Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study.

BACKGROUND: The COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals' organisational and management strategies in primary care settings during the COVID-19 pandemic. DESIGN: Qualitative, exploratory study based on the analysis of participants' accounts within a hermeneutic phenomenologicaly approach. METHODS: Research was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years' experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews. RESULTS: A total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: "liquid" healthcare and "the best healthcare system in the world". During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers' perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement. CONCLUSION: Primary care workers' professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance. TRIAL REGISTRATION: The study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).

Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG).

BACKGROUND: Laparoscopic adrenalectomy has become the standard of care for treating adrenal tumors. Conversion from laparoscopic adrenalectomy to an open approach during surgery may be necessary in some cases. This study aimed to identify the risk factors for open conversion of laparoscopic adrenalectomy. METHODS: Retrospective analysis of all consecutive patients undergoing lateral transperitoneal laparoscopic adrenalectomy in six endocrine surgery units of the Spanish Adrenal Surgery Group (SASG) between January 2005 and December 2017. Demographic, clinical, surgical, and histopathologic characteristics were recorded. Risk factors for conversion were assessed by logistic regression analysis. RESULTS: Of a total of 865 patients included in the study, 58 (6.7%) required conversion to open surgery. In the univariate analysis, factors associated with conversion from laparoscopic to open adrenalectomy were body mass index (BMI) ≥ 30 kg/m2 (P = 0.002), previous abdominal surgery (P = 0.015), tumor size > 5 cm (P = 0.001), and surgery for pheochromocytoma (P = 0.034). In the multivariate analysis, independent risk factors were BMI ≥ 30 kg/m2 [odds ratio (OR) 4.26, 95% confidence interval (CI) 2.81-8.75; P = 0.001], tumor size > 5 cm (OR 10.15, 95% CI 4.24-28.31; P < 0.001), and surgery for pheochromocytoma (OR 2.96, 95% CI 1.89-11.55; P = 0.015). CONCLUSIONS: Obesity, tumor size, and pheochromocytoma as the type of adrenal tumor were predictive factors for intraoperative conversion from laparoscopic to open adrenalectomy. Preoperative assessment of these characteristics should be valuable to clinicians in discussing conversion risk in patients and for surgical planning.

Perceptions and Profiles of Young People Regarding Spa Tourism: A Comparative Study of Students from Granada and Aachen Universities.

Spa tourism has undergone important changes in recent decades, actively embracing wellness and wellbeing. However, this transition is taking place in different ways in Europe, and this has led to varying perceptions of thermalism that have little to do with its original conception. The main aim of this study was to analyse current perceptions of spa tourism amongst university students, so as to identify profiles and compare the differences between two study cases: Granada (Spain) and Aachen (Germany). For this purpose, we applied a methodology that combines artificial intelligence techniques with questionnaires containing both quantitative and qualitative variables. This enabled us to identify and characterize a series of profiles, so as to acquire detailed knowledge of the perceptions of these students regarding spa tourism in Granada and Aachen. On the basis of the results, the interviewees were grouped together into seven profiles from which we deduced that young Germans from Aachen visit spas more frequently and have a more realistic perception of the thermal sector than young Spanish people from Granada. This situation could limit present and future demand for spas in southern Spain. With this in mind, in this paper we present an updated assessment of the demand for spas amongst university students, in order to design effective geomarketing strategies in two cities with long spa traditions.

Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS: Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS: A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS: Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.

Emotions in the Time of COVID-19: Affections and Impacts among the Spanish Primary Care Workforce.

BACKGROUND: The literature review shows that most studies on the psychological impact of COVID-19 on healthcare professionals have focused on hospital staff, with few specifically addressing the primary care workforce. This study aims to explore primary care workers' verbal accounts of the emotions they experienced. METHODS: This is a qualitative study carried out between July and December 2020 in Spain. Semi-structured interviews and focus groups were conducted with primary care workers. Data were analysed through thematic content analysis. Participants were selected using purposive sampling. RESULTS: A total of 53 primary care workers participated in the study, of whom 38 were individually interviewed, and 15 participated in three focus groups. Our analysis revealed themes in two categories: (1) from infection to affection; and (2) affected, but not patients-a discourse based on the acceptance of their experience as part of their work in primary care, creating an ideological construct or "shield" based on emotional self-management. CONCLUSIONS: Self-reflection on the emotional impact of COVID-19 is scarce. Examples of emotional affections include an obsessive focus on hygiene, the inability to establish clear boundaries between the personal and the professional spheres, and experiencing-and having to self-manage-emotional strain.

[Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art].

Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art. BACKGROUND: The empirical evidence accumulated on the efficacy, effectiveness, and efficiency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and problems in childhood and adolescence. METHOD: A review was carried out of the psychological treatments for different psychological disorders and problems in social-emotional or behavioral adjustment in the child-adolescent population according to the Spanish National Health System (Clinical Practice Guidelines) levels of evidence and degrees of recommendation. RESULTS: The findings suggest that psychological treatments have empirical support for addressing a wide range of psychological problems in these developmental stages. The degree of empirical support ranges from low to high depending on the phenomenon analyzed. The review suggests unequal progress in the different fields of intervention. CONCLUSIONS: From this update, psychologists will be able to make informed decisions when implementing those empirically supported treatments to address the problems that occur in childhood and adolescence.

Mothers Who Take Care of Children with Disabilities in Rural Areas of a Spanish Region.

