Autoría latinoamericana sobre salud mental en tiempos de pandemia / Latin American authorship on mental health in times of pandemic

No disponible

[Healthcare for premenstrual discomfort patients. Women's perspective]. / Atención sanitaria al malestar premenstrual. La perspectiva de las mujeres.

OBJECTIVE: The prevalence of premenstrual discomfort among Spanish women is very high, and has a negative impact on their quality of life. By adopting the biopsychosocial approach, this study aims to understand women's experiences and insights, delve further into their beliefs and attitudes towards premenstrual syndrome and menstrual suppression, and to identify their proposals in order to adapt healthcare professionals' response to their needs and demands. METHODS: A qualitative study was conducted based on individual in-depth interviews with 16 women located in the Granada region. Purposive sampling was made using theoretical profiles. Informed consent was given. The study included data assessment, investigator triangulation, and a literature review. RESULTS: Premenstrual discomfort has an impact on physical and psychological health, disrupting daily lives and resulting in self-medication. Healthcare is considered deficient, since remedies are limited to medicalisation, but the source of the discomfort is not investigated. Different beliefs about the premenstrual syndrome (PMS) were found: PMS is inherent to menstrual cycle and cannot be avoided; PMS is the result of endogenous factors (such as genetics, defects or biochemical and hormonal disorders); exogenous factors (such as stress, eating habits, or exercise); the science and industry describe and treat PMS as a disease. Menstrual suppression is considered an option by women with children, though there is reticence due to the side effects found. Health education programmes for women are proposed, as well as the appropriate training for health professionals in order to overcome the pharmacological approach. CONCLUSIONS: The biopsychosocial approach helps to determine the perspective of the women, their needs and expectations in order to provide better healthcare services to premenstrual discomfort patients.

[Chronic patient activation and their relationship with health professionals in Andalusia]. / La activación de pacientes crónicos y su relación con el personal sanitario en Andalucía.

BACKGROUND: To evaluate the (inter)relation between chronic patient activation and its relationship with health professionals in Andalusia. METHODS: Descriptive and quantitative study involving 258 chronic patients from the School of Patients, contacted by email. One hundred and forty-two answered the Patient Activation Measurement (PAM) and the chronic patient's experience (IEXPAC) questionnaires. Statistical analyses included correlation study and comparison of means. RESULTS: The mean of Patient Activation Measurement was 87 points (scale from 0 to 100) and IEXPAC scale was 5.3 (scale from 0 to 10), with a directly proportional relation between variables. Males and participants belonging to patients' associations had higher levels of activation. The relationship with health professionals was better among patients with primary education and with <10 years of chronic disease. In general, medical staff received better evaluation, yet nurses were considered more prone to encouraging relationships among patients. The dimensions with higher impact on patient activation were inter-professional coordination and the attention paid to treatment and medication. Feeling confident to communicate one's concerns had more impact on IEXPAC scale. CONCLUSIONS: The correlation observed between patient activation and its relationship with health professionals leads to the need to improve the involvement and self-management of chronic patients, as well as to strengthen improved professional coordination and patient-staff communication.

[Quality in the anesthesia department of San Cecilio Hospital from the professionals' perspective]. / La calidad en el Bloque Quirúrgico del Hospital Clínico San Cecilio. La perspectiva del cliente interno.

OBJECTIVE: To evaluate the quality of the services provided by the anaesthesia department of the San Cecilio Clinical University Hospital, from the health professionals' point of view. MATERIAL AND METHODS: Location: Andalusia. PARTICIPANTS: 134 health professionals in contact with the hospital anaesthesia department. Tool: self-administered questionnaire, measuring: accessibility, personal treatment, comfort, scientific and technical quality (scale 1 to 5), overall satisfaction (scale 0 to 10), and suggestions for improvement. A descriptive statistical and correlation analysis were performed, including mean differences (by sex, frequency of contact with the anaesthesia department, and unit), as well as a regression model. RESULTS: The quality of personal treatment received a mean of 4.2 points (SD 0.651), the scientific and technical quality 4.00 points (SD 0.532), accessibility 3.3 (SD 0.795), professional comfort 3.30 (SD 0.988), and patient comfort 2.62 points (SD 1.051). Overall satisfaction obtained a mean of 7.1 points (0 to 10 scale). Women and professionals working in units with less than 10 people had a better general evaluation of the anaesthesia department. The worse perspective was that of staff with daily contact with the anaesthesia department. Among the suggestions for improvement there were: Reducing waiting lists, creating special rooms to give information to families, improving working conditions, training and work satisfaction for staff, and achieving better communication and collaboration between health professionals. CONCLUSIONS: The internal evaluation shows the need for training strategies and organisational interventions in the anaesthesia department, in order to achieve a better quality and satisfaction for both professionals and patients.

