Social Experiences and Health Needs of Patients with Severe Mental Illness and their Caregivers during the first year of the COVID-19 pandemic in Spain.

BACKGROUND: The strict isolation measures for the population imposed by the health authorities caused a prolonged disruption of informal social support networks. Both this new social situation and the decrease in accessibility to health care have generated new needs in people with severe mental illness (SMI) and their caregivers. OBJECTIVES: This study provides insight into life experiences and health needs of a population with SMI during the first year of the COVID-19 pandemic in Spain. METHODS: Qualitative design using semi-structured dyadic interviews, conducted from January through December 2022. A purposive sampling of patients with SMI and their caregivers was carried out through key informants in rural and urban localities in southern Spain. Verbatims were identified and classified by triangulation after the evaluation of the interview transcripts. The codes were defined through content analysis using the NVivo software. RESULTS: Semi-structured dyadic interviews (21), identifying three main categories: 1. Social isolation: increased, causing greater personal vulnerability, exacerbation of psychiatric symptoms and exhaustion in caregivers. 2. Accessibility to Health Services: decreased with fewer face-to-face consultations, with difficulty in managing urgent situations and telephone attention in decompensated and disabled patients. 3. Continuity of healthcare: decreased with distrust in health professionals due to lack of communication between primary care and the hospital. CONCLUSION: COVID-19 confinement exacerbated loneliness and worse health self-perception in SMI people. Greater formal social support was required. GPs role is key to avoiding delays in appointments and lack of coordination between primary and specialised care.

Quality of life and medical care for SMI people got worse in controlled confinement during COVID-19 pandemic.Caregiving burden and isolation were common, especially in rural areas and in populations at social risk.SMI people requested an improvement in medical care accessibility, continuity, and more social resources.

Patients with severe mental illness and their carers' expectations for GPs' communication skills: a qualitative approach in Spain.

BACKGROUND: Effective communication with GPs (General Practitioners) enables higher rates of patient satisfaction and adherence to treatment plans. People with severe mental illness (SMI) and their caregivers present unique characteristics that present difficulties in the GP-carer-patient communication process. AIM: To explore the expectations of patients with SMI and their caregivers regarding GPs' communication skills in primary care consultations. DESIGN & SETTING: Face-to-face interviews, using focus group methodology, which were undertaken in southern Spain. METHOD: Forty-two participants took part in 21 paired semi-structured interviews with an average duration of 19±7.2 minutes. Information was audio-recorded and transcribed verbatim. Qualitative content analysis was undertaken, obtaining a codification in categories by means of triangulation. RESULTS: Four themes emerged from the analysis. Theme 1 was interviewer communication characteristics. The ability of GPs to use a language that was colloquial and adapted to each person was perceived as a determinant of the quality of care provided. An empathetic attitude, low reactivity, and efficient time management were the most valued communication skills. Theme 2 was telemedicine: telephone consultation and video consultation. The telephone consultation was perceived as a useful tool to care for people with SMI. Video consultation was valued as a requirement in isolated rural areas. Theme 3 was the role of the caregiver during the clinical interview. The caregiver was considered by the patients as an ally who improves the clinical interview. Theme 4 was the perceived barriers and facilitators during the clinical interview. The continuity of care, defined by a low turnover of GPs, determined the quality perceived by those who required care. CONCLUSION: Themes emerging from this study have suggested that people with SMI require an inclusive, collaborative, and personalised approach in the care they receive from the public health system. Improved communication between GPs and patients with SMI is an essential requirement for quality medical care.

Qualitative study on the use of emergency services by people with serious mental disorder in Spain.

