Heroína, pero no Superwoman. Evaluación de una formación entre iguales para mujeres con cáncer de mama / Heroine, but no Superwoman. Evaluation of a peer-training activity for women with breast cancer

OBJETIVO: Evaluar una actividad formativa entre iguales para pacientes con cáncer de mama desde la perspectiva de género; conocer los resultados y profundizar en las experiencias de pacientes y profesionales sanitarios participantes. MÉTODO: Diseño multicéntrico mixto (Andalucía, 2017) con un cuestionario de evaluación pretest/postest con 102 pacientes formadas, midiendo hábitos de vida, limitaciones, uso y comunicación con los servicios sanitarios, y autocuidados; y con un análisis de contenido de entrevistas individuales y grupales (con 21 pacientes formadoras y 5 profesionales), centradas en experiencias, necesidades y propuestas de mejora. RESULTADOS: Las pacientes describen una buena salud general, con mejoras en dieta (7 a 7,7 de prestest a postest), limitaciones (se redujeron de 1,93 a 1,64 puntos) y autoeficacia (aumentó de 6,46 a 7,42 puntos), con diferencias significativas por edad, estado civil y nivel de estudios (mayor mejoría entre los perfiles más vulnerables). Las participantes reflejaron los beneficios de la formación en los aspectos personal, relacional, psicoemocional y sociocultural, y expresaron cambios en sus modelos identitarios y de vivencias de roles de género tras la formación. Los ámbitos de mejora fueron las cuestiones organizativas, de evaluación y continuidad de la estrategia formativa. CONCLUSIONES: La estrategia formativa es una experiencia con resultados positivos en la salud física, relacional y emocional de las participantes, y desde la perspectiva de género se constituye como una oportunidad, individual y compartida, para (re)negociar o deconstruir roles de género, en torno a la experiencia del cáncer de mama

OBJECTIVE: To evaluate a peer-training intervention for women with breast cancer, from a gender perspective: to discover the results of the intervention and examine in-depth the personal experiences of patients and health professionals participating in the training activity. METHOD: Mixed method multicentre design completed in 2017 in Andalusia (Spain), with a pre and post evaluation questionnaire with 102 patients, measuring life style, limitations, use of health services, communication with professionals and self-management; and content analysis of semi-structured interviews and focus groups with 21 patient-trainers and 5 health professionals, looking at experiences, needs and suggestions for improvement. RESULTS: The patients described a good general health status, with improvements of: diet quality (7 in pre-test to 7.7 in post-test), limitations for daily life (from 1.93 to 1.64 points), self-efficacy (from 6.46 to 7.42 points). Age, civil status and level of education generated statistically significant differences, with more improvement in more vulnerable social profiles. Participants revealed the benefits of the peer-training at a personal, relational, psycho-emotional and socio-cultural level and expressed how the training changed their experiences around identity-construction and gender roles. The improvement dimensions related to organization, evaluation and continuity. CONCLUSIONS: The peer-training intervention is a positive experience for women's physical, relational and emotional health and, from a gender perspective, it represents an opportunity, at both individual and group level, to negotiate and deconstruct gender roles when living with breast cancer

Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos / Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors

OBJETIVO: Evaluar el impacto de la formación entre iguales de la Escuela de Pacientes sobre la salud autopercibida y los hábitos de vida de las personas con enfermedades crónicas. DISEÑO: Descriptivo, transversal de evaluación cuantitativa pretest/postest. EMPLAZAMIENTO: Andalucía. PARTICIPANTES: Novecientos sesenta y cuatro pacientes con diabetes, fibromialgia e insuficiencia cardíaca participantes en la Escuela de Pacientes entre 2013 y 2015. INTERVENCIONES: Sesión de formación para formadores en autocuidados para personas con enfermedades crónicas. Mediciones principales: Se usó un cuestionario que midió salud autopercibida, limitaciones, dieta y actividad física. El análisis estadístico fue descriptivo, bivariante, de correlaciones y de ganancias netas. RESULTADOS: Tras realizar la formación se observó una mejoría de la salud, con menos limitaciones y mejor dieta y ejercicio físico, con diferencias estadísticamente significativas en función del sexo, enfermedad, nivel de estudios y estado civil. Se plantean propuestas de mejora de la estrategia formativa, con atención a las necesidades específicas de los colectivos más vulnerables: mujeres y personas con menor nivel educativo. CONCLUSIONES: El impacto de la formación fue positivo y diferencial en función de los perfiles de participantes. Se recomienda profundizar en los resultados, a través de metodología cualitativa, realizar mediciones postest posteriores y adaptar la estrategia formativa a la heterogeneidad de las necesidades de la población formada

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. Main measurement: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations

[Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors]. / Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos.

