Financial toxicity in allogeneic haematopoietic stem cell transplant patients from a social determinants of health perspective.

PURPOSE: Financial toxicity (FT) refers to the subjective perception of financial distress resulting from objective economic strain due to illness, exerting a detrimental influence on health outcomes. This study aimed to describe FT among allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients within a public health framework, employing a social determinants of health approach. METHODS: A multi-centre cross-sectional study involving adult allo-HSCT patients was conducted across three public hospitals in Madrid. FT was assessed using a validated COST scale (range 0-44; lower scores indicating higher FT). Patient-administered paper/online questionnaires were utilized to collect data on sociodemographic, socioeconomic, clinical, and healthcare access variables. Descriptive, non-parametric univariate statistical analysis and multiple linear regression models were performed. RESULTS: Sixty-six patients, with a mean age: 52.5 years (SD: 11.5), 50% women, 28.7% displaced to Madrid for HSCT, and 71.4% lacking financial support were included. The median FT score was 20 points (IQR 12-27.25). Independent factors associated with higher FT included being females (Coef = -3.26; p = 0.079), perceived income loss after HSCT (Coef = -6.81; p < 0.001) and a monthly household income of ≤1000 € compared to 1001-2500€ (Coef = 8.29; p = 0.005) or >2500 € (Coef = 15.75; p < 0.001). CONCLUSIONS: Despite the limited sample size, our findings underscore the presence of financial toxicity among allo-HSCT patients, shaped by social determinants of health. Recognizing and addressing FT within the HSCT process is essential to mitigate social inequalities in health.

Advancing migration and health research by examining return migration.

This essay offers an analysis of research on return migration and health by adopting the social determinants of health (SDH) framework proposed by the WHO. Specifically, we argue that the SDH are implicated in the decision to migrate, stay or return, which in itself also contributes to social health inequities. Most theoretical frameworks developed to study migration have predominantly considered primary migration movements. The lack of a fluid consideration of the migration phenomenon has a direct impact on our understanding of the relationship between migration and health. In this essay, we, first, address the challenges of defining and studying return and its implications for health research. Second, we propose to use the WHO's SDH framework to understand how social factors shape migrants' health, influence the decision to return and can contribute to health inequalities. The conceptual approach developed in this paper can help design future studies on the health of return migrants, fostering interdisciplinary collaborations to investigate how social factors are embodied, giving rise to health inequities in society that are intricately linked to the migration experience.

Flexibilidad en las pautas take home de metadona en los CAD de Madrid Salud durante la pandemia de Covid-19 / Flexibility in the methadone take home guidelines in the CAD of Madrid Salud during the Covid-19 pandemic

El objetivo del estudio fue examinar qué cambios se realizaron en los horarios de dispensación y las pautas take home de metadona solución oral y comprimidos, en los siete Centros de Atención a las Adicciones (CAD) de Madrid Salud, a raíz del estado de emergencia y a lo largo de un año posterior a su entrada. Se realizó un estudio descriptivo longitudinal, obteniendo los datos de la revisión de los informes elaborados por la unidad de farmacia, encargada del suministro y control de la metadona, en tres momentos: febrero de 2020 y marzo de 2021, para las pautas de metadona quincenal; y además en noviembre de 2020 para las de tratamiento con metasedín. Se realizó un análisis de estadística descriptiva, calculándose frecuencias absolutas y relativas, así como el porcentaje de variación entre el primer momento y el último momento de medición. En todos los centros se redujeron los días de dispensación. Las pautas quincenales take home de solución de metadona aumentaron más del 50% en todos los centros, manteniéndose un año después un incremento total del 97%. Las personas en tratamiento de mantenimiento con Metasedín se incrementaron en un 45,3%. Las restricciones de movilidad debido al confinamiento por Covid-19 obligaron a flexibilizar y ampliar el take home. La buena respuesta de las personas en tratamiento ha favorecido el mantenimiento de los cambios, lo que ayuda a la normalización de un tratamiento estigmatizado. (AU)

