all patients (case CE) and another specialized center which uses the traditional form of the test (diagnosis in thirty days) (control CE). Results: CE (case) had a significant increase in the number of tests performed between the two periods. In the CE (case) there was a decrease in the proportion of people in the general population who were tested and an increase in the people most vulnerable to HIV Conclusions: the implementation of the rapid test had a positive impact on the number of tests carried out and also on the access provided to people in vulnerable situations.

Resumo Objetivo: Avaliar o impacto da implantação do aconselhamento e teste rápido de HIV e doenças sexualmente transmissíveis em um Centro de Testagem e Aconselhamento (CTA). Método: Estudo analítico com um grupo de intervenção e um grupo controle em que foram comparadas as médias mensais de Testagem e Aconselhamento realizada em um CTA (caso) que implementou o teste rápido de HIV para todos os pacientes e outro CTA (controle) que utiliza o teste tradicional de HIV em que o resultado fica disponível em 30 dias. Resultados: O CTA (caso) teve um aumento significativo no número de testes realizados entre os dois períodos. Em CTA (caso), houve uma diminuição na proporção de pessoas que realizaram o teste da população geral e o aumentou da realização dos testes pelas pessoas consideradas mais vulneráveis ao HIV Conclusões: A implantação do teste rápido teve um impacto positivo sobre o número de testes realizados e acesso a pessoas em situação de vulnerabilidade.

El autocuidado y apoyo social de mujeres de un proyecto de seguimiento mamográfico en Porto Alegre/Brasil / Self care and social support in women in a program of mammographic monitoring in Porto Alegre/Brasil

Objetivo: Identificar prácticas preventivas de autocuidado y analizar las configuraciones de red de apoyo de mujeres con y sin cáncer de mama registradas en un proyecto de seguimiento mamográfico de Porto Alegre/Brasil. Método: se realizó un diseño secuencial mixto, que amplió los resultados de la etapa cuantitativa (corte transversal y correlacional) a la etapa cualitativa (entrevistas narrativas). Participaron 37 mujeres con diagnóstico de cáncer de mama (grupo 1) y 72 sin este diagnóstico (seguimiento - grupo 2). Los instrumentos utilizados: Cuestionario de Evaluación de la Capacidad de Autocuidado (ASA-A) y Cuestionario de Evaluación del Apoyo Social Percibido y Comunitario. Fueron realizados análisis descriptivos y de comparación de medias (t test y ANOVA) entre los dos grupos. Para profundizar en la comprensión de los datos, seleccionamos cuatro mujeres con cáncer de mama con niveles extremos en la escala de Apoyo Social para participar de las entrevistas biográficas de carácter narrativo. Resultados: los análisis indican que las mujeres que tuvieron cáncer de mama presentan mejores prácticas de autocuidado que las mujeres del proyecto de seguimiento (t=1,791; p=0,027). En cuanto a los análisis del apoyo social, no hubo diferencias estadísticas significativas entre los dos grupos. Todas presentan un nivel medio de apoyo social percibido y comunitario. Los datos cualitativos destacan que después del diagnóstico de cáncer de mama las mujeres mostraron comportamientos de autocuidado que antes no tenían. Conclusiones: el autocuidado fue significativamente mayor en el grupo de mujeres con cáncer de mama, donde el diagnóstico de cáncer fue el que promovió el aumento del autocuidado

Objective: Identify preventive self-care practices and analyze the configurations of the network support for women with and without breast cancer registered in a mammographymonitoring project from Porto Alegre/Brazil. Method: a mixed sequential delimitation was performed, which expanded the results of the quantitative step (cross and correlation section) in a qualitative step (narrative interviews). 37 women diagnosed with breast cancer (group 1) and 72 without this diagnosis (group 2 - monitoring) participated. The following instruments were used: Assessment Questionnaire Self-care Ability (ASA-A) and Assessment Questionnaire Perceived Social Support and Community. There were performed descriptive analysis and comparison of means (t test and ANOVA) between the two groups. To deepen the understanding of the data, we selected four women with breast cancer with extreme levels on the scale of Social Support to participate in the biographical narrative interviews. Results: the analysis indicate that women who had breast cancer have better self-care practices than the women from the monitoring project (t = 1.791, P = 0.027). As for the analysis of social support, there were no statistically significant differences between the two groups. All participants have an average level of perceived social and community support. It was highlighted by the qualitative data that it was after the diagnosis of breast cancer that women lived self-care aspects they had not previously experienced. Conclusions: the self-care was significantly bigger in the group of women with breast cancer, where the cancer diagnosis was a trigger to increase self-care

