ABSTRACT
OBJETIVO: Evaluar la validez y la fiabilidad del cuestionario de «Conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades vitales anticipadas» (VVA). DISEÑO: Estudio transversal en 3 fases: a) pilotaje con cuestionario administrado en papel para valorar pérdidas y problemas de ajuste del cuestionario; b) valoración de la validez y fiabilidad interna del cuestionario, y c) evaluación de la estabilidad (test-retest) del cuestionario filtrado de la fase previa. Emplazamiento: Área Sanitaria Costa del Sol (Málaga). Enero de 2014 a abril de 2015. PARTICIPANTES: Profesionales sanitarios del Distrito de Atención Primaria Costa del Sol y la Agencia Sanitaria Costa del Sol. Contestaron 391 (23,6%). Cien participaron en la evaluación de la estabilidad (83 respuestas). Mediciones principales: El cuestionario constaba de 2 bloques: a) Conocimientos (5 dimensiones y 41 ítems), y b) Actitudes (2 dimensiones y 17 ítems). RESULTADOS: En el estudio piloto, en ningún ítem las perdidas superaron el 10%. En la fase de evaluación de la validez y la fiabilidad, el cuestionario se redujo a 41 ítems (29 de conocimientos y 12 de actitudes). En la fase de evaluación de la estabilidad, todos los ítems evaluados, bien cumplieron criterio de kappa superior a 0,2, o tenían un porcentaje de acuerdo absoluto superior al 75%. CONCLUSIONES: El cuestionario permitirá identificar el estado y las áreas de mejora en el entorno sanitario, y posibilitar posteriormente una mejora de la cultura de las VVA en la población general
OBJECTIVE: Evaluate the validity and reliability of the knowledge and attitudes of health professionals questionnaire on the Living Will Declaration (LWD) process. DESIGN: Cross-sectional study structured into 3 phases: (I) pilot questionnaire administered with paper to assess losses and adjustment problems; (II) assessment of the validity and internal reliability, and (III) assessment of the pre-filtering questionnaire stability (test-retest). LOCATION: Costa del Sol (Malaga) Health Area. January 2014 to April 2015. PARTICIPANTS: Healthcare professionals of the Costa del Sol Primary Care District and the Costa del Sol Health Agency. There were 391 (23.6%) responses, and 100 participated in the stability assessment (83 responses). MAIN MEASUREMENTS: The questionnaire consisted of 2 parts: (I) Knowledge (5 dimensions and 41 items), and (II) Attitudes (2 dimensions and 17 items). RESULTS: In the pilot study, none of the items lost over 10%. In the evaluation phase of validity and reliability, the questionnaire was reduced to 41 items (29 of knowledge, and 12 of attitudes). In the stability evaluation phase, all items evaluated met the requirement of a kappa higher than 0.2, or had a percentage of absolute agreement exceeding 75%. CONCLUSIONS: The questionnaire will identify the status and areas for improvement in the health care setting, and then will allow an improved culture of LWD process in general population
Subject(s)
Humans , Advance Directives/statistics & numerical data , Living Wills/statistics & numerical data , Health Knowledge, Attitudes, Practice , Health Personnel/statistics & numerical data , Surveys and Questionnaires , Patient Rights , Reproducibility of Results , Reproducibility of ResultsABSTRACT
OBJECTIVE: Evaluate the validity and reliability of the knowledge and attitudes of health professionals questionnaire on the Living Will Declaration (LWD) process. DESIGN: Cross-sectional study structured into 3 phases: (i)pilot questionnaire administered with paper to assess losses and adjustment problems; (ii)assessment of the validity and internal reliability, and (iii)assessment of the pre-filtering questionnaire stability (test-retest). LOCATION: Costa del Sol (Malaga) Health Area. January 2014 to April 2015. PARTICIPANTS: Healthcare professionals of the Costa del Sol Primary Care District and the Costa del Sol Health Agency. There were 391 (23.6%) responses, and 100 participated in the stability assessment (83 responses). MAIN MEASUREMENTS: The questionnaire consisted of 2 parts: (i)Knowledge (5 dimensions and 41 items), and (ii)Attitudes (2 dimensions and 17 items). RESULTS: In the pilot study, none of the items lost over 10%. In the evaluation phase of validity and reliability, the questionnaire was reduced to 41 items (29 of knowledge, and 12 of attitudes). In the stability evaluation phase, all items evaluated met the requirement of a kappa higher than 0.2, or had a percentage of absolute agreement exceeding 75%. CONCLUSIONS: The questionnaire will identify the status and areas for improvement in the health care setting, and then will allow an improved culture of LWD process in general population.
Subject(s)
Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Living Wills , Self Report , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
OBJETIVO: Identificar áreas de interés subyacentes en el proceso de Declaración de Voluntades Vitales Anticipadas (DVVA) y consensuar un cuestionario de conocimientos y actitudes dirigido a profesionales de la salud. DISEÑO: Estudio a través de técnica Delphi con método Rand. Dos fases: 1) propuestas de dimensiones: generación de ideas y posterior priorización de estas; 2) propuesta y priorización de ítems agrupados en bloques de conocimientos y actitudes. Desarrollado entre agosto de 2012 y enero de 2013. Emplazamiento: El trabajo se realizó por contacto inicial telefónico con panelistas y posteriormente vía correo electrónico. Los panelistas pertenecen al Sistema Sanitario Público Andaluz. PARTICIPANTES: Los criterios para la selección de los 8 componentes del panel fueron los conocimientos y la experiencia en el ámbito de la autonomía del paciente en Andalucía. RESULTADOS: Se identificó en Conocimientos: 1. °A) aspectos legales/generales; 2. °A) definición conceptual; 3. °A) documentación normalizada de las voluntades vitales anticipadas; 4. °A) experiencia práctica; 5. °A) procedimiento y registro de las DVVA. El segundo bloque fueron de Actitudes: 1. °B) actitudes del profesional en el momento de la aplicación del DVVA en la práctica clínica; 2. °B) actitudes del profesional ante escenarios éticos «complejos». Los 7 panelistas que finalmente participaron propusieron 165 ítems. Tras aplicar los criterios de priorización, puntuación y selección de escenarios, se identificaron 58 (35,2%) ítems como escenario adecuado. CONCLUSIONES: El cuestionario propuesto recoge amplias parcelas de conceptos y contenidos, y una vez validado ayudará a medir las intervenciones formativas realizadas en profesionales sanitarios para la mejora del conocimiento y las actitudes sobre el entorno de las DVVA
OBJECTIVE: To identify the underlying interests of the Living Will Declaration (LWD) process and to determine the consensus, using a questionnaire, of the knowledge and attitudes of health professionals. DESIGN: A study was performed in two phases using a Delphi technique with a Rand method.1. Dimensions proposed: generation of ideas and their subsequent prioritizing; 2. Proposal and prioritizing of items grouped into blocks of Knowledge and Attitudes, developed between August 2012 and January 2013. SETTING: The work was carried out by initial telephone contact with panellists, and then later by the panellists belonged to the Andalusia Public Health System. PARTICIPANTS: The criteria for selecting the eight components of the panel were knowledge and experience in the field of the freedom of the patient in Andalusia. RESULTS: The Knowledge identified included: 1 A) Legal and general aspects; 2 A) A conceptual definition; 3 A) Standardised LWD documents: 4 A) Practical experience; 5 A) Procedure and registering of the LWDs. The second block included Attitudes: 1 B) Attitudes of the professional in the application of LWDs in clinical practice, and 2 B) Attitudes of the professional in «complex» ethical scenarios The 7 panellists who finally took part proposed 165 items. After applying the prioritizing criteria, scores, and scenario selection, 58 (35.2%) items were identified as suitable scenarios. CONCLUSIONS: The proposed questionnaire included wide parcels of concepts and contents that, once validated, will help to measure the training interventions carried out on health professionals in order to improve knowledge and attitudes on the subject of LWDs
Subject(s)
Female , Humans , Male , Health Knowledge, Attitudes, Practice , Health Personnel/trends , Advance Directive Adherence/organization & administration , Advance Directive Adherence/standards , Advance Directive Adherence , Patient Rights/standards , Surveys and Questionnaires , Patient Advocacy/standards , Patient Advocacy/trendsABSTRACT
OBJECTIVE: To identify the underlying interests of the Living Will Declaration (LWD) process and to determine the consensus, using a questionnaire, of the knowledge and attitudes of health professionals. DESIGN: A study was performed in two phases using a Delphi technique with a Rand method. 1. Dimensions proposed: generation of ideas and their subsequent prioritizing; 2. Proposal and prioritizing of items grouped into blocks of Knowledge and Attitudes, developed between August 2012 and January 2013. SETTING: The work was carried out by initial telephone contact with panellists, and then later by the panellists belonged to the Andalusia Public Health System. PARTICIPANTS: The criteria for selecting the eight components of the panel were knowledge and experience in the field of the freedom of the patient in Andalusia. RESULTS: The Knowledge identified included: 1 A) Legal and general aspects; 2 A) A conceptual definition; 3 A) Standardised LWD documents: 4 A) Practical experience; 5 A) Procedure and registering of the LWDs. The second block included Attitudes: 1 B) Attitudes of the professional in the application of LWDs in clinical practice, and 2 B) Attitudes of the professional in «complex¼ ethical scenarios The 7 panellists who finally took part proposed 165 items. After applying the prioritizing criteria, scores, and scenario selection, 58 (35.2%) items were identified as suitable scenarios. CONCLUSIONS: The proposed questionnaire included wide parcels of concepts and contents that, once validated, will help to measure the training interventions carried out on health professionals in order to improve knowledge and attitudes on the subject of LWDs.
Subject(s)
Health Knowledge, Attitudes, Practice , Health Personnel , Living Wills , Humans , Surveys and QuestionnairesABSTRACT
Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia.
Subject(s)
Atlases as Topic , Internet , Mortality , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Mortality/trends , SpainABSTRACT
Los atlas de mortalidad publicados hasta la fecha son estáticos. La mayoría describen la distribución geográfica de la mortalidad agrupando datos de varios años y usando razones de mortalidad estandarizadas que resumen la mortalidad de todos los grupos de edad. Sin embargo, esta metodología presenta limitaciones para estudiar cambios temporales en la distribución geográfica de la mortalidad o diferencias entre grupos etarios. Aplicando una metodología alternativa surge el Atlas Interactivo de Mortalidad en Andalucía (AIMA), un Sistema de Información Geográfica dinámico que permite visualizar en web-site más de 12.000 mapas y 338.000 gráficos de tendencias correspondientes a la distribución espacio-temporal de las principales causas de muerte en Andalucía por grupos de edad y sexo desde 1981. El objetivo de este trabajo es describir la metodología utilizada para el desarrollo de AIMA, dar a conocer sus características y especificaciones técnicas y mostrar las posibilidades interactivas que ofrece. El sistema está disponible en el hipervínculo productos de www.demap.es. AIMA es el primer SIG interactivo de estas características implementado en España. Para el análisis de datos se han utilizado modelos jerárquicos bayesianos espacio-temporales, integrando posteriormente los resultados en web-site utilizando entorno PHP y cartografía dinámica en formato Flash. La selección de mapas temáticos muestra el carácter dinámico de la distribución geográfica de la mortalidad, con un patrón diferente para cada año, grupo de edad y sexo. La información contenida actualmente en este sistema y las futuras actualizaciones contribuirán a la reflexión sobre el pasado, presente y futuro de la salud en Andalucía (AU)
Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia (AU)
Subject(s)
Humans , Male , Female , Atlases as Topic , Indicators of Morbidity and Mortality , Bayes Theorem , Records , Death , Mortality/statistics & numerical data , Maps as Topic , Geographic Information Systems/standards , Geographic Information Systems , 28599 , Internet/standardsABSTRACT
FUNDAMENTO: En 1997 el 18,5 por ciento de los casos de enfermedad meningocócica por serogrupo C en Andalucía fueron niños de 2 a 4 años de edad; edades donde respuesta inmune inicial y duración de la vacuna antimeningocócica de polisacárido capsular A+C, es menor que en edades superiores. Se diseñó una investigación para medir la respuesta inmune producida por esta vacuna, en niños de 2 a 6 años de edad, y compararla con la inmunidad natural presente en niños no vacunados. MÉTODOS: I.- Doble estudio de seguimiento: a) grupos de niños previamente vacunados y grupos control, b) grupo de niños que iba a ser vacunado, para análisis pre y postvacunal (1, 6 y 12 meses) y grupo control. II.- La actividad bactericida se midió según protocolo estandarizado del CDC frente a cepa de N. meningítidis C-11. Los sueros con título de actividad bactericida (TAB) ³ 1:8 se consideraron protectores. RESULTADOS: Al mes y a los 2 meses de vacunarse la proporción de TAB³ 1:8 era significativamente superior a la del grupo control (65,5 por ciento y 73,9 por ciento frente a 2,2 por ciento y 12 por ciento. En el prevacunal y en el postvacunal a los 6, 7, 12 y 13 meses no se observó diferencia significativa entre vacunados y controles. CONCLUSIONES: Las diferencias entre vacunados y no vacunados 1 y 2 meses después de la vacunación indican seroconversión en los vacunados. Para el grupo de edad de 2 a 6 años la actividad bactericida adquirida declina rápidamente, ya que a los 6 meses dejan de observarse diferencias con el grupo control (AU)