The objective of the study was to examine the changes made in the dispensing schedules and oral solution methadone take home doses and tablets, in the seven Addiction Care Centers (CAD) of Madrid Salud, because of the state of emergency, and which ones remain one year later. A longitudinal descriptive study was conducted, obtaining the data from the review of the reports prepared by the pharmacy unit, responsible for supply and control of methadone, at three times: February 2020 and March 2021, for the two weeks methadone doses; in addition, people treated with Metasedín were included in November 2020. A descriptive statistical analysis was performed, calculating absolute and relative frequencies, as well as the percentage of variation between the first moment and the last moment of measurement. Dispensing days were reduced in all centers. Two weeks methadone solution take home doses increased by more than 50% in all centers, maintaining a total increase of 97% one year later. People in Metasedín maintenance treatment increased by 45.3%. Mobility restrictions due to confinement by Covid-19 forced to make more flexible and expand the take home. The good response of people in treatment has favored maintaining the changes, which helps to normalize a stigmatized treatment. (AU)

Recruiting Participants in Vulnerable Situations: A Qualitative Evaluation of the Recruitment Process in the EFFICHRONIC Study.

In recent years, stakeholder involvement in research has become a central element of responsible research. The EFFICHRONIC project reflects these principles and aims to reduce the burden of chronic diseases and increase the sustainability of the healthcare system through the implementation of an evidence-based chronic disease prevention and self-management programme. The qualitative study presented here is part of EFFICHRONIC and aims to explore and understand the recruitment strategies implemented in the participating countries (Spain, UK, Netherlands, Italy, and France). Semi-structured interviews were conducted with the country coordinators (purposive sampling of the five coordinators responsible for the recruitment strategy), and a coding and synthesis process was used to conduct a thematic analysis. The analysis resulted in five main categories: (1) Stakeholder recruitment strategies. (2) Facilitators to recruitment. (3) Barriers to recruitment. (4) Strategies developed to address recruitment challenges. (5) Lessons learned. From a collaborative approach to the co-production process, recruitment has helped to build a wide network and new relationships with local actors, explore and learn about the social world, step out of the comfort zone of health institutions, combine a wide variety of strategies, and innovate by taking into account the institutional and cultural contexts of each country.

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65 / Factores psicosociales en la adherencia al tratamiento farmacológico y el control de la diabetes mellitus en pacientes mayores de 65 años

Aim: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. Design: Cross-sectional study.Setting and participantsAdults over 65 years of age with T2DM treated at the Madrid Primary Care Service. Main measurements: Data collection: Electronic Health Record database. Variables: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. Results: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15–13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86–16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04–12.02). Conclusions: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.(AU)

Objetivo: Explorar la influencia de los síntomas de ansiedad/depresión y del riesgo social en pacientes mayores de 65 años con diabetes mellitus tipo 2 (DM2), tanto en la no adherencia al tratamiento farmacológico (no AdhT) como en el mal control de la DM2.Diseño: Estudio descriptivo transversal. Emplazamiento y participantesAdultos mayores de 65 años con DM2 atendidos en el Servicio de Atención Primaria de Madrid.Principales mediciones: Recogida de datos: base de datos de historia clínica electrónica. Variables: mal control de T2DM (HBA1c) y no AdhT (prueba de Morisky-Green); principales variables clínicas: síntomas de depresión/ansiedad y riesgo social. Se utilizaron modelos globales de regresión logística multivariante y desagregados por sexo para no AdhT y mal control de DM2. Resultados: Se obtuvieron datos de 884 sujetos. Prevalencia de no AdhT: 4,4%; prevalencia de mal control de DM2: 37,2%. Los modelos de regresión logística multivariante para no AdhT en hombres mostraron un mayor riesgo si tenían síntomas de ansiedad/depresión (OR: 3,88; IC del 95%: 1,15-13,07); y en mujeres, si tenían riesgo social (OR: 5,61; IC del 95%: 1,86-16,94). Los modelos de regresión logística multivariante para el control deficiente de la DM2 en los hombres revelaron un mayor riesgo si no tenían AdhT (OR: 3,53; IC del 95%: 1,04-12,02). Conclusiones: En personas mayores de 65 años con DM2, aunque la no AdhT es baja, la prevalencia de mal control de la DM2 es alta. Los síntomas de depresión o ansiedad son un factor de riesgo de no AdhT en los hombres, mientras que el riesgo social tiene el mismo efecto en las mujeres. La no AdhT en los hombres aumenta el riesgo de un control deficiente de la DM2. Desde una perspectiva de género, es importante detectar problemas de salud social y mental en adultos mayores con diabetes y reforzar estrategias para mejorar su adherencia al tratamiento farmacológico y control glucémico en estos pacientes.(AU)

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65.