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. MAIN MEASUREMENT: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations.

[Heroine, but no Superwoman. Evaluation of a peer-training activity for women with breast cancer]. / Heroína, pero no Superwoman. Evaluación de una formación entre iguales para mujeres con cáncer de mama.

OBJECTIVE: To evaluate a peer-training intervention for women with breast cancer, from a gender perspective: to discover the results of the intervention and examine in-depth the personal experiences of patients and health professionals participating in the training activity. METHOD: Mixed method multicentre design completed in 2017 in Andalusia (Spain), with a pre and post evaluation questionnaire with 102 patients, measuring life style, limitations, use of health services, communication with professionals and self-management; and content analysis of semi-structured interviews and focus groups with 21 patient-trainers and 5 health professionals, looking at experiences, needs and suggestions for improvement. RESULTS: The patients described a good general health status, with improvements of: diet quality (7 in pre-test to 7.7 in post-test), limitations for daily life (from 1.93 to 1.64 points), self-efficacy (from 6.46 to 7.42 points). Age, civil status and level of education generated statistically significant differences, with more improvement in more vulnerable social profiles. Participants revealed the benefits of the peer-training at a personal, relational, psycho-emotional and socio-cultural level and expressed how the training changed their experiences around identity-construction and gender roles. The improvement dimensions related to organization, evaluation and continuity. CONCLUSIONS: The peer-training intervention is a positive experience for women's physical, relational and emotional health and, from a gender perspective, it represents an opportunity, at both individual and group level, to negotiate and deconstruct gender roles when living with breast cancer.

La formación entre iguales para pacientes con diabetes mellitus 2. Una evaluación cuantitativa y cualitativa en el País Vasco y Andalucía / Peer training for patients with diabetes mellitus 2. A quantitative and qualitative evaluation in the Basque Country and Andalusia

OBJETIVO: Evaluar la estrategia formativa entre iguales para pacientes con diabetes mellitus tipo 2 de los programas «Paciente Activo» (País Vasco) y «Escuela de Pacientes» (Andalucía). DISEÑO: Diseño mixto cuantitativo/cualitativo de evaluación pre/post de los programas de formación llevado a cabo entre 2012 y 2014. Emplazamiento: País Vasco y Andalucía. PARTICIPANTES: Un total de 409 pacientes y pacientes-formadores, participantes en la formación entre iguales. Muestreo intencional de 44 pacientes para el estudio cualitativo. MÉTODO: Análisis estadístico bivariante y ganancias netas de las variables comunes de cuestionarios pre/post del País Vasco y Andalucía: salud autopercibida, actividades diarias, ejercicio físico, uso de servicios sanitarios y autocuidados. Análisis de contenido de 8 grupos focales con pacientes y pacientes-formadores, incluyendo: codificación, árbol de categorías y triangulación de resultados. RESULTADOS: La formación entre iguales incide positivamente en la realización de ejercicio físico, uso de recursos sanitarios y autoeficacia en los cuidados, con diferencias por género en algunas dimensiones. La formación se valora positivamente en cuanto que: favorece la relación de los/las pacientes con el personal sanitario, genera apoyo grupal y autoconfianza y facilita la gestión emocional. Las áreas de mejora identificadas son: acceso y continuidad de la formación, y aceptación y apoyo por parte del personal y las instituciones sanitarias. CONCLUSIONES: Los beneficios en salud y calidad de vida promovidos a través de la formación entre iguales requiere la colaboración de las instituciones y personal sanitario, que deben facilitar el acceso, la continuidad y la adecuación de los contenidos a las necesidades y expectativas de los/las pacientes