[Self-perception of health care team leaders in Andalusia. A quantitative and qualitative study]. / Autopercepción de las personas responsables en los equipos sanitarios de Andalucía. Estudio cuantitativo y cualitativo.

OBJECTIVE: To determine the perception and self-assessment on leadership among health care team leaders in Andalusia. MATERIAL AND METHODS: Design: Exploratory descriptive study using quantitative and qualitative methodology, developed between 2013 and 2015, using a questionnaire and semi-structured interviews. PLACE: Andalusia. PARTICIPANTS: All health managers from the Primary Care Management Units and Health Management Areas of the Departments of Paediatrics, Emergency and Internal Medicine, for the quantitative study. A purposive sample of 24 health managers was used for the qualitative study. METHODS: Descriptive statistical study and bivariate analysis of comparison of means. Content analysis of the semi-structured interviews: Codification, category tree, and triangulation of results. RESULTS: The best self-assessment dimension relates to support, and the worst to considering oneself as a 'good leader'. The definition of a 'good leader' includes: Honesty, trust, and attitudes of good communication, closeness, appreciation, and reinforcement of the health team members. Different leadership styles were perceived. Main difficulties for leadership are related to the economic crisis and the management of personal conflicts. CONCLUSIONS: Health managers describe an adaptive leadership style, based on personal and professional support, and using communication as the main cohesive element for the team project. More studies on leaders' perspectives are important, in order to better understand their experiences, needs and expectations.

Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy.

BACKGROUND: Limited published evidence shows oral desensitization to be a potential intervention option for cow's milk protein (CMPs) allergy. OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of oral desensitization in 2-year-old children with cow's milk allergy, as a treatment alternative to elimination diet. METHODS: A total of 60 children aged 24-36 months with IgE-mediated allergy to CMPs were included in this multi-center study and were randomized into two groups. Thirty children (group A: treatment group) began oral desensitization immediately, whereas the remaining 30 (group B: control group) were kept on a milk-free diet and followed-up for 1 year. RESULTS: After 1-year follow-up period, 90% of the children in group A had become completely tolerant vs. 23% of the children in group B. In group A, cow's milk skin reactivity and serum-specific IgE to milk and casein decreased significantly from the initial assessment, whereas group B showed no significant change after 1 year of follow-up. Twenty-four patients (80%) developed some reaction during the treatment period: 14 children developed moderate reaction (47%) and 10 mild reaction (33%). The most common manifestations were urticaria-angioedema, followed by cough. CONCLUSIONS AND CLINICAL RELEVANCE: In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.

[Evaluation of a child health prevention and promotion telephone service before its introduction]. / Evaluación de un servicio telefónico de prevención y promoción de salud infantil antes de su puesta en funcionamiento.

OBJECTIVES: To evaluate a telephone-information service on health issues for children before its implementation. To determine the overall assessment of the service and quality of the information available from the perspective of a potential user population. DESIGN: Simulation of a telephone call to the telephone service and further evaluation using qualitative techniques. SETTING: Primary and special care in the city of Granada. PARTICIPANTS: Parents, who were not health professionals, of children between 0 and 14 years old, resident in Andalusia and recruited from both primary care and hospitals throughout the city of Granada. A comprehensive assessment of service and quality of information offered through interviews and focus groups. The number of participants was established on two criteria: evaluation of the whole range of information provided by the telephone service; response saturation. RESULTS: The overall service assessment was positive, emphasising the quick and easy access to information, time saving and confidence building. The information received was described as clear, easily understood and expressed in a respectful tone. To improve the service it has been suggested that the calls be free and that the range of information topics available should be extended. CONCLUSIONS: The methodology used is novel, as most telephone services are evaluated after they have been put in place and without the participation of the future users.

[Emotional climate in health professional teams in Andalusia]. / Clima emocional en equipos de profesionales sanitarios de Andalucía.

OBJECTIVE: The emotional climate in the health care environment is one of the main factors that affect professional duties and quality of care. The aim of this research is to analyse the emotional climate in health work teams, relating it with the number of members in each group. METHOD: A cross-sectional, descriptive, and observational study with 212 professionals from 17 health centres. They were given a Likert scale questionnaire and the results were analysed using SPSS program, comparing the mean, standard deviation and Anova test. RESULTS: There was no linear relationship between group size and emotional climate. Using "group size" as a qualitative variable, significant results appear: Small groups (<8 persons) scored 18.3 points on the Emotional Climate Scale (-50,+50 scale). Personal recognition received 5.3 points (-15,+15 scale), interpersonal relationships 6.0 points (-15,+15 scale) and shared projects 6.9 points (-15,+15 scale). Medium groups (8-12 persons) had a better evaluation (23.7 points for the general scale and 7.9, 6.4 and 9.3 for the scale dimensions). Large groups (>12 persons) registered the best results (26.4 points for the general scale and 9.0, 9.2 and 11.5 points for the scale dimensions). CONCLUSIONS: Team size directly influences emotional climate: larger groups lead to better emotional climate.

El clima emocional en los equipos de atención primaria. Una aproximación cualitativa / Emotional climate in Primary Health Care teams. A qualitative approach

Fundamento. Las interacciones sociales en los equipos de trabajo de Atención primaria movilizan importantes aspectos emocionales que afectan el ambiente, rendimiento y satisfacción de profesionales y pacientes. El objetivo del estudio es describir el clima emocional de los equipos de trabajo de Atención primaria, planteando si hay diferencias en la percepción del clima emocional en función de la categoría profesional y de la pertenencia a un grupo con clima emocional positivo o negativo. Métodos. Se ha empleado metodología cualitativa: 2 grupos nominales y 2 grupos focales, con 18 profesionales (personal médico y de enfermería) de Atención primaria de 2 distritos sanitarios andaluces. La información se ha grabado y posteriormente, se ha realizado un análisis de contenido. Resultados. El personal sanitario identificó las siguientes dimensiones explicativas del clima emocional: relaciones profesionales (con un alto peso), proyecto común, reconocimiento profesional, estilo de liderazgo, desgaste y actitudes personales y condiciones de trabajo. Se perciben diferencias entre las opiniones del personal médico y enfermero, asociado a la existencia de un clima emocional negativo. Conclusiones. Se requieren más investigaciones sobre el clima emocional en Atención primaria, de cara a proponer líneas de actuación para mejorar la satisfacción y la calidad de vida de los y las profesionales(AU)

Objective. The social interactions met in the Primary Health Care work teams are driven by important emotional aspects that affect the environment, results and the satisfaction of the professional and the patients. The objective of this work is to describe the emotional climate of Primary Care work teams, looking for the perceptions of different professional category and different work groups (selected by the quality of their emotional climate). Methods. A qualitative methodology was used: 2 nominal groups and 2 focal groups, with 18 physicians and nurses working in the Andalusian Primary Health Care system. The information was recorded and then a content analysis was made. Results. Health care professionals identify the following explanatory dimensions: professional relationship (high scored), shared work project, professional recognition, leadership, burnout and personal attitudes, as well as work conditions. Different opinions were recorded among physicians and nurses, especially when the group had a bad emotional atmosphere. Conclusions. More studies on the emotional climate in Primary Health Care are needed in order to propose strategies to improve satisfaction and quality of work life among professionals(AU)

[Emotional climate in Primary Health Care teams. A qualitative approach]. / El clima emocional en los equipos de atención primaria. Una aproximación cualitativa.

OBJECTIVE: The social interactions met in the Primary Health Care work teams are driven by important emotional aspects that affect the environment, results and the satisfaction of the professional and the patients. The objective of this work is to describe the emotional climate of Primary Care work teams, looking for the perceptions of different professional category and different work groups (selected by the quality of their emotional climate). METHODS: A qualitative methodology was used: 2 nominal groups and 2 focal groups, with 18 physicians and nurses working in the Andalusian Primary Health Care system. The information was recorded and then a content analysis was made. RESULTS: Health care professionals identify the following explanatory dimensions: professional relationship (high scored), shared work project, professional recognition, leadership, burnout and personal attitudes, as well as work conditions. Different opinions were recorded among physicians and nurses, especially when the group had a bad emotional atmosphere. CONCLUSIONS: More studies on the emotional climate in Primary Health Care are needed in order to propose strategies to improve satisfaction and quality of work life among professionals.

[Patient perceptions on healthcare safety]. / Percepción de los pacientes sobre la seguridad de la asistencia sanitaria.

BACKGROUND AND OBJECTIVE: Patient Safety is an issue of growing interest in healthcare politics and specialized bibliography, but there are limited studies that include the perspective of the public on healthcare safety. MATERIAL AND METHOD: Qualitative research performed in 4 Spanish Autonomous Regions, using focus groups and semi-structured interviews with patients and representatives of associations. Discourse analysis and result triangulation. RESULTS: For the patients interviewed, the concept of safety is not limited to absence of error, but includes aspects such as confidence, communication, information and participation. In the process of resolving of adverse events, an apologetic attitude by the professionals is considered a key element. Existing interventions such as protocols and notification systems are positively valued, at same time pointing out difficulties in the implementation process. As regards information, the patients demand that the professional is trained in communication skills. More participation in their own healthcare process and clinical management is considered appropriate, at same time, it was stated that few members of the public have the opportunity to participate in current safety policies. CONCLUSIONS: Regarding healthcare safety, patients and key agents indicate the importance of moving from a blame culture to a confidence culture.

Sensitization in early age to food allergens in children with atopic dermatitis.

BACKGROUND: Clinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question. OBJECTIVE: To prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD. METHODS: We studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, egg-white, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay. Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out. RESULTS: Of the 44 patients studied, sensitization to foods was detected in 27 (61 %). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %). CONCLUSIONS: A high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet. In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results.

Los programas de tratamiento con metadona: situación real e ideal, definida por profesionales de Andalucía / The methadone maintenance programs: real and ideal situation, definition by Andalucia´s professionals

Objetivos. Se explora la situación actual de los programas de tratamiento con metadona (PTM) en Andalucía, definida por los profesionales implicados y cómo ellos valoran que dicho programa debiera ser en términos de excelencia. Para ello se ofrecen propuestas y medidas de mejora con las que acercar las situaciones descritas. Material y métodos. Reunión de expertos articulada con una variante del grupo nominal. Participaron 9 profesionales. Resultados. La situación ideal y en términos de excelencia de los PTM no concuerda en buena parte de sus cláusulas con la realidad actual de estas intervenciones. Los aspectos más destacados sobre cómo debieran ser los PTM son la dispensación, la agilidad y rapidez de los programas, junto a la existencia de una buena coordinación entre los recursos. La descripción y valoración de la situación actual de los PTM es menos favorable con rela ción a la situación ideal definida por los asistentes. Se recogen y puntúan propuestas y medidas de mejora con las que acercar ambas situaciones. Conclusiones. Aunque los PTM sean intervenciones de eficacia comprobada por la evidencia científica, son susceptibles de mejora. Para ello recoger la voz de los protagonistas directos en estas prácticas es importante para asegurar su continuidad y dotarlos de mayor calidad

Objectives. This study explores the methadone maintenance programs (MMPs) currently offered in Andalucia based on the opinions of providers involved, as well as their views on how these programs should be organised to achieve excelence. In order to advance towards this goal, proposals and measures for improvement are also provided. Material and methods. Experts' consensus meeting (9 providers) based on an adaptation of the nominal group technique. Results. there is a lack of concordance between the ideal situation of the MMPs in terms of excelence and the real situation of current service provision. The most relevant components of an ideal MMP were dispensing procedures, steadiness and rapidity in program provision, and good coordination across available resources. Description and assessment of the actual situation was less favourable when compared with the ideal situation as defined by participants. Proposals and measures for program improvement to approach both situations were also gathered. Conclusions. Although available scientific evidence has proved the efficiency of MMT programs, there is still room for improvement. Therefore, it is important to gather the views of the main actors in order to ensure the continuity of existing programs and to improve their quality