AIM: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Adults over 65 years of age with T2DM treated at the Madrid Primary Care Service. MAIN MEASUREMENTS: Data collection: Electronic Health Record database. VARIABLES: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. RESULTS: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15-13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86-16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04-12.02). CONCLUSIONS: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.

Non-pharmaceutical interventions during COVID-19 in the UK and Spain: a rapid realist review.

The paper is located at the crossroads of two modern intellectual movements. The first, evidence-based policy, seeks to locate vital information that will inform and improve key policy decisions on such matters as population health, social welfare, and human wellbeing. The second, complexity theory, describes the nature of the social world and perceives human action as persistently adaptive and social institutions as incessantly self-transformative. The first assumes that policies and programmes can achieve sufficient control to meet specific and measurable objectives. The second assumes that social actions are sufficiently capricious so that the society never conforms to anyone's plans - even those of the most powerful. The unparalleled resources committed to control the unprecedented attack of the COVID-19 pandemic are the epitome of complexity. The long struggle to contain the virus thus constitutes an ideal test bed to investigate this paradigmatic split. The paper undertakes this mission - focusing specifically on the effectiveness non-pharmaceutical interventions and examining evidence from the UK and Spain.

Nurses competence in the reporting of medication-related incidents: An intervention study.

OBJECTIVES: Less than 5% of all harmful medicine-related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs. DESIGN: One-group pre-test-posttest design. SETTING: Tertiary, public, teaching hospital in Spain. PARTICIPANTS: A total of 139 RNs responded to pre- and postintervention questionnaires constituting the paired sample subjected to analysis. INTERVENTION: A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes. MAIN OUTCOME MEASURES: Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34-170 points) by means of an electronic questionnaire. RESULTS: A statistically significant 7.96-point increase in OC from baseline to the final measurement was obtained (CI: 5.05-10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06-9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no-harm MI postintervention compared to 4.4% pre-intervention (p < .001). A one-point increase in OC improved the probability of becoming reporter by 2.9% and a one-point increase in skills by 6.4%. CONCLUSION: MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no-harm MIs reported.

[Uncovering infertility: the experience of women undergoing assisted reproductive technologies.] / Descubrir la infertilidad: la experiencia de mujeres sometidas a técnicas de reproducción asistida.

OBJECTIVE: Infertility is a huge reproductive health problem in developed countries. The aim was to understand the infertility experience of women who have undergone assisted reproduction technologies. METHODS: Qualitative study using Grounded Theory. Through intentional sampling and theoretical sampling, 20 women who had undergone Assisted Reproduction Technologies in public hospitals and specialized private clinics in Spain were selected. Data were collected using semi-structured interviews and were analysed using the principles of Grounded Theory: initial coding and focused coding, memo writing, theoretical sampling and constant comparative method. RESULTS: "Uncovering infertility: unveiling the unknown" is the core category that explains the process which women go through. Four subcategories emerged and describe the temporal process from seeking pregnancy to reception and coping with the infertility diagnosis: "Seeking for a vital desire: being mothers/fathers", "Suspecting infertility: the absence of the natural", "In search of a diagnosis: knowing and understanding the problem" and "The impact of diagnosis: a vital grief". CONCLUSIONS: Uncovering infertility is a process that has an impact on the different areas of women's lives. This process produces different emotions and feelings such as guilt, frustration, sadness or anger. This process could be easier if women have the support of their partner, their social environment and if they share their problem with women who have the same situation.

