Estado actual sobre la opinión e implantación en la sociedad de los psicólogos en España / Current status on the opinion and implantation in society of psychologists in Spain

Existen pocos estudios que presenten la imagen de la profesión de psicología en el contexto español. Este estudio de tipo descriptivo y correlacional tiene como objetivo describir el estado actual de la opinión que existe en la sociedad española. Se obtiene una muestra de 920 personas de forma incidental utilizando como instrumento un cuestionario específico. Se realiza un análisis descriptivo de las respuestas que generan un patrón global y se hace un agrupamiento por clúster, que divide a la muestra en cuatro perfiles específicos de respuestas. Los principales resultados indican que las opiniones son en general positivas, aunque todavía existen algunos mitos y visiones más tradicionales que se observan en algunos clústers, por lo que se ha de seguir trabajando en aumentar y difundir el conocimiento de la sociedad en relación con la profesión

There are few studies that present the image of the profession of psychology in the Spanish context. This descriptive and correlational study aims to describe the current state of opinion about psychology that exists in Spanish society. An incidental sample of 920 were surveyed. A descriptive analysis of the responses that generate a global pattern is carried out. Also a cluster analysis which divides the sample into four specific response profiles was performed. The main results indicate that opinions are generally positive, although there are still some myths and more traditional visions that are observed in some clusters, so work should continues to increase and spread the knowledge of society in relation to the profesión

Efectos secundarios y prácticas para mejorar la gestión de la diabetes tipo 2 desde el punto de vista de la vivencia del individuo y de la gestión de la atención sanitaria. Revisión narrativa / Side effects and practices to improve management of type 2 diabetes mellitus from the viewpoint of patient experience and health care management. A narrative review

Introducción: El número de enfermos de diabetes tipo 2 está creciendo de forma alarmante. Este aumento está causando problemas personales, familiares, sociales, económicos y políticos. El objetivo de este artículo es revisar los efectos secundarios de los tratamientos, complicaciones que experimentan los pacientes y prácticas para mejorar la gestión de esta enfermedad desde el punto de vista de la vivencia del individuo y de la gestión de la atención sanitaria. Material y métodos: Se realizó una revisión narrativa de los estudios sobre la diabetes tipo 2 publicados en inglés y en español indexados en PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection y Google Académico. Se identificaron 1.118 artículos, de los cuales 42 se referían a los objetivos de la revisión y cumplían los criterios de inclusión. Resultados: Los efectos secundarios y complicaciones que experimentan los pacientes y la percepción de recibir escasa información repercuten en una falta de adherencia al tratamiento. Esto implica una disminución de la salud de los pacientes y un aumento de los costes sanitarios. Las propuestas de los estudios revisados encaminan las acciones para mejorar la adherencia al tratamiento y así mejorar la calidad de vida del paciente, disminuir los efectos secundarios, la mortalidad y, por tanto, los costes asociados a esta enfermedad a través de: 1) tener un acceso a la atención médica rápido y fácil, 2) una educación de calidad y 3) permitir que el paciente participe en las decisiones de su tratamiento y autogestione su enfermedad para realizar los mínimos cambios en su estilo de vida

Introduction: There is an alarming increase in the number of patients with type 2 diabetes mellitus. This increase is causing personal, family, social, economic, and political problems. The aim of this article is to review the side effects of treatments, the complications suffered by patients, and the practices to improve management of this disease from the viewpoint of the experience of patients and health care management. Material and methods: A narrative review was conducted of studies on type 2 diabetes mellitus published in English and Spanish indexed in PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection, and Google academic. A total of 1,118 articles were found, 42 of which referred to the objectives of the review and met the inclusion criteria. Results: The side effects and complications experienced by patients and their perception that they do not receive adequate information, together with poor satisfaction, lead to non-adherence to treatment, which impairs patient health and increases health care costs. The proposals in the reviewed studies guide the actions to improve treatment adherence and, thus, quality of life of patients, to decrease side effects and mortality and, therefore, the costs associated to type 2 diabetes mellitus through: 1) quick and easy access to medical care, 2) quality health education, and 3) participation of patients in the decisions about their treatment and in self-management of their disease to make minimum changes in their lifestyles

Side effects and practices to improve management of type 2 diabetes mellitus from the viewpoint of patient experience and health care management. A narrative review. / Efectos secundarios y prácticas para mejorar la gestión de la diabetes tipo 2 desde el punto de vista de la vivencia del individuo y de la gestión de la atención sanitaria. Revisión narrativa.

INTRODUCTION: There is an alarming increase in the number of patients with type 2 diabetes mellitus. This increase is causing personal, family, social, economic, and political problems. The aim of this article is to review the side effects of treatments, the complications suffered by patients, and the practices to improve management of this disease from the viewpoint of the experience of patients and health care management. MATERIAL AND METHODS: A narrative review was conducted of studies on type 2 diabetes mellitus published in English and Spanish indexed in PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection, and Google academic. A total of 1,118 articles were found, 42 of which referred to the objectives of the review and met the inclusion criteria. RESULTS: The side effects and complications experienced by patients and their perception that they do not receive adequate information, together with poor satisfaction, lead to non-adherence to treatment, which impairs patient health and increases health care costs. The proposals in the reviewed studies guide the actions to improve treatment adherence and, thus, quality of life of patients, to decrease side effects and mortality and, therefore, the costs associated to type 2 diabetes mellitus through: 1) quick and easy access to medical care, 2) quality health education, and 3) participation of patients in the decisions about their treatment and in self-management of their disease to make minimum changes in their lifestyles.

Structure of Enhanced Cued Recall Task in the 7 Minute Screen Test.

Episodic memory in the 7 Minute Screen is assessed by the Enhanced Cued Recall (ECR) test. The ECR test is composed of three phases, Identification, Immediate Recall, and Free and Cued Recall. However, just the last phase is considered for the total score. We believe that collecting the performance data of the Identification and Immediate Recall phases could provide information regarding possible difficulties or impairments in the different aspects involved in the temporal mnesic process of acquisition of new information, such as in working memory or visual identification. The objective was to assess the goodness of fit for the three phases of the ECR test using a Confirmatory Factor Analysis (CFA) to show if each phase is separated from each other as a different aspect that participates in the mnesic process. A total of 311 participants greater than 65 years were included in this study. Confirmatory factor analyses were conducted for each individual phase. The analyses show that the ECR test consists of three separate phases that identify different steps of the mnesic process. Individual scores for each phase could allow for investigation of patient performance in different aspects of the memory process and could help in further neuropsychological assessment.

Developing and Pilot Testing a Spanish Translation of CollaboRATE for Use in the United States.

BACKGROUND/AIM: Given the need for access to patient-facing materials in multiple languages, this study aimed to develop and pilot test an accurate and understandable translation of CollaboRATE, a three-item patient-reported measure of shared decision-making, for Spanish-speaking patients in the United States (US). METHOD: We followed the Translate, Review, Adjudicate, Pre-test, Document (TRAPD) survey translation protocol. Cognitive interviews were conducted with Spanish-speaking adults within an urban Massachusetts internal medicine clinic. For the pilot test, all patients with weekday appointments between May 1 and May 29, 2015 were invited to complete CollaboRATE in either English or Spanish upon exit. We calculated the proportion of respondents giving the best score possible on CollaboRATE and compared scores across key patient subgroups. RESULTS: Four rounds of cognitive interviews with 26 people were completed between January and April 2015. Extensive, iterative refinements to survey items between interview rounds led to final items that were generally understood by participants with diverse educational backgrounds. Pilot data collection achieved an overall response rate of 73 percent, with 606 (49%) patients completing Spanish CollaboRATE questionnaires and 624 (51%) patients completing English CollaboRATE questionnaires. The proportion of respondents giving the best score possible on CollaboRATE was the same (86%) for both the English and Spanish versions of the instrument. DISCUSSION: Our translation method, guided by emerging best practices in survey and health measurement translation, encompassed multiple levels of review. By conducting four rounds of cognitive interviews with iterative item refinement between each round, we arrived at a Spanish language version of CollaboRATE that was understandable to a majority of cognitive interview participants and was completed by more than 600 pilot questionnaire respondents.

Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study).

BACKGROUND: We analyzed the associations between diabetes and cognitive impairment (CI) and dependence in a population of patients 65 years or older. METHODS: Cross-sectional study. We randomly selected 311 participants over the age of 65 living in an urban area of Spain. The mean age of the cohort was 75.89 ± 7.12 years, and 69 of the individuals (22.2%) had diabetes. Two questionnaires were used to assess cognitive performance (MMSE and Seven Minute Screen Test), and two assessments were used to evaluate patient dependence (Barthel Index and Lawton-Brody Index). Clinical information and sociodemographic data were also gathered. RESULTS: Nearly one quarter of patients with diabetes (21.7%) lived alone. Diabetic patients were more sedentary (p = .033) than non-diabetic patients. Roughly one sixth (15.3%) of the diabetics and 10.1% of the non-diabetics were depressed (p = .332). CI was present in 26.1% of the diabetics and 14.5% of non-diabetics (p = .029). Diabetic patients had a MMSE score that was significantly worse than non-diabetics (24.88 ± 4.74 vs 26.05 ± 4.03; p <.05), but no differences were found in the Seven Minute Screen Test. Logistic regressions revealed that the presence of diabetes was independently associated with CI (adjusted for age, gender, years of education, sedentary lifestyle, body mass index, diastolic blood pressure, cholesterol, and depression (OR = 2.940, p = .013). Patients with diabetes showed greater dependence, as measured by the Barthel Index (p = .03) and Lawton-Brody Index (p <.01). Nevertheless, when dependence (dependence or not dependence for each questionnaire) used as a dependent variable in the logistic regression analyses, no significant association with diabetes was found, after adjusting for confounding variables. CONCLUSIONS: Diabetic patients over the age of 65 are more likely to present CI but not dependence. These findings support the need to include both a functional and cognitive assessment as necessary components in a standard evaluation in both clinical guides and randomized trials of therapeutic interventions in patients with diabetes.

Factorial Structure and Measurement Invariance of the PANAS in Spanish Older Adults.

Developmental theories suggest age-related changes in the structure of affect. Paradoxically, the internal structure of the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) has not been tested in Spanish older adults by means of confirmatory factor analysis (CFA) despite it is the most widely used measure of emotional well-being in later life. The aim of this study was to examine competing models of the internal structure of the Spanish version of the PANAS, its measurement invariance, reliability, and external validity. Participants were a representative sample of 585 community-dwelling people aged 60 and over, who also completed depression, loneliness and life satisfaction measures. Results showed that the orthogonal two-factor model with correlated errors (RMSEA = .057, 90% CI [.051, .063], SRMR = .084, CFI = .97, NNFI = .97) was the best fitting solution. Measurement invariance analyses confirmed that the two-independent factor structure can be used across young-old and very old people, as well as in both males and females. It showed good reliability (PA: α = .93, NA: α = .83), criterion, convergent and discriminant validity (p < .01). Our discussion highlights the role of age and culture in the experience and expression of emotions.

Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review.

OBJECTIVE: To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings. METHODS: Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached. RESULTS: Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups. CONCLUSION: Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.

Factorial structure and measurement invariance of the PANAS in Spanish older adults

Developmental theories suggest age-related changes in the structure of affect. Paradoxically, the internal structure of the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) has not been tested in Spanish older adults by means of confirmatory factor analysis (CFA) despite it is the most widely used measure of emotional well-being in later life. The aim of this study was to examine competing models of the internal structure of the Spanish version of the PANAS, its measurement invariance, reliability, and external validity. Participants were a representative sample of 585 community-dwelling people aged 60 and over, who also completed depression, loneliness and life satisfaction measures. Results showed that the orthogonal two-factor model with correlated errors (RMSEA = .057, 90% CI [.051, .063], SRMR = .084, CFI = .97, NNFI = .97) was the best fitting solution. Measurement invariance analyses confirmed that the two-independent factor structure can be used across young-old and very old people, as well as in both males and females. It showed good reliability (PA: α = .93, NA: α = .83), criterion, convergent and discriminant validity (p < .01). Our discussion highlights the role of age and culture in the experience and expression of emotions (AU)

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Psychometric properties and measurement invariance of the Spanish version of the 11-item De Jong Gierveld loneliness scale.

ABSTRACT Background: Loneliness has been associated with physical and mental health problems. It has also been considered a serious social problem that increases the use and costs of health services. The most widely used instrument in Europe for measuring loneliness is the de Jong Gierveld Loneliness Scale (DJGLS). The aim of this study was to examine the psychometric properties of the 11-item DJGLS by means of the Rasch model, and its convergent and discriminant validity. Methods: Participants were a representative sample of Spanish community-dwelling adults aged 60 and older. We evaluated sociodemographic variables, health, social support, social activity, and subjective well-being measures. Results: Person and item fit statistics, and standardized residual principal component analysis revealed that the DJGLS was essentially unidimensional. However, we found DIF across marital status and living arrangements. Moderate to high associations were found between loneliness and depression, self-rated loneliness, positive and negative emotions, and satisfaction with life. The DJGLS differentiated between well known-groups according to gender, marital status, living arrangements, health, structural and functional aspects of social networks, and social activity. Conclusions: The DJGLS is a valid and reliable instrument for measuring loneliness in Spanish older adults. The addition of a few items in order to improve the measurement range is strongly recommended. Our findings are consistent with previous research indicating that loneliness is an important aspect of mental health and subjective well-being, and support the use of the scale to detect vulnerable population in old age.

Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol.

BACKGROUND: New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging. METHODS/DESIGN: A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness. DISCUSSION: Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT02016014.

Perceived Organizational Justice in Care Services: creation and multi-sample validation of a measure.

Organizational justice (OJ) perceptions predict attitudes and behaviors of customers and employees across a broad range of services. Although OJ has proven predictive power and relevance, it has rarely been studied in health care settings. This stems partially from the lack of a reliable and valid measure of patients' OJ in health care encounters. The objective here was to create and validate a measure of patients' OJ. With that purpose, a survey study with two sampling contexts - the U.S. and Spain - was carried out in order to provide a cross-national validation of the scale in two versions: English (Perceived Organizational Justice in Care Services, PJustCS) and Spanish (Percepción de Justicia Organizacional en el Ámbito Sanitario, PJustAS). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to select the appropriate items in the final version of the instrument. Reliability and validity of the measure were tested. A total of 406 patients in the U.S. and 473 patients in Spain participated. The measures used were the newly created scale of Perceived Organizational Justice in Care Services (PJustCS/PJustAS) and scales of patients' Satisfaction, Trust and Global Justice. Factor Analyses supported the four dimensional structure of the instrument for each group. Multigroup CFA substantiated invariant factor loadings and invariant structural models across both samples, hence, supporting that the instrument is applicable in its two versions: English and Spanish. Validation results showed expected positive relations of OJ with patients' satisfaction, trust in clinicians and global perceived justice. These results point out the importance of health care customers' perceived organizational justice in the explanation of health care dynamics. The scale has desirable psychometric properties and shows adequate validity, contributing to the potential development of the area.

Prevalencia de enfermedades cardiovasculares y de factores de riesgo cardiovascular en mayores de 65 años de un área urbana: estudio DERIVA / Prevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study

Objetivo: Estimar la prevalencia de enfermedades cardiovasculares, los factores de riesgo cardiovascular y las características psicosociales asociadas en mayores de 65 años de una población urbana. Diseño: Estudio descriptivo transversal, poblacional. Emplazamiento: Ciudad de Salamanca (España). Participantes: Mediante un muestreo aleatorio estratificado por zona de salud, seleccionamos 480 sujetos mayores de 65 años. Se efectuó una encuesta de salud en el domicilio de los sujetos mediante un cuestionario. Medidas principales: Peso, talla, circunferencia de cintura, presión arterial, glucemia y colesterol. Se estimó la prevalencia estandarizada a la población europea. Resultados: Se entrevistaron 327 sujetos (68,10% de los seleccionados), edad media de 76 años (DE: 7,33). El 64,5% eran mujeres. El 20,2% (15,8-24,5) presentaban enfermedad cardiovascular. La cardiopatía isquémica (12,1% [6,1-18]) fue la más prevalente en varones y la insuficiencia cardiaca (10,4% [6,3-14,6]) en mujeres. La hipertensión era el factor de riesgo más frecuente tanto en varones (63,8% [53,2-70,9]) como en mujeres (69,7% [63,5-75,9]), seguido de diabetes en varones (36,2% [27,5-45]) y sedentarismo en mujeres (36,0% [29,5-42,5]). Los que presentaban enfermedades cardiovasculares eran más dependientes y mostraron peor pronóstico (Índice de Comorbilidad de Charlson). Conclusiones: La cardiopatía isquémica fue la enfermedad más prevalente en varones y la insuficiencia cardiaca en mujeres. Casi el 80% de los mayores de 65 años no presentaban ninguna de las 3 enfermedades cardiovasculares que suponen las principales causas de muerte en este grupo de edad. Los participantes que presentaban alguna enfermedades cardiovasculares fueron más dependientes para las actividades de la vida diaria (AU)

Objective: To estimate the prevalence of cardiovascular diseases, cardiovascular risk factors, and the psychosocial characteristics associated with them in an urban population aged 65 years and older. Design: Descriptive cross-sectional study of the population. Setting: City of Salamanca (Spain). Participants: A total of 480 participants aged 65 and older were selected using a stratified randomized sampling method. A health questionnaire was completed in the participants’ homes. Main measurements: Weight, height, waist circumference, arterial pressure, blood glucose and cholesterol, were measured, and the standardized prevalence for a European population was estimated. Results: A total of 327 participants were interviewed (68.10% of those selected), mean age of participants was 76 (SD: 7.33). Of the total, 64.5% were women and 20.2% (15.8-24.5) had some cardiovascular disease. In males, the most prevalent cardiovascular disease was ischemic heart disease (12.1% [6.1-18]), while in females it was heart failure (10.4% [6.3-14.6]). Hypertension was the most frequent cardiovascular risk factor for males (63.8% [53.2-70.9]) and females (69.7%. [63.5-75.9]), followed by diabetes in males (36.2% [27.5-45]), and sedentary lifestyle in females (36.0% [29.5-42.5]). Those with cardiovascular diseases were more dependent and had a worse prognosis (Charlson's Comorbility Index) .Conclusions: Ischemic heart disease is the most prevalent heart disease in males, while heart failure is the most prevalent disease for females. Almost 80% of the population aged 65 and older did not suffer any of the three cardiovascular diseases that are the main causes of mortality in this group of age. Participants who had a CVD were more dependent for activities of daily living (AU)

[Prevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study]. / Prevalencia de enfermedades cardiovasculares y de factores de riesgo cardiovascular en mayores de 65 años de un área urbana: estudio DERIVA.

OBJECTIVE: To estimate the prevalence of cardiovascular diseases, cardiovascular risk factors, and the psychosocial characteristics associated with them in an urban population aged 65 years and older. DESIGN: Descriptive cross-sectional study of the population. SETTING: City of Salamanca (Spain). PARTICIPANTS: A total of 480 participants aged 65 and older were selected using a stratified randomized sampling method. A health questionnaire was completed in the participants' homes. MAIN MEASUREMENTS: Weight, height, waist circumference, arterial pressure, blood glucose and cholesterol, were measured, and the standardized prevalence for a European population was estimated. RESULTS: A total of 327 participants were interviewed (68.10% of those selected), mean age of participants was 76 (SD: 7.33). Of the total, 64.5% were women and 20.2% (15.8-24.5) had some cardiovascular disease. In males, the most prevalent cardiovascular disease was ischemic heart disease (12.1% [6.1-18]), while in females it was heart failure (10.4% [6.3-14.6]). Hypertension was the most frequent cardiovascular risk factor for males (63.8% [53.2-70.9]) and females (69.7%.[63.5-75.9]), followed by diabetes in males (36.2% [27.5-45]), and sedentary lifestyle in females (36.0% [29.5-42.5]). Those with cardiovascular diseases were more dependent and had a worse prognosis (Charlson's Comorbility Index). CONCLUSIONS: Ischemic heart disease is the most prevalent heart disease in males, while heart failure is the most prevalent disease for females. Almost 80% of the population aged 65 and older did not suffer any of the three cardiovascular diseases that are the main causes of mortality in this group of age. Participants who had a CVD were more dependent for activities of daily living.

Relationships between quality of life and family function in caregiver.

BACKGROUND: There are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregiver's situation has not been the subject of much evaluation. The aim of this study is to analyse the relationship between the functionality of the family and the QoL of caregivers of dependent relatives. METHODS: We conducted a cross-sectional study including 153 caregivers. SETTING: Two health centers in the city of Salamanca(Spain). Caregiver variables analysed: demographic characteristics, care recipient features; family functionality (Family APGAR-Q) and QoL (Ruiz-Baca-Q) perceived by the caregiver. Five multiple regressions are performed considering global QoL and each of the four QoL dimensions as dependent variables. The Canonical Correspondence Analysis (CCA) was used to study the influence of the family function questionnaire on QoL. RESULTS: Family function is the only one of the variables evaluated that presented an association both with global QoL and with each of the four individual dimensions (p<0.05). Using the CCA, we found that the physical and mental well-being dimensions are the ones which present a closer relationship with family functionality, while social support is the quality dimension that is least influenced by the Family APGAR-Q. CONCLUSION: We find an association between family functionality and the caregiver's QoL. This relation holds for both the global measure of QoL and each of its four individual dimensions.

Effectiveness of an intervention in groups of family caregivers of dependent patients for their application in primary health centers. Study protocol.

BACKGROUND: Although Primary Health Care (PHC) Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers.The study aims to evaluate the effectiveness of an intervention of psychotherapy in improving the mental health and Quality of life of caregivers. This intervention is based on theoretical approaches to care adjusted to cognitive theory, in order to be applied in primary health care centres. METHODS/DESIGN: This is multicentre clinical trials study, randomized in two parallel groups, carry out in two PHC, Study population: 150 caregivers will be included by consecutive sampling and they will be randomized the half to experimental group and the other half to control group. They provide mostly all the assistance to care-dependent familiars receiving attention in PHC Centers. MEASUREMENTS: Each caregiver will be evaluated on a personal interview. The caregivers' assessment protocol: 1) Assessment of different socio-demographic related to care, and caregiver's personal situation. 2)Care-dependent individuals will also be assessed by Barthel Index and Pfeiffer Questionnaire (SPMSQ). 3)Change in caregivers will be the principal measure: family function (Family APGAR Questionnaire), burden short questionnaire (Short Zarit Burden Interview), quality of life (Ruiz & Baca: 1993 Questionnaire), the Duke-UNK Functional Social Support Questionnaire, the General Health Questionnaire-12, and changes in Dysfunctional Thoughts about caring. 4) Intervention implementation measures will also be assessed. INTERVENTION: A psychotherapeutic intervention will be 8 sessions of 90 minutes in groups. This intervention has been initially developed for family caregivers of patients with dementia. DISCUSSION: Psychotherapeutic interventions have been proved to obtain better results to reduce symptomatology and improve emotional state of caregivers. Moreover, this intervention has been proved to be effective in a different setting other than PHC, and was developed by professionals of Mental Health. If we found that this intervention is effective in PHC and with our professionals, it would be an important instrument to offer to caregivers of care-dependent patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01177696.

Exploration of fairness in health services: a qualitative analysis.

A content analysis of fair and unfair experiences described by students as customers of health care services was made. The way customers had been treated by the staff during the implementation of procedures, along with the information exchange between client and service providers turned out to have a strong impact on justice perception. An outstanding point is the reciprocity on the treatment. The clients' comments about waiting times and the physical and emotional consequences of patients' encounters with health services also played a major role in fairness perception and the patients' assessment of their experience. These matters should be considered in the management of health care services.