Experiences of Spanish out-of-hospital emergency workers with high levels of depression during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic had a major psychological impact on health care workers (HCWs). This study was embedded in a larger quantitative study on the mental health care of out-of-hospital HCWs in Spain. To better understand this, a qualitative study was conducted to explore the experiences, coping strategies, and influencing factors of out-of-hospital HCWs who scored high (> 25 points) on the Depression Anxiety Stress Scale (DASS-21) in a previous quantitative mental health study. METHODS: A qualitative study was conducted using six in-depth interviews with individuals who scored high on the depression scale and agreed to be contacted by email between May and June 2021, using the phenomenological approach. The data were analysed using Brawn and Clare's method. RESULTS: The main results findings related to four themes. The emotional impact of assuming a professional role with high self-demands and responsibilities; Factors influencing the development of negative emotions such as the cruelty of the pandemic, the helplessness in relation to health management and policy, the changing role of the professional and the relationship with society; Personal protection through coping strategies to manage negative emotions such as support from colleagues and family; Good practices for the future looking for different management strategies that can influence individuals and their personal, professional, and social relationships. CONCLUSION: The strong impact of the circumstances experienced points to the need to develop psychological support programmes that can protect people's mental health from depression during a crisis and improve the relationship between workers and their managers.

RESUMEN: ANTECEDENTES: La pandemia de COVID-19 tuvo un gran impacto psicológico en el personal sanitario. Este estudio forma parte de un estudio cuantitativo más amplio sobre la atención a la salud mental de los trabajadores sanitarios extrahospitalarios en España. Para comprenderlo mejor, se llevó a cabo un estudio cualitativo para explorar las experiencias, estrategias de afrontamiento y factores de influencia de los trabajadores extrahospitalarios que obtuvieron puntuaciones altas (> 25 puntos) en la Escala de Depresión, Ansiedad y Estrés (DASS-21) en un estudio cuantitativo previo sobre salud mental. MéTODOS: Se realizó un estudio cualitativo mediante seis entrevistas en profundidad con individuos que puntuaron alto en la escala de depresión y aceptaron ser contactados por correo electrónico entre mayo y junio de 2021, utilizando el enfoque fenomenológico. Los datos se analizaron utilizando el método de Brawn y Clare. RESULTADOS: Los principales hallazgos de los resultados se relacionaron con cuatro temas. El impacto emocional de asumir un rol profesional con altas autoexigencias y responsabilidades; Factores que influyen en el desarrollo de emociones negativas como la crueldad de la pandemia, la impotencia en relación con la gestión y la política sanitaria, el papel cambiante del profesional y la relación con la sociedad; Protección personal a través de estrategias de afrontamiento para gestionar las emociones negativas como el apoyo de los compañeros y la familia; Buenas prácticas para el futuro buscando diferentes estrategias de gestión que puedan influir en los individuos y en sus relaciones personales, profesionales y sociales. CONCLUSIóN: El fuerte impacto de las circunstancias vividas apunta a la necesidad de desarrollar programas de apoyo psicológico que puedan proteger la salud mental de las personas durante una crisis y mejorar la relación entre los trabajadores y sus jefes.

Agresiones a personal adscrito a la Gerencia de Atención Primaria de Tenerife y pandemia por SARS-CoV2 / Attacks on personnel assigned to the Primary Care Management of Tenerife and the SARS-CoV2 pandemic