BACKGROUND: The population with severe mental disorders (SMD) is a frequent user of emergency services. Situations of psychiatric decompensation can have devastating consequence and can cause problems in getting urgent medical care. The objective was to study the experiences and needs of these patients and their caregivers regarding the demand for emergency care in Spain. METHODS: Qualitative methodology involving patients with SMD and their informal caregivers. Purposive sampling by key informants in urban and rural areas. Paired interviews were carried out until data saturation. A discourse analysis was conducted, obtaining a codification in categories by means of triangulation. RESULTS: Forty-two participants in twenty-one paired interviews (19 ± 7.2 min as mean duration). Three categories were identified. 1º Reasons for urgent care: poor self-care and lack of social support, as well as difficulties in accessibility and continuity of care in other healthcare settings. 2º Urgent care provision: trust in the healthcare professional and the information patients receive from the healthcare system is crucial, telephone assistance can be a very useful resource. 3º Satisfaction with the urgent care received: they request priority care without delays and in areas separated from the other patients, as well as the genuine interest of the professional who attends them. CONCLUSIONS: The request for urgent care in patients with SMD depends on different psychosocial determinants and not only on the severity of the symptoms. There is a demand for care that is differentiated from the other patients in the emergency department. The increase in social networks and alternative systems of care would avoid overuse of the emergency departments.

Influencia del acompañante en las consultas de Atención Primaria sobre las habilidades en comunicación y el tiempo de entrevista / Influence of the companion in Primary Care consultations on communication skills and interview time

Objetivos: Valorar la influencia del acompañante en consulta sobre la calidad de la comunicación médico-paciente y la duración de la consulta. Diseño: Descriptivo transversal. Emplazamiento: Diez centros de salud. Participantes: Médicos residentes de Medicina Familiar y Comunitaria. Intervenciones: Auditoría por pares de videograbaciones de consultas a demanda. Mediciones principales: Habilidades en comunicación utilizando el cuestionario CICAA-2 (mejorable, aceptable o adecuada); edad (MIR), sexo (MIR, paciente y acompañante), motivos de consulta y duración de la entrevista. Análisis bivariante y multivariante. Autorización del CEI, consentimiento informado oral y custodia de las videograbaciones. Resultados: Participaron 73 MIR (53,8% mujeres, 32,9±7,7 años) valorando 260 entrevistas (60,3% mujeres, 2,1±1,0 motivos de consulta). Un 27,7% de consultas con acompañante (sexo femenino 65,3%). La duración media de las entrevistas fue de 8,5±4,0 minutos, superior 2,7±0,5 minutos en consultas con acompañante (p<0,001 t de Student) y con mayor número de motivos de consulta (40% con ≥ 3 motivos, p=0,048 X2). El valor medio de la puntuación total de la escala CICAA-2 (46,9±16,5) fue superior en las consultas con acompañante (diferencia 4,6±2,3), al igual que la tarea 2 (39,3±15,8 con diferencia 4,4±2,2) (p<0,05 t de Student). El modelo obtenido con regresión logística binaria muestra una mayor duración de la consulta con acompañante (OR 1,2; IC [1,1-1,3]) y posiblemente mejor puntuación en la tarea 2 (OR 1,02; IC [0,99-1,1]). Conclusiones: Las comunicaciones triádicas suponen un desafío para las habilidades de comunicación del médico, que mejora sus capacidades para identificar y comprender los problemas del paciente, aunque a costa de una mayor inversión de tiempo.(AU)

Objetives: To know the influence of the companion in triadic clinical encounter on the quality of doctor–patient communication and the duration of the interview. Design: Cross-sectional descriptive study. Location: 10 Primary Care Centers. Participants: Resident doctors of Family and Community Medicine. Interventions: Peer review of video recordings of clinical demand consultations. Main measurements: CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. Results: 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1–1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99–1.1]). Conclusions: Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.(AU)

[Influence of the companion in Primary Care consultations on communication skills and interview time]. / Influencia del acompañante en las consultas de Atención Primaria sobre las habilidades en comunicación y el tiempo de entrevista.

OBJETIVES: To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview. DESIGN: Cross-sectional descriptive study. LOCATION: 10 Primary Care Centers. PARTICIPANTS: Resident doctors of Family and Community Medicine. INTERVENTIONS: Peer review of video recordings of clinical demand consultations. MAIN MEASUREMENTS: CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. RESULTS: 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]). CONCLUSIONS: Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.

Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía / Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)

Objetivos: Conocer las características de la atención inicial y el seguimiento telefónico de pacientes con sospecha de COVID-19 en la primera ola de la pandemia. Diseño: Observacional retrospectivo (auditoría de historias clínicas).Emplazamiento: Centro de salud urbano. Participantes: Casos probables de SARS-CoV-2 (15/03/2020 a 15/06/2020). Mediciones principales Ámbito de atención inicial y seguimiento telefónico (número de llamadas y duración). Variables sociodemográficas (incluyendo estructura familiar). Curso clínico (sintomatología, vulnerabilidad, pruebas, ingreso hospitalario y desenlace). Resultados Trescientos uno pacientes (51,5 [±17,8] años, 23% vulnerables, 17% estructura familiar no nuclear). Valoración inicial en el centro de salud (59,8%: telefónica; 25,2%: presencial). En urgencias hospitalarias (11%) presentaron síntomas similares que en atención primaria, predominan estructuras familiares no nucleares (p<0,05; test χ2), realizando más pruebas (p<0,05; test χ2). En domicilio (3,9%) son pacientes ancianos vulnerables (p<0,01, test ANOVA). El seguimiento telefónico duró 17,1 [±10,3] días con 8,2 [±4,4] llamadas, superior si provenían de urgencias o domicilio (p<0,03; test ANOVA). Se incrementa tras ≥2 consultas presenciales (OR: 4,8), la presencia de síntomas de alarma (OR: 2,3) y la edad ≥45 años (OR: 2,0). Se realizaron pocas pruebas de confirmación (19,3% antigénicas, 13% serologías). El 15,3% ingresos hospitalarios (todos valorados en centros de salud), con 6,3% casos severos y 2,3% exitus. Conclusión Durante la primera ola de la pandemia, la población optó por ser atendida de forma telemática en su centro de salud. Las valoraciones iniciales en urgencias del hospital se relacionan con la falta de apoyo social, pero no con mayor gravedad clínica. El seguimiento telefónico fue aceptado por la población y permitió seleccionar a los pacientes con peor curso clínico.

ObjectiveTo know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. Design: Observational, retrospective (audit of medical records).Location: Urban Primary Care Center of Andalusia (Spain). Participants: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). Principal measurements Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). Results Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. Conclusion Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

[Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)]. / Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía.

OBJECTIVE: To know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. DESIGN: Observational, retrospective (audit of medical records). LOCATION: Urban Primary Care Center of Andalusia (Spain). PARTICIPANTS: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). PRINCIPAL MEASUREMENTS: Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). RESULTS: Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. CONCLUSION: Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

El desafío de informar a la población como estrategia para la cobertura óptima de la vacunación contra la COVID-19 / No disponible

No disponible

Inercia diagnóstica para la hipertensión arterial en pacientes diabéticos con seguimiento en atención primaria / Diagnostic inertia for hypertension in diabetic patients with follow-up in primary care

Objetivos: Se buscó estimar la prevalencia de hipertensión arterial no diagnosticada en pacientes con diabetes mellitus tipo 2 y las variables relacionadas. Métodos: Cohorte histórica mediante auditoría de historias clínicas (años 2012-2015), recogiendo los registros de presión arterial para cuantificar hipertensión arterial no diagnosticada (HTAND) según criterios de la American Diabetes Association (ADA) (presión arterial > 130/80 mm Hg) y criterios de la European Society of Hypertension/European Society of Cardiology (ESC/ESH) (presión arterial > 40/90 mm Hg) (año 2013). Otras variables: edad, sexo, frecuentación sanitaria, control metabólico, antecedentes personales, índice de masa corporal y formación previa a los médicos de familia sobre el tema. Análisis descriptivo, bivariado y multivariado (regresión logística). Aprobado por el Comité de Ética de la Investigación. Resultados: Setecientos treinta y dos pacientes (10% pérdidas) de 10 centros de salud (64 médicos), con una media de edad de 63.1 ± 12.4 años y 62% de mujeres. El 76% consulta a demanda de forma anual, con 72% de visitas programadas y 2.1 ± 2.3 de registros anuales de presión arterial. La duración de la diabetes fue de 6.3 ± 4.5 años, el 67% presentó control óptimo y el 15%, complicaciones vasculares, con el 77% con sobrepeso/obesidad. La incidencia de HTAND con criterios de la ADA fue del 43.2% y se relacionó con la obesidad (OR: 1.06) y las complicaciones vasculares (OR: 6.5). Con los criterios de la ESC/ESH fue del 13.4%, relacionada con polifarmacia (OR: 1.2) y con complicaciones vasculares (OR: 3.0), mientras que el mayor número de registros de presión arterial (OR: 0.9) y la atención programada (OR: 0.8) la evitan. Conclusión: Un elevado porcentaje de diabéticos no son correctamente diagnosticados de HTA, lo cual varía según el criterio diagnóstico empleado. La atención en programas, con especial atención a polifarmacia, complicaciones vasculares y obesidad, puede mejorar la inercia diagnóstica.