OBJECTIVE: To evaluate a peer training strategy for patients with type 2 diabetes mellitus, developed in two training programmes in the Basque Country and Andalusia. DESIGN: Quantitative pre- and post-intervention and qualitative evaluation, developed between 2012 and 2014. Place: The Basque Country and Andalusia. PARTICIPANTS: A total of 409 patients and trainer-patients, participating in self-management peer training programmes. Intentional sample of 44 patients for the qualitative study. METHOD: Bivariate analysis and net gains for common variables used in questionnaires in the Basque Country and Andalusia: self-reported health, daily activities, physical activity, use of health services, and self-management. Content analysis of 8 focus groups with patients and trainer-patients, including: coding, categorisation, and triangulation of results. RESULTS: Peer training has a positive impact on physical activity, the use of health services, and self-management, with some gender differences. The peer-training strategy is considered positive, as it strengthens the patient-health provider relationship, generates group support and self-confidence, and improves the emotional management. Patients identify two areas of potential improvement: access and continuity of training strategies, and more support and recognition from health providers and institutions. CONCLUSIONS: The positive impact on health and quality of life that this patient peer-training provides, requires the collaboration of health professionals and institutions, which should improve the access, continuity and adaptation to patient needs and expectations

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.

[Peer training for patients with diabetes mellitus 2. A quantitative and qualitative evaluation in the Basque Country and Andalusia]. / La formación entre iguales para pacientes con diabetes mellitus 2. Una evaluación cuantitativa y cualitativa en el País Vasco y Andalucía.

OBJECTIVE: To evaluate a peer training strategy for patients with type2 diabetes mellitus, developed in two training programmes in the Basque Country and Andalusia. DESIGN: Quantitative pre- and post-intervention and qualitative evaluation, developed between 2012 and 2014. PLACE: The Basque Country and Andalusia. PARTICIPANTS: A total of 409 patients and trainer-patients, participating in self-management peer training programmes. Intentional sample of 44 patients for the qualitative study. METHOD: Bivariate analysis and net gains for common variables used in questionnaires in the Basque Country and Andalusia: self-reported health, daily activities, physical activity, use of health services, and self-management. Content analysis of 8 focus groups with patients and trainer-patients, including: coding, categorisation, and triangulation of results. RESULTS: Peer training has a positive impact on physical activity, the use of health services, and self-management, with some gender differences. The peer-training strategy is considered positive, as it strengthens the patient-health provider relationship, generates group support and self-confidence, and improves the emotional management. Patients identify two areas of potential improvement: access and continuity of training strategies, and more support and recognition from health providers and institutions. CONCLUSIONS: The positive impact on health and quality of life that this patient peer-training provides, requires the collaboration of health professionals and institutions, which should improve the access, continuity and adaptation to patient needs and expectations.

La publicidad de bebidas alcohólicas en España y su repercusión en la población adolescente / No disponible

Objetivos: El consumo de alcohol entre jóvenes es un problema de salud pública, condicionado en gran parte por los medios de comunicación y la publicidad. El objetivo de este estudio es analizar los mensajes publicitarios de alcohol difundidos en radio y televisión en España y conocer su potencial influencia en los adolescentes. Métodos: Análisis cuantitativo y cualitativo de la publicidad emitida en radio y TV, entre 1 de diciembre de 2006 y 9 de enero de 2007, a través de los siguientes pasos: seleccionar emisoras y canales TV; identificar y grabar la publicidad de programas de radio y TV dirigidos a los y las adolescentes; seleccionar y analizar los spots y cuñas radiofónicas. Las variables del estudio cuantitativo han sido: minutos dedicados a la publicidad de alcohol; análisis de audiencias en la población adolescente; y análisis del número de cuñas emitidas. La parte cualitativa se ha centrado en: marca y eslogan, público al que se dirige, estética, protagonistas del anuncio, valores que se transmiten, carga emocional del mensaje. Resultados: Se detectan 914 anuncios publicitarios de bebidas alcohólicas en TV. El 100% de los programas y eventos deportivos analizados presentan marcas de alcohol. El 26% de los spots y el 50% de las cuñas radiofónicas se dirigen específicamente a los jóvenes y todos muestran una imagen positiva del alcohol, valores de libertad, rebeldía y éxito. Conclusiones: Los adolescentes están expuestos a recurrentes mensajes positivos sobre el alcohol. La información y prevención son medidas claves para combatir la convivencia naturalizada con el alcohol