Objetivo Medir y caracterizar las agresiones sufridas por los profesionales sanitarios en el ámbito de la atención primaria de Tenerife entre el año 2018-2019 (prepandemia) y el 2020-2021 (pandemia). Secundariamente, analizar el grado de conocimiento de los profesionales en relación con el procedimiento de actuación frente a agresiones, las medidas de seguridad existentes y aspectos mejorables para su protección. Materiales y métodos Estudio observacional, descriptivo y transversal mediante un formulario autocumplimentado telemáticamente. Se difundió mediante los diferentes canales de comunicación con los profesionales sanitarios estando disponible entre marzo y abril del año 2022. Las variables cuantitativas se analizaron mediante medidas de tendencia central y de dispersión, y las cualitativas en porcentaje, realizando además un análisis bivariado utilizando el test χ2 y el test de la t de Student. Resultados De los participantes, 72,50% ha sufrido algún tipo de agresión en el ámbito laboral, siendo más frecuente en la zona metropolitana de Tenerife, las cuales se producen fundamentalmente por parte del paciente como de sus familiares. Estas agresiones son mayormente verbales y se producen en mayor cantidad hacia mujeres con la categoría de enfermera. Conclusiones La enfermería es la categoría que más sufre las agresiones en la atención primaria de Tenerife, de manera independiente a la zona de la isla donde desempeñe su trabajo (AU)

Objective To measure and characterize the aggressions suffered by health professionals in the field of primary care in Tenerife between 2018–2019 (pre-pandemic) and 2020–2021 (pandemic). Secondly, to analyze the degree of knowledge of the professionals in relation to the procedure for action against aggressions as well as the existing security measures and aspects that could be improved for their protection. Materials and methods Observational, descriptive and cross-sectional study using a self-completed form electronically. It was disseminated through the different communication channels with health professionals, being available between March and April 2022. The quantitative variables were analyzed using measures of central tendency and dispersion, and the qualitative variables in percentage, also performing a bivariate analysis using the Chi square and Student's T. Results 72.50% of the participants have suffered some type of aggression in the workplace and they are more frequent causes in the metropolitan area of Tenerife, which are produced fundamentally by the patient and their relatives. These aggressions are mostly verbal and occur in greater quantity towards women with the category of nurse. Conclusions Nursing is the category that suffers the most aggressions in primary care in Tenerife, regardless of the area of the island where they carry out their work (AU)

Female genital mutilation in the Canary Islands: A qualitative study on the perspectives of women and healthcare professionals.

Introduction: Migration to Western countries is associated with social and health challenges that are difficult to manage. Female genital mutilation (FGM) is a harmful practice that still occurs in the 21st century. According to the World Health Organization, FGM is a ritual procedure involving the partial or total removal of the external female genitalia for non-therapeutic reasons. Objectives: (I) To explore the experiences of women residing in the Canary Islands, in Spain, who had suffered FGM, and their assessment of the healthcare received. (II) To explore the perspectives of healthcare professionals who had attended to these cases, care pathways, and prevention. Methods: A qualitative study, phenomenologically oriented based on a pragmatic perspective, was conducted. We conducted open in-person interviews, and written documents were sent via email for data collection. Purposeful and snowball sampling methods were used to select women who had undergone FGM and healthcare providers who had attended to such patients. Nine participants were recruited, five health professionals and four women. Although the sample size was not very large, the data had enough depth and richness to meet the goals of the study. The data were analyzed using the thematic analysis technique. Results: Six main themes emerged, including the "meaning of FGM," "health consequences," "benefits of treatments," "knowledge about FGM," "experiences of professionals and with professionals," and "recommendations of professionals in improving care." Conclusions: Professionals and women identified the lack of training to address this problem, and both parties perceived FGM as a negative practice. The women lack knowledge about the relationship between some health problems they suffer and FGM, which poses a challenge for accurate diagnosis and treatment. Therefore, professionals need to know in detail all health conditions related to FGM to diagnose and treat these women more accurately. When affected women arrive in Western countries and receive correct information on the consequences of FGM, they are more likely to reject this practice. The identification of cases of FGM in women born in the Canary Islands urges the need to develop strategies to avoid such situations.

[Attacks on personnel assigned to the Primary Care Management of Tenerife and the SARS-CoV2 pandemic]. / Agresiones a personal adscrito a la Gerencia de Atención Primaria de Tenerife y pandemia por SARS-CoV2.