Prevalence and factors associated with burnout syndrome in professionals in basic health units / Prevalencia y factores asociados al síndrome de burnout en profesionales de centros de atención básica a la salud

El objetivo del estudio es identificar la prevalencia y los factores asociados a Síndrome de Burnout (SB) en 127 profesionales de salud del área metropolitana de Porto Alegre. Se trata de un estudio transversal epidemiológico. Los instrumentos utilizados fueron un cuestionario con datos sociodemográficos y laborales, la batería de evaluación de riesgos psicosociales y el Inventario de Maslach Burnout. Fueron realizados análisis de prevalencia, comparación de medias (ANOVA y test-t) y de correlación de Pearson. Los resultados muestran una prevalencia del 36,2% de agotamiento emocional, 15,7% de despersonalización y el 7,9% de baja realización profesional, que cambian según la categoría profesional. El análisis de asociación muestra que cuanto menor es la edad y la experiencia profesional mayor es el agotamiento emocional. El feedback positivo de los pacientes disminuye el cansancio emocional y aumenta la realización profesional. El feedback positivo de los jefes disminuye el Agotamiento Emocional. A partir de los resultados, es posible pensar en estrategias para reducir la prevalencia de SB entre los profesionales de la salud, teniendo en cuenta las características específicas de cada grupo profesional.

The study aims to identify the prevalence and factors associated with Burnout in 127 graduates from Basic Health Units in the municipal network of a city in the metropolitan area of Porto Alegre. The research tools used were a questionnaire to obtain socio-demographic data and employment variables, the battery of psychosocial risk assessment and the Maslach Burnout Inventory. The results showed a prevalence of 36.2% of Emotional Exhaustion, 15.7% of Depersonalization and of 7.9% Professional Accomplishment. The association analysis shows that psychologists have higher levels of Emotional Exhaustion and Professional Accomplishment and doctors have higher levels of Depersonalization. The higher the pay, the higher Depersonalization and Professional Accomplishment levels go. The role conflict results in an elevation of the dimensions of Emotional Exhaustion and Depersonalization. The positive feedback from patients decreases Emotional Exhaustion and increases Professional Accomplishment, while feedback from supervisors also decreases Emotional Exhaustion.

Prevalencia de problemas de salud mental y su asociación con variables socioeconómicas, de trabajo y salud: resultados de la Encuesta Nacional de Salud de España / Prevalence of mental health problems and their association with socioeconomic, work and health variables: findings from the Spain National Health Survey

El objetivo del estudio es conocer la prevalencia de personas con problemas de salud mental en España y su asociación con variables socioeconómicas, de trabajo y salud. Se trata de un estudio transversal con los datos de la Encuesta Nacional de Salud de España (2006) en el que participaron 29.476 personas (16 y 64 años). El instrumento de cribado de problemas de salud mental utilizado es el General Health Questionnaire (GHQ-12). Se realizaron análisis descriptivos y de regresión logística para verificar la asociación entre la prevalencia de problemas de salud mental y las variables independientes. La prevalencia de problemas de salud mental es mayor en mujeres (24,6%) que en hombres (14,7%). Las variables más asociadas a una mayor prevalencia de problemas de salud mental son estar separado o divorciado, ser inmigrante de un país en vías de desarrollo, tener peores condiciones socioeconómicas, tener poco apoyo social (hombres OR 3,6; mujeres OR 3,3), estar desempleado o en baja laboral, tener enfermedades crónicas, estar limitado/a en la realización de actividades cotidianas en función de un problema de salud (hombres OR 7,5; mujeres OR 7,1). Estos resultados permiten la identificación de grupos de la población más vulnerables y pueden ser de utilidad para diseñar intervenciones(AU)

The aim of this study is to determine the prevalence of people with mental health problems in Spain and their association with socioeconomic, health and work variables. This is a cross-sectional study with data from the National Health Survey of Spain including 29,476 non-institutionalized people between 16 and 64 years of age. The screening instrument of mental health problems used is the General Health Questionnaire (GHQ-12). Descriptive analyses were performed, and logistic regression was used to verify the association between the prevalence of mental health problems and independent variables, by calculating odds ratios (OR) and the confidence interval. The prevalence of mental health problems is higher in women (24.6%) than in men (14.7%). The variables associated with an increased prevalence of mental health problems are being separated or divorced, being an immigrant from a developing country (men OR 1.3; women OR 1.5), having little social support (men OR 3.6; women OR 3.3), being unemployed or on sick leave, having chronic diseases, and being restricted or severely restricted in one’s daily activities because of a health problem (men OR 7.5; women OR 7.1). These results allow the identification of the most vulnerable population groups and may be useful to design interventions(AU)