Objective: Alcohol drinking among adolescents is a problem of public health and it is highly conditioned by media and advertising. The objective of this study is to analyze Spanish television and radio alcohol advertising and promotions and to identify their potential influence on adolescents. Methods: A qualitative and quantitative analysis was made of radio and TV alcohol advertising, emitted between 1 December 2006 and 9 January 2007. The methodological steps were: channel and radio station selection; recording of radio and TV programmes directed to adolescents; selection and analysis of TV and radio spots. The variables in the quantitative analysis were: minutes of advertising, audience analysis in the young people; number of radio spots. The qualitative study referred to: brand and slogan, public to which it is directed, advertising protagonists, values and emotional content of the message. anuncio Results: There were identified 914 TV alcohol advertising. 100% of analyzed programs and sport events included alcohol advertise, with spots being the most usual strategy. 26% of spots were specifically directed to adolescents and all showed a positive image of alcohol. 50% of radio commercials sent values like freedom, diversion, social and sexual success. Conclusions: Adolescents are exposed to recurrent positive messages about alcohol, so information and prevention turn extremely important to reduce the naturalized image of alcohol drinking

El consumo de alcohol en la población joven (12-17 años). El punto de vista de los profesionales de la salud / Alcohol consumption in adolescents (12 to 17 years). The point of view of health professionals

Objetivo: Conocer las opiniones del personal sanitario sobre el consumo de alcohol en menores. Conocer la valoración que hacen los profesionales de la salud acerca de las medidas reguladoras del consumo de alcohol. Metodología: Diseño: Estudio cualitativo. Diseño exploratorio basado en entrevistas semiestructuradas. Emplazamiento: Cuatro ciudades de 4 CC. AA. diferentes: Palma de Mallorca, Granada, Barcelona y Pamplona. Participantes: Treinta y seis médicos/as y enfermeros/as de atención primaria y de urgencias, de 4 CC. AA., seleccionados por muestreo intencional. Mediciones: Treinta y seis entrevistas semiestructuradas analizadas a través del programa Nudist Vivo 4.0.Resultados: Los profesionales de la salud aceptan su papel fundamental en la prevención e intervención sobre el consumo de alcohol en adolescentes. En general, consideran el problema en términos de salud pública. La prevención se asocia a la atención primaria, mientras que el servicio de urgencias actúa en situaciones concretas de consumo abusivo. El acceso de los adolescentes a las consultas es escaso, por lo que la prevención se centra en los centros educativos y necesita la colaboración constante de padres y docente. Los sanitarios tienen un conocimiento insuficiente de la normativa vigente antialcohol y consideran que las medidas educativas son más eficientes que las sancionadoras. Conclusiones: La importancia de asumir responsabilidades y de coordinar la actuación desde los ámbitos sanitario, educativo y familiar requiere la formación específica de los profesionales sanitarios y la adecuación de la normativa vigente(AU)

Objective: To find out the opinions of health professionals on adolescent alcohol drinking and their evaluation of the existing legal regulation measures. Methodology: Design: Qualitative and exploratory study, based on semi-structured interviews. Setting: Four cities representing four different regions in Spain: Palma de Mallorca, Granada, Barcelona and Pamplona. Participants: A total of 36 physicians and nurses from four Spanish regions, working in Primary Care and Emergency Care, selected by intentiones samples. Measurements: A total of 36 deep interviews, analysed using the software Nudist Vivo 4.0.Results: Health professionals accept their important role in preventing and intervening in adolescent alcohol drinking. Generally, they consider it as a public health problem. Prevention is associated with Primary Care, while the Emergency Departments act in specific situations of alcohol abuse. Adolescents infrequently visit Primary Care, thus prevention must centre on education system and constant coordination between health professional and parents. Health personnel do not have sufficient knowledge on legal regulations. They consider educational measures as more efficient than sanctions. Conclusions: Specific professional training is required in order to guarantee the coordination between the health and education systems and the family(AU)

La visión de la ciudadanía sobre la epidemia de gripe H1N1 2009-2010. Un enfoque cualitativo / Public opinions about the 2009/2010 H1N1 pandemic influenza. A qualitative approach