OBJECTIVE: To measure and characterize the aggressions suffered by health professionals in the field of primary care in Tenerife between 2018-2019 (pre-pandemic) and 2020-2021 (pandemic). Secondly, to analyze the degree of knowledge of the professionals in relation to the procedure for action against aggressions as well as the existing security measures and aspects that could be improved for their protection. MATERIALS AND METHODS: Observational, descriptive and cross-sectional study using a self-completed form electronically. It was disseminated through the different communication channels with health professionals, being available between March and April 2022. The quantitative variables were analyzed using measures of central tendency and dispersion, and the qualitative variables in percentage, also performing a bivariate analysis using the Chi square and Student's T. RESULTS: 72.50% of the participants have suffered some type of aggression in the workplace and they are more frequent causes in the metropolitan area of Tenerife, which are produced fundamentally by the patient and their relatives. These aggressions are mostly verbal and occur in greater quantity towards women with the category of nurse. CONCLUSIONS: Nursing is the category that suffers the most aggressions in primary care in Tenerife, regardless of the area of the island where they carry out their work.

Neurodevelopmental Outcomes among Brazilian Children with Cyanotic Congenital Heart Disease and Its Associated Factors.

Objectives: The aim of this study was to evaluate neurodevelopmental outcomes (motor development, nonverbal intelligence, and attention) in children with cyanotic congenital heart disease (CHD) compared with healthy children from a public hospital in southern Brazil. Materials and Methods: This was a cross-sectional study with pediatric patients of both sexes: 37 children with cyanotic CHD and a control group with 38 healthy children. Parents/guardians undertook a questionnaire and the SNAP IV scale (to evaluate attention) was applied. Two instruments were applied to each child: the R-2 Non-Verbal Intelligence test and the motor development scale. To assess the factors associated with insufficient performance in the three fields of neurodevelopment, a Poisson regression analysis was performed with a robust estimate. Results: There were no significant differences between children with cyanotic CHD and the control group for any of the neurodevelopmental outcomes studied. Low socioeconomic class was a factor associated with worse performance on the intelligence test and inattention. Furthermore, age was a factor for performance on the intelligence test, while a greater number of siblings was a factor associated with worse performance on the attention test. Conclusions: Public policies regarding child health must involve prioritizing the improvement of families' social conditions.

Co-Creation of Massive Open Online Courses to Improve Digital Health Literacy in Pregnant and Lactating Women.

BACKGROUND: Digital health literacy (DHL) increases the self-efficacy and empowerment of pregnant and lactating women (PLW) in using the Internet for health issues. The European project IC-Health aimed to improve DHL among PLW, through the co-creation of Massive Open Online Courses (MOOCs). METHODS: The co-creation of the MOOCs included focus groups and the creation of communities of practice (CoPs) with PLW and healthcare professionals aimed to co-design the MOOCs. The quantitative measures of MOOCs' acceptability, experience in the co-creation process and increase in DHL (dimensions of finding, understanding and appraisal) were assessed. RESULTS: 17 PLW participated in focus groups, 113 participants were included in CoPs and 68 participants evaluated the acceptability of MOOCs. A total of 6 MOOCs aimed at improving PLW's DHL were co-designed. There was a significant improvement in self-perceived DHL after using MOOCs (p-value < 0.001). The acceptability of MOOCs and co-creation experience were positively valued. CONCLUSIONS: The preliminary results of the quantitative assessment showed a higher self-perceived DHL after the IC-Health MOOCs. These results suggest that IC-Health MOOCs and the co-creation methodology appear to be a viable process to carry out an intervention aimed to improve DHL levels in European PLW.

Knowledge, Attitudes and Expectations of Physicians with Respect to Palliative Care in Ecuador: A Qualitative Study.