We sought to estimate the prevalence of undiagnosed hypertension in patients with type 2 diabetes mellitus and related variables. Methods: Historical cohort by auditing medical records (years 2012-2015), collecting blood pressure records to quantify undiagnosed arterial hypertension (HTAND) according to criteria of the American Diabetes Association (ADA) (blood pressure> 130/80 mm Hg ) and criteria of the European Society of Hypertension / European Society of Cardiology (ESC / ESH) (blood pressure> 40/90 mm Hg) (year 2013). Other variables: age, sex, health care, metabolic control, personal history, body mass index and previous training for family doctors on the subject. Descriptive, bivariate and multivariate analysis using logistic regression. Approved by the Research Ethics Committee. Results: Seven hundred thirty-two patients (10% losses) from 10 health centers (64 physicians), with a mean age of 63.1 ± 12.4 years and 62% women. 76% consult on demand annually, with 72% scheduled visits and 2.1 ± 2.3 annual blood pressure records. The duration of diabetes was 6.3 ± 4.5 years, 67% presented optimal control and 15% vascular complications, and 77% overweight or obesity. The incidence of undiagnosed arterial hypertension according to the ADA criteria was 43.2% and it was related to obesity (OR: 1.06) and vascular complications (OR: 6.5). With the ESC / ESH criteria prevalence it was 13.4%, related to polypharmacy (OR: 1.2) and with vascular complications (OR: 3.0), while the highest number of blood pressure records (OR: 0.9) and scheduled care (OR: 0.8) avoid it. Conclusion: A high percentage of diabetics are not correctly diagnosed with HT, which varies according to the diagnostic criteria used. Specific diabetic care programs, with special attention to polypharmacy, vascular complications, and obesity, can improve diagnostic inertia

Oferta de actividades preventivas propuestas por médicos residentes de Medicina Familiar en Atención Primaria y su relación con las habilidades comunicacionales / Accomplishment of preventive activities proposed by resident doctors of Family Medicine in Primary Care and its relationship with communication skills

Objetivo: Conocer la oferta de actividades preventivas propuestas por médicos residentes de medicina familiar en la consulta a demanda de Atención Primaria y su relación con las habilidades comunicacionales. Diseño: Estudio descriptivo multicéntrico mediante videograbación de la consulta médica. Emplazamiento: Ocho centros de salud de Jaén (Andalucía). Participantes: Setenta y tres médicos residentes de cuarto año. Mediciones principales: Se valora la oferta de actividades preventivas (según el Programa español de actividades preventivas y promoción de la salud -PAPPS-) y las características del médico, el paciente y la consulta. Valoración por pares de la comunicación médico-paciente mediante la escala CICAA. Análisis descriptivo, bivariable y de regresión logística. Resultados: Se valoran 260 entrevistas (duración 8,5 ± 4,0 min) de 73 residentes (50,7% mujeres, edad media 32,9 ± 7,7 años, 79% medio urbano). El paciente es más frecuentemente mujer (60%), que acude sola (72%) por procesos agudos (80%) y con 2,1 ± 1,0 motivos de consulta. Se ofertan actividades preventivas en un 47% (duración inferior al minuto) de tipo primario (70%) y secundario (59%) mediante consejo (72%) o cribado (52%), centradas en el área cardiovascular (52%) y estilos de vida (53%). Un 80% se relaciona con el motivo de consulta. Habilidades en comunicación: 41% mejorables, 26% adecuadas, 23% excelentes. La oferta de actividades preventivas se relaciona con la duración de la consulta (OR = 1,1; IC 95% 1,01; 1,16) y la puntuación del CICAA (OR = 1,03; IC 95% 1,01; 1,10). Conclusiones: Se realizan actividades preventivas en casi la mitad de las consultas, aunque centradas en consejo y cribado y ligadas a la demanda del paciente. El tiempo de consulta y las habilidades de comunicación favorecen una mayor oferta preventiva