Justificación: La epidemia de gripe H1N1 marcó el mapa sanitario epidemiológico del invierno 2009-2010. Objetivo: Conocer las opiniones de la población general, de los grupos de riesgo y del personal sanitario, sobre la epidemia de gripe. Diseño: cualitativo, estudio exploratorio. Metodología: 10 grupos focales en 3 CCAA, con 51 participantes. Análisis de contenido. Resultados principales: Las actitudes y opiniones de la población general y de los grupos de riesgo evolucionan a lo largo del proceso, desde un estado de preocupación inicial motivado por la sobreinformación y estado de alerta impulsado desde los medios de comunicación, hacia la reducción de la percepción de riesgo, la falta de confianza en las fuentes de información y la necesidad de mayor implicación de las autoridades y fuentes formales. Conclusión: Las autoridades deben apoyarse en sistemas de información avanzados, preparar al personal sanitario, coordinar e implicar a todos los sectores (AU)

Introduction: The H1N1 influenza pandemic of 2009-2010 has important health, social and media repercussions. Objective: to identify the opinions of the general population, risk groups and medical personnel on the 2009-2010 influenza epidemic. Design: Exploratory study, qualitative methodology. Methods: 10 focus groups in 3 Spanish regions with 51 participants. Content analysis. Main results: The attitudes and opinions of the general population and risk groups gradually change from a state of initial concern, caused by the social alert promoted by the media to a reduced perceived risk. The lack of trust in the information sources and the need for a greater involvement of the authorities also appear. Conclusion: The authorities must rely on advanced information systems, train personnel of health services and organize their work on coordination and involvement of all sectors (AU)

[Alcohol consumption in adolescents (12 to 17 years): the point of view of health professionals]. / El consumo de alcohol en la población joven (12-17 años). El punto de vista de los profesionales de la salud.

OBJECTIVE: To find out the opinions of health professionals on adolescent alcohol drinking and their evaluation of the existing legal regulation measures. DESIGN: Qualitative and exploratory study, based on semi-structured interviews. SETTING: Four cities representing four different regions in Spain: Palma de Mallorca, Granada, Barcelona and Pamplona. PARTICIPANTS: A total of 36 physicians and nurses from four Spanish regions, working in Primary Care and Emergency Care, selected by intentiones samples. MEASUREMENTS: A total of 36 deep interviews, analysed using the software Nudist Vivo 4.0. RESULTS: Health professionals accept their important role in preventing and intervening in adolescent alcohol drinking. Generally, they consider it as a public health problem. Prevention is associated with Primary Care, while the Emergency Departments act in specific situations of alohol abuse. Adolescents infrequently visit Primary Care, thus prevention must centre on education system and constant coordination between health professional and parents. Health personnel do not have sufficient knowledge on legal regulations. They consider educational measures as more efficient than sanctions. CONCLUSIONS: Specific professional training is required in order to guarantee the coordination between the health and education systems and the family.

Quality of internal communication in health care and the professional-patient relationship.

A study was undertaken for the purpose of describing internal communication and the professional-patient relationship and to establish a descriptive model of the interaction between these 2 variables. A nationwide survey was carried out in primary care and specialist care centers in Spain. A simple random sampling method was used with 1183 health care professionals. The data collection instrument was a Likert questionnaire that recorded information on the perceived quality of internal communication (0-100 scale), professional-patient relationships (0-100 scale), and sociodemographic variables. The results were analyzed using SPSS 15.0, performing mean comparisons and a suitable linear regression model.The total average of the quality of internal communication was 53.79 points, and that of the professional-patient relationships was 74.17 points. Sex made no statistically significant difference. Age shows that the older the participant, the better his/her opinion of internal communication and professional-patient relationships. Nursing staff had the highest opinion of internal communication and professional-patient relationships. The association between internal communication and professional-patient relationship was positive (R = 0.45).It was concluded that continuous exchange of information among health care professionals, together with learning and shared decision making or a positive emotional climate, is an element that will consolidate good professional-patient relationships and ensure patient satisfaction.

