Chronicity and use of health services: peer education of the School of Patients. / Cronicidad y uso de servicios sanitarios: la formación entre iguales de la Escuela de Pacientes.

OBJECTIVE: To evaluate the impact of the training strategy of the Escuela de Pacientes (School of Patients) on the use of health services among people with chronic diseases. METHOD: Quantitative design study of pretest and posttest evaluation with a population of 3,350 chronic patients of the Escuela de Pacientes (Andalusia, 2013-2015). A questionnaire adapted from the Stanford University was used. It measured the self-perceived health, number of health visits, and level of trust and communication with health personnel. A descriptive and bivariate study, a correlation study and a pretest/posttest net gain analysis were performed. RESULTS: Participation of 964 patients (28.8% of the population), of which 18.8% were men, mean age 56 years. Training increased trust in Primary Care (PC) and Hospital Care (HC) professionals (0.44 and 0.65 points), medical visits decreased by 25%, and hospital admissions fell by 51% with statistically significant differences by sex and disease. The correlation index between trust in professionals and use of health services was -0.215. CONCLUSION: The training strategy had a positive impact on the use of health services and trust in health professionals, and were identified areas of improvement from which recommendations are established.

Cronicidad y uso de servicios sanitarios: la formación entre iguales de la Escuela de Pacientes / Cronicidade e utilização de serviços de saúde: a formação entre iguais na Escola de Pacientes / Chronicity and use of health services: peer education of the School of Patients

RESUMEN Objetivo: Evaluar el impacto de la estrategia formativa de la Escuela de Pacientes en el uso de servicios sanitarios entre las personas con enfermedades crónicas. Método: Diseño cuantitativo de evaluación pretest y postest con una población de 3350 pacientes crónicos de la Escuela de Pacientes (Andalucía, 2013-2015). Se empleó un cuestionario adaptado de la Universidad de Stanford, que midió: salud autopercibida, número de visitas médicas y nivel de confianza y comunicación con el personal sanitario. Se realizó estudio descriptivo y bivariante, estudio de correlación y análisis de ganancias netas pretest/postest. Resultados: Participaron 964 pacientes (28,8% de la población): el 18,8% hombres, edad media 56 años. La formación aumentó la confianza en el personal de Atención Primaria (AP) y Atención Hospitalaria (AH) (0,44 y 0,65 puntos), descendieron las visitas médicas en un 25% y los ingresos hospitalarios en un 51%, con diferencias estadísticamente significativas por sexo y enfermedad. El índice de correlación entre confianza con profesionales y uso de servicios sanitarios fue de −0,215. Conclusión: La estrategia formativa tuvo un impacto positivo en el uso de servicios sanitarios y confianza con personal sanitario, detectándose áreas de mejora a partir de las cuales se establecen recomendaciones.

Resumo Objetivo: Avaliar o impacto da formação da Escola de Pacientes entre iguais sobre a utilização de serviços sanitários das pessoas com doenças crónicas. Método: Desenho quantitativo da avaliação pré-teste e pós-teste com uma população de 3.350 pacientes da Escola de Pacientes (Andaluzia, 2013-2015). Foi usado um questionário adaptado da Universidade de Stanford, que mediu: saúde autopercebida, visitas médicas, nível de confiança e comunicação com o pessoal sanitário. A análise estatística incluiu estudo estatístico descritivo e bivariado, estudo de correlação e análise de ganhos líquidos pré-teste/pós-teste. Resultados: Participaram 964 pacientes (28,8% da população do estudo), 18,8% homens, idade média de 56 anos. Depois da formação, a confiança no pessoal de Atenção Primária (AP) e Atenção Hospitalar (AH) aumentou (0,44 e 0,65 pontos, respectivamente), as visitas médicas decresceram em 25% e as entradas hospitalares em 51%, com diferenças estatisticamente significativas por sexo e doença. O índice de correlação entre confiança nos profissionais e utilização de serviços de saúde foi de −0,215. Conclusão: A estratégia formativa teve um impacto positivo na utilização dos serviços de saúde e na confiança no pessoal de saúde, detectando-se áreas de melhoria a partir das quais se estabelecem recomendações.

ABSTRACT Objective: To evaluate the impact of the training strategy of the Escuela de Pacientes (School of Patients) on the use of health services among people with chronic diseases. Method: Quantitative design study of pretest and posttest evaluation with a population of 3,350 chronic patients of the Escuela de Pacientes (Andalusia, 2013-2015). A questionnaire adapted from the Stanford University was used. It measured the self-perceived health, number of health visits, and level of trust and communication with health personnel. A descriptive and bivariate study, a correlation study and a pretest/posttest net gain analysis were performed. Results: Participation of 964 patients (28.8% of the population), of which 18.8% were men, mean age 56 years. Training increased trust in Primary Care (PC) and Hospital Care (HC) professionals (0.44 and 0.65 points), medical visits decreased by 25%, and hospital admissions fell by 51% with statistically significant differences by sex and disease. The correlation index between trust in professionals and use of health services was −0.215. Conclusion: The training strategy had a positive impact on the use of health services and trust in health professionals, and were identified areas of improvement from which recommendations are established.

Evaluación de una estrategia formativa entre iguales en fibromialgia: Un análisis de género / Evaluation of a Training Strategy between Peers in the Field of Fibromyalgia: A Gender Analysis / Avaliação de uma estratégia formadora entre pessoas com fibromialgia: Uma análise de gênero

La fibromialgia es una enfermedad crónica altamente feminizada que requiere mayor autonomía y autoeficiencia en el manejo de los cuidados. Objetivo: evaluar, desde una perspectiva de género, la estrategia formativa de pacientes con fibromialgia de la Escuela de Pacientes, basada en la formación "entre iguales". Método: estudio cuantitativo, con diseño cuasiexperimental pretest- postest, con 600 participantes con fibromialgia. Se utilizó un cuestionario adaptado del Programa de Paciente Experto de la Universidad de Stanford que recoge las variables: salud autopercibida, estrés emocional, calidad y hábitos de vida, limitaciones, relación con el personal sanitario y autoeficiencia. Se empleó el análisis bivariado y multivariado y análisis del cambio entre pretest/postest. Resultados: los participantes en la formación (98 % mujeres) describieron un mal estado de salud, con altos niveles de cansancio, dolor y limitaciones, con diferencias significativas en función del perfil sociodemográfico. Tras la formación, mejoró el estrés emocional y los hábitos de vida, se redujeron las visitas médicas y aumentó el automanejo de la enfermedad. Conclusión: la formación entre iguales representó una estrategia educativa eficiente y un espacio óptimo para reforzar el compromiso y apoyo social, con resultados positivos para la salud emocional y autoconfianza de las mujeres con fibromialgia.

Fibromyalgia is a chronic disease found more commonly in women that requires a greater autonomy and self-sufficiency in care management. Objective: To evaluate, from a gender perspective, the strategy for training fibromyalgia patients from the School of Patients, based on training "between peers". Method: Quantitative study before and after testing, with 600 participants with fibromyalgia. A questionnaire adapted from the Expert Patients Programme at Standford University that includes the following variables: self-perceived health, emotional stress, quality and lifestyle, limitations, relationship with the health care personnel and self-efficacy. The bivariate and multivariate analysis was used, as well as the analysis of change between pre-test/post-test. Results: Participants in the training (98% women) described a poor health, with high levels of fatigue, pain and limitations, with significant differences according to the sociodemographic profile. After the training, emotional stress and lifestyle improved, the number of visits to the doctor dropped and disease self-management increased. Conclusion: Training between peers represented an effective education strategy and an optimal opportunity to reinforce social commitment and support, with positive results for the emotional health and self-confidence of women with fibromyalgia.

A fibromialgia é uma doença crônica altamente feminizada que requer maior autonomia e autoeficiência na gestão dos cuidados. Objetivo: avaliar, sob uma perspectiva de gênero, a estratégia formadora de pacientes com fibromialgia da Escola de Pacientes, baseada na formação "entre iguais". Método: estudo quantitativo pré-teste e pós-teste, realizado com 600 participantes na formação sobre fibromialgia. Utilizou-se um questionário adaptado do Programa de Paciente Especializado da Stanford University, que coleta as variáveis: saúde autopercebida, estresse emocional, qualidade e hábitos de vida, limitações, relação com o pessoal sanitário e autoeficiência. Empregou-se a análise bivariada e multivariada, e a análise da mudança entre pré-teste e pós-teste. Resultados: os participantes na formação (98% mulheres) descreveram um mau estado de saúde, com altos níveis de cansaço, dor e limitações, com diferenças significativas em função do perfil sociodemográfico. Após a formação, melhorou-se o estresse emocional e os hábitos de vida, reduzem-se as visitas médicas e aumentou-se a autogestão da doença. Conclusão: a formação entre iguais representou uma estratégia educativa eficiente e um espaço adequado para reforçar o compromisso e o apoio social, com resultados positivos para a saúde emocional e a autoconfiança das mulheres com fibromialgia.

