Validation of an Inhaled Therapy Beliefs Questionnaire in Patients with Chronic Obstructive Pulmonary Disease.

Background: To carry out a validation questionnaire that assesses beliefs about inhaled treatments in patients with chronic obstructive pulmonary disease (COPD), as knowing patients' beliefs could help to improve medication adherence and health outcomes. Methods: We evaluated data from 260 COPD patients from electronic medical record databases from five primary healthcare centers, in a descriptive, cross-sectional study with a sample size calculated for a 10-item questionnaire, with an estimated Cronbach's alpha of 0.70 and a 95% confidence level. Study participants were selected via systematic random sampling. Variables: Ten-item Inhaled Therapy Beliefs Questionnaire, CCTI-Questionnaire v.2.0, time for completion, age, sex, educational level, spirometry severity (GOLD criteria), exacerbations (previous year), characteristics of inhaled treatment, and smoking habit. A two-year follow-up in a subsample of 77 patients from one health center was utilized. The Morisky-Green test, pharmacy dispensing data, test-retest (kappa coefficient), and an exploratory analysis of the adherence-belief relationship (ji-squared) were measured. Results: The 10-item questionnaire showed good viability (3 min completion time) when performed face-to-face or telephonically; its psychometric properties were acceptable, with an internal consistency (Cronbach's alpha) score of 0.613. Three factors explained 47.58% of the total variance (p < 0.0001): use (factor 1), effects (factor 2), and objectives (factor 3) of inhalers. The two-year follow-up ultimately considered 58 out of the 77 patients (10 deceased, 4 unlocated, 2 mistakes, 2 no inhaled treatment, and 1 withdrawal). Non-adherence was 48.3% in terms of the Morisky-Green test; 31% in terms of pharmacy dispensing data; and 40.4% considering both methods. There was low test-retest reliability, indicated by items 4, 8, and 9 of the CCTI-Questionnaire (Kappa = 0.4, 0.26, and 0.34; p-value < 0.0001, 0.008, and 0.001, respectively). There was mild correlation between beliefs and adherence. Conclusions: The ten-item CCTI-Questionnaire v.2.0 demonstrated acceptable psychometric properties regarding feasibility, reliability, and content validity.

Alteration of the ankle brachial index, follow-up of patients at risk of peripheral arterial disease, a descriptive longitudinal study.

Background The objective of this study was to detect peripheral arterial disease (PAD) by measuring the ankle-brachial index (ABI) in patients attending medical offices in primary health care who presented a moderate or high risk on the risk scale of Framingham. Design longitudinal descriptive. Setting urban health center. Materials and methods Patients at risk of peripheral arterial disease of the lower limbs: diabetes mellitus (DM), cardiovascular disease (CVD), high cardiovascular risk (HCR) (SCORE>5%), and/or compatible symptoms. Consecutive sampling, n=136 (expected prevalence 8%, alpha 0.05, precision 0.95, projected losses 20%). Dependent variable: ankle-brachial index (ABI). Independent variables: hypertension (HBP), age, sex, CVD, DM, glycosylated hemoglobin (HbA1C), hyperlipidemia (HLP), LDL cholesterol (LDL), smoking, body mass index (BMI), pulses, treatment. Multivariate analysis: linear regression. Confidence level 95%. Results From a sample of 136 patients, 90 were male (66.2%) and 46 were female (33.8%), with a mean age of 72.2 years (in 2021), and a standard deviation (SD) of 7. The prevalence of abnormal ABI (ABI <0.9) was 11%, with a mean ABI of 0.7 (SD 0.18). The bivariate analysis showed a significant relationship between abnormal ABI and pulse palpation (p<0.0001). Excluding patients with ABI ≥ 1.4, in the multivariate analysis (coefficient of determination 0.977), the B coefficients and their 95% confidence intervals (CI) are as follows: age B=0.006, 95% CI (0.002-0.010) (p=0.003); diabetes B=0.289, 95% CI (0.1-0.479) (p=0.003); pulse palpation B= -0.199, 95% CI (-0.289- -0.11) (p<0.0001). Conclusions Doctor consultations in primary care are a favorable context for making an early diagnosis of PAD, by measuring the ABI. The performance of the ABI should be included as part of the annual examination for chronic patients who regularly attend consultations, particularly those with moderate or high cardiovascular risk. In this way, preventive measures could be intensified to prevent future cardiovascular complications in these patients. The predictors of ABI are age, diabetes, and palpation of pulses.

Rich oleocanthal and oleacein extra virgin olive oil and inflammatory and antioxidant status in people with obesity and prediabetes. The APRIL study: A randomised, controlled crossover study.

