Effects of a home care community-dwelling intervention on cognition, mental health, loneliness and quality of life in elder people: The VERA study.

BACKGROUND: New technologies can provide practical solutions that respond to the needs of the elderly, improving their quality of life and well-being. The aim of this research was to validate a multimodal approach based on a video call system, by comparing the scores of different clinically validated tests at baseline and at the end of the intervention. METHODS: A longitudinal study was conducted with 7 healthy participants aged 61 to 92 years over a 6-month period. To measure the effectiveness of the intervention, five variables were assessed: cognitive impairment, quality of life, general health, perceived loneliness, and depression. The following inventories were used as instruments to measure the aforementioned variables at baseline, mid intervention and after intervention: MEC-35 scale, Fototest, FUMAT scale, WHOQOL-BREF scale, Yesavage Geriatric Depression Scale, the Spanish adaptation of the Hamilton Scale, the revised ESTE scale and the Goldberg's GHQ28 Mental Health scale. RESULT: The obtained results confirmed our hypothesis and the participants showed significant improvements after intervention in all the assessed domains except the cognitive domain, as expected. Results in FUMAT, WHOQOL-BREF, Yesavage Geriatric Depression, revised ESTE and the Goldberg's GHQ28 Mental Health scales were statistically significant (p < 0.05) and the effect sizes were large after intervention compare to baseline. CONCLUSIONS: We have shown that the intervention has been effective in providing the participants with psychological and social benefits in the variables of quality of life, general health, perceived loneliness and depression. The high clinical relevance achieved from the results obtained makes the system a very suitable tool to promote the independence and well-being of people who receive community-dwelling home care.

Social support as a mediator in the relationship between technostress or academic stress and health: analysis by gender among university students.

Introduction: This research aims to study the role of social support as a mediator in the relationship between technostress or academic stress and health in university students. Methods: A descriptive, quantitative cross-sectional study has been carried out through a self-reported survey answered by 389 students during March and April 2022. The current level of health was the outcome variable. Technostress and academic stress were the criterion variables. Perceived social support was the mediator variable. The sociodemographic variables and ICT use at the educational level were the independent variables. Results: Women have higher levels of technostress and academic stress than men. Social support significantly and positively mediates the relationship between academic stress and self-perceived health in men. Discussion: There is a clear need to develop new social management strategies that assist students in developing stable and long-lasting social networks, which can reduce stress during the student period and provide personal tools for later working life.

Clinical characterization and factors associated with quality of life in Long COVID patients: Secondary data analysis from a randomized clinical trial.

BACKGROUND: Long COVID patients suffer a negative impact on their quality of life, as well as their functioning, productivity or socialization. There is a need to better understand the individual experience and circumstances surrounding these patients. OBJECTIVE: To characterize clinical picture of Long COVID patients and to identify factors associated with quality of life. METHODS: A secondary data analysis from a randomized clinical trial (RCT) was carried out with 100 Long COVID patients treated by Primary Health Care and residents in the territory of Aragon (northeast of Spain). The main variable of the study was quality of life, evaluated using the SF-36 Questionnaire, in relation to socio-demographic and clinical variables. In addition, ten validated scales were used that contemplated their cognitive, affective, functional and social status, as well as personal constructs. Correlation statistics and linear regression model were calculated. RESULTS: Long COVID patients suffer a decrease in their levels of physical and mental health. On the one hand, the higher number of persistent symptoms (b = -0.900, p = 0.008), worse physical functioning (b = 1.587, p = 0.002) and sleep quality (b = -0.538, p = 0.035) are predictors of worse quality of life, physical subscale. On the other hand, higher educational level (b = 13.167, p = 0.017), lower number of persistent symptoms (b = -0.621, p = 0.057) and higher affective affectation (b = -1.402, p<0.001) are predictors of worse quality of life, mental subscale. CONCLUSION: It is necessary to design rehabilitation programs that consider both the physical and mental health of these patients, thus obtaining an improvement in their quality of life.

The role of aggression and maladjustment in the teacher-student relationship on burnout in secondary school teachers.