Background: The worldwide need for palliative care is high, especially in mid- income countries like Ecuador, where the percentage of patients receiving such care is very small due to the scarcity of infrastructure and specialized personnel and to the unequal distribution in the country. The objective of this study is to explore the knowledge, attitudes and expectations related to palliative care of the physicians in Ecuador. Methods: A qualitative study based on 28 semi-structured interviews, from March 2014 to November 2016, with physicians working in four cities in Ecuador recruited through the snowball technique. Thematic analysis was developed supported by the ATLAS.ti software. Results: Five core themes were identified: (1) training, (2) health policy, (3) professionals' activities, (4) health services and (5) development of palliative care in Ecuador. Conclusions: Strategies are needed which intensify the training of medical professional in palliative care, as well as avail the human resources and materials for providing it.

Primeras medidas de salud pública para la contención del COVID-19: cuarentena de un hotel / First public health measures for the containment of COVID-19: a hotel in quarantine

No disponible

Participación pública en los proyectos de investigación: formas de crear conocimiento colectivo en salud / Public participation in research projects: ways of creating collective knowledge in health

La participación pública en los proyectos de investigación es un ámbito emergente en España y en los países latinoamericanos. Existen cinco tipos de proyectos según el grado de implicación que las personas participantes tienen en los procesos: contributivos, colaborativos, cocreados, contractuales e independientes. Para promover la participación pública en los equipos de investigación del ámbito de la salud es necesario redefinir sus prácticas y sus competencias. Para ello, puede ser útil formularse preguntas en las diferentes fases de la investigación, así como desarrollar estrategias que incluyan audiencias que cuenten con menos canales de participación en pro de favorecer la equidad en salud. Esta forma de hacer ciencia permite reunir experiencia y experticia priorizando y adecuando la investigación a las necesidades de la población, lo que aumenta su capacidad transformadora y el impacto social de sus resultados

Public participation in research projects is an emerging area in Spain and Latin American countries. There are five types of projects according to the degree of involvement that the participants have in the processes: contributory, collaborative, co-created, contractual and independent. In order to promote public participation in health research teams, their practices and competencies need to be redefined. To this end, it may be useful to ask questions in the different phases of the research, as well as to develop strategies that include audiences that have fewer channels of participation in favour of favouring equity in health. This way of doing science allows gathering experience and expertise prioritizing and adapting the research to the needs of the population, which increases its transforming capacity and the social impact of its results

[Public participation in research projects: ways of creating collective knowledge in health]. / Participación pública en los proyectos de investigación: formas de crear conocimiento colectivo en salud.

Public participation in research projects is an emerging area in Spain and Latin American countries. There are five types of projects according to the degree of involvement that the participants have in the processes: contributory, collaborative, co-created, contractual and independent. In order to promote public participation in health research teams, their practices and competencies need to be redefined. To this end, it may be useful to ask questions in the different phases of the research, as well as to develop strategies that include audiences that have fewer channels of participation in favour of favouring equity in health. This way of doing science allows gathering experience and expertise prioritizing and adapting the research to the needs of the population, which increases its transforming capacity and the social impact of its results.

La participación ciudadana en la investigación desde la perspectiva de investigadores de atención primaria / Public participation in research from the perspective of primary health care researchers