BACKGROUND: Oleocanthal and oleacein are olive oil phenolic compounds with well known anti-inflammatory and anti-oxidant properties. The main evidence, however, is provided by experimental studies. Few human studies have examined the health benefits of olive oils rich in these biophenols. Our aim was to assess the health properties of rich oleocanthal and oleacein extra virgin olive oil (EVOO), compared to those of common olive oil (OO), in people with prediabetes and obesity. METHODS: Randomised, double-blind, crossover trial done in people aged 40-65 years with obesity (BMI 30-40 kg/m2) and prediabetes (HbA1c 5.7-6.4%). The intervention consisted in substituting for 1 month the oil used for food, both raw and cooked, by EVOO or OO. No changes in diet or physical activity were recommended. The primary outcome was the inflammatory status. Secondary outcomes were the oxidative status, body weight, glucose handling and lipid profile. An ANCOVA model adjusted for age, sex and treatment administration sequence was used for the statistical analysis. RESULTS: A total of 91 patients were enrolled (33 men and 58 women) and finished the trial. A decrease in interferon-γ was observed after EVOO treatment, reaching inter-treatment differences (P = 0.041). Total antioxidant status increased and lipid and organic peroxides decreased after EVOO treatment, the changes reaching significance compared to OO treatment (P < 0.05). Decreases in weight, BMI and blood glucose (p < 0.05) were found after treatment with EVOO and not with OO. CONCLUSIONS: Treatment with EVOO rich in oleocanthal and oleacein differentially improved oxidative and inflammatory status in people with obesity and prediabetes.

Internet como fuente de datos en investigación cualitativa en ciencias de la salud. Comunidades virtuales de pacientes / Internet as a data source in qualitative research in health sciences. Virtual Patient Communities

Las comunidades virtuales de pacientes en Internet son una fuente de datos potencial para investigaciones cualitativas, permitiendo explorar la perspectiva y vivencia de los pacientes sobre sus problemas de salud. En este artículo analizamos las posibilidades de utilización de estas comunidades virtuales y aportamos una propuesta metodológica. Se parte de una revisión bibliográfica y se realiza una adaptación práctica de la metodología cualitativa siguiendo el esquema: pregunta de investigación-objetivos-hipótesis-muestreo-análisis de hilos de conversación. Se aplican principios de netnografía y ciberhabla. La base de muestreo son lugares web de comunidades virtuales de pacientes, seleccionadas según enfermedad, objetivos y calidad, estableciendo límites temporales. Contenido del análisis de los hilos: tema, número de participantes, secuencias conversacionales, protagonistas, reglas y clima. Se realiza un informe provisional, definitivo tras la devolución a la comunidad virtual para aportaciones. El ciclo se reinicia si no se responden las preguntas de investigación.(AU)

Virtual Patient Communities are a potential data source for qualitative research, allowing to explore the patient perspective and experience about their chronic diseases. In this article we analyse the possibilities of using these virtual patient communities, and we provide a methodological proposal. It starts from a bibliographic review and a practical adaptation to the qualitative methodology is carried out following the scheme: research question-objectives-hypothesis-sampling-analysis of conversation threads. Principles of netnography and netspeak are applied. The sampling frame is websites of virtual patient communities that are selected according to disease, objectives, quality and time limits. Content of the analysis of the threads: theme, number of participants, conversational sequences, protagonists, rules and climate. A provisional report is made, and the definitive report will be make after the return to virtual patient community for their contributions. The cycle restarts if the research questions are not answered.(AU)

Fomento de la dieta mediterránea mediante la práctica de la cocina tradicional / Promotion of the Mediterranean diet based on the practice of traditional cuisine

Los hábitos de vida son un importante determinante de la salud, encontrándose entre ellos la alimentación saludable. Es primordial centrar nuestros esfuerzos en promocionar la dieta mediterránea. OBJETIVOS: fomentar el conocimiento y la práctica de la cocina tradicional basada en la dieta mediterránea en la población adscrita a un centro de salud. MÉTODOS: estrategia de participación comunitaria basada en el trabajo coordinado de asociaciones vecinales, ciudadanas y culturales de la zona, para promocionar un envejecimiento saludable. Intervención comunitaria basada en el fortalecimiento de la comunidad mediante distintas actividades compartidas. RESULTADOS: Libro de recetas: recetas tradicionales aportadas por personas de la zona. Dos ediciones (2014 y 2018) con 23 y 25 recetas. Receta del mes: difundida en consultas del centro de salud, los expositores y las páginas web de asociaciones de la zona. Talleres de cocina (2015-2019): elaboración grupal y comida colectiva, recetas de cocina popular. Se realizan tres sesiones prácticas, con 15 personas. 1) Cocinamos (grupos de 5 personas). 2) Comemos juntos, siguiendo la «forma de comer» mediterránea: encuentro, compañía y disfrute. 3) Puesta en común de la forma de elaboración por la persona responsable del plato. 4) Recogida y limpieza. Sesiones divulgativas: metodología participativa, enfoque práctico. Se han realizado las siguientes sesiones divulgativas: taller de aceites de oliva (2015), taller de quesos (2016), taller de tipos de pan (2017), taller de leches (2018), taller de azúcares (2019) y sesiones sobre alimentación saludable en centros educativos. Desayunos saludables (2016-2019): se han organizado en el centro educativo en el que se realiza el taller de cocina. CONCLUSIONES: el fomento de la dieta mediterránea puede hacerse desde la participación comunitaria con intervenciones colaborativas