Introduction: Multiple studies have examined the individual and socio-demographic variables that can contribute to the development of burnout in teachers. Although the evidence supports that this syndrome is generated through the interaction between the aspects of the organization and those of the person, little attention has been spent on the impact of the teacher-student relationship adjustment and, especially, on the role of violence exercised by students or their families toward secondary school teachers, who seem to be more vulnerable than teaching professionals in general. Objective: To analyze the role of the possible mismatch in the student-teacher relationship, as well as, the physical and verbal violence toward teachers from pupils or their parents, on the professional wear of high school educators. Materials and methods: A cross-sectional study was carried out on a teacher sample (n = 677) in Aragón, Spain, through a questionnaire with socio-demographic data; the "Maslach Burnout Inventory" (MBI), "Areas of Worklife Scale," the "Fears and Rejection in Education Questionnaire" (FREQ), and a list of the possible aggressions received in the development of the teaching activity. Results: While 3.8% of teachers have been a victim of physical attacks, 34.9% have suffered verbal abuse at least once. Although physical violence is extremely rare (and low intensity), verbal victimization or threats are associated with burnout in a highly significant manner, which confirms previous findings about school violence and burnout. Also, FEAR and REJECTION dimensions, defined as discomfort, tension, anxiety, and pressure caused by pupils, which contributed considerably on two dimensions of burnout (emotional exhaustion and cynicism). Different covariates such as maladjustment in the teacher-pupil relationship, violence experienced at work, and complaints received explain the 56.4% variance of exhaustion, 48.8% variance in cynicism, and 35.5% for efficacy. Conclusion: Very different variables can contribute to the development of burnout syndrome, both personal, and organizational variables. Therefore, when designing prevention programs in each work environment, the possible areas of risk and the interactions between them must be considered.

Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain.

The purpose of this study is to understand the health-related quality of life (HRQoL) in patients with celiac disease (CD) and analyze its main determinants. A transversal descriptive study of 738 patients with celiac disease was carried out. A series of questionnaires were answered related to their HRQoL, adherence to a gluten-free diet (GFD), and self-efficacy beliefs among other relevant variables. Regression analyses were carried out in order to explore the predictive variables in adherence to the GFD and HRQoL. A total of 61.2% showed a good HRQoL, and the main predictors of HRQoL were specific self-efficacy, adherence to the diet, risk perception, time since diagnosis, and age. While 68.7% of participants showed good or excellent adherence to the GFD, and the main predictors of adherence were specific self-efficacy, perceived adoption of recommended behaviors, HRQoL and gender. The HRQoL of patients with CD, and adherence to the GFD in Spain, are good. It is the self-efficacy expectation, measured specifically and not generally, which is the best predictor of both adherence and HRQoL. It is necessary to develop programs to improve the HRQoL of patients with CD that focus on improving specific self-efficacy.

The effect of self-efficacy expectations in the adherence to a gluten free diet in celiac disease.

Objective: To analyse the effect of general and specific self-efficacy on the adherence to a gluten free diet (GFD) in patients with celiac disease along with the effect of other relevant variables.Design: 271 patients with celiac disease participated in this transversal descriptive study and completed a series of questionnaires regarding adherence (CDAT), general self-efficacy (GSES) and specific self-efficacy (Celiac-SE) and quality of life (CD-Qol), among others.Main Outcome Measures: Dependent variable was adherence to the Gluten Free Diet (GFD). Main independent variables were general self-efficacy, specific self-efficacy and quality of life. Model tests were conducted using regression analysis.Results: 71.9% of patients show an excellent or good adherence to the diet. Higher levels of adherence are positively associated to a high expectancy of specific self-efficacy, to the perceived adoption of recommended behaviours, risk perception and better quality of life (these variables accounted for 36.4% of the variance in the adherence to a GFD, p < .001).Conclusions: Specific self-efficacy rather than general has a predictive value in adherence to a GFD. Therefore, we need to develop and transculturally adapt new instruments to assess specific self-efficacy. Celiac-SE has proved to be a useful scale for this objective.

Prevalence of celiac disease in primary care: the need for its own code.

BACKGROUND: Celiac disease (CD) is an autoimmune chronic enteropathy of the small intestine caused by exposure to gluten in genetically predisposed individuals. CD is not easy to diagnose due to its unspecific symptomatology, especially in adults, a diagnosed/undiagnosed ratio of 1:7 is estimated. CD does not have its own code in the International Classification of Primary Care (ICPC) but it is coded under code D99 "Disease digestive system, other", which hinders diagnosis, intervention and research. The aim of this study is to investigate the prevalence of CD in Aragón, Spain, using the information available from Primary Care, as well as to discuss the difficulties involved in determining prevalence of CD from data collected at this level of medical intervention. METHODS: We designed an epidemiological cross-sectional study and analysed 26,964 electronic clinical records from the Aragonese Health Service under code ICPC D99 collected up to December 31st, 2016. The clinical records were classified by their editable field "descriptor" according to their probability of being related to CD. Analyses of gender, age, age at diagnosis, province and health sector were carried out. RESULTS: We found 4534 clinical records under 293 different descriptors with a high probability of referring to CD. Prevalence in Aragón was estimated to be 0.35% ranging from 0.24 to 0.81% with important differences among health sectors. CONCLUSIONS: The prevalence of 0.35% is a long way from the generally accepted 1% but within the usually considered ratio 1:7 of diagnosed:undiagnosed cases. Differences among sectors should be carefully analysed. Lacking its own ICPC code, diagnosis of CD in Primary Care Services is not included in a single category, but it is distributed under several descriptors, which makes it difficult to offer any firm diagnosis for treatment and hinders research. Finally, the high prevalence of CD justifies its own ICPC code and the need to withdraw CD from the generic D99 code "Disease digestive system other".

Relation of the Psychological Constructs of Resilience, Mindfulness, and Self-Compassion on the Perception of Physical and Mental Health.

PURPOSE: Health factors that enhance an individual's ability to perceive and maintain health and well-being are referred to as "health assets". Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population. PATIENTS AND METHODS: A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables. RESULTS: The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense. CONCLUSION: The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.

Development and Validation of a Specific Self-Efficacy Scale in Adherence to a Gluten-Free Diet.

The aim of this study was to develop a scale to assess the levels of specific self-efficacy in order to enhance adherence to a gluten-free diet and the life quality of celiac patients. Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed people. The only treatment is a strict lifelong gluten-free diet. Within the framework of Social Cognitive Theory, expectation of self-efficacy is understood as the degree in which a person believes himself to be capable of performing a certain task (e.g., adhering to a gluten-free diet), a construct which has been widely studied in its relation with adopting healthy behaviors, but scarcely in relation to celiac disease. A validation study was carried out in various stages: preparation of the protocol; construction of the questionnaire and a pilot run with 20 patients; validation of the scale with 563 patients and statistical analysis. A 25-item scale was developed. Feasibility was excellent (99.82% of participants completed all the questions). Factorial analysis pointed to the existence of five factors that explained 70.98% of the variance with a Cronbach alpha of 0.81 for the scale overall and between 0.64 and 0.90 for each factor. The scale showed a Spearman's Rho coefficient of 0.279 with the General self-efficacy Scale. This easily administered scale provides good psychometric properties for evaluating specific self-efficacy of celiac patients in adhering to treatment. It seeks to be the first scale that provides not only a measurement of specific self-efficacy in celiac disease, but also to determine its levels for each of the areas as a first step toward designing interventions of self-management and empowerment programs to cope with the disease.

Adaptación transcultural y validación del Celiac Dietary Adherence Test. Un cuestionario sencillo para determinar la adherencia a la dieta sin gluten / Transcultural adaptation and validation of the Celiac Dietary Adherence Test. A simple questionnaire to measure adherence to a gluten-free diet

Antecedentes y objetivos: la dieta sin gluten es, hasta la fecha, el único tratamiento para la enfermedad celiaca, pero revisiones sistemáticas indican que sólo entre un 42% y un 91% de los pacientes siguen la dieta estrictamente, dependiendo del método de evaluación y de la definición de adherencia. Es importante contar con herramientas adaptadas transculturalmente que permitan evaluar la adherencia más allá de preguntas autoinformadas o de invasivas analíticas. El objetivo es adaptar transculturalmente y validar el Celiac Dietary Adherence Test de Leffler a la población española en lengua castellana. Métodos: estudio transversal observacional en dos fases: una primera de traducción/retrotraducción por cuatro traductores cualificados y una fase de validación en la que se aplicó el cuestionario a 306 pacientes de Aragón con enfermedad celiaca entre los 12 y los 72 años. Se evaluaron la estructura factorial, la validez de criterio y la consistencia interna. Resultados: la traducción al castellano mantuvo sus 7 ítems con una estructura de 3 factores. a factibilidad fue muy buena con todas las preguntas contestadas y con efectos suelo y techo muy bajos (4,3% y 1%, respectivamente). La correlación de Spearman con las escalas de autoeficacia y calidad de vida y la pregunta autoinformada resultaron estadísticamente significativas (p < 0,01). Aplicando los criterios de este cuestionario se obtuvo una adherencia del 72,3%. Conclusión: la adaptación española del CDAT muestra unas propiedades psicométricas adecuadas, por lo que su uso estaría indicado para el estudio de la adherencia a la dieta sin gluten en entornos clínicos y de investigación (AU)