Objetivo: Explorar las debilidades, amenazas, fortalezas y oportunidades (DAFO) para el desarrollo de la participación de la ciudadanía en los proyectos de investigación gestionados por el Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) según los investigadores de atención primaria de salud de Cataluña. Método: Estudio transversal realizado en 2017 con 36 equipos de investigación de atención primaria de salud acreditados por el IDIAPJGol y su personal de gestión. Se diseñó y pilotó un cuestionario abierto (papel y online) para desarrollar una técnica DAFO. Se obtuvieron 65 respuestas (14 en papel y 51 online). Se realizó un análisis de contenido temático. Resultados: La mayoría de informantes considera la participación de la ciudadanía en la investigación una estrategia útil, innovadora, viable e imprescindible, pero exige un cambio de mentalidad y un alejamiento del paradigma jerárquico. Puede ser difícil su ejecución y complicar los estudios. Les preocupa a qué ciudadanos implicar, cómo seleccionarlos, los posibles conflictos de intereses y las necesidades de formación. Las principales propuestas para su implementación son difundir estrategias previas, fomentar la motivación y las sinergias entre ciudadanos, investigadores e instituciones, y clarificar los roles de los actores implicados. El IDIAPJGol debería elaborar recomendaciones para la participación de la ciudadanía en la investigación, incentivar su inclusión, disponer de un referente y asesorar a los equipos investigadores. Conclusiones: A pesar de los retos, desarrollar la participación de la ciudadanía en la investigación en atención primaria de salud es imprescindible y factible, pero partiendo de una estrategia participativa con todos los actores. La ciudadanía puede participar en cualquier diseño y fase de la investigación adaptando cada proyecto, siendo la atención primaria un ámbito privilegiado para desarrollar la participación ciudadana en la investigación

Objective: Explore the strengths, weaknesses, opportunities and threats (SWOT) for development of public involvement in research by Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) according to primary health care researchers in Catalonia (Spain). Methods: Cross-sectional study carried out in 2017 with 36 primary health care research teams accredited by IDIAPJGol and its management staff. An open questionnaire (paper and online) was designed and piloted to develop a SWOT technique, and 65 answers were obtained (14 in paper and 51 online). A thematic content analysis was carried out. Results: Most informants consider public involvement in research a useful, innovative, viable and essential strategy, but it requires a change of mentality and a move away from the hierarchical paradigm. It can be difficult to execute and can complicate studies. They are concerned about which citizens should be involve, how to select them, possible conflicts of interest and training needs. The main proposals for its implementation are to disseminate previous strategies, encourage motivation and synergies among citizens, researchers and institutions, and to clarify the roles of the actors involved. IDIAPJGol should develop recommendations for the public involvement in research, encourage their inclusion, have a mentor and advise the research teams. Conclusions: Despite the challenges, developing public involvement in research in primary health care is essential and feasible, what it is more should be based on a participatory strategy with all actors. The citizens can participate in any kind of design and phase of the research, adapting each project, being the primary health care a privileged area to develop the public involvement in research

[Public participation in research from the perspective of primary health care researchers]. / La participación ciudadana en la investigación desde la perspectiva de investigadores de atención primaria.

OBJECTIVE: Explore the strengths, weaknesses, opportunities and threats (SWOT) for development of public involvement in research by Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) according to primary health care researchers in Catalonia (Spain). METHODS: Cross-sectional study carried out in 2017 with 36 primary health care research teams accredited by IDIAPJGol and its management staff. An open questionnaire (paper and online) was designed and piloted to develop a SWOT technique, and 65 answers were obtained (14 in paper and 51 online). A thematic content analysis was carried out. RESULTS: Most informants consider public involvement in research a useful, innovative, viable and essential strategy, but it requires a change of mentality and a move away from the hierarchical paradigm. It can be difficult to execute and can complicate studies. They are concerned about which citizens should be involve, how to select them, possible conflicts of interest and training needs. The main proposals for its implementation are to disseminate previous strategies, encourage motivation and synergies among citizens, researchers and institutions, and to clarify the roles of the actors involved. IDIAPJGol should develop recommendations for the public involvement in research, encourage their inclusion, have a mentor and advise the research teams. CONCLUSIONS: Despite the challenges, developing public involvement in research in primary health care is essential and feasible, what it is more should be based on a participatory strategy with all actors. The citizens can participate in any kind of design and phase of the research, adapting each project, being the primary health care a privileged area to develop the public involvement in research.

[Transsexuality and the process of sexual reassignment from the perspective of male transsex: A qualitative study]. / La transexualidad y el proceso de reasignación sexual desde la perspectiva de los varones transexuales: un enfoque cualitativo.