Lifestyles are important determinants of health, including healthy diet. This is fundamental to focus our efforts on promoting a Mediterranean diet. OBJECTIVES: To encourage knowledge and practice of traditional cuisine based on a Mediterranean diet in the population assigned to a Health Centre. METHODS: Community participation strategy based on coordination with neighborhood, city and cultural associations in the area to promote healthy ageing. Community intervention based on strengthening the community by shared activities. RESULTS: Recipe book: Traditional recipes provided by local people. There are two editions (2014, 2018) with 23 and 25 recipes, respectively. Recipe of the month: Widespread coverage in health centre, display to the public and area association websites. Cooking workshops: Group cooking and collective meals of popular cuisine recipes, three practice sessions, 15 people. 1) We cook; 3-5 people. 2) We share the meal. Dish tasting according to the Mediterranean style of eating: meeting, company and enjoyment. 3) Sharing the way the dish was cooked by the person responsible for it. 4) Collecting and cleaning. Informative sessions: Participatory methodology, practical approach. Workshops which took place: "Olive oil workshop" (2015). "Cheese workshop" (2016). "Types of bread workshop"(2017). "Milk workshop" (2018). "Sugar workshop" (2019). Sessions about healthy eating in schools. Healthy breakfast (2016-2019): in schools with cooking workshops. CONCLUSIONS: The Mediterranean diet can be promoted from community participation with collaborative interventions

[The effect of a falls prevention program in elderly people in primary health care. What does Tai Chi practice provide?] / Efecto de un programa de prevención de caídas en personas mayores en atención primaria. ¿Qué aporta la práctica de Tai Chi?

OBJECTIVE: Falls in the elderly are a major health problem. There are multiple experiences of intervention in primary care. Aim: To evaluate the impact of a multifactorial intervention in the prevention of falls in elderly people. To compare the differential effect of the practice of Tai Chi. METHODS: Non-randomized before-after quasi-experimental design in an urban health center between the years 2014-2017. The study population was those over 65 years old with a high risk of falls. The intervention consisted of an individual assessment of risk factors: sensory problems, balance, orthostatic hypotension, treatments (psychotropic drugs, hypotensive drugs), barriers, technical aids. It was intervened in its correction. Tai Chi group participation is proposed. The dependent variables (baseline and year measurements) were Barthel, Unipodal Station Test (TEU), number of falls per year, Anxiety/Depression Goldberg Scale (EADG), number of medical consultations per year, walking aids, Daily Dose Defined of analgesics (DDD)/ year. The before-after analysis was performed using the Chi2 and T Student statistics for paired samples. RESULTS: A total of 93 patients participated with an average age of 76+06,65, 84.9% women. Falls/year baseline 1.65 + 0.24; no significant differences between groups with or without Tai Chi in any baseline variable. At one year, average reduction of falls/year 0.53 (IC95% 0,07-0,99) (p=0.023), EADG anxiety 1.4±0.33 points (p<0.0001), EAGD depression 0.73±0.26 points (p=0.007). 44 patients practiced Tai Chi; finding: reduction of 1.88 (IC95% 0.90-2.80) points (p<0.0001) in EADG anxiety and 0.86 points (IC95% 0.12-1.60) (p=0.024) in EADG depression; 30.9% of patients abandoned technical aids (p<0.0001); 11% started psychotropic drugs. 49 patients did not practice Tai Chi; of them: EADG anxiety reduction of 1,020 points (IC95% 0.07-1.96) (p=0.035); 41.2% of patients initiated psychotropic drugs (p=0.001); none of the patients abandoned technical aids and 14.3% started them (p<0.001). CONCLUSIONS: The intervention reduced the number of falls, anxiety, the use of psychotropic drugs, depression, and the use of walking aids, with differential benefit of Tai Chi in these last three aspects.