Objective: To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities. Design: A descriptive multicentre study assessing medical consultations video recording. Location: Eight Primary Healthcare centres in Jaen (Andalucia). Participants: Seventy-three resident physicians (4th year) filmed and observed with patients. Principal measurements: Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed. Results: Two hundred and sixty interviews were evaluated (duration 8.5 ± 4.0 min) of 73 residents (50.7% women, mean age 32.9 ± 7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1 ± 1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR = 1.1, 95% CI 1.01; 1.16) and communication skills (OR = 1.03, 95% CI 1.01; 1.10). Conclusions: Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer

[Accomplishment of preventive activities proposed by resident doctors of Family Medicine in Primary Care and its relationship with communication skills]. / Oferta de actividades preventivas propuestas por médicos residentes de Medicina Familiar en Atención Primaria y su relación con las habilidades comunicacionales.

OBJECTIVE: To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities. DESIGN: A descriptive multicentre study assessing medical consultations video recording. LOCATION: Eight Primary Healthcare centres in Jaen (Andalucia). PARTICIPANTS: Seventy-three resident physicians (4th year) filmed and observed with patients. PRINCIPAL MEASUREMENTS: Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed. RESULTS: Two hundred and sixty interviews were evaluated (duration 8.5±4.0min) of 73 residents (50.7% women, mean age 32.9±7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1±1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR=1.1, 95% CI 1.01; 1.16) and communication skills (OR=1.03, 95% CI 1.01; 1.10). CONCLUSIONS: Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer.

Cambios en el consumo alcohólico de riesgo en población adolescente en la última década (2004-2013): una aproximación cuanti-cualitativa / Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design

Objetivo: Conocer los cambios del consumo alcohólico de riesgo en los adolescentes en la última década, así como sus motivaciones y vivencias. Diseño: 1) descriptivo transversal: encuesta autoadministrada; 2) cualitativo explicativo: grupos de discusión videograbados, con análisis de contenido (codificación, triangulación de categorías y verificación de resultados). Emplazamiento y participantes: Alumnos de un instituto urbano de educación secundaria, administrando un cuestionario cada 3 años de 2004 a 2013. En el año 2013 se realizan las entrevistas grupales, con muestreo de conveniencia. Criterio de homogeneidad: nivel educativo; criterios de heterogeneidad: edad, sexo y consumo de drogas. Mediciones principales: Cuestionario: edad, sexo, consumo de drogas y cuestionario CAGE. Entrevistas: semiestructuradas sobre un guión previo, valorando vivencias y expectativas. Resultados: Descriptivo: 1.558 encuestas, edad 14,2 ± 0,3años, 50% mujeres. Disminuye la prevalencia de consumo de alcohol (13%), aumentando el consumo de riesgo (11%; p < 0,001 χ2). Relacionado con ser mujer (p < 0,01 χ2), mayor consumo alcohólico (> 6 unidades de bebida estándar/semana; p < 0,001 ANOVA) en fin de semana (56%; p < 0,01 χ2) y policonsumo (p < 0,01 χ2). Cuestionario CAGE: 37% ≥ 1 respuesta positiva (relacionado con consumo de riesgo, p < 0,05 χ2), 18% ≥ 2 respuestas. Cualitativo: 48 entrevistados; se establecen 4 categorías: determinantes personales (edad, género), influencias sociales (familia, amigos), normalización del consumo (accesibilidad, ocio nocturno) y adicción (riesgo, policonsumo). Conclusión: Es preocupante el aumento del porcentaje del consumo alcohólico de riesgo, pese a disminuir las prevalencias del consumo. Se relaciona con el sexo femenino, el consumo binge-drinking y el policonsumo. El ocio nocturno y la normalización social son las principales motivaciones argumentadas por los adolescentes, sin percepción del riesgo de este tipo de consumo (AU)