OBJETIVO: La infertilidad es uno de los grandes problemas de salud reproductiva en los países desarrollados. El objetivo de este estudio fue comprender la experiencia vivida de la infertilidad por mujeres que se han sometido a técnicas de reproducción asistida. METODOS: Estudio cualitativo de Teoría Fundamentada. Mediante muestreo intencional y muestreo teórico se seleccionaron 20 mujeres que habían sido sometidas a técnicas de reproducción asistida tanto en hospitales públicos como en clínicas privadas especializadas en España. La técnica de recogida de los datos fue la entrevista semiestructurada. El análisis siguió los procedimientos de la Teoría Fundamentada: codificación inicial y focalizada, escritura de memos analíticos, muestreo teórico y método de comparación constante. RESULTADOS: "Descubrir la infertilidad: desvelar lo desconocido" es la categoría principal que explica el proceso que viven las mujeres. Emergieron cuatro subcategorías que describen el proceso temporal desde el inicio de la búsqueda de embarazo hasta la recepción y afrontamiento del diagnóstico de infertilidad: "Buscar un deseo vital: ser madres/padres", "Sospechar la infertilidad: la ausencia de lo natural", "En busca de un diagnóstico: conocer y comprender el problema" y "El impacto del diagnóstico: un duelo vital". CONCLUSIONES: Descubrir la infertilidad es un proceso que afecta a los distintos ámbitos de la vida de las mujeres y en el que aparecen emociones y sentimientos como culpa, frustración, tristeza o rabia. Este proceso puede estar facilitado cuando se tiene el apoyo de su pareja, el entorno y se comparte el problema con mujeres que tienen su misma situación.

Grupo de Investigación en Enfermería y Cuidados de Salud. Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA) / Research Group in Nursing Care. Puerta de Hierro-Segovia de Arana Institute for Health Research (IDIPHISA)

Este artículo tiene como propósito dar a conocer la trayectoria del Grupo de Investigación en Enfermería y Cuidados de Salud del Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), así como sus líneas de investigación, producción científica y logros. El grupo cuenta con una reconocida trayectoria en investigación en el ámbito nacional. De los 22 institutos de investigación sanitaria acreditados por el Instituto de Salud Carlos III en el periodo 2009-2014, el IDIPHISA fue uno de los seis primeros que reconoció el Grupo de Investigación en Enfermería (mayo, 2014). Las líneas de investigación del grupo son: innovación en cuidados; seguridad del paciente; cuidados en parto, puerperio y recién nacido; cuidados en pacientes críticos; cuidados en procesos crónicos, dependencia y cuidado familiar; innovación docente y tecnológica; humanización de la atención; innovación en fisioterapia. En la actualidad, está integrado por 28 miembros, de los cuales 14 (50%) tienen el grado de doctor y ocho (28,6%) están realizando el doctorado. Entre 2015-2019 el grupo ha producido 105 publicaciones, con un factor de impacto acumulado de 119,89, y ha generado/contribuido con 17 tesis.(AU)

This article explains the historical trajectory of the Research Group in Nursing Care from the Puerta de Hierro-Segovia de Arana Institute for Health Research (IDIPHISA), as well as its lines of research, scientific output and achievements. The group has an acknowledged trajectory in research in the national setting. Of the 22 institutes for heath research certified by the Instituto de Salud Carlos III (ISCIII) during 2009-2014, the IDIPHISA was one of the six first to acknowledge the Research Group in Nursing Care (certified in May 2014). From 2015 on, additional groups have been acknowledged in the new certified institutes for research. The lines of research of the group are: innovation in care; patient safety; childbirth, post-partum and newborn care; critical patient care; care for chronic conditions; dependence and family care; educational and technological innovation; humanization in care; innovation in physiotherapy. Currently it includes 28 members; 14 (50%) have a doctor’s degree and eight (28,6%) are studying for their doctorate. In the past five years (2015-2019) the group has presented 105 publications, with an accumulated impact factor of 119.89; and they have generated / contributed with 17 theses.(AU)

Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol.

INTRODUCTION: Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS: A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION: Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER: CRD42020147655.

Bayesian spatio-temporal models for mapping TB mortality risk and its relationship with social inequities in a region from Brazilian Legal Amazon.