Tabaco y publicidad. Revisión de los estudios publicados entre 2000 y 2008 / Tobacco and advertising. Systematic review of the articles published between 2000 and 2008

Objetivo: Evaluar la influencia de la publicidad de tabaco en los hábitos de consumo. Diseño: Revisión sistemática. Fuente de datosPubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma e Isooc (CSIC) (enero 2000-septiembre 2008). Métodos: Se han incluido 44 artículos de ámbito nacional o internacional que relacionan el consumo de tabaco con alguna práctica publicitaria o de promoción. Se han eliminado los artículos que no se centran en el impacto de la publicidad y la promoción del tabaco sobre la conducta de consumo y las investigaciones referidas a prevención, a intervención o a prohibición a través de campañas, medidas, planes y leyes antitabaco. El análisis de los artículos se ha centrado en los actores identificados, la metodología empleada y la temática. Resultados: La publicidad influye en el consumo de tabaco. Los mensajes publicitarios llevan a iniciar el hábito (5 artículos) y a mantener el hábito (3 artículos), construyen el concepto y la imagen de la persona fumadora (5 artículos) y usan diferentes estrategias publicitarias (22 artículos). Conclusiones: La publicidad desarrollada por las industrias tabacaleras emplea diversas estrategias de influencia directa en el consumo de tabaco de la población (AU)

Objective: To evaluate the influence of tobacco advertising on consumer habits. Design: Systematic review. Data sources PubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma, Isooc (CSIC) (January 2000-September 2008). Methods: A total of 44 national and international articles, linking the consumption of tobacco with any promotional or advertising practice. Articles not focused on the impact of advertising and promotion of cigarettes and research on prevention, intervention, plans and laws were removed. Results: Advertising influences tobacco consumption. Publicity leads to starting smoking (5 articles) and maintaining the habit (3 articles). It uses the relationship between advertising and smoker's image and concept (5 articles) and different advertising strategies (22 articles). Conclusions: The advertising developed by the tobacco industry uses different strategies of influence on the consumption of cigarettes in the population (AU)

Posicionamiento de padres y madres ante el consumo de alcohol en población de 12 a 17 años en el ámbito urbano de seis Comunidades Autónomas / Parent’s positioning towards alcohol consumption in 12 to 17 years old adolescents from six urban areas in Spain

ObjetivosConocer las opiniones de padres y madres de zonas urbanas sobre el consumo de alcohol en menores y analizar su posicionamiento respecto a las medidas reguladoras existentes.Material y métodosEstudio cualitativo de seis grupos focales con 42 padres y madres de adolescentes de 6 Comunidades Autónomas, respetando la diversidad sociocultural. La parte cuantitativa consiste en un cuestionario en escala 1–10 sobre la aceptación de las medidas reguladoras del consumo de alcohol en menores, calculando medias y desviación típica.ResultadosPadres y madres no consideran un problema el consumo de alcohol de sus hijos/as, siempre que sea moderado y relacionado con el ocio. El hábito se normaliza en un contexto social y cultural permisivo. El consumo depende de factores externos (la presión social o del grupo de pares) e internos (los familiares). La intervención paterna se inclina hacia imponer la autoridad, las madres prefiriendo la vía de la comunicación y educativa. La labor de los profesores se considera adecuada, sobre todo cuando se les atribuye funciones en la educación integral del alumno, no sólo como transmisor de conocimientos. Sin embargo, los padres y las madres consideran que las instituciones públicas y las autoridades son en parte culpables de la desinformación y de las escasas alternativas de ocio juvenil, así como de no asegurar el cumplimiento de las normas vigentes. En cuanto a las medidas legales, tiene buena aceptación la prohibición de la venta de alcohol y de la publicidad.ConclusionesPadres y madres tienen conciencia del consumo de alcohol en sus hijos/as, pero tienden a normalizar el problema. Desarrollan estrategias diferentes de actuación y, en general, aprueban las medidas reguladoras existentes(AU)

ObjectivesTo determine the opinions of urban parents on alcohol drinking in teenagers and their positioning regarding the legal restrictive measures.Material and methodsWe performed a qualitative study of six focal groups including 42 mothers and fathers of adolescents from six different Spanish regions and from diverse social strata. The quantitative part of the study consisted of a 1–10 scale questionnaire, measuring parents’ acceptance and opinion about legal measures restricting underage drinking. Means and standard deviation were calculated.ResultsParents did not consider adolescent alcohol drinking to be a problem so long as it was moderate and leisure time-related. The social and cultural context was permissive with the alcohol consumption. Alcohol intake depended on both external (social pressure) and internal (family) factors. Fathers’ preferred to exercise authority, while mothers preferred communication and education skills. Parents approved of teachers’ interventions, especially when based on the student’s overall education and not restricted to knowledge transmission. Public institutions and authorities were held responsible for adolescents’ lack of information, the scarcity of leisure-time alternatives and for not ensuring compliance with current regulations. Parents approved restrictions regarding the sale and advertising of alcohol.ConclusionsParents recognize adolescent alcohol drinking as a problem and tend to deal with it. Parents use distinct intervention strategies and generally approve legal measures(AU)

Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa / Fibromyalgia: Patient perception on their disease and health system. Qualitative research study

Objetivo Conocer la experiencia y vivencia de personas con fibromialgia y sus expectativas sobre el sistema sanitario y sus profesionales. Métodos Diseño cualitativo a través de grupos focales. Se realizaron tres grupos, uno con pacientes que pertenecían a asociaciones de fibromialgia. Participaron 20 mujeres y 1 varón. Se incluyeron personas que recibían atención en el sistema sanitario público, con distintas trayectorias asistenciales y evolución. Se pidió consentimiento informado. Análisis de contenido. Resultados Describen una vivencia difícil con una sintomatología que puede ser incapacitante para las actividades cotidianas. Hasta que reciben el diagnóstico, perciben incomprensión y soledad. Desarrollan distintas estrategias de afrontamiento, como buscar información o asociarse. Esperan del sistema sanitario: atención y diagnósticos ágiles, acceso a consultas, pruebas que necesiten y terapias beneficiosas o impulso a la investigación. Quieren profesionales con formación para abordar la fibromialgia, una actitud proactiva, interés, empatía e información. Discusión La metodología cualitativa fue idónea para profundizar en la experiencia de pacientes. La atención sanitaria debe dirigirse a mejorar su calidad de vida facilitando su proceso asistencial y ofreciendo acompañamiento, interés, comprensión y apoyo(AU)

Objective To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. Methods Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. Results Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. Discussion Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients’ quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support(AU)

[Fibromyalgia: Patient perception on their disease and health system. Qualitative research study]. / Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa.

OBJECTIVE: To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. METHODS: Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. RESULTS: Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. DISCUSSION: Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients' quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support.

[Tobacco and advertising. Systematic review of the articles published between 2000 and 2008]. / Tabaco y publicidad. Revisión de los estudios publicados entre 2000 y 2008.

OBJECTIVE: To evaluate the influence of tobacco advertising on consumer habits. DESIGN: Systematic review. DATA SOURCES: PubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma, Isooc (CSIC) (January 2000-September 2008) METHODS: A total of 44 national and international articles, linking the consumption of tobacco with any promotional or advertising practice. Articles not focused on the impact of advertising and promotion of cigarettes and research on prevention, intervention, plans and laws were removed. RESULTS: Advertising influences tobacco consumption. Publicity leads to starting smoking (5 articles) and maintaining the habit (3 articles). It uses the relationship between advertising and smoker's image and concept (5 articles) and different advertising strategies (22 articles). CONCLUSIONS: The advertising developed by the tobacco industry uses different strategies of influence on the consumption of cigarettes in the population.

[Parental stance towards alcohol consumption in 12- to 17-year-old adolescents from six urban areas in Spain]. / Posicionamiento de padres y madres ante el consumo de alcohol en población de 12 a 17 años en el ámbito urbano de seis Comunidades Autónomas.

OBJECTIVES: To determine the opinions of urban parents on alcohol drinking in teenagers and their positioning regarding the legal restrictive measures. MATERIAL AND METHODS: We performed a qualitative study of six focal groups including 42 mothers and fathers of adolescents from six different Spanish regions and from diverse social strata. The quantitative part of the study consisted of a 1-10 scale questionnaire, measuring parents' acceptance and opinion about legal measures restricting underage drinking. Means and standard deviation were calculated. RESULTS: Parents did not consider adolescent alcohol drinking to be a problem so long as it was moderate and leisure time-related. The social and cultural context was permissive with the alcohol consumption. Alcohol intake depended on both external (social pressure) and internal (family) factors. Fathers' preferred to exercise authority, while mothers preferred communication and education skills. Parents approved of teachers' interventions, especially when based on the student's overall education and not restricted to knowledge transmission. Public institutions and authorities were held responsible for adolescents' lack of information, the scarcity of leisure-time alternatives and for not ensuring compliance with current regulations. Parents approved restrictions regarding the sale and advertising of alcohol. CONCLUSIONS: Parents recognize adolescent alcohol drinking as a problem and tend to deal with it. Parents use distinct intervention strategies and generally approve legal measures.