Understanding the Impact of Chronic Non-Cancer Pain on Daily Life from a Gender Perspective Using the PAIN_Integral Scale©.

The experience of chronic non-cancer pain differs between women and men due to gender-related factors. This study (1) assessed the difference in responses to the impact of chronic non-cancer pain on daily life in women and men using the PAIN_Integral Scale© and (2) evaluated its invariance through multigroup confirmatory factor analysis. This was conducted by means of an analysis of invariance through a multigroup confirmatory factor analysis. A cross-sectional sample of 400 participants over 18 years of age with Chronic Non-Oncological Pain in Pain Units and Primary Care Centres belonging to the Spanish Public Health System was recruited (January to March 2020). An analysis was performed to assess whether any of the items in the instrument showed different behaviours. All analyses were performed using AMOS® v.26 software. The results showed that the structure of the PAIN_Integral© Scale remained adequate when analysing its invariance in women and men, showing no metric, scalar and/or strict invariance. Therefore, these results indicated that the PAIN_Integral Scale© instrument has a different interpretation for women and men, identifying eight items with a singular functioning in both sexes and belonging to the subscales of proactivity, resilience and support network. These findings can be explained by gender stereotypes, since the dimensions where there are differences have an important social burden.

Alcohol use among children and adolescents with chronic pain. Scoping review.

AIM: To examine and map alcohol consumption in children and adolescents with chronic pain (CP). METHOD: A scoping review of international databases (CINAHL, WOS, PubMed, PsycINFO, Scopus, Embase, and MEDLINE) and grey literature was conducted between September 2022 and February 2023. Documents addressing the relationship between alcohol consumption and CP in children and adolescents, published in English and Spanish between 2012 and 2023, were included. Those papers with a population suffering from CP derived from neurodegenerative diseases, chronic infectious diseases or cognitive impairment were excluded. We assessed the level of evidence (LE) and the degree of recommendation (DR) of the studies included in accordance with the Scottish Intercollegiate Guidelines Network. Finally, 11 documents were considered out of the 479 reviewed. RESULTS: The relationship between substance consumption and CP in adolescents is a scarcely investigated topic. While there is a trend towards lower rates of alcohol consumption in youth with pain, there is evidence suggesting an association, particularly in cases of intense pain. The use of various substances, both legal and illegal, for pain management underscores the importance of comprehensively addressing this phenomenon in this population. CONCLUSIONS: Further research is needed to assess the relationship between alcohol consumption in children and adolescents with CP.

Cuidados enfermeros en el duelo perinatal. Una revisión sistemática y crítica de las actitudes y los conocimientos en la práctica clínica / Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice

Objetivo: Revisar y sintetizar la evidencia disponible sobre las actitudes y conocimientos de las enfermeras ante el duelo perinatal de los progenitores. Método: Se realizó una revisión sistemática de artículos originales publicados desde enero del 2016 hasta febrero del 2023, sin límite de idioma, en las bases de datos Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect y Web Of Science. Se utilizó el marco metodológico de la Declaración Preferred Reporting Items for Systematic reviews and Meta-Analyse (PRISMA) para revisiones sistemáticas y metaanálisis. Todo el proceso se efectuó por pares, siendo solventadas las discrepancias por un tercer revisor. Se evaluó la calidad de los artículos siguiendo los criterios Critical Appraisal Skills Programme Español (CASPe). Resultados: Se obtuvieron 12 artículos en esta revisión tras aplicar los criterios de inclusión, de los cuales, salvo un estudio cuantitativo transversal (8,33%), los demás eran análisis cualitativos realizados mediante entrevistas (75%) o grupos de discusión (16,66%). Se destaca que existen diferentes problemas biopsicosociales relacionados con las necesidades de cuidado que demanda la familia y que, por escasa formación o cultura del profesional sanitario, no se abordan de una manera adecuada. Los estudios encontrados muestran diversos recursos para atender adecuadamente el duelo perinatal, existiendo discrepancias en relación con permitir o no que se muestre y/o coja el cuerpo del bebé fallecido; existen también desacuerdos respecto a si el equipo asistencial debe fundamentar su práctica en protocolos o teorías como la del duelo de Kübler-Ross. La mayoría de los estudios (75%) consideran necesarias más formación y sensibilización contemplando la naturaleza biopsicosocial del usuario.(AU)

Aim: To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents. Methods: A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The PRISMA Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the Critical Appraisal Skills Program Spanish (CASPe criteria). Results: Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed. The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kübler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.(AU)

Interplay between chronic widespread pain and lifestyle factors on the risk of type 2 diabetes: longitudinal data from the Norwegian HUNT Study.

INTRODUCTION: Chronic widespread pain (CWP) and diabetes commonly co-occur; however, it is unclear whether CWP infers an additional risk for diabetes among those with known risk factors for type 2 diabetes. We aimed to examine if CWP magnifies the effect of adverse lifestyle factors on the risk of diabetes. RESEARCH DESIGN AND METHODS: The study comprised data on 25 528 adults in the Norwegian HUNT Study without diabetes at baseline (2006-2008). We calculated adjusted risk ratios (RRs) with 95% CIs for diabetes at follow-up (2017-2019), associated with CWP and body mass index (BMI), physical activity, and insomnia symptoms. The relative excess risk due to interaction (RERI) was calculated to investigate the synergistic effect between CWP and adverse lifestyle factors. RESULTS: Compared with the reference group without chronic pain and no adverse lifestyle factors, those with BMI ≥30 kg/m2 with and without CWP had RRs for diabetes of 10.85 (95% CI 7.83 to 15.05) and 8.87 (95% CI 6.49 to 12.12), respectively; those with physical activity <2 hours/week with and without CWP had RRs for diabetes of 2.26 (95% CI 1.78 to 2.88) and 1.54 (95% CI 1.24 to 1.93), respectively; and those with insomnia symptoms with and without CWP had RRs for diabetes of 1.31 (95% CI 1.07 to 1.60) and 1.27 (95% CI 1.04 to 1.56), respectively. There was little evidence of synergistic effect between CWP and BMI ≥30 kg/m2 (RERI=1.66, 95% CI -0.44 to 3.76), low physical activity (RERI=0.37, 95% CI -0.29 to 1.03) or insomnia symptoms (RERI=-0.09, 95% CI -0.51 to 0.34) on the risk of diabetes. CONCLUSIONS: These findings show no clear interaction between CWP and adverse lifestyle factors on the risk of diabetes.

Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice.

AIM: To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents. METHODS: A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The Prisma Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the CASPe criteria (Critical Appraisal Skills Program Spanish). RESULTS: Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed. DISCUSSION: The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kubler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.

Primary healthcare nurses' experiences of addressing intimate partner violence in supportive legal and health system contexts.

AIM: To explore the experiences of primary healthcare (PHC) nurses caring for women experiencing intimate partner violence (IPV) in a context of institutional support for the management of this health issue. DESIGN: Secondary qualitative analysis. METHODS: A purposeful sample (n = 19) of registered nurses, working in a PHC setting, with experience providing care to women who had disclosed intimate partner violence completed an in-depth interview. Thematic analysis was used to code, categorize and synthesize the data. RESULTS: Four themes were developed from the analysis of the interview transcripts. The first two themes address the characteristics of the type of violence most frequently encountered by participants, and how these characteristics shape the needs of women and the care nurses provide them. The third theme encompasses uncertainties and strategies developed to deal with the aggressor during the consultations as the woman's companion or as the patient himself. Finally, the fourth theme reflects the positive and negative consequences of caring for women exposed to intimate partner violence. CONCLUSION: When there is a supportive legal framework and health system to address IPV, nurses are able to implement evidence-based best practices in caring for women experiencing intimate partner violence. The predominant type of violence experienced by women at the time they enter the healthcare system shapes their needs and the service/unit they reach. These varying needs should be considered in the development of training programmes for nurses and should be adapted for different healthcare services. Caring for women experiencing intimate partner violence implies an emotional burden even in an institutional supportive context. Therefore, actions to prevent nurses' burnout should be considered and implemented. IMPACT: Lack of institutional support usually hinders the potential role nurses can play in the care provided to women who have experienced intimate partner violence. Findings from this study demonstrated that primary healthcare nurses are able to implement evidence-based best practices in the care for women experiencing intimate partner violence when there is a supportive legal framework and the health system context is openly favourable to addressing intimate partner violence. Findings from this study could inform the design and implementation of programmes and/or policies to improve nurses' responses to intimate partner violence in primary healthcare services.

Violencia en el noviazgo y su relación con la ansiedad, la depresión y el estrés en jóvenes universitarios andaluces / Dating violence and its relationship with anxiety, depression, and stress in young Andalusian university students

Objetivo: Analizar la prevalencia de la violencia en el noviazgo (VN) y su relación con los estados de depresión, ansiedad y estrés en jóvenes universitarios andaluces. Método Estudio cuantitativo descriptivo transversal en 8 universidades públicas de Andalucía. La recogida de datos se realizó de septiembre a noviembre de 2020 a través de un cuestionario autoadministrado que incluía variables sociodemográficas y variables relacionadas con la VN, depresión, ansiedad y estrés. Para el análisis de los datos se realizó un descriptivo y pruebas no paramétricas a través de la U de Mann-Whitney y rho de Spearman para la relación entre variables. Resultados: Participaron 1.091 jóvenes universitarios andaluces. La VN más prevalente fue la psicológica, incluyendo conductas relacionadas con el ciberacoso, control-vigilancia y psicoemocional (68,42-42,90%), seguida de la sexual (16,68-3,57%) y por último la física (5,60-1,92%). Se mostraron diferencias estadísticamente significativas en función del sexo y la VN, donde las chicas puntuaron más alto en ser víctimas de conductas relacionadas con el ciberacoso, control-vigilancia y sexual, y los chicos en perpetrar violencia de tipo psicoemocional, física y sexual. Todos los tipos de VN evidenciaron correlaciones significativas y positivas con la depresión, la ansiedad y el estrés, menos la VN física perpetrada con el estrés. Conclusiones: La alta prevalencia de VN y su relación con la salud mental muestran la importancia de realizar investigaciones en esta línea en el ámbito educativo, ya que es un espacio garante de relaciones igualitarias y promotor de la salud.(AU)

Aim: To analyze the prevalence of dating violence (DV) and its relationship with states of depression, anxiety, and stress in young Andalusian university students. Method: Cross-sectional descriptive quantitative study in 8 public universities in Andalusia. Data collection was carried out from September to November 2020 through a self-administered questionnaire that included sociodemographic variables and variables related to DV, depression, anxiety, and stress. For the analysis of the data, descriptive and nonparametric tests were performed through the U Mann–Whitney and Spearman rho for the relationship between variables. Results: Thousand ninety-one young university students from Andalusia were participated. The most prevalent DV was psychological, including behaviors related to cyberbullying, control-surveillance and psychoemotional (68.42-42.90%), followed by sexual (16.68-3.57%) and finally physical (5.60-1.92%). Statistically significant differences were shown according to sex and DV, where girls scored higher in being victims of behaviors related to cyberbullying, control-surveillance and sexual, and boys in perpetrating psycho-emotional, physical and sexual violence. All types of DV showed significant and positive correlations with depression, anxiety, and stress, except physical DV perpetrated with stress. Conclusions: The high prevalence of DV and its relationship with mental health show the importance of conducting research on this line in the educational field, since it is a space that guarantees egalitarian relationships and promotes health.(AU)

Short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language: Instrument development and psychometric evaluation.

AIMS: To develop and psychometrically test the short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language to detect violence perpetrated and suffered in dating relationships. DESIGN: A psychometric instrument development and validation study. METHODS: A two-phase approach was used: Phase (1) the items of the original instrument were revised and new items related to online violence and sexual violence were incorporated. Content validation by a Delphi panel with 25 psychometric and dating violence experts were performed. Next, a face validity was performed in 32 students followed by a pilot study in another 74 participants. Phase (2) Psychometric validation, the instrument was tested in a sample of 1091 university students, analysing the psychometric properties based on construct validity and internal consistency. The study was conducted from September to November 2020 in the context of the Andalusian Public University System. RESULTS: In phase (1) 42 items for each subscale (perpetration, victimization) were accepted by the Delphi panel, and acceptable values were obtained for the criteria of clarity, coherence, and relevance. In phase (2) the MSDV 2.0 showed acceptable psychometric properties. Confirmatory factor analysis showed a five-dimensional structure with 18 items for each subscale with excellent fit rates. Reliability analysis indicated adequate internal consistency (α = .879-.802) and correlations with the Depression, Anxiety, and Stress Scale (ρ = .418-.225) and the self-perceived health item (ρ = .380-.179), providing evidence of its convergent validity. Cut-off points were also calculated for each dimension, with their corresponding sensitivity and specificity, indicating to be a good instrument for detecting possible cases of dating violence. CONCLUSION: The MSDV 2.0 is the only short instrument published to date that measures the dating violence suffered and perpetrated taking into account all its dimensions. Its use would serve as support in prevention programs and design of public policies. IMPACT: The short version of the MSDV 2.0 could be a comprehensive enough instrument to enable a detection and evaluation of dating violence in the educational setting.

Instruments used to measure dating violence: A systematic review of psychometric properties.

AIMS: To identify, synthesize and evaluate the psychometric properties of instruments that measure dating violence (DV). DESIGN: Psychometric systematic literature review. DATA SOURCES: The databases SCOPUS, PubMed, CINAHL, PsychINFO, and Web of Science were searched up to December 2021. REVIEW METHOD: We evaluated the psychometric properties of the instruments included and their methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. The Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. The entire process was carried out by three independent reviewers. The review was registered at PROSPERO (registry number CRD42020161137). RESULTS: A total of 35 studies evaluated 29 instruments measuring DV. Most studies reported data on content validity, structural validity and internal consistency. No studies tested measurement error and responsiveness. Only one instruments tested cross-cultural validity. It is of interest that the data reported for content validity were the worst evaluated, despite the fact that content validity is one of the key properties in developing and validating the measuring instrument. CONCLUSIONS: There are a significant number of instruments published in this field, and it is important to evaluate and show their psychometric properties to help select evidence-based instruments. After carrying out the evaluation following the COSMIN guidelines, the authors of this study recommend that the three most suitable instruments are CADRI, WAS/Chinese version and PMWI-SF/Portuguese version (in that order). IMPACT: Identifying and evaluating DV is the first step in designing effective interventions. To achieve this, it is necessary to have validated instruments with suitable psychometric properties. To date, this is the only published systematic review evaluating the psychometric properties of instruments that measure DV which reports on their methodological qualities. The results we found show a growing trend in developing new instruments, with the most suitable approach being to make a cross-cultural adaptation and validation of the instrument that best suits the value to be measured. In this way, data can be compared between different countries and standardized health care plans and policies designed to achieve better health outcomes. This study may help future researchers to choose the most suitable instrument for their research.

[Proposals for the community orientation of primary health care: to identify key agents for training]. / Propuestas para la orientación comunitaria de la atención primaria: identificar agentes clave para la formación.

OBJECTIVE: To identify the strengths available for the community orientation of primary health care (PHC) in the context of the evaluation of the piloting of a training program in Community Health for Resident Internal Specialists in Andalusia (Spain). METHOD: We will conduct a qualitative, phenomenologically-oriented, explanatory research in which the opinion of the participants is analyzed. Sixty-seven professionals from six PHC Districts of Andalusia which were part of the training program called Project to Support the Revitalization of Primary Care Assets for Community Health (PARAC) were interviewed. RESULTS: There is consensus in giving training a key weight in the community orientation of PHC. For this reason, those agents linked to training are identified as assets: general practice (GP) trainers, young professionals in training who bring updated perspectives and approaches to accredited PHC training centers, whose professionals must respond to the needs of their GP trainees, the multi-professional teaching units responsible for the GP trainees training and a medium and long-term health system thinking along with structures that coordinate and support the community work at the PHC centers. CONCLUSIONS: The community orientation of PHC is an objective that requires the participation of all levels of the health system. Knowing its assets and working with them can contribute to provide proposals to advance towards a community-oriented PHC system.

Dating violence and its relationship with anxiety, depression, and stress in young Andalusian university students.

AIM: To analyze the prevalence of dating violence (DV) and its relationship with states of depression, anxiety, and stress in young Andalusian university students. METHOD: Cross-sectional descriptive quantitative study in 8 public universities in Andalusia. Data collection was carried out from September to November 2020 through a self-administered questionnaire that included sociodemographic variables and variables related to dating violence, depression, anxiety, and stress. For the analysis of the data, descriptive and nonparametric tests were performed through the U Mann-Whitney and Spearman Rho for the relationship between variables. RESULTS: Thousand ninety-one young university students from Andalusia participated. The most prevalent DV was psychological, including behaviors related to cyberbullying, control-surveillance and psychoemotional (68.42-42.90%), followed by sexual (16.68-3.57%) and finally physical (5.60-1.92%). Statistically significant differences were shown according to sex and DV, where girls scored higher in being victims of behaviors related to cyberbullying, control-surveillance and sexual, and boys in perpetrating psycho-emotional, physical and sexual violence. All types of DV showed significant and positive correlations with depression, anxiety, and stress, except physical DV perpetrated with stress. CONCLUSIONS: The high prevalence of DV and its relationship with mental health show the importance of conducting research on this line in the educational field, since it is a space that guarantees egalitarian relationships and promotes health.

Factors that influence the impact of Chronic Non-Cancer Pain on daily life: A partial least squares modelling approach.

BACKGROUND: Chronic Non-Cancer Pain is pain of more than three months' duration and is not associated with an oncological condition. There is ample literature that recognises that Chronic Non-Cancer Pain impacts numerous areas of the life of the person who suffers from it. This impact is difficult to determine and quantify because Chronic Pain is a subjective experience. OBJECTIVE: The objective of this study was to test a recursive model of hypothesised factors that comprise the concept of Chronic Non-Cancer Pain Impact on daily life using Partial Least Squares-Structural Equation Modelling. DESIGN: A cross-sectional study was carried out. The sample size was calculated using G*Power V.3.1.9.4 with five parameters (two-tailed, large effect size (f2 = 0.35), power of 0.95, statistical significance of 95% (α = 0.05) and 36 predictors). The minimum number of subjects was considered to be 137. METHODS: A recursive model was built based on data from a sample of 395 people over 18 years of age with Chronic Non-Cancer Pain. Data collection was conducted between January and March 2020 at Pain Units and Primary Healthcare Centres belonging to the Spanish Public Health System in the province of Seville (Spain). Analyses were based on Partial Least Squares-Structural Equation Modelling. The internal consistency, convergent validity and discriminant validity of the internal measurement model were assessed. For the external measurement model, global model adjustment and structural validity were assessed. The predictive capacity of the final model was also evaluated. All analyses were performed using SmartPLS version 3.3.2 in consistent mode. RESULTS: Findings showed an adequate validity of the proposed model, which comprised nine factors: pain catastrophising, hopelessness due to pain, support network, proactivity, treatment compliance, self-care, mobility, resilience, and sleep. The internal validity of the model (Cronbach's alpha and rho_A > 0.70; Average Variance Extracted>0.50; standardised outer loadings>0.60; Heterotrait-Monotrait-Ratio < 0.85), goodness of fit (Standardised Root Mean Square Residuals<0.08; Geodesic and Euclidean distance p-value<0.05) and predictive power with out-of-sample values (Stone-Geisser test>0.5) were adequate. The hypothesised structure of the instrument has also been confirmed (path coefficients>0.3; R2 > 0.1; f2 > 0.2). CONCLUSIONS: The results have shown an adequate internal consistency, convergent validity and discriminant validity of the model. Likewise, the model has shown an adequate goodness of fit, and the validity of its structure and the hypothesis have been confirmed. However, more research is needed in this regard as the possible interaction between the different factors evaluated in the model with the confounding or moderating variables that may exist.

Propuestas para la orientación comunitaria de la atención primaria: identificar agentes clave para la formación / Proposals for the community orientation of primary health care: to identify key agents for training

Objetivo: Identificar las fortalezas disponibles para la orientación comunitaria de la atención primaria de salud (APS) en el contexto de la evaluación del pilotaje de un programa formativo en salud comunitaria para especialistas internos residentes en Andalucía. Método: Estudio cualitativo explicativo de diseño fenomenológico, en el que se analiza la opinión de las personas participantes, que fueron 67 profesionales pertenecientes a seis distritos sanitarios de Andalucía implicados en el proceso formativo del Proyecto de Apoyo a la Revitalización de la Atención Primaria Activos para la Salud Comunitaria (PARAC). Resultados: Existe consenso en que la formación tiene un papel clave en la orientación comunitaria de la APS. Se identifican como activos los agentes vinculados a la docencia: los/las residentes, jóvenes profesionales en formación que traen perspectivas y enfoques renovados a los centros de salud docentes, donde los/las profesionales deben dar respuesta a las necesidades de sus residentes, coordinados con las unidades docentes multiprofesionales responsables de la formación de los/las residentes en un sistema sanitario con la vista puesta en el medio y largo plazo con estructuras que permitan organizar y apoyen la labor comunitaria de los centros de salud. Conclusiones: La orientación comunitaria de la APS es un objetivo que requiere el concurso de todos los niveles del sistema sanitario. Conocer y trabajar con los activos de la APS puede aportar propuestas para avanzar hacia la orientación comunitaria de esta. (AU)

Objective: To identify the strengths available for the community orientation of primary health care (PHC) in the context of the evaluation of the piloting of a training program in Community Health for Resident Internal Specialists in Andalusia (Spain). Method: We will conduct a qualitative, phenomenologically-oriented, explanatory research in which the opinion of the participants is analyzed. Sixty-seven professionals from six PHC Districts of Andalusia which were part of the training program called Project to Support the Revitalization of Primary Care Assets for Community Health (PARAC) were interviewed. Results: There is consensus in giving training a key weight in the community orientation of PHC. For this reason, those agents linked to training are identified as assets: general practice (GP) trainers, young professionals in training who bring updated perspectives and approaches to accredited PHC training centers, whose professionals must respond to the needs of their GP trainees, the multi-professional teaching units responsible for the GP trainees training and a medium and long-term health system thinking along with structures that coordinate and support the community work at the PHC centers. Conclusions: The community orientation of PHC is an objective that requires the participation of all levels of the health system. Knowing its assets and working with them can contribute to provide proposals to advance towards a community-oriented PHC system. (AU)

Nutritional aspects in chronic non-cancer pain: A systematic review.

Objectives: Chronic pain (CP) is an unpleasant emotional and sensory experience that can be accompanied by tissue damage that persists for more than 3 months. Recent studies show that certain nutritional strategies can help to improve pain, so this study is aimed to systematically review scientific evidence to understand and map the effect of the use of nutritional strategies on the presence or intensity of chronic non-cancer pain (CNCP) and the association of these nutritional aspects with the presence or intensity of CNCP. Study design: A systematic review. Methods: Two independent researchers searched for randomized clinical trials (RCTs) and observational studies that explored the relationship between nutrition and CNCP in adults from 2010 to 2020 in PubMed, Web of Science, Scopus, and Cochrane Library databases. A total of 24 studies were included, of which 20 were RCTs and 4 were observational studies. They are classified into the administration of nutritional supplements, dietary modification, and incorporation of food. Results: Of these studies, those that have a significant effect on pain are dietary modification and the use of nutritional supplements. On the other hand, the main results from the few observational studies included in this review point to the existence of an association relationship between less pain and a ketogenic or hypocaloric diet or adherence to the Mediterranean diet. Conclusion: Dietary modification seems to be one plausible therapeutic option to improve and relieve CNCP. However, more research is needed in this regard to obtain better conclusions. Systematic Review Registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021226431].

Profiles of adult people in a Spanish sample with chronic pain: Cluster analysis.

AIM: To establish groups of people with chronic non-cancer pain according to the impairment caused by pain and to identify factors associated with the group with a higher level of impairment. BACKGROUND: Knowing the profiles of people who suffer from chronic non-cancer pain could make it possible to direct their treatment and to detect associated risks. DESIGN: A cross-sectional study. METHODS: A sample of 395 people with chronic non-cancer pain was collected in Pain Units and Primary Healthcare Centres in southern Spain (January to March 2020). A cluster analysis was performed to divide the population into groups and a binary logistic regression model was established to determine factors associated with the group with a higher level of impairment. RESULTS: Two groups were identified: lower level of impairment due to pain, characterized by being 45-65 years old, not medicated with opioids or anxiolytics, employed and with a mild level of impact on daily life; and higher level of impairment characterized by being older than 65 years old, medicated with opioids and anxiolytics, retired or on medical leave and with a severe impact on daily life. In addition, among women, being widowed, single or a smoker are risk factors for belonging to the group with a higher level of impairment; being smokers or consuming alcohol three or less times a week would be risk factors in men. CONCLUSIONS: Age, chronic non-cancer pain impact on daily life, work situation and the consumption of opioid drugs and/or anxiolytics are factors that appear to influence the level of impairment due to chronic pain. IMPACT: These findings could help detect impairment due to pain in its early stages, determining the specific needs of each person.

Effectiveness of telemedicine psychoeducational interventions for adults with non-oncological chronic disease: A systematic review.

AIM: To evaluate the effectiveness of telemedicine psychoeducational interventions (PIs) in adult patients on the clinical management of chronic non-oncological diseases compared with another therapeutic option or no treatment. DESIGN: Systematic review of randomized controlled trials. DATA SOURCES: Six databases were searched between January 2011 and August 2021. REVIEW METHODS: A systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection, quality appraisal and data extraction were conducted independently by two reviewers. A third arbiter was available if discrepancies. RESULTS: A total of 719 articles were reviewed and 17 studies met the inclusion and quality criteria. The included studies related to smoking, chronic pain, obesity and mental illness. Most interventions were based on cognitive behavioural theory. Most of the included studies (12/17, 70.5%) showed improvements in health and significant reductions in anxiety, pain and depression with variable effect sizes. Patients reported a high satisfaction rate and indicated lectures or self-report writings as helpful in their recovery compared with more interactive items. Only financial incentives demonstrated greater adherence. A specific intervention format or complementary professional support was not associated with health outcomes. CONCLUSIONS: Telemedicine PIs are a safe and effective option for the clinical management of adults with chronic diseases. Future longitudinal studies are needed to assess the impact of these interventions on chronic physical and mental disease, evaluating the quality of life, morbidity and mortality. IMPACT: The results reinforce the telemedicine PIs with effects on clinical management similar to those of the face-to-face modality and can be carried out in a safe environment for patients at a lower cost to the health system. These conditions make them suitable for comprehensive care in the epidemiological COVID-19 context with the highest safety conditions for the patients and professionals.

Promoción de la salud: las enfermeras con la población adolescente en la violencia de género / Health promotion: nurses with adolescents in gender-based violence

Objetivo: Explorar las prácticas de promoción de la salud de las enfermeras de atención primaria en la violencia de género con la población adolescente. Metodología: Estudio cualitativo a través de grupos de discusión y entrevistas semi-estructuradas. Participaron 37 informantes, 23 enfermeras y 14 enfermeros, vinculados a atención primaria de Sevilla y provincia. Se llevó a cabo un análisis del contenido con el software QSR NudisNVivo12®. Resultados: Del análisis emergen varias categorías: prácticas para la educación de la población adolescente, prácticas para la detección de situaciones desigualitarias y prácticas para intervenir en la violencia en el noviazgo. Conclusiones: Enfermeras y enfermeros realizan intervenciones educativas promoviendo relaciones igualitarias, con diferentes técnicas. Solo las enfermeras realizan cribado y asesorías para detectar casos. Enfermeras y enfermeros realizan intervenciones para interrumpir relaciones abusivas. Se evidencia sensibilidad a la violencia de género y la necesidad de evaluar la efectividad y la rentabilidad de las intervenciones realizadas.(AU)

Objective: Explore the health promotion practices of primary care nurses in gender violence with the adolescents. Methods: Qualitative study with discussion groups and semi-structured interviews. 37 informants participated, 23 female nurses and 14 male nurses, of primary care in Seville and the province. A content analysis was carried out with the QSR NudisNVivo12® software. Results: Several categories emerge from the analysis: practices for the education of the adolescents, practices for detecting and practices for intervening in dating violence. Conclusions: Female nurses and male nurses carry out educational interventions promoting egalitarian relationships, with different techniques. Only nurses female perform screening and counseling to detect cases. Female nurses and male nurses perform interventions to interrupt abusive relationships. There is sensitivity to gender violence and the need to evaluate the effectiveness and profitability of the interventions carried out is evidenced.(AU)

Alcohol, Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study.

BACKGROUND: Substance use seems to be higher among populations with chronic pain. AIM: The aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men. METHOD: Linear and logistic regression analyses were carried out using data from the 2015-2016 adults' version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men). RESULTS: Disabling chronic pain was statistically associated with higher tobacco consumption among men (ß = -30.0, 95% confidenct interval [CI] -59.5 to -0.60; t = -2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: ß = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: ß = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs. CONCLUSIONS: Chronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.