OBJETIVO: Las caídas en las personas mayores son un problema de salud de primer orden. Existen múltiples experiencias de intervención en atención primaria. El objetivo de este trabajo fue evaluar el impacto de una intervención multifactorial en prevención de caídas en personas mayores y comparar el efecto diferencial de practicar Tai Chi. METODOS: Diseño cuasiexperimental antes-después no aleatorizado en un centro de salud urbano entre los años 2014-2017. La población de estudio fueron los mayores de 65 años con alto riesgo de caídas. La intervención consistió en una valoración individual de factores de riesgo: problemas sensoriales, equilibrio, hipotensión ortostática, tratamientos (psicofármacos, hipotensores), barreras arquitectónicas, ayudas técnicas. Se intervino en su corrección. Se propone la participación en grupo de Tai Chi. Las variables dependientes (mediciones basal y al año) fueron: Índice de Barthel, Test Estación Unipodal (TEU), número de caídas/año, Escala Ansiedad/Depresión de Goldberg (EADG), número de consultas médicas/año, uso de ayudas para la marcha, Dosis Diaria Definida(DDD) analgésicos/año. Se realizó el análisis antes-después utilizando Chi2 y T Student para muestras apareadas. RESULTADOS: Participaron un total de 93 pacientes, con una edad media de 76±6,65 años y un 84,90% mujeres. Número de Caídas/año basal 1,65±0,24; sin diferencias significativas entre grupos con/sin Tai Chi en ninguna variable inicial. Al año, reducción media de caídas/año a 0,53 (IC95% 0,07-0,99) (p=0.023), EADG ansiedad 1,40±0,33 puntos(p<0,0001), EADG depresión 0,73±0,26 puntos (p=0.007). Practicaron Tai Chi 44 pacientes, encontrándose: reducción de 1,88 (IC95% 0,90-2,80) puntos (p<0.0001) en EADG ansiedad y 0,86 puntos (IC95% 0,12-1,60) (p=0,024) en EADG depresión; 30,90% de pacientes abandonaron ayudas técnicas (p<0.0001); iniciaron psicofármacos 11%. No practicaron Tai Chi 49 pacientes, en ellos se redujo 1,02 puntos la EADG ansiedad (IC95% 0,07-1,96) (p=0,035); 41,20% de pacientes iniciaron psicofármacos (p=0,001); ningún paciente abandonó ayudas técnicas y 14,30% las iniciaron (p<0,001). CONCLUSIONES: La intervención redujo las caídas, la ansiedad, el uso de los psicofármacos, la depresión, y el uso de ayudas para la marcha, con beneficio diferencial del Tai Chi en estos tres últimos aspectos.

Efecto de un programa de prevención de caídas en personas mayores en atención primaria. ¿Qué aporta la práctica de Tai Chi? / The effect of a falls prevention program in elderly people in primary health care. What does Tai Chi practice provide?

OBJETIVO: Las caídas en las personas mayores son un problema de salud de primer orden. Existen múltiples experiencias de intervención en atención primaria. El objetivo de este trabajo fue evaluar el impacto de una intervención multifactorial en prevención de caídas en personas mayores y comparar el efecto diferencial de practicar Tai Chi. MÉTODOS: Diseño cuasiexperimental antes-después no aleatorizado en un centro de salud urbano entre los años 2014-2017. La población de estudio fueron los mayores de 65 años con alto riesgo de caídas. La intervención consistió en una valoración individual de factores de riesgo: problemas sensoriales, equilibrio, hipotensión ortostática, tratamientos (psicofármacos, hipotensores), barreras arquitectónicas, ayudas técnicas. Se intervino en su corrección. Se propone la participación en grupo de Tai Chi. Las variables dependientes (mediciones basal y al año) fueron: Índice de Barthel, Test Estación Unipodal (TEU), número de caídas/año, Escala Ansiedad/Depresión de Goldberg (EADG), número de consultas médicas/año, uso de ayudas para la marcha, Dosis Diaria Definida(DDD) analgésicos/año. Se realizó el análisis antes-después utilizando Chi2 y T Student para muestras apareadas. RESULTADOS: Participaron un total de 93 pacientes, con una edad media de 76+/-6,65 años y un 84,90% mujeres. Número de Caídas/año basal 1,65+/-0,24; sin diferencias significativas entre grupos con/sin Tai Chi en ninguna variable inicial. Al año, reducción media de caídas/año a 0,53 (IC95% 0,07-0,99) (p=0.023), EADG ansiedad 1,40+/-0,33 puntos(p<0,0001), EADG depresión 0,73+/-0,26 puntos (p=0.007). Practicaron Tai Chi 44 pacientes, encontrándose: reducción de 1,88 (IC95% 0,90-2,80) puntos (p<0.0001) en EADG ansiedad y 0,86 puntos (IC95% 0,12-1,60) (p=0,024) en EADG depresión; 30,90% de pacientes abandonaron ayudas técnicas (p<0.0001); iniciaron psicofármacos 11%. No practicaron Tai Chi 49 pacientes, en ellos se redujo 1,02 puntos la EADG ansiedad (IC95% 0,07-1,96) (p=0,035); 41,20% de pacientes iniciaron psicofármacos (p=0,001); ningún paciente abandonó ayudas técnicas y 14,30% las iniciaron (p<0,001). CONCLUSIONES: La intervención redujo las caídas, la ansiedad, el uso de los psicofármacos, la depresión, y el uso de ayudas para la marcha, con beneficio diferencial del Tai Chi en estos tres últimos aspectos