The purpose of this research is to describe how the mothers of children with disabilities in rural areas of Extremadura perceive care tasks and the subjective impact that these tasks have on their daily life and health, as well as the subjective assessment that these mothers make of the benefits and services of the Spanish welfare policy. An interpretative paradigm was selected, using a qualitative approach and a phenomenological design. Twelve mothers were included. Data were collected through semi-structured interviews. A discourse analysis of the narrative information was performed using open, axial, and selective coding processes and the constant comparative method. Three topics have been extracted from the findings of the analysis: (1) extensive care responsibilities, (2) impacts upon well-being and daily life, and (3) resources that "barely" help. The care tasks performed by mothers of children with disabilities in rural areas have an enormous impact on their daily life and health. This involvement in caregiving generates a significant occupational imbalance which has an impact on their mental health, and which causes economic and social problems.

Dependency and Care: Perspectives from the Point of View of Professionals Assessing Situations of Dependency in Spain.

OBJECTIVE: To describe how the assessors of dependency have perceived the process of implementation of the Dependency Act in Spain. METHODS: A qualitative method was used to analyse interview data (discourse analysis). Purposive sampling was applied. Sixteen occupational therapists were included, who served as dependency assessors in Extremadura, a region of southern Spain. Data were collected through semi-structured interviews between February and March 2019, focused on the characteristic of the Dependency Act. A discourse analysis of the narrative information was performed using processes of open, axial, and selective coding, as well as the constant comparative method. RESULTS: Three topics were identified: (1) Benefits of implementation, connected with the consideration as subjects of rights and the increase in resources. (2) Difficulties linked to the bureaucratization of the process, the lack of sensitivity of the scale of assessment, and the unequal access to benefits and services. (3) The impact of the 2012 budget cuts on financing and on dependent people and their families. CONCLUSIONS: The Dependency Act has established itself as a political tool that has generated important social and economic benefits. However, significant difficulties have emerged, which should be addressed to ensure better care for dependent persons.

Occupational therapy culture seen through the multifocal lens of fieldwork in diverse rural areas.

BACKGROUND: Existing occupational therapy culture has not yet fully articulated diverse worldviews on occupation, health, and well-being and the link between them. Taking into consideration the diversity of the global world, incorporating different worldviews would be a valuable contribution to expanding the relevance of occupational therapy. AIM: The aim of this research was to analyse worldviews regarding human occupation and the link between occupation, health, and well-being among people from rural Honduras, Morocco, Burkina Faso, Tanzania, and Ecuador. METHODS: This ethnographic research used three methods, i.e. semi-structured interviews, participant observations, and in-depth interviews, to collect data from 27 participants in five countries. The material was analysed using a Grounded Theory approach. RESULTS: One core category, "Occupations are social practices", was identified and it included three subcategories: "Occupation, health and well-being as a personal and community experience"; "Co-occupations, collective occupations and collaborative occupations are the most important occupations"; and "Occupation, health and well-being mutually influence each other". Conclusion and significance. The overall findings showed that taking different worldviews into account is needed for developing an occupational therapy culture that is useful globally and hosts diverse meanings and occupation-focused practices.

Adrenalectomy for solid tumor metastases: results of a multicenter European study.

BACKGROUND: We assessed the results of adrenalectomy for solid tumor metastases in 317 patients recruited from 30 European centers. METHODS: Patients with histologically proven adrenal metastatic disease and undergoing complete removal(s) of the affected gland(s) were eligible. RESULTS: Non-small cell lung cancer (NSCLC) was the most frequent tumor type followed by colorectal and renal cell carcinoma. Adrenal metastases were synchronous (≤6 months) in 73 (23%) patients and isolated in 213 (67%). The median disease-free interval was 18.5 months. Laparoscopic resection was used in 46% of patients. Surgery was limited to the adrenal gland in 73% of patients and R0 resection was achieved in 86% of cases. The median overall survival was 29 months (95% confidence interval, 24.69-33.30). The survival rates at 1, 2, 3, and 5 years were 80%, 61%, 42%, and 35%, respectively. Patients with renal cancer showed a median survival of 84 months, patients with NSCLC 26 months, and patients with colorectal cancer 29 months (P = .017). Differences in survival between metachronous and synchronous lesions were also significant (30 vs. 23 months; P = .038). CONCLUSION: Surgical removal of adrenal metastasis is associated with long-term survival in selected patients.

[Motivations for adolescent pregnancy]. / Motivaciones para el embarazo adolescente.

OBJECTIVES: To identify the motivations (beliefs, values) for adolescent pregnancy among girls aged less than 17 years old. METHOD: We performed a phenomenological qualitative study with audio recording of in-depth interviews with 12 pregnant adolescents between March and September 2008. Purposive sampling of pregnant adolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed, using education, voluntariness of pregnancy, urban-rural setting of the family residence and family socioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results. RESULTS: The adolescent's sociocultural context was of considerable weight in sexual and reproductive decisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showing an attitude of acceptance and resignation, which later became a tendency to rationalize the events and claim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear idea of the consequences of having a child. Previous ideas about pregnancy were mainly related to physical changes without taking into account other changes that occur during and after pregnancy. CONCLUSIONS: The family context and socialization of girls are based on a traditional division of gender roles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenage pregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their lives were determined by circumstances.

Nuevas definiciones de evidencia en la medicina contemporánea: aportes desde la antropología / New definitions of evidence in contemporary medicine: contributions from anthropology

Este artículo explora la importancia productiva de las Humanidades y de las Ciencias Sociales - en particular de la Antropología - a través de la revisión del "impacto" producido en un campo eminentemente empírico: la Medicina. El impacto de las Humanidades en general y la Antropología en particular tiene aquí una doble vertiente: 1) como base crítica epistemológica a una visión positivista "fundamentalista" - