Physical restraints in nursing homes: A qualitative study with multiple stakeholders.

AIM: This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN: A qualitative methodology was employed. METHODS: Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.

Nonconsensual Condom-Use Deception: An Empirically Based Conceptualization of Stealthing.

In recent years, the act of stealthing, also termed nonconsensual condom removal (NCCR), has become an emerging important topic related to nonconsensual sexual experiences. We performed a rapid review by searches in Web of Science (245 articles), Medline (157 articles), and PsycINFO (72 articles). The studies, in English, French, Italian, or Spanish, that reported empirical data on stealthing were included, except for those focusing on the legal response to the phenomenon. The final sample of 16 articles of various design is analyzed. According to this review, more than 10% of women experience stealthing in their lifetime, and men having sex with men also experience stealthing. The article describes the empirical research literature in the field, explores terminological and conceptual challenges, and proposes a new and more comprehensive term (nonconsensual condom-use deception), and a revised definition and categorization of the behavior, according to the concrete manifestation of consent breach, the associated practices, or the underlying motivation. We argue that research, as well as policy and practice responses to this growing problem need to be guided by a conceptual framework that uses information gathered directly from those who experienced it.

Psychopathological aspects of sexting and IBSA perpetrators: A brief research report.

Introduction: IBSA has been defined as taking, distributing, and/or making threats to distribute, a sexual image without a person's consent, and up to date there is still limited research on IBSA perpetration and characteristics of IBSA perpetrators. Thus, the aim of this study was to identify characteristics of IBSA perpetrators, in order to guide future intervention and prevention programs. Methods: An online survey was conducted regarding IBSA related behaviors and psychopathology. The original sample comprised 1,370 Spanish college students (74% females). Results: The IBSA perpetrator subsample comprised 284 participants (49.5% females). Our findings indicate that perpetrators are more commonly males, with higher psychopathology scores, especially in hostility scales, with previous IBSA victimization experiences, and who usually target friends, to have fun or as a joke, or partners, to flirt. Furthermore, when examining intragroup differences regarding perpetration level of severity, results showed that those who reported engaging in the most severe forms of IBSA reported higher rates of psychopathology and hostility. Yet, to intervene in those who present more severe behaviors, we must also pay attention to depression, somatization and sleep disturbances. Conclusions: IBSA perpetrators share key factors that could be targeted in forensic and clinical interventions, and that should be taken into account when designing effective offender intervention programs. Intervention programs should focus on anger-management issues that help reduce perpetrators' hostility and anxiety symptoms, and should also be aimed at modifying attitudes that justify perpetration behaviors and contribute to harmful interactions with their friends or to intimate partner violent dynamics.

On-call-related sleep deprivation and hypomania in healthcare workers.

OBJECTIVE: Acute sleep deprivation can induce antidepressant effects. We hypothesized that overnight calls can trigger symptoms of hypomania during the post-on-call period. METHODS: Online anonymous cross-sectional survey among Spanish-speaking healthcare professionals, including the Hypomania Symptom Checklist-32 (HCL-32). RESULTS: 2099 respondents. Most of them reported that they usually feel worse on their post-on-call period (91,3%), but the 51,6% acknowledged having felt better at least once and 33,4% reported it happened in at least at 50% of their calls. Up to 4,9% reached the cut-off at HCL-32. Males, younger professionals, those with less years of practice and residents were more likely to full fit hypomania criteria. Participants and their environment correctly identified the symptoms and their negative consequences. CONCLUSIONS: On-calls with sleep deprivation may trigger hypomanic symptoms with reported negative consequences among healthcare professionals, showing how working conditions' impact in professionals' wellbeing and raising concerns about decision-making performance after long-lasting working shifts.

De la modificación de la capacidad a la provisión de apoyos en personas con discapacidad / From capacity modification to support measures in people with disabilities

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COVID-19 Pandemic Psychological Impact and Volunteering Experience Perceptions of Medical Students after 2 Years.

Undergraduate healthcare students were mobilized to support healthcare systems during the COVID-19 pandemic, but we have scarce information regarding their experience and its impact on their wellbeing. An anonymous online survey was conducted among undergraduate students and recently graduated physicians of a medical university in Spain, regarding their symptoms and volunteering experience during the initial months of the Spanish COVID-19 pandemic. Respondents showed a high prevalence of perceived stress, anxiety, and depressive symptoms, measured by the PHQ-9 and GAD-7. 14.5% reported healthcare-related volunteering tasks. Volunteering was a satisfactory experience for most of the respondents and the majority felt ready to do volunteering tasks (66.6%). Yet, 16.6% acknowledged not getting appropriate specific-task education before starting, 20.8% reported not having appropriate supervision, and 33.3% feel they did not have proper protective equipment. More than half of volunteers feared getting infected, more than 70% feared infecting their relatives or friends, and 54.2% reported stigmatization. Volunteers showed significantly higher stress, anxiety, and depression scores than the rest of the respondents, and 32% reported a highly traumatic event during volunteering, with high scores on the IES-R in the 16% of volunteers. Our results should help guide future potential volunteering processes in emergencies, enhance academic programs at medical schools and provide valuable data for psychological support services.

Help Seeking of Highly Specialized Mental Health Treatment before and during the COVID-19 Pandemic among Health Professionals.

(1) Background: Ongoing specialized programs for health professionals (HPs) adapted their treatment services during the COVID-19 pandemic. (2) Methods: We conducted a retrospective observational study of medical e-records of HPs with mental disorders working in Catalonia that were consecutively admitted to the Galatea Care Program Clinical Unit. The sample (N = 1461) was divided into two periods: 21.5 months before (n = 637) and after (n = 824) 14 March 2020. (3) Results: There was a significant increase (29.4%) in the number of referrals to the specialized Clinical Unit during the pandemic, especially with respect to physicians compared to nurses. The percentage of HP women at admission and the clinical severity of the first treatment episode remained without changes before and after the COVID-19 pandemic. The most prevalent main diagnoses also remained similar: adjustment disorders (41.5%), mood disorders (24.9%), anxiety disorders (14.4%), and substance use disorders (11.8%). (4) Conclusions: HPs, particularly physicians, more frequently sought voluntary help from specialized mental health programs during the COVID-19 pandemic. Future studies are needed to analyze the reasons behind this finding and the evolution of referrals to these types of programs after the COVID-19 outbreak.

Medicina de urgencias y emergencias: ¿una especialidad de riesgo de reclamación? / Emergency medicine: a specialty at risk for malpractice claims?

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Responsabilidad profesional médica en la asistencia urgente de especialistas en medicina familiar y comunitaria / Professional liability in primary care emergencies of specialists of family and community medicine

Introducción: La atención urgente en atención primaria es un ámbito clave del sistema sanitario, señalándose como un estresor importante el estar expuestos a recibir reclamaciones por responsabilidad profesional. El objetivo fue analizar las reclamaciones por responsabilidad profesional en la asistencia urgente de especialistas en medicina familiar y comunitaria y sus principales características en nuestro entorno.MétodosAnálisis descriptivo/retrospectivo de las reclamaciones contra especialistas de medicina familiar y comunitaria entre 1986 y 2015.ResultadosSe analizaron 224 reclamaciones, todas ellas resueltas, motivadas por error o retraso diagnóstico (122-54,5%), problemas de accesibilidad en la atención médica (48-21,4%), errores en el tratamiento (29-12,9%) y errores en la emisión de documentos (25-11,1%). En 147 (65,6%) se trataba de asistencia urgente y en 77 (34,3%) programada. La vía de interposición fue judicial en el 71,4%. En 6 casos (2,6%) la resolución implicó una indemnización, tratándose de 3 casos de asistencia urgente y 3 de programada.ConclusiónSe confirma el riesgo muy bajo de reclamación y de indemnización, no habiéndose hallado diferencias entre asistencia urgente y programada. Debe insistirse en aspectos de seguridad clínica, enfatizando en el error diagnóstico. (AU)

Introduction: Urgent assistance in primary care is a key area of the health system, being as an important stressor to be claimed for professional liability. The objective was to analyze the professional liability in primary care emergencies of specialists of family and community medicine and their main characteristics in our environment.MethodsRetrospective descriptive analysis of claims against General Practitioners between 1986 to 2015 was performed.Results224 claims, all resolved, were analyzed, due to error or diagnostic delay (122-54.5%), accessibility problems in medical care (48-21.4%), treatment errors (29-12.9%) and errors in the issuance of documents (25-11.1%). In 147 (65.6%) it was urgent assistance and in 77 (34.3%) scheduled. The way of interposition was judicial in 71.4%. In 6 cases (2.6%) the resolution involved compensation in 3 cases of urgent assistance and 3 of scheduled.ConclusionThe very low risk of claim and compensation payment is confirmed, with no differences found between urgent and scheduled assistance. Clinical safety aspects should be emphasized, especially in the diagnostic error. (AU)

The Impact of Malpractice Claims on Physicians' Well-Being and Practice.

OBJECTIVES: Malpractice litigation causes extreme stress. We examine the psychological impact of malpractice claims on physicians' well-being and the consequences on patient care. METHODS: A confidential telephone survey, administered to physicians with both open and closed claims from the previous year, explored symptoms, well-being changes, needs, impairments, and practice changes. RESULTS: Of the 282 respondents, more than half (56.38%) reported a notable psychological reaction to the malpractice claim, with no differences between the open and closed claims (P = 0.2477) or between closed claims with and without a payout (P = 1). Physicians facing criminal proceedings were more likely to experience a notable psychological impact (P = 0.0206). Almost half of the respondents (45.39%) acknowledged practice changes: viewing patients as potential plaintiffs (45.39%), paying more attention to recordkeeping (42.19%), obtaining medicolegal training (37.94%), ordering more tests (36.17%), and avoiding specific kinds of patients (21.63%) or procedures (19.85%). Acknowledging a psychological impact was positively and significantly associated with professional practice changes (P < 0.0001), and the mean number of symptoms was significantly higher among those who acknowledged practice changes (P = 0.0001). CONCLUSIONS: Our results confirm the psychological impact of a malpractice claim and that impacted physicians are more likely to change their care practices, involving defensive medicine practices. Therefore, care for physicians facing malpractice claims needs to be considered under the umbrella of health care quality. Timely mental health referral paths could help mitigate the psychological impact and avoid the pernicious effects of negative practice changes.

Victimization as a Result of Non-Consensual Dissemination of Sexting and Psychopathology Correlates: An Exploratory Analysis.

Sexting is generally known as creating, sending and/or forwarding of sexual content using electronic devices. When such content is non-consensually disseminated, it becomes a criminally relevant behavior. To date, very few empirical studies have examined the prevalence of non-consensual dissemination of sexting, and none of them have analyzed the relationship with psychopathology and further victimization outcomes. Therefore, the aims of this study were (1) to examine the prevalence of non-consensual dissemination of sexual content, (2) to analyze the prevalence of further victimization as a result of non-consensual dissemination of sexting and (3) to investigate the association between secondary victimization as a result of non-consensual dissemination of sexting and psychopathology. The sample comprised 1370 Spanish college students (73.6% female; mean age = 21.4 years; SD = 4.85) who answered an online survey about their engagement in sexting behaviors, online sexual victimization and psychopathology, measured by a sexting scale and the Listado de Síntomas Breve (LSB-50), respectively. Overall, 43 participants (3.14) were victims of non-consensual dissemination of sexting, and results showed those participants who had suffered further victimization reported higher psychopathology scores than those who were not victimized and that being victimized by an ex-partner was associated with poorer mental health outcomes in the victim. Further implications are discussed.

Exploring Sexting and Online Sexual Victimization during the COVID-19 Pandemic Lockdown.

The COVID-19 pandemic lockdown has impacted daily routines, forcing people to stop socializing in person and changing the way people express their feelings and their romantic or sexual interactions. Social distancing has changed the way people behave online, and we expect that engagement in sexting and online sexual victimization behaviors have increased during lockdown. The aim of this paper is to study the prevalence of sexting and online sexual victimization behaviors during the COVID-19 lockdown in Spanish adults in order to explore how social distancing has affected these behaviors. The sample comprised 293 Spanish adults (mean age = 30.3; 66.2% female) who took part in an online survey about their engagement in sexting behaviors and online sexual victimization experiences. Overall results were apparently not supportive of our main hypothesis, showing that both sexting engagement and online sexual victimization decreased during lockdown despite the increase in internet use. Apart from differences in time period of reference, some alternative hypotheses relate to the increased presence of capable guardians according to the routine activities theory and to forced distance as a demotivation to sext. Possible explanations and hypotheses for these results are discussed further in the paper.