Background and aims: A gluten-free diet is to date the only treatment available to celiac disease sufferers. However, systematic reviews indicate that, depending on the method of evaluation used, only 42% to 91% of patients adhere to the diet strictly. Transculturally adapted tools that evaluate adherence beyond simple self-informed questions or invasive analyses are, therefore, of importance. The aim is to obtain a Spanish transcultural adaption and validation of Leffler’s Celiac Dietary Adherence Test. Methods: A two-stage observational transversal study: translation and back translation by four qualified translators followed by a validation stage in which the questionnaire was administered to 306 celiac disease patients aged between 12 and 72 years and resident in Aragon. Factorial structure, criteria validity and internal consistency were evaluated. Results: The Spanish version maintained the 7 items in a 3-factor structure. Reliability was very high in all the questions answered and the floor and ceiling effects were very low (4.3% and 1%, respectively). The Spearman correlation with the self-efficacy and life quality scales and the self-informed question were statistically significant (p < 0.01). According to the questionnaire criteria, adherence was 72.3%. Conclusion: The Spanish version of the Celiac Dietary Adherence Test shows appropriate psychometric properties and is, therefore, suitable for studying adherence to a gluten-free diet in clinical and research environments (AU)

Transcultural adaptation and validation of the Celiac Dietary Adherence Test. A simple questionnaire to measure adherence to a gluten-free diet.

BACKGROUND AND AIMS: A gluten-free diet is to date the only treatment available to celiac disease sufferers. However, systematic reviews indicate that, depending on the method of evaluation used, only 42% to 91% of patients adhere to the diet strictly. Transculturally adapted tools that evaluate adherence beyond simple self-informed questions or invasive analyses are, therefore, of importance. The aim is to obtain a Spanish transcultural adaption and validation of Leffler's Celiac Dietary Adherence Test. METHODS: A two-stage observational transversal study: translation and back translation by four qualified translators followed by a validation stage in which the questionnaire was administered to 306 celiac disease patients aged between 12 and 72 years and resident in Aragon. Factorial structure, criteria validity and internal consistency were evaluated. RESULTS: The Spanish version maintained the 7 items in a 3-factor structure. Reliability was very high in all the questions answered and the floor and ceiling effects were very low (4.3% and 1%, respectively). The Spearman correlation with the self-efficacy and life quality scales and the self-informed question were statistically significant (p < 0.01). According to the questionnaire criteria, adherence was 72.3%. CONCLUSION: The Spanish version of the Celiac Dietary Adherence Test shows appropriate psychometric properties and is, therefore, suitable for studying adherence to a gluten-free diet in clinical and research environments.

[Aggression faced by doctors during social service in Mexico]. / Agresiones hacia los médicos durante el servicio social.

OBJECTIVES: Physicians during their work activities have been exposed to suffering physical and non-physical aggression (insults, threats, sexual assaults and even murder) by patients. The frequency of such attacks has increased in recent years. The aim of this study is to identify the risk of attacks on physicians associated with the type of work place that health institutions have assigned them for their year of social service in Mexico. METHODS: A cross-sectional questionnaire survey was conducted during 2012 of 371 physicians who were assigned to work in various community health centers called type "A", "B" or "C". RESULTS: Having worked in a work place type "C" was associated with physical aggression (OR: 2.32; 95% CI: 1.03-5.37), threats (OR: 2.64; 95% CI: 1.43-4.93), and insults (OR: 2.28; 95% CI: 1.35-3.88). CONCLUSIONS: The results should be interpreted with caution, but they suggest that physicians who are assigned to work in the places type "C" (where they must care for patients in a solitary manner and at night) during the year of social service in Mexico have a significant risk of being attacked.