Language and Cultural Barriers and Facilitators of Sexual and Reproductive Health Care for Migrant Women in High-Income European Countries: An Integrative Review.

INTRODUCTION: Dealing with intercultural communicative barriers in European countries' national health services is an increasing and necessary challenge to guarantee migrant women's right to health care. This integrative review describes the communication barriers and facilitators that migrant women encounter to access and use sexual and reproductive health (SRH) services in Europe. METHODS: A literature search was performed to identify original studies in PubMed, CINAHL, PsycINFO, Web of Science, and Scopus, using keywords associated with migrant women and SRH services. This was supplemented by scanning the reference lists from relevant studies and similar reviews. Studies exploring the perspective of migrant women about communication barriers and facilitators to the access and use of SRH services were included, whereas those that solely explored health professional's experiences were excluded. Findings were organized into 4 themes: (1) verbal-linguistic barriers, (2) nonverbal language barriers, (3) cultural barriers, and (4) communication facilitators. RESULTS: Nineteen studies met the inclusion criteria. Results showed that when women had problems understanding or being understood by health professionals, they experienced feelings of anxiety, fear, insecurity, and discrimination that discouraged them from using SRH services. The most requested facilitators by women were health education, access to professional interpreters and translation of written information, and increasing the practitioners' cultural competence. DISCUSSION: Communication barriers undermine migrant women's right to benefit from preventive SRH programs and to make informed decisions concerning their health. It is necessary to establish tailored plans in each health care center to improve intercultural communication that integrate facilitators proposed by women. Future research should provide solid evidence on the effectiveness of each facilitator implemented.

Heart failure admission across glomerular filtration rate categories in a community cohort of 125,053 individuals over 60 years of age.

A reduced estimated glomerular filtration rate (eGFR) has been described as a predictor of heart failure (HF). However, the increased risk across eGFR categories has not been fully evaluated, which is especially relevant in older individuals in whom both the prevalence of HF and decreased eGFR are higher. Furthermore, this association has not been studied in Mediterranean populations, where coronary heart disease (CHD), a frequent cause of HF, has a low prevalence. We performed a retrospective cohort study using the electronic medical records from primary and hospital settings in northeastern Spain. We included 125,053 individuals ≥60 years old with the determination of creatinine and without diagnosis or previous admission due to HF. The eGFR was calculated according to the CKD-EPI formula and classified by clinical categories. The association between eGFR, as a continuous and categorical variable, and the risk of admission due to HF was assessed by Cox proportional risk analysis, considering death as a competitive risk. During a median follow-up of 38.8 months, 2,176 individuals (1.74%) were hospitalized due to HF. The unadjusted admission rates were 4.02, 13.0, 26.0, and 48.6 per 1000 person-years for eGFR > 60, 45-59, 30-44, and 15-29 ml/min/1.73 m2, respectively. The corresponding hazard ratios (95% confidence interval; reference eGFR 60-89) were 1.38 (95% CI 1.23-1.55), 2.02 (95% CI 1.76-2.32) and 3.46 (95% CI 2.78-4.31). In this Mediterranean community-based cohort of individuals ≥60 years old without previous HF, the risk of admission due to HF gradually increased with decreasing eGFR.

Carga actual de los médicos de familia; ¿una necesidad de intervención psicológica? / No disponible