Proceso de adaptación en mujeres con lesión medular: relaciones entre variables psicológicas y sociodemográficas / Adaptation Process in Women with Spinal Cord Injury: The Relationship between Psychological and Socio-demographic Variables / Processo de adaptação em mulheres com lesão medular: relações entre variáveis psicológicas e sociodemográficas

Objetivo: conocer el funcionamiento psicológico de 44 mujeres con LM en el proceso de adaptación a la lesión; en concreto, las estrategias de afrontamiento, la motivación y ansiedad de ejecución, el neuroticismo-extraversión, la depresión y su posible relación con variables sociodemográficas. Método: se trata de un estudio con estrategia correlacional y diseño de evaluación transversal. El proceso de selección ha sido realizado a través de centros sanitarios y de asociaciones de personas con discapacidad. Participaron un total de 44 mujeres con LM, residentes en su mayoría en el Principado de Asturias (54,5%) y en Euskadi (40,9%), aunque también contamos con una pequeña representación de mujeres procedentes de Valladolid (4,5%). Resultados: las diferencias significativas halladas nos muestran puntuaciones más elevadas en la escala de depresión en mujeres casadas y con menor nivel educativo. Los datos de este estudio reflejan la existencia de procesos individualizados de adaptación con un funcionamiento bastante aleatorio respecto a las variables sociodemográficas y, por tanto, apoyan los postulados del modelo de diferencias individuales en el proceso de adaptación a la LM. Conclusión: se sugiere que los procesos terapéuticos deben ser sensibles a la aparición de sentimientos de desesperanza y depresión en las mujeres con LM.

Objective: The primary objective of this research is to examine the psychological reaction of 44 women with SCI during their process of adaptation to spinal cord injury, specifically with regard to coping strategies, motivation, performance anxiety, neuroticism, extraversion, depression and the possible relationship between these variables and others of a socio-demographic nature. Method: this is a correlational study with cross design strategy and evaluation. The selection process was carried out through health centers and associations of people with disabilities. A total of 44 women with LM participated, mostly resident in Principality of Asturias (54.5%) and Basque Country (40.9%), although they have a small representation of women from Valladolid (4.5%). Results: The significant differences that were found show the highest scores on the depression scale pertain to women who are married and have less schooling. Moreover, the data from the study reflect the existence of individualized processes of adaptation with highly random functioning in terms of the sociodemographic variables, thereby supporting the assumptions on the model of individual differences in the process of adaptation to spinal cord injury. Conclusion: They also suggest therapeutic processes must be sensitive to the appearance of feelings of hopelessness and depression in women with spinal cord injury.

Objetivo: conhecer o funcionamento psicológico de 44 mulheres com LM no processo de adaptação à lesão; em concreto, as estratégias para enfrentar a doença, a motivação e a ansiedade de execução, o neuroticismo-extraversão, a depressão e a sua possível relação com variáveis sociodemográficas. Método: este é um estudo correlacional com a estratégia de design da cruz e avaliação. O processo de seleção foi realizado por meio de centros de saúde e associações de pessoas com deficiência. Um total de 44 mulheres com LM, a maioria residente no Principado das Astúrias (54,5%) e País Basco (40,9%), embora tenham uma pequena representação das mulheres de Valladolid (4,5%). Resultados: as diferenças significativas encontradas nos mostram pontuações mais elevadas na escala de depressão em mulheres casadas e com menor nível educativo. Os dados deste estudo refletem a existência de processos individualizados de adaptação com um funcionamento bastante aleatório a respeito das variáveis sociodemográficas. Conclusão: apoiam as premissas do modelo de diferenças individuais no processo de adaptação à LM.

Eficacia del contacto e información como técnicas de cambio de actitudes hacia personas con discapacidad en niños de Educación Primaria / Effectiveness of Contact and Information as Attitudes Change Techniques towards People with Disabilities in Primary School Children

La actitudes negativas hacia las personas con discapacidad imperantes en la sociedad plantean la necesidad de intervenciones que modifiquen tales actitudes. Con este objetivo se ha desarrollado un programa de cambio de actitudes hacia personas con discapacidad en alumnos de educación primaria, 100 niños y niñas, entre 7 y 10 años, asignados 39 al grupo experimental y 61 al grupo control. Se utilizaron como técnicas de cambio la información y el contacto. También se efectuó un seguimiento de dos años y medio, durante el que se realizaron actividades recordatorio. El instrumento de evaluación utilizado fue la Escala de Actitudes hacia Personas con Discapacidad (Verdugo, Arias & Jenaro, 1994). Los resultados alcanzados abogan por la eficacia de estas técnicas, al encontrase entre las medidas pretratamiento y postratamiento diferencias estadísticamente significativas para estas últimas a favor del grupo experimental. Tales cambios se mantienen en el seguimiento.

The negative attitudes toward people with disabilities prevailing in our society suggest the need for interventions to modify those attitudes. With this aim a program in changing attitudes towards people with disabilities in primary school children has been developed. 100 children between 7 and 10 years old took part in the study, 39 were assigned to the experimental group and 61 to the control group. Information and contact have been used as change techniques. It has also been followed up for two years and a half. During this time, activities reminders have been made. The assessment instrument used was the Scale of Attitudes toward People with Disabilities (Verdugo, Arias & Jenaro, 1994). The results obtained argue for the effectiveness of these techniques. There are statistically significant differences between pretreatment and posttreatment measures in favor of the experimental group. Also, these changes at follow up have been maintained.

Relación entre variables clínicas y psicológicas en mujeres con lesión medular / Relationship between clinical and psychological variables in women with spinal cord injury

Este artículo se enmarca en la línea de estudios centrados en el abordaje de los aspectos psicológicos implicados en la rehabilitación de las personas con discapacidad. En este contexto se analiza, en un grupo de 44 mujeres con lesión medular (LM), la relación entre una serie de variables psicológicas y otro grupo de variables clínicas, todas ellas relevantes a lo largo del proceso de adaptación a la lesión. En general, los resultados muestran independencia entre las puntuaciones en las distintas escalas psicológicas y las variables clínicas analizadas. Estos datos reflejan la existencia de procesos individualizados de adaptación, y ofrecen soporte empírico al modelo de las diferencias individuales en el estudio del proceso de adaptación a la LM...

This article uses, as a framework, research focused on the psychological aspects of rehabilitating people with physical disabilities. In this study the cases of 44 women with spinal cord injury (SCI) were analyzed with regards to the relationship between a series of psychological variables and another group of clinical variables, all of them relevant in the SCI adaptation process. In general the results of this study show the subjects as independent as measured by various psychological scales and other analyzed clinical variables. These data reflect the existence of individualized adaptation processes and empirically support the individual differences model in studying the SCI adaptation process...

[Perceived health and use of health care services in inmates of an Andalusian prison, 1999]. / Percepción del estado de salud y utilización de servicios sanitarios por parte de las personas internas en una prisión Andaluza, 1999.

BACKGROUND: The study of the health condition of the populations under confinement in penitentiaries is based on the evidence of a more deteriorated health than the general population and a greater degree of social exclusion, which is associated with worse general health. This study is aimed at ascertaining how the inmates of an Andalusian penitentiary perceive their health condition and the use made thereby of the healthcare services, as well as the factors associated with those variables. METHODS: Descriptive, cross-sectional study. The data was collected with a questionnaire. The sample size was 450 inmates, 90.4% of whom were males. RESULTS: Seventy-two percent of those taking part in the study considered their health to be good or very good, 32.7% stating having seen the doctor once a month or more often. A total 43.1% of the participants stated having chronic illnesses, mainly HIV (19.1%) and hepatitis C (18.2%); 40.9% stating that they take medication. Worse health was perceived among the older inmates, those who have to serve longer than a five-year sentence, those who are repeat offenders and those not having pending trials. Those perceiving their health to have deteriorated over the past year have chronic illnesses and take medication. The regression model for the use of healthcare services shows that they are used to a greater extent by those who are serving a longer than a 5-year sentence, those who have been in prison for less than a year and those who take medication. CONCLUSIONS: The results show the importance of increasing the monitoring of possible addictive disorders upon entering prison and of the trend and treatment of chronic diseases.