OBJECTIVE: To understand the process of sexual reassignment from the perspective of people who undergo this procedure; to know how their body image influences their day to day life and the impact on their sexuality, and to learn from transgender male experiences in order to guide the health care teams involved, so that they can provide care in a more adjusted way to actual needs. METHOD: Qualitative study with a total of 7 male transsexuals over 18 years of age, undergoing at least one surgery intervention for sexual reassignment, using data collection techniques such as individual, semi structured, open, audio recorded interviews and writing of reflective diaries. RESULTS: Decision making to undergo surgery to change their body image and sexual identity is complex. Factors influencing this decision are related to: the need to accept their own body, the experience with hormonal treatments, the relationship with the family and social context and with the partner, management of their own fears, the organization of health care services, the relationship and communication with the health care professionals, and the economic aspects. CONCLUSIONS: Both professionals and health services should consider and delve into the topic with the goal to understand the meaning of sex reassignment procedures to ensure better care for transsexualism.

La transexualidad y el proceso de reasignación sexual desde la perspectiva de los varones transexuales: un enfoque cualitativo / Transsexuality and the process of sexual reassignment from the perspective of male transsex: a qualitative study

Objetivo. Entender el proceso de reasignación sexual desde la perspectiva de las personas que lo realizan, conocer cómo influye en su día a día su imagen corporal y el impacto en su sexualidad, y aprender de los varones transexuales para orientar a los equipos sanitarios implicados, de forma que puedan ofrecer una atención más ajustada a las necesidades reales. Método. Estudio cualitativo con un total de 7 varones transexuales mayores de 18 años, sometidos como mínimo a una intervención quirúrgica, utilizando como técnica de recogida de datos las entrevistas individuales, semiestructuradas, abiertas grabadas en audio y la redacción de diarios reflexivos. Resultados. El decidir someterse a una intervención con el fin de modificar la imagen corporal para ajustarla a su identidad de género es compleja. Los factores que influyen se relacionan con: la necesidad de aceptación de su propio cuerpo, la experiencia con los tratamientos hormonales, la relación con la familia y el entorno social y de pareja, el manejo de los propios miedos, la organización de los servicios sanitarios y la relación y comunicación con los profesionales sanitarios y aspectos económicos. Conclusiones. Tanto los profesionales como los servicios sanitarios deben tener en cuenta y profundizar en el tema de conocer el significado de las intervenciones de reasignación sexual para asegurar una mejor atención a la transexualidad

Objective. To understand the process of sexual reassignment from the perspective of people who undergo this procedure; to know how their body image influences their day to day life and the impact on their sexuality, and to learn from transgender male experiences in order to guide the health care teams involved, so that they can provide care in a more adjusted way to actual needs. Method. Qualitative study with a total of 7 male transsexuals over 18 years of age, undergoing at least one surgery intervention for sexual reassignment, using data collection techniques such as individual, semi structured, open, audio recorded interviews and writing of reflective diaries. Results. Decision making to undergo surgery to change their body image and sexual identity is complex. Factors influencing this decision are related to: the need to accept their own body, the experience with hormonal treatments, the relationship with the family and social context and with the partner, management of their own fears, the organization of health care services, the relationship and communication with the health care professionals, and the economic aspects. Conclusions. Both professionals and health services should consider and delve into the topic with the goal to understand the meaning of sex reassignment procedures to ensure better care for transsexualism

The Use of Humor in Palliative Care: A Systematic Literature Review.