OBJECTIVE: Falls in the elderly are a major health problem. There are multiple experiences of intervention in primary care. Aim: To evaluate the impact of a multifactorial intervention in the prevention of falls in elderly people. To compare the differential effect of the practice of Tai Chi. METHODS: Non-randomized before-after quasi-experimental design in an urban health center between the years 2014-2017. The study population was those over 65 years old with a high risk of falls. The intervention consisted of an individual assessment of risk factors: sensory problems, balance, orthostatic hypotension, treatments (psychotropic drugs, hypotensive drugs), barriers, technical aids. It was intervened in its correction. Tai Chi group participation is proposed. The dependent variables (baseline and year measurements) were Barthel, Unipodal Station Test (TEU), number of falls per year, Anxiety/Depression Goldberg Scale (EADG), number of medical consultations per year, walking aids, Daily Dose Defined of analgesics (DDD)/ year. The before-after analysis was performed using the Chi2 and T Student statistics for paired samples. RESULTS: A total of 93 patients participated with an average age of 76+06,65, 84.9% women. Falls/year baseline 1.65 + 0.24; no significant differences between groups with or without Tai Chi in any baseline variable. At one year, average reduction of falls/year 0.53 (IC95% 0,07-0,99) (p=0.023), EADG anxiety 1.4+/-0.33 points (p<0.0001), EAGD depression 0.73+/-0.26 points (p=0.007). 44 patients practiced Tai Chi; finding: reduction of 1.88 (IC95% 0.90-2.80) points (p<0.0001) in EADG anxiety and 0.86 points (IC95% 0.12-1.60) (p=0.024) in EADG depression; 30.9% of patients abandoned technical aids (p<0.0001); 11% started psychotropic drugs. 49 patients did not practice Tai Chi; of them: EADG anxiety reduction of 1,020 points (IC95% 0.07-1.96) (p=0.035); 41.2% of patients initiated psychotropic drugs (p=0.001); none of the patients abandoned technical aids and 14.3% started them (p<0.001). CONCLUSIONS: The intervention reduced the number of falls, anxiety, the use of psychotropic drugs, depression, and the use of walking aids, with differential benefit of Tai Chi in these last three aspects

[Polio and post-polio syndrome, viewed by patients and health professionals in primary care]. / Polio y postpolio. Visión de pacientes y profesionales en atención primaria.

OBJECTIVE: Polio affects the quality of life of those who have suffered from it and causes health problems including the post-polio syndrome. The main goals of this work were to know the patients perspective of how they have been affected by the disease and establish the knowledge of post-polio syndrome among patients and primary health care professionals. METHODS: Interpretive qualitative research based on the Grounded Theory carried out in two health-care centers in the city of Malaga, one of them with care-rural clinics. Four focal groups were established with the participation of thirteen patients and two focus groups with twenty-six professional participants. Intentional sampling is performed until saturation. The analysis follows an inductive strategy using the Atlas Ti5.2 software. RESULTS: The people affected by polio reports their personal histories of suffering counteracted by strong family support and an active coping attitude, marked by great effort exertion, willpower and endurance. These people made a positive assessment of their lives minimising the limitations. They presented compatible symptoms with post-polio syndrome, which remain unidentified due to the lack of knowledge of it among patients and health-care professionals. The health care provided was considered deficient due to several causes as for instance lack of involvement, communication problems. CONCLUSIONS: The day-to-day polio experience is focused on personal overcoming with major roles played by family support, difficult relationships with the healthcare system and lack of knowledge of the post-polio syndrome.