Objective: To determine the changes in hazardous drinking in adolescents in the last decade, as well as their motivations and experiences. Design: Firstly, a descriptive design using a self-report questionnaire, and secondly an explanatory qualitative design, with video recordings of discussion groups with content analysis (coding, triangulation of categories and verification of results). Setting and participants: Pupils from an urban High School, administering a questionnaire every 3 years from 2004 to 2013. Purposive sampling was used to elect groups in qualitative design. Homogeneity criteria: education level; heterogeneity criteria: age, gender, and drug use. Main measurements: Questionnaire: age, gender, drug use, and the CAGE test. Interviews: semi-structured on a previous script, evaluating experiences and expectations. Results: Descriptive design: A total of 1,558 questionnaires, age 14.2 ± 0.3 years, 50% female. The prevalence of alcohol drinking decreases (13%), but its hazardous use increases (11%; P < .001, χ2). This is associated with being female (P < .01 χ2), higher alcohol consumption (> 6 standard drink units weekly; P < .001, ANOVA), during the weekend (56%; P<.01, χ2) and multiple drug use (P < .01, χ2). CAGE questionnaire: 37% ≥ 1 positive response (related to hazardous drinking, P < .05 χ2), 18% ≥ 2 answers. Qualitative: A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). Conclusion: Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk (AU)

[Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design]. / Cambios en el consumo alcohólico de riesgo en población adolescente en la última década (2004-2013): una aproximación cuanti-cualitativa.

OBJECTIVE: To determine the changes in hazardous drinking in adolescents in the last decade, as well as their motivations and experiences. DESIGN: Firstly, a descriptive design using a self-report questionnaire, and secondly an explanatory qualitative design, with video recordings of discussion groups with content analysis (coding, triangulation of categories and verification of results). SETTING AND PARTICIPANTS: Pupils from an urban High School, administering a questionnaire every 3 years from 2004 to 2013. Purposive sampling was used to elect groups in qualitative design. Homogeneity criteria: education level; heterogeneity criteria: age, gender, and drug use. MAIN MEASUREMENTS: Questionnaire: age, gender, drug use, and the CAGE test. Interviews: semi-structured on a previous script, evaluating experiences and expectations. RESULTS: Descriptive design: A total of 1,558 questionnaires, age 14.2±0.3years, 50% female. The prevalence of alcohol drinking decreases (13%), but its hazardous use increases (11%; P<.001, χ2). This is associated with being female (P<.01 χ2), higher alcohol consumption (>6 standard drink units weekly; P<.001, ANOVA), during the weekend (56%; P<.01, χ2) and multiple drug use (P<.01, χ2). CAGE questionnaire: 37% ≥1positive response (related to hazardous drinking, P<.05 χ2), 18% ≥2answers. QUALITATIVE: A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). CONCLUSION: Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk.

Prevalencia y factores asociados a la práctica del consejo clínico contra el consumo de drogas entre los especialistas internos residentes de Andalucía (España) / Prevalence and factors associated with clinical counselling on drug use among internal specialists residents of Andalusia (Spain)

OBJETIVOS: Conocer la frecuencia de la oferta de consejo clínico contra el consumo de alcohol, tabaco y drogas ilegales por los especialistas internos residentes (EIR) y los factores relacionados con dicho consejo. DISEÑO: Estudio multicéntrico transversal mediante encuesta autoadministrada. EMPLAZAMIENTO Y PARTICIPANTES: EIR de Andalucía (España), mediante correo electrónico. MEDICIONES PRINCIPALES: Consejo declarado contra alcohol, tabaco y drogas ilegales, mediante escala Likert categorizada como ®frecuente»/®no frecuente». Variables independientes: edad/sexo, especialidad, país de origen y características del consumo de drogas. Análisis mediante regresión logística. RESULTADOS: Cuatro mil doscientos cuarenta y cinco participantes con el 66% de respuestas, 29% no respondedores y 5% mala cumplimentación; edad media 29,1 ± DE 5,1 años, 69% mujeres, 89% nacionalidad española, 84% con formación en medicina (hospitalaria 73%, medicina familiar 27%). El consejo frecuente contra tabaco (85%) y alcohol (82%) es superior al de drogas ilegales (56%; p < 0,001 test de Chi cuadrado). El consejo frecuente contra el alcohol se relaciona con la especialidad (medicina familiar: OR = 2,8, IC 95% [1,4-4,6]; enfermería: OR = 2,5 [1,7-4,4]) y la edad del primer consumo alcohólico (OR = 1,07; [1,03-1,1]). Para el tabaco hay relación con la especialidad (medicina familiar: OR = 12,9 [7,6-21,9]; enfermería: OR = 8,4, [4,3-16,5]), el tabaquismo (OR = 1,5 [1,2-2,0]) y edad del primer consumo alcohólico (OR = 1,06 [1,01-1,1]), más importante para el vino (OR = 1,1 [1,04-1,3]). Aconsejar contra drogas ilegales se relaciona con la edad del primer consumo alcohólico (OR = 1,09 [1,05-1,1]) y el tabaquismo (OR = 0,58 [0,4-0,7]). CONCLUSIÓN: Hay una alta oferta de consejo contra el consumo por los EIR, aunque llamativamente menor para drogas ilegales. Los factores que influyen son tanto elementos formativos de su propia especialidad como el consumo personal de alcohol y tabaco, que deben ser tenidos en cuenta para una mejora de esta actividad preventiva