BACKGROUND: Humor has its own place in the context of medicine. Nevertheless, its acceptance by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy. OBJECTIVES: To understand the significance, appropriateness, and pertinence of the use of humor in palliative care and to analyze its applicability. DESIGN: A narrative systematic review was undertaken and included in PROSPERO. DATA SOURCES: Online searches were carried out on PUBMED, PSYCINFO, EBSCO (CINHAL), EMBASE, SCIELO, SCOPUS, TESEO, WEB of SCIENCE, and COCHRANE between their launch date and December 31, 2015, complemented with manual searches with queries to experts. A total of 156 studies were identified, which were then filtered in pairs by means of an established hierarchy, selecting studies that discussed the use of humor specifically in palliative care from all perspectives and designs, and finally published in Spanish, English, French, or Portuguese. Critical reading of all the selected studies took place, with no exclusions due to quality evaluation. RESULTS: Thirty-four studies were included. Five main topics were identified: (1) definition of humor, (2) use and functions of humor in palliative care, (3) how to use humor, (4) when not to use humor, and (5) humor before and after the diagnosis of terminal illness. CONCLUSIONS: Humor plays an unquestionable role in palliative care, but its use needs training and appropriate use.

Prevalence of Schizophrenia Spectrum Disorders in Average-IQ Adults with Autism Spectrum Disorders: A Meta-analysis.

Since their separation as independent diagnostics, autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) have been conceptualized as mutually exclusive disorders. Similarities between both disorders can lead to misdiagnosis, especially when it comes to average-IQ adults who were not identified during childhood. The aim of this review was to examine the occurrence of SSD in average-IQ adults with ASD. Electronic and manual searches identified a total of 278 references, of which 10 were included in a meta-analysis. The pooled prevalence of SSD in the total ASD sample was close to 6%, pointing to a high co-occurrence of the two conditions. Further research is needed to determine the factors that predispose members of this population to the emergence of psychotic disorders.

Construcción de un instrumento de valoración del riesgo y gravedad de las lesiones del área del pañal en lactantes RDIC-lac / Construction of an instrument of risk assessment and injury severity for the diaper area in infants: RDIC-lac

Objetivo. Diseño de una escala para valorar el deterioro de la integridad cutánea en el área del pañal del lactante y la gravedad de la lesión para la prevención y manejo de la dermatitis irritativa de pañal. Metodología. Estudio en 3 etapas: 1) revisión exhaustiva y lectura crítica de literatura para el diseño preliminar del instrumento; 2) evaluación crítica de propuesta inicial por grupo de expertos (enfermería y medicina pediátrica) con cuestionarios de opinión y guía de preguntas ad hoc; 3) análisis de contenido mediante tabulación de datos para la modificación y diseño final del instrumento. Ámbito. Gerencia de Atención Primaria de Tenerife. Resultados. En la 1.ª fase se diseña una propuesta de instrumento: dos grupos de factores de riesgo (10 moduladores del riesgo y 9 de alto riesgo) y escala de gravedad con 5 aspectos a valorar de 4-5 ítems cada uno (profundidad, localización, extensión, tipo de lesión, signos de infección). En la 2.ª fase participan 19 profesionales. Se realiza una tabulación de los datos agrupados en factores a añadir u omitir. La 3.ª fase finaliza con una versión del instrumento modificada: 10 factores moduladores, 5 de alto riesgo y 4 ítems para cada aspecto a valorar en escala de gravedad. Discusión-Conclusiones. La escasa bibliografía encontrada y la ausencia de herramientas similares justificaron el diseño. La siguiente fase será la validación del instrumento RDIC-lac. Relevancia clínica. Susceptibilidad de prevenir lesiones cutáneas en el área del pañal en la edad pediátrica (AU)

Objective. To design an instrument to measure impairment of skin integrity in the diaper area of infants and severity of injury for the prevention and management of irritative diaper dermatitis. Methodology. Design in 3 phases: 1) comprehensive review and critical appraisal of literature to design the preliminary content of the instrument; 2) critical evaluation of initial proposal by an expert group (nursing and pediatric medicine) with opinion survey and ad hoc questions; 3) content analysis using data tabulation for the modification and final design of the instrument. Setting. Primary Care Management of Tenerife Results. In the 1st phase a proposed instrument is designed: two groups of risk factors (10 modulators risk and 9 high risk); and a severity scale with 5 aspects to assess including 4-5 items each (depth, location, extension, type of injury, signs of infection). The 2nd phase involved 19 professionals. A Tabulation of the data grouped into add or omit factors was used. The 3rd phase ends with a modified version of the instrument: 10 modulating factors, 5 of hig risk and 4 items for each aspect to assess severity. Discussion-Conclusions. The scarce bibliography found and the absence of similar tools explain the design. The next phase will be the validation of RDIC-lac instrument. Clinical relevance. Susceptibility to prevent skin lesions in the diaper area in the pediatric age (AU)

[Construction of an Instrument of Risk Assessment and Injury Severity for the Diaper Area in Infants: RDIC-lac]. / Construcción de un instrumento de valoración del riesgo y gravedad de las lesiones del área del pañal en lactantes RDIC-lac*.

Objective: To design an instrument to measure impairment of skin integrity in the diaper area of infants and severity of injury for the prevention and management of irritative diaper dermatitis. Methodology: Design in 3 phases: 1) comprehensive review and critical appraisal of literature to design the preliminary content of the instrument; 2) critical evaluation of initial proposal by an expert group (nursing and pediatric medicine) with opinion survey and ad hoc questions; 3) content analysis using data tabulation for the modification and final design of the instrument. Setting: Primary Care Management of Tenerife. Results: In the 1st phase a proposed instrument is designed: two groups of risk factors (10 modulators risk and 9 high risk); and a severity scale with 5 aspects to assess including 4-5 items each (depth, location, extension, type of injury, signs of infection). The 2nd phase involved 19 professionals. A Tabulation of the data grouped into add or omit factors was used. The 3rd phase ends with a modified version of the instrument: 10 modulating factors, 5 of hig risk and 4 items for each aspect to assess severity. Discussion-Conclusions: The scarce bibliography found and absence of similar tools explain the design. The next phase will be the validation of RDIC-lac instrument. Clinical Relevance: Susceptibility to prevent skin lesions in the diaper area in the pediatric age.

Metodología para un proceso apreciativo, dinámico y colaborativo: III Plan de Salud de Canarias / Methodology for an appreciative, dynamic and collaborative process: 3rd Canary Islands (Spain) Health Plan

La necesidad de nuevos enfoques de planificación estratégica con la incorporación de la visión de profesionales y ciudadanos ha orientado un nuevo modelo para el III Plan de Salud de Canarias (IIIPSC). Se propone un proceso participativo con soporte de metodología cualitativa en dos etapas: 1) fase local: estudio cuantitativo-cualitativo a través de una acción formativa y de investigación-acción-participación, y 2) fase insular: conferencias de salud, con debate sobre resultados en sesiones presenciales en cada área de salud (isla) y propuestas de acción. El proceso define una priorización de problemas y un plan de acción específico para cada isla mediante operaciones consideradas viables, agrupadas por temas y ponderadas según el potencial impacto sobre los problemas priorizados. Este proceso de interacción puede contribuir a orientar los cambios de modelo de planificación y la toma de decisiones en política sanitaria, y se encuentra recogido en el Proyecto del IIIPSC para su tramitación parlamentaria (AU)

The need for new approaches to strategic planning by incorporating the perspectives of professionals and inhabitants has led to a new model for the 3rd Canary Islands (Spain) Health Plan (IIIPSC). A dual-phase participatory process using qualitative techniques is proposed: 1) local phase: a quantitative and qualitative study based on training and a research-action-participation initiative; and 2) insular phase: health conferences with face-to-face discussion of results in each health area (island) and proposals for action. The process prioritises problems and establishes a specific action plan for each island through initiatives that are considered to be viable, grouped by themes and weighted according to the potential impact on priority problems. This process of interaction may help to guide planning model changes and health policy decision-making, and was included in the IIIPSC Project for its parliamentary procedure (AU)