OBJETIVO: La polio afecta a la calidad de vida de las personas que la han padecido y ocasiona problemas de salud entre los que se encuentra el síndrome postpolio. Los objetivos de este estudio fueron conocer la perspectiva de pacientes sobre cómo les ha afectado la enfermedad y describir el conocimiento sobre el síndrome postpolio de pacientes y profesionales de atención primaria. METODOS: Investigación cualitativa interpretativa basada en la Teoría Fundamentada, realizada en dos centros de salud de la ciudad de Málaga, uno de ellos con consultorios rurales. Se realizaron cuatro grupos focales con participación de trece pacientes y dos grupos focales con veintiséis profesionales participantes. Muestreo intencional hasta saturación. El análisis siguió una estrategia inductiva con ayuda del programa Atlas Ti 5.2. RESULTADOS: Los pacientes relataron una historia personal de sufrimiento, contrarrestada por un fuerte apoyo familiar y afrontamiento activo (categoría central), marcado por el sobreesfuerzo, la superación y una alta resiliencia. Realizaron una valoración positiva de sus vi- das, minimizando las limitaciones. Presentaron síntomas compatibles con el síndrome postpolio, no identificado por el gran desconocimiento de pacientes y profesionales. La atención sanitaria fue considerada deficitaria (falta de implicación y problemas de comunicación). CONCLUSIONES: La vivencia de la polio está centrada en la superación personal, con gran relevancia del apoyo familiar, las difíciles relaciones con el sistema sanitario y el desconocimiento del síndrome postpolio.

Polio y postpolio. Visión de pacientes y profesionales en atención primaria / Polio and post-polio syndrome, viewed by patients and health professionals in primary care

Fundamentos: La polio afecta a la calidad de vida de las personas que la han padecido y ocasiona problemas de salud entre los que se encuentra el síndrome postpolio. Los objetivos de este estudio fueron conocer la perspectiva de pacientes sobre cómo les ha afectado la enfermedad y describir el conocimiento sobre el síndrome postpolio de pacientes y profesionales de atención primaria. Métodos: Investigación cualitativa interpretativa basada en la Teoría Fundamentada, realizada en dos centros de salud de la ciudad de Málaga, uno de ellos con consultorios rurales. Se realizaron cuatro grupos focales con participación de trece pacientes y dos grupos focales con veintiséis profesionales participantes. Muestreo intencional hasta saturación. El análisis siguió una estrategia inductiva con ayuda del programa Atlas Ti 5.2. Resultados: Los pacientes relataron una historia personal de sufrimiento, contrarrestada por un fuerte apoyo familiar y afrontamiento activo (categoría central), marcado por el sobreesfuerzo, la superación y una alta resiliencia. Realizaron una valoración positiva de sus vidas, minimizando las limitaciones. Presentaron síntomas compatibles con el síndrome postpolio, no identificado por el gran desconocimiento de pacientes y profesionales. La atención sanitaria fue considerada deficitaria (falta de implicación y problemas de comunicación). Conclusiones: La vivencia de la polio está centrada en la superación personal, con gran relevancia del apoyo familiar, las difíciles relaciones con el sistema sanitario y el desconocimiento del síndrome postpolio

Backgrounds: Polio affects the quality of life of those who have suffered from it and causes health problems including the post-polio syndrome. The main goals of this work were to know the patients perspective of how they have been affected by the disease and establish the knowledge of post-polio syndrome among patients and primary health care professionals. Methods: Interpretive qualitative research based on the Grounded Theory carried out in two health-care centers in the city of Malaga, one of them with care-rural clinics. Four focal groups were established with the participation of thirteen patients and two focus groups with twenty-six professional participants. Intentional sampling is performed until saturation. The analysis follows an inductive strategy using the Atlas Ti5.2 software. Results: The people affected by polio reports their personal histories of suffering counteracted by strong family support and an active coping attitude, marked by great effort exertion, willpower and endurance. These people made a positive assessment of their lives minimising the limitations. They presented compatible symptoms with post-polio syndrome, which remain unidentified due to the lack of knowledge of it among patients and health-care professionals. The health care provided was considered deficient due to several causes as for instance lack of involvement, communication problems. Conclusions: The day-to-day polio experience is focused on personal overcoming with major roles played by family support, difficult relationships with the healthcare system and lack of knowledge of the post-polio syndrome

Cómo vivir con EPOC: percepción de los pacientes / How to live with COPD: patient´s perception

Este estudio pretende conocer la representación mental sobre la Enfermedad Pulmonar Obstructiva Crónica (EPOC) que tienen los pacientes que la presentan, siguiendo el Modelo de Autorregulación de Sentido Común de Leventhal. Para ello llevamos a cabo un estudio exploratorio descriptivo mediante metodología cualitativa. Incluimos pacientes diagnosticados de EPOC atendidos en 3 centros de salud urbanos y 1 rural. Utilizamos la entrevista grupal video-grabada y analizamos el contenido utilizando el programa Atlas.Ti. 5.2. Realizamos 22 entrevistas grupales (2009- 2011) incluyendo 58 pacientes y 3 sesiones de validación del informe por los participantes. Los resultados muestran que no existe un modelo mental compartido de la EPOC: la enfermedad tiene poco reconocimiento como tal; se diagnostica en descompensaciones y se confunde con otras enfermedades; la causa se atribuye no sólo al tabaco sino a "algo más" (humos, resfriados, trabajos duros); se minimizan los síntomas, incluyendo también los no respiratorios (dolor, cansancio) y se confunden con los de otras enfermedades. Existen creencias erróneas sobre los "resfriados", efecto del "fumar poco" y efecto "nocivo" de los inhaladores. Aparecen sentimientos de desesperanza, resignación y miedo. Concluimos que los pacientes con EPOC manifiestan confusión en muchos aspectos de la enfermedad mostrando dificultades para identificar un modelo mental sobre ella

The aim of this study is to determine the mental model that patients with COPD (chronic obstructive pulmonary disease) have about their illness analyzed by the Leventhal´s Common Sense of Self-Regulation Model. An exploratory-descriptive study using qualitative methodology was performed. We included COPD-diagnosed patients attending three urban and a rural primary care centres. We used video-taped group interviews and transcribed them using Atlas.Ti 5.2 program. 22 group interviews (2009 - 2011) and 58 patients were included. There were 3 additional sessions to final inform validation. The results show that patients did not have a defined mental model about COPD: this disease was insufficiently recognized; diagnosis was made in exacerbations and it was confused with other diseases; the cause of illness was related to tobacco consumption and to "something else": fumes, colds and hard work. Patients tended to minimize their symptoms and limitations. Participants had wrong beliefs about colds, smoking only a few cigarettes effects and damage of inhaled treatment. Emotions as despair, resignation and fear were reported. We conclude that COPD patients showed confusion about many aspects of the disease (causes, symptoms, treatments). It was difficult to identify a mental model of the disease among COPD patients

Modelo de estadios de cambio: compatibilidad con relatos biográficos de mujeres que sufren violencia doméstica / Stages of change model: adjustment to biographical narrations of women whose are victims of intimate partner violence

El objetivo es analizar el ajuste de las vivencias de mujeres que sufren violencia inflingida por sus parejas o exparejas al Modelo de Cambio o Transteorético de Prochaska y Di Clemente. Se realiza una investigación cualitativa interpretativa con participación de 35 mujeres que sufren violencia de género, detectadas en atención primaria, que reconocen su situación (maltrato percibido). Se trata de un estudio multicéntrico realizado en seis centros de salud urbanos de Málaga. Se utiliza la técnica de Relato Biográfico mediante entrevista, que es audio grabado y transcrito, sobre el que se realiza el análisis de contenido según fases del Modelo Transteorético. Para la codificación se usa el programa ATLAS-TI 5.0.Las fases más relevante son la precontemplativa y las de mantenimiento y finalización, con poca presencia de las fases de acción. Las principales características de cada fase son la ceguera e inexplicabilidad en la precontemplativa; el análisis de pros y contras en la contemplativa; la dificultad en la toma de decisiones en las fases de acción; el sufrimiento y la lucha por salir adelante en la fase de mantenimiento y la determinación y capacidad de análisis en la de finalización. Se ofrecen claves para la intervención según la fase del proceso (AU)

This study aims to analyze the adjustment of women, victims of intimate partner violence, by applying the Prochaska and Di Clemente Stages of Change Model. An interpretative qualitative study was made in 35 domestic violence victims women detected in primary care, women who recognized their relationship as abusive (perceived maltreatment). This is a multicentric study, with participation of six health centers of Malaga city. Biographical Narration technique by audio-recorded and transcribed interview was used; about this, thematic analysis adjustment to Transtheoretic Model phases was applied. ATLAS-TI 5.0 program was used for codification. Precontemplative, maintenance and ending stages were more represented while action phases were poorly mentioned. Main phases characteristics were: "blindness" and inexplicability in precontemplative stage; pros / cons analysis in contemplative phase; making decisions difficulty in action phases; suffering and going ahead purpose in maintenance stage, and determination and analysis capacity in the ending stage. Keys for intervention according to the phase of the process were offered (AU)

El torbellino de la violencia. Relatos biográficos de mujeres que sufren maltrato / Coming out of the whirlwind of abuse. Qualitative research on gender violence

Objetivo. Analizar la experiencia de mujeres que sufren violencia de género desde su propio punto de vista. Identificar los factores relacionados con el mantenimiento o la ruptura de la situación. Diseño. Investigación cualitativa interpretativa. Perspectiva fenomenológica.EmplazamientoEstudio multicéntrico en 6 centros de salud urbanos de Málaga.ParticipantesMujeres que sufren violencia de género. Estos casos se detectaron en atención primaria y las mujeres reconocieron su situación (maltrato percibido).MétodosTécnica de relato biográfico mediante entrevista entre la mujer informante y la trabajadora social, de forma audiograbada y transcrita. Asimismo, se utilizó la teoría fundamentada de Glasser y Strauss, la codificación abierta y axial, y el programa ATLAS-TI 5.2.ResultadosSe analizaron 35 relatos. La vivencia del maltrato fue descrita mediante la metáfora del «torbellino» (ceguera, aislamiento, indefensión, sufrimiento, destino, dependencia, fantasías y círculos viciosos). Ésta se relacionó con el término «aguantar»: valores inculcados, ideal de familia, incertidumbre, anulación, fracaso personal, amor, falta de apoyos, imagen de sí misma y pública, protección a los hijos, miedos múltiples y aspectos materiales. Las mujeres identifican 2 tipos de «salidas» con distintas repercusiones según la participación en la toma de decisiones: una activa y otra pasiva. El término «salir» se relacionó con: situaciones límite, hartazgo, intervención de los hijos, ruptura del ideal de familia y pérdida del miedo. Salir es un proceso de cambio o un «camino». No siempre se da el apoyo institucional y se valora más el apoyo emocional que el legal. Conclusiones. Las mujeres definen «aguantar» y «salir» como estados cualitativamente distintos, con intervención de múltiples factores personales y culturales, y definen un «camino» o proceso entre ambos, que puede ser distinto según el grado de protagonismo de la mujer en la toma de decisiones (AU)

Objectives. To analyse the experience from the point of view of women who have suffered domestic violence. To identify factors related to continuing or resolving the problem.DesignQualitative interpretative research from a phenomenological perspective.Population sampleWomen, detected in primary care, who have suffered domestic violence and have recognised the problem, and who accepted to participate in this research.Multicentre StudySix health centres in the city of Malaga.Methods and techniquesThe technique used is the biographical narration using individual open interviews between social workers and women. This narration was tape-recorded and verbatim transcribed to written text. Grounded theory. Qualitative analysis was made with ATLAS-TI 5.2.OutcomesA total of 35 narrations were analysed. The abuse situation was described as “whirl-wind” metaphor (blindness-isolation-helplessness-suffering-destiny-dependence-fantasies -about love, protection, happiness, change- and vicious circles). Enduring experience is reported to be related to several factors: inculcated gender values, family-ideal, uncertainty, annulment, personal failure sensation, love, support defects, self-image, children protection, multiple fears and material aspects. They identified two types of “exit”: passive and active with different mechanisms and repercussions. Exit experience is related to: limit situations, children intervention, family ideal attempts, and fear-loss. Leaving is a transitional process or “pathway”. Institutional support is not always guaranteed and emotional support is better evaluated than a legal one.ConclusionsEnduring and coming out are reported as two qualitatively different states, which involve many cultural and personal factors. There is a gap between these two states with a process that varies depending on the involvement of the women in decision-making(AU)

[Coming out of the whirlwind of abuse. Qualitative research on gender violence]. / El torbellino de la violencia. Relatos biográficos de mujeres que sufren maltrato.

OBJECTIVES: To analyse the experience from the point of view of women who have suffered domestic violence. To identify factors related to continuing or resolving the problem. DESIGN: Qualitative interpretative research from a phenomenological perspective. POPULATION SAMPLE: Women, detected in primary care, who have suffered domestic violence and have recognised the problem, and who accepted to participate in this research. MULTICENTRE STUDY: Six health centres in the city of Malaga. METHODS AND TECHNIQUES: The technique used is the biographical narration using individual open interviews between social workers and women. This narration was tape-recorded and verbatim transcribed to written text. Grounded theory. Qualitative analysis was made with ATLAS-TI 5.2. OUTCOMES: A total of 35 narrations were analysed. The abuse situation was described as "whirl-wind" metaphor (blindness-isolation-helplessness-suffering-destiny-dependence-fantasies -about love, protection, happiness, change- and vicious circles). Enduring experience is reported to be related to several factors: inculcated gender values, family-ideal, uncertainty, annulment, personal failure sensation, love, support defects, self-image, children protection, multiple fears and material aspects. They identified two types of "exit": passive and active with different mechanisms and repercussions. Exit experience is related to: limit situations, children intervention, family ideal attempts, and fear-loss. Leaving is a transitional process or "pathway". Institutional support is not always guaranteed and emotional support is better evaluated than a legal one. CONCLUSIONS: Enduring and coming out are reported as two qualitatively different states, which involve many cultural and personal factors. There is a gap between these two states with a process that varies depending on the involvement of the women in decision-making.

Envejecimiento activo y desigualdades de género / Active ageing and gender inequalities

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