Este estudio estaba dirigido a determinar en una muestra de Médicos de Atención Primaria (MAP) (a) su actual nivel de burnout, satisfacción profesional, bienestar psicológico y actitudes hacia la salud mental; (b) la influencia del burnout, satisfacción profesional y algunas variables socio-demográficas sobre el bienestar psicológico. Se desarrolló un estudio observacional-transversal con 38 MAPs. Se administraron cuestionarios para evaluar el burnout, satisfacción profesional, actitudes hacia la salud mental y una entrevista psiquiátrica para evaluar el bienestar psicológico. Algunos indicadores administrativos y de gestión sanitaria fueron también considerados. Los niveles de burnout (median= 38, IQR= 29, 54) y satisfacción laboral (median= 75.5, IQR= 73, 79) fueron moderados. Sólo el 5.26% de los MAPs informó de un alto burnout. La ansiedad, la depresión y las preocupaciones somáticas fueron los síntomas psiquiátricos predominantes. El 55.26% presentaron síntomas de moderados a extremadamente severos en al menos un síntoma psiquiátrico. Los modelos regresión logística reflejaron como el burnout desarrollaba un papel clave sobre los síntomas psiquiátricos. Los MAPs presentaron unos resultados heterogéneos en los diferentes parámetros de salud laboral analizados y altos niveles de síntomas psiquiátricos. Concluimos que existes una necesidad de proteger y mejorar la salud laboral y el bienestar psicológico de los MAPs

This study was aimed at determining in a sample of in a sample of General practitioners (GPs) (a) their current level of burnout, professional satisfaction, psychological well-being and the attitudes towards mental health; (b) the influence of burnout, professional satisfaction and some socio-demographic variables on the level of psychological well-being. A transversal observational study with 38 GPs was carried out. Self-report measures were administered to assess burnout, professional satisfaction, attitudes toward mental health and a psychiatric interview to evaluate psychological well-being. Some administrative and health care management indicators were also considered. Burnout (median= 38, IQR = 29, 54), and job satisfaction levels were moderate (median = 75.5, IQR = 73, 79). Only 5.26% of GPs reported a high burnout. Anxiety, depression and somatic concerns were the predominant psychiatric symptoms. Focusing only on these worrying cases, a 55.26% of GPs presented from moderate to extremely severe symptoms in at least one psychiatric symptom. Regression models reflected like burnout played a key role work on psychiatric symptoms. GPs presented heterogeneous (generally moderate) levels across the different work-related health parameters analyzed and high levels of psychiatric symptoms. We conclude that there's a need to protect and improve GPs' work-related health and psychological wellbeing

Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado / Heart failure in primary care: Attitudes, knowledge and self-care

OBJETIVO: Conocer actitudes, conocimientos y prácticas en autocuidado en pacientes con insuficiencia cardiaca (IC) atendidos en atención primaria, e identificar factores asociados a mayor autocuidado. DISEÑO: Estudio transversal multicéntrico. Emplazamiento: Atención primaria. PARTICIPANTES: Individuos mayores de 18 años con diagnóstico activo de IC a 1 de diciembre de 2011 en 10 centros de salud del Área Metropolitana de Barcelona. Medidas principales: Se realizó entrevista y revisión de historia clínica para obtención de datos sociodemográficos, clínicos y tests de actitudes (Self-efficacy Managing Chronic Disease Scale), conocimientos (Patient Knowledge Questionnaire), autocuidado (European Heart Failure Self-care Behaviour Scale), grado autonomía (Barthel) y cribado ansiedad-depresión (test Goldberg). Se analizaron las variables asociadas a autocuidado mediante modelo de regresión lineal múltiple de efectos mixtos jerarquizado por centros. RESULTADOS: n = 295 individuos (77,6%), edad media 75,6años (DE: 11), 56,6% mujeres, 62% sin estudios primarios. Se obtuvo una media global de autocuidado de 28,65 (DE: 8,22) puntos. Un 25% de los pacientes presentaron puntuaciones inferiores a 21 puntos. En el modelo multivariante final (n = 282; R2 condicional = 0,3382), un mayor autocuidado se relacionó con mejores conocimientos sobre la IC (coeficiente -1,37; intervalo de confianza 95%: -1,85 a -0,90) y el diagnóstico de cardiopatía isquémica (-2,41; -4,36: -0,46). CONCLUSIONES: El grado de prácticas en autocuidado es moderado. La asociación de mejor autocuidado y mayor nivel de conocimientos sobre la IC, potencialmente modificables, subraya la oportunidad de implementar estrategias para su mejora adaptadas a las características diferenciales de los pacientes con IC atendidos de atención primaria

OBJECTIVE: To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DESIGN: Cross-sectional and multicentre study. SETTING: Primary Care. PARTICIPANTS: Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. MAIN MEASUREMENTS: Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. RESULTS: A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n = 282; R2 conditional = 0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). CONCLUSION: Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care

[Heart failure in primary care: Attitudes, knowledge and self-care]. / Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado.