OBJECTIVES: To determine the percentage of women who have had a Pap smear in the last 5 years, and the place where it was carried out. To detect cytological abnormalities and precursors of cervical cancer in un-screened or inadequately screened women and the prevalence of HPV-positive determinations. DESIGN: Cross sectional study. SETTING: Natahoyo Health Centre, Gijón (Spain). PARTICIPANTS: Women aged 40-50 years living in the area and assigned to the Health Centre. METHODS: The information was collected from databases, telephone and home surveys. There was active recruitment of unscreened women or inadequately screened in Primary Care as well as offering to perform cytology and HPV determination. RESULTS: Of the 1420 women aged 40 to 50 years, 1236 (87%) had cytology in the last 5 years, and 184 women (13%) had no screening or it was inadequate. Of these 184 women, 108 (58.7%) agreed to have cytology and HPV test performed. No high-grade cervical dysplasia was diagnosed. The prevalence of HPV-positive was 8.3%. CONCLUSIONS: In our population there is a high coverage of opportunistic screening for cervical cancer. The active recruitment of women who were not in the screening program was not useful

[Prevalence and factors associated with clinical counselling on drug use among internal specialists residents of Andalusia (Spain)]. / Prevalencia y factores asociados a la práctica del consejo clínico contra el consumo de drogas entre los especialistas internos residentes de Andalucía (España).

OBJECTIVES: To determine the frequency of offering clinical counseling against the consumption of alcohol, tobacco and illegal drugs by internal specialist residents (EIR) of Andalusia, and the factors related to such advice. DESIGN: Multicenter cross-sectional study by self-administered questionnaire sent by mail. SETTING AND PARTICIPANTS: EIR of Andalusia. MAIN MEASUREMENTS: The questionnaire collected the frequency of counseling against the use of alcohol, tobacco and illegal drugs (dependent variable). INDEPENDENT VARIABLES: age/gender, specialty, drug consumption and Fagerström test. RESULTS: Out of a total of 4245 participants, 66% responded, 29% did not respond, and 5% poorly completed questionnaires. The mean age was 29.1(±SD 5.1) years, 69% female, 89% Spanish nationality, 84% in medical training (73% hospital, 27% family medicine). The frequency of counseling against tobacco (85%) and alcohol (82%) is higher than illegal drugs (56%, p<.001, χ(2) test). Counseling against alcohol consumption is related to family medicine (OR=2.8; 95% CI [1.4-4.6]) and nursing (OR=2.5 [1.7-4.4]), and the age of first alcohol consumption (OR=1.07 [1.03-1.1]). Counseling against smoking is related to family medicine (OR=12.9;[7.6-21.9]) and nursing (OR=8.4;[4.3-16.5]), personal consumption of tobacco (OR=1.5 [1.2-2.0]), and wine (OR=1.1 [1.04-1.3]), and age of first alcohol consumption (OR=1.06 [1.01-1.1]). Counseling against illegal drugs is related to the age of first alcohol consumption (OR=1.09 [1.05-1.1]) and smoking (OR=.58 [.4-.7]). CONCLUSION: There is a high frequency of counseling against consumption of tobacco and alcohol by EIR, although remarkably smaller for illegal drugs. The influencing factors are both formative elements of their own specialty such as personal consumption of alcohol and tobacco, which should be considered for improvement of this preventive activity.

Diagnóstico comunitario mediante técnicas cualitativas de las expectativas y vivencias en salud de una zona necesitada de transformación social / Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation

Objetivo: Conocer las opiniones, vivencias y expectativas sobre la atención prestada por el Sistema Sanitario Público Andaluz (SSPA) de los usuarios de una zona urbana necesitada de transformación social (ZNTS). Diseño: Metodología cualitativa, estudio exploratorio. Emplazamiento: Zona básica de salud urbana (16.000 habitantes; 40% ZNTS). Participantes: Usuarios del SSPA mediante muestreo intencional de usuarios y líderes de la comunidad. Criterios de homogeneidad: edad. Criterios de heterogeneidad: sexo, frecuentación, activo/pensionista, nivel cultural/económico. Intervenciones principales: Técnicas conversacionales registradas mediante videograbación y moderadas por una socióloga (grupos de discusión para usuarios y entrevistas en profundidad para líderes sociales). Análisis con transcripción literal de los discursos, codificación, triangulación de categorías y obtención de resultados. Resultados: Siete grupos (43 participantes; 58% ZNTS) y 6 líderes sociales. Se desea continuidad en la atención y libre elección de profesionales, criticando cambios sin información previa y la discontinuidad atención primaria/hospitalaria. Hay mala accesibilidad física por el entorno urbano y críticas a los servicios de admisión y los trámites burocráticos; la cita previa y la receta electrónica son mejoras pero solicitan más derivaciones y revisiones hospitalarias. Hay buena valoración de los profesionales (atención primaria-mayor cercanía, hospital-mayor capacidad técnica). Se precisa mejorar la formación de enfermería y la rapidez de la asistencia urgente. Hay falta de liderazgo en la organización del SSPA, muy fragmentada. Se conoce una oferta de servicios centrada en la demanda asistencial, siendo poco difundidas otras actividades. Conclusión: El SSPA debe incorporar las opiniones y expectativas de las comunidades en riesgo social para una mejora real de la calidad asistencial (AU)

Objective: To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). Design: Qualitative methodology (exploratory study). Location: Urban basic health zone (16,000 inhabitants, 40% ZNTS). Participants: Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. Main interventions: Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). Analysis: transcription of speeches, coding, categories triangulation and final outcome. Results: Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. Conclusion; The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care (AU)

[Drugs consumption among Intern Specialists in Jaén (Spain) and their relationship to clinical counseling]. / Consumo de drogas entre los Especialistas Internos Residentes de Jaén (España) y su relación con el consejo clínico.

There are few studies on the prevalence of alcohol, tobacco and illegal drugs consumption among Specialist Interns (EIR) and their counseling to the patients. A multicenter cross-sectional study is carried out, consisting in a self-administered validated questionnaire to describe the consumption of the EIR of 17 health centers in Jaen (Andalusia) (4 hospitals, 13 primary care) and their relationship with their counseling. 215 EIR participate with 81% of valid questionnaires: mean age 31.2 years (± 0.7), 70% women, 13% foreigners, only 6% nursing. Of them 78% consumed alcohol (onset age 16.8 years ± 0.3), 81% occasionally and 17% weekend. The alcohol average weekly intake was 5.9 (± 5.8) UBE, especially beer and cocktails; 17% show a binge-drinking pattern (more frequent in men, p = .001 x 2). 19% smoke. A total of 71% smoke on a daily bases (mean of 8.9 ± 1.6 cigarettes/day); the nicotine dependence is low (68%) and two thirds have tried to quit. Only 3% use cannabis. A fifth part of EIR does not usually advise against smoking use (21%), a third part does not advise against alcohol (34%) and almost half of them neither advises against drugs (44%) (p = .001 x 2). Logistic regression shows greater clinical advice from older EIR. Advice against drinking alcohol provided by EIR women is more frequent (OR 2.93) and, probably, even more in EIR that binge drink (OR 2.32). Late smoking onset is related to less clinical advice against illegal drugs (OR 0.76).