BACKGROUND: Reducing TB mortality is a great challenge in Brazil due to its territorial extension, cultural variations and economic and political crises, which impact the health system. This study aimed to estimate in space and time the risk of TB mortality and test its relationship with social inequities. METHODS: This was an ecological study that included deaths from TB between 2006 and 2016 in Cuiabá, Brazilian Legal Amazon. Bayesian models based on the integrated nested Laplace approximation approach were used to estimate spatio-temporal RRs. RRs for TB mortality were obtained according to the covariables representative of social inequities. RESULTS: The risk of TB mortality was stable between 2006 and 2016 and high-risk areas were identified throughout the municipality studied. Regarding social inequities, income was an important factor associated with TB mortality risk, as an increase of 1 SD in income resulted in a 35.4% (RR 0.646; CI 95% 0.476 to 0.837) decrease in risk. CONCLUSIONS: The results provided evidence of areas with higher TB mortality risks that have persisted over time and are related to social inequities. Advancing social policies and protections in these areas will contribute to achieving the WHO's End TB strategy.

El sistema de información sanitaria en Atención Primaria de Brasil. Soporte para la gestión local / The Primary Care Health Information System in Brazil. Support for local management

OBJETIVO: analizar las experiencias del uso del sistema e-SUS AB (Estrategia del Sistema única de Salud de la Atención Básica) en un municipio brasileño, y explorar si da soporte al proceso de trabajo y a la gestión local. MÉTODO: investigación cualitativa, efectuada en el estado de São Paulo, a través de entrevistas semiestructuradas a 17 profesionales de la Atención Primaria de Salud que utilizan el Sistema e-SUS AB. Se realizó análisis temático empleando el conjunto de elementos de la lógica procesual DICCA (Dato, Información, Conocimiento, Comunicación y Acción). RESULTADOS: fueron obtenidos cinco temas: Uso restringido de los Sistemas de Información en Salud (SIS) (falta de habilidad de los profesionales sobre el uso de las herramientas del sistema, limitándose a la introducción de datos); Necesidad de entender para poder utilizar (los profesionales no identifican de manera inmediata el valor que tiene registrar y usar los SIS en el proceso de cuidado de la salud); Fallos en la comunicación interprofesional (son percibidos privilegios de uso del sistema para profesionales de medicina, lo que interfiere en la prestación de cuidados interdisciplinares); Fortalezas del sistema e-SUS AB (los elementos de calidad del sistema, como es el aumento de información accesible, repercuten positivamente en la organización del trabajo); y Debilidades del sistema e-SUS AB (deficiencias tecnológicas, el registro en los múltiples sistemas y la falta de herramientas para facilitar la sistematización de la atención enfermera, hacen que el trabajo no sea eficiente). CONCLUSIONES: aunque se han producido importantes avances con la Estrategia e-SUS AB, el colapso en la comunicación y la permanencia de los profesionales en hábitos relacionados a SIS normativos dificultan la necesaria visión ampliada para completar los procesos decisorios que se precisan en el ámbito local

OBJECTIVE: to analyze the experiences of use with the e-SUS AB system (Unified Health System Strategy for Primary Care) in a Brazilian district, and to explore whether it supports the work process and local management. METHOD: a qualitative research conducted in the state of São Paulo, through semi-structured interviews with 17 Primary Care health professionals using the e-SUS AB system. Thematic analysis was conducted, using the set of elements from the DIKCA procedural logic (Data, Information, Knowledge, Communication and Action). RESULTS: five subjects were retrieved: Restricted use of the Health Information Systems (HIS) (lack of ability by professionals to use the tools of the system, and merely entering data); Need to understand in order to use (professionals cannot identify immediately the value to record and use HIS in the healthcare process); Failures in communication between professionals (the perception of privileges for using the system by medical professionals, which interferes in interdisciplinary patient care); Strengths of the e-SUS AB system (the quality elements of the system, such as the increase in accessible information, have a positive impact in the organization of work); and Weaknesses of the e-SUS AB system (technological deficiencies, recording in multiple systems, and lack of tools to facilitate the systematization of nursing care, leading to lack of work efficiency). CONCLUSIONS: even though there have been major advances with the e-SUS AB strategy, the collapse in communication and the permanence of professionals in habits associated with regulatory HIS prevents the wider vision necessary in order to complete the decision-making processes required at local level

COVID-19: la vulnerabilidad en el ojo del huracán / COVID-19: vulnerability in the eye of the hurricane

No disponible

Desigualdades sociales en salud sexual y reproductiva en mujeres con discapacidad intelectual / Social inequalities in sexual and reproductive health in women with intellectual disability

La adopción de la Convención de los Derechos de las Personas con Discapacidad oficializó un cambio de paradigma de un modelo biomédico a uno social en la comprensión de la discapacidad, permitiendo establecer el foco en su entorno y la importancia de adaptarlo a sus necesidades específicas. Sin embargo, este colectivo sigue haciendo frente a barreras a la hora de ejercer sus derechos. Uno de los mayores obstáculos a los que se enfrentan se produce en el ámbito de la salud, especialmente en la salud sexual y reproductiva, donde las mujeres con discapacidad intelectual conforman el grupo más vulnerable. Este trabajo tiene como propósito presentar el estado de la cuestión en lo que respecta a las desigualdades sociales en salud en materia de salud sexual y reproductiva en mujeres con discapacidad intelectual. Para ello se parte de un planteamiento de la discapacidad intelectual desde el modelo social, posteriormente se hace un análisis de los determinantes sociales en salud en la discapacidad intelectual, para llegar a exponer cuestiones concretas de la salud sexual y reproductiva en mujeres con discapacidad intelectual y que ponen de manifiesto las desigualdades sociales en salud. Ello evidencia la necesidad de generar datos sólidos acerca de su salud y de adaptar la atención sanitaria en el ámbito sexual y reproductivo de esta población

Adopting the Convention on the Rights of Persons with Disabilities formalized a change in paradigm from a biomedical to a social model in terms of understanding disability, allowing to place the focus on their setting and the importance of adapting it to their specific needs. However, this group still faces barriers at the time of exercising their rights. One of the major obstacles faced occurs in the health setting, particularly regarding sexual and reproductive health, where women with intellectual disability are the most vulnerable group. The objective of this article is to present the state of the matter regarding social inequalities in health, in the area of sexual and reproductive health in women with intellectual disability. To this aim, we have approached intellectual disability from the social model, with a subsequent analysis of the social determinants in health regarding intellectual disability, in order to finally present specific issues regarding sexual and reproductive health in women with intellectual disability, which show the social inequalities in health. This shows the need to generate solid data about their health, and adapt healthcare in the sexual and reproductive setting for this population

[Aging in a methadone maintenance program. A perspective from the framework of social determinants of health]. / Envejecer en un programa de mantenimiento con metadona. Una perspectiva desde el marco de los determinantes sociales de la salud.

OBJECTIVE: People on methadone treatment have increased their life expectancy, aging prematurely with comorbidities. The objective of this study was to know the sociodemographic and clinical profile of these people in the Center for Addiction Care in the district of Latina (belonging to Madrid Salud), as well as the perception of the influence of the treatment on their aging. The Social Determinants of Health Model was used as a framework. METHODS: A mixed methodology was used in two phases: a quantitative one, to describe the sociodemographic and clinical characteristics of the study population; and another qualitative one, through semi-structured interviews to an intentional sample, to explore the history of life and the perception of future needs regarding the health of the participants. RESULTS: The results highlighted that the average age of the sample was 48.28 years, that they were mostly men (81.25%), of Spanish origin, with a low level of education and economics and with a medium stay in treatment with methadone of ± 13 years. An increase in mental pathologies was found the more years they had been in the program, as well as, at a lower age of onset in consumption, the presence of HIV and Hepatitis C virus increased. In their speeches it was found that the social determinants of Health have conditioned its vital history. CONCLUSIONS: Both consumption and methadone contribute to its stigmatization, not favoring its normalized inclusion in society and determining a high state of vulnerability. This increases as age does, not receive adequate resources to meet their future needs.

OBJETIVO: Las personas en tratamiento con metadona han aumentado su esperanza de vida, envejeciendo de una forma prematura con comorbilidades. El objetivo de este estudio fue conocer el perfil sociodemográfico y clínico de estas personas en el Centro de Atención a las Adicciones del distrito de Latina (perteneciente a Madrid Salud), así como la percepción de la influencia del tratamiento en su envejecimiento. Se tuvo como marco el Modelo de los Determinantes Sociales de Salud. METODOS: Se utilizó una metodología mixta en dos fases: una cuantitativa, para describir las características sociodemográficas y clínicas de la población de estudio; y otra cualitativa, mediante entrevistas semiestructuradas a una muestra intencional, para explorar el historial de vida y la percepción de necesidades futuras respecto de la salud de los participantes. RESULTADOS: En los resultados destacó que la edad media de la muestra era de 48,28 años, que eran en su mayoría hombres (81,25%), de origen español, con un nivel de estudios y económico bajos y con una estancia media en tratamiento con metadona de ±13 años. Se encontró un aumento de patologías mentales cuantos más años llevaban en el programa, así como que, a menor edad de inicio en el consumo, aumentaba la presencia de VIH y virus de la Hepatitis C. En sus discursos se halló que los determinantes sociales de la salud han condicionado su historia vital. CONCLUSIONES: Tanto el consumo como la metadona contribuyen a su estigmatización, no favoreciendo su inclusión normalizada en la sociedad y determinando un estado elevado de vulnerabilidad. Ésta aumenta a medida que lo hace su edad, no recibiendo los recursos adecuados para atender a sus futuras necesidades.

Envejecer en un programa de mantenimiento con metadona. Una perspectiva desde el marco de los determinantes sociales de la salud / Aging in a methadone maintenance program. A perspective from the framework of social determinants of health

OBJETIVO: Las personas en tratamiento con metadona han aumentado su esperanza de vida, envejeciendo de una forma prematura con comorbilidades. El objetivo de este estudio fue conocer el perfil sociodemográfico y clínico de estas personas en el Centro de Atención a las Adicciones del distrito de Latina (perteneciente a Madrid Salud), así como la percepción de la influencia del tratamiento en su envejecimiento. Se tuvo como marco el Modelo de los Determinantes Sociales de Salud. MÉTODOS: Se utilizó una metodología mixta en dos fases: una cuantitativa, para describir las características sociodemográficas y clínicas de la población de estudio; y otra cualitativa, mediante entrevistas semiestructuradas a una muestra intencional, para explorar el historial de vida y la percepción de necesidades futuras respecto de la salud de los participantes. RESULTADOS: En los resultados destacó que la edad media de la muestra era de 48,28 años, que eran en su mayoría hombres (81,25%), de origen español, con un nivel de estudios y económico bajos y con una estancia media en tratamiento con metadona de +/-13 años. Se encontró un aumento de patologías mentales cuantos más años llevaban en el programa, así como que, a menor edad de inicio en el consumo, aumentaba la presencia de VIH y virus de la Hepatitis C. En sus discursos se halló que los determinantes sociales de la salud han condicionado su historia vital. CONCLUSIONES: Tanto el consumo como la metadona contribuyen a su estigmatización, no favoreciendo su inclusión normalizada en la sociedad y determinando un estado elevado de vulnerabilidad. Ésta aumenta a medida que lo hace su edad, no recibiendo los recursos adecuados para atender a sus futuras necesidades

OBJECTIVE: People on methadone treatment have increased their life expectancy, aging prematurely with comorbidities. The objective of this study was to know the sociodemographic and clinical profile of these people in the Center for Addiction Care in the district of Latina (belonging to Madrid Salud), as well as the perception of the influence of the treatment on their aging. The Social Determinants of Health Model was used as a framework. METHODS: A mixed methodology was used in two phases: a quantitative one, to describe the sociodemographic and clinical characteristics of the study population; and another qualitative one, through semi-structured interviews to an intentional sample, to explore the history of life and the perception of future needs regarding the health of the participants. RESULTS: The results highlighted that the average age of the sample was 48.28 years, that they were mostly men (81.25%), of Spanish origin, with a low level of education and economics and with a medium stay in treatment with methadone of +/- 13 years. An increase in mental pathologies was found the more years they had been in the program, as well as, at a lower age of onset in consumption, the presence of HIV and Hepatitis C virus increased. In their speeches it was found that the social determinants of Health have conditioned its vital history. CONCLUSIONS: Both consumption and methadone contribute to its stigmatization, not favoring its normalized inclusion in society and determining a high state of vulnerability. This increases as age does, not receive adequate resources to meet their future needs