OBJECTIVE: To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DESIGN: Cross-sectional and multicentre study. SETTING: Primary Care. PARTICIPANTS: Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. MAIN MEASUREMENTS: Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. RESULTS: A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). CONCLUSION: Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care.

Insuficiencia cardíaca. Perspectiva desde atención primaria / Heart failure: a view from primary care

Objetivo: Conocer la situación de la insuficiencia cardíaca (IC) en atención primaria (AP). Diseño: Estudio transversal multicéntrico. Emplazamiento: Cuatro centros de salud y el hospital de referencia de un área urbana de Barcelona. Participantes: De una población de 35.212 habitantes mayores de 45 años, se incluyeron todos los pacientes (333) diagnosticados de IC en AP en 2006.MedicionesMediante cuestionario estandarizado se recogieron datos demográficos, clínicos y tratamiento. Resultados: Un 61,4% eran mujeres, la edad media en varones fue de 74,5 (desviación estándar [DE]: 10) y en mujeres de 79 (DE: 9,8) (p<0,0001), el 46% tenía una evolución de la enfermedad menor de 5 años. La comorbilidad en el momento del diagnóstico y al inicio del estudio fue hipertensión (65,4–73%), diabetes (33,6–40%), dislipidemia (40–53%), enfermedad coronaria (30–27%), valvulopatías (23,7–27%) y enfermedad pulmonar obstructiva crónica (20–26%). Resultados: Un 64% tenía registrado el grado funcional New York Heart Association (el 48% de clase II; el 30%, III; el 6,6%, IV). El 36% de los varones y el 20,5% de las mujeres tenían controlada la presión arterial (p=0,002). En un 75,4% constaba registro de electrocardiograma, un 57% de radiografía de tórax, un 58% en varones y un 46% en mujeres (p=0,02) de ecocardiograma. Los fármacos más prescritos fueron diuréticos (85,3%), inhibidores de la enzima de conversión de la angiotensina (43%), antagonistas de los receptores de la angiotensina (33%) y bloqueadores beta (27%). Conclusiones: Los pacientes atendidos son fundamentalmente mujeres de avanzada edad y elevada comorbilidad. Debe preocuparnos en AP el poco registro de exploraciones complementarias básicas y la poca utilización de BB (AU)

Objective: Our aim was to find out the situation of heart failure (HF) in primary care. Design: Cross-sectional multicentre study.Setting Four primary health care centres and a hospital in an urban area of Barcelona. Participants: From a registered population of 35,212 inhabitants older than 45 years, we studied all patients (333) diagnosed with HF in 2006 in primary care. Measurements: A standardised questionnaire was used to record demographic, clinical and treatment data. Results: There were 61.4% females. Mean age was 74.5 (standard deviation [SD]: 10) for men and 79 (SD: 9.8) for women. A total of 46% of patients had HF for <5 years. The comorbidity diagnosis and at the beginning of the study were: hypertension 65.4% and 73%, diabetes 33.6% and 40%, dyslipaemia 40% and 53%, coronary disease 30% and 27%, and valvular disease 23.7% and 27%, respectively. Results: A total of 64% of patients had registered New York Heart Association functional class (48% class II, 30% III and 6.6% IV). Blood pressure was controlled in 36% men and 20.5% women (P=0.002); 75.4% had an electrocardiogram, 57% X-ray; 58% of men and 46% of women (P=0.02) had echocardiography. The most prescribed drugs were diuretics 85.3%, the least, beta blockers 27%.ConclusionsPatients with HF in primary care are elderly females with a lot of comorbidities. We must be concerned by the suboptimal use of basic investigations (electrocardiogram and X-ray) and beta blocker treatments (AU)

[Heart failure: a view from primary care]. / Insuficiencia cardíaca. Perspectiva desde atención primaria.

OBJECTIVE: Our aim was to find out the situation of heart failure (HF) in primary care. DESIGN: Cross-sectional multicentre study. SETTING: Four primary health care centres and a hospital in an urban area of Barcelona. PARTICIPANTS: From a registered population of 35,212 inhabitants older than 45 years, we studied all patients (333) diagnosed with HF in 2006 in primary care. MEASUREMENTS: A standardised questionnaire was used to record demographic, clinical and treatment data. RESULTS: There were 61.4% females. Mean age was 74.5 (standard deviation [SD]: 10) for men and 79 (SD: 9.8) for women. A total of 46% of patients had HF for <5 years. The comorbidity diagnosis and at the beginning of the study were: hypertension 65.4% and 73%, diabetes 33.6% and 40%, dyslipaemia 40% and 53%, coronary disease 30% and 27%, and valvular disease 23.7% and 27%, respectively. A total of 64% of patients had registered New York Heart Association functional class (48% class II, 30% III and 6.6% IV). Blood pressure was controlled in 36% men and 20.5% women (P=0.002); 75.4% had an electrocardiogram, 57% X-ray; 58% of men and 46% of women (P=0.02) had echocardiography. The most prescribed drugs were diuretics 85.3%, the least, beta blockers 27%. CONCLUSIONS: Patients with HF in primary care are elderly females with a lot of comorbidities. We must be concerned by the suboptimal use of basic investigations (electrocardiogram and X-ray) and beta blocker treatments.

Disfunción ventricular transitoria o síndrome de Tako-Tsubo / Transient ventricular dysfunction or Tako-Tsubo syndrome

El síndrome de disfunción ventricular transitoria (SDAT) o Tako-Tsubo es una entidad que se presenta en mujeres de mediana edad, sin riesgo cardiovascular elevado, que se caracteriza por un cuadro clínico indicativo de síndrome coronario agudo de causa desconocida desencadenado por una situación de estrés súbito. Se presenta un caso clínico de este síndrome. Mujer de 46 años de edad, atendida de urgencias en su centro de salud por un cuadro de dolor torácico precordial, con cambios electrocardiográficos de lesión subepicárdica encara anterior. En el hospital de referencia, se detectó elevación de los marcadores de daño miocárdico. El cateterismo no mostró lesiones angiográficamente significativas. En la ventriculografía se observó aquinesia apical confracción de eyección disminuida. El resultado de las exploraciones complementarias orientó al diagnóstico de SDAT. El SDAT es una entidad a tener en cuenta en pacientes sin riesgo cardiovascular elevado, dada la diferente implicación pronóstica y de tratamiento (AU)

Transient ventricular dysfunction (TVD) or Tako-Tsubo syndrome is a disorder that occurs in middle aged women with an increased cardiovascular risk. It is characterised by a clinical picture suggestive of acute coronary syndrome of unknown cause, triggered by an acute stress situation. A clinical case of this syndrome is presented. A 46 year old female patient was seen as an emergency in her health centre die to a clinical picture of precordial chest pain with electrocardiography changes of an anterior subepicardiallesion. Increases in the myocardial damage markers were detected in the reference hospital. The angiographic catheter showed significant lesions. Ventriculography showed evidence of apical a kinesia with a decrease dejection fraction. The results of the complementary examinations led to the diagnosis of a transient ventricular dysfunction syndrome TVDS). TVDS is a condition to take into account inpatients who do not have a high cardiovascular risk given the prognostic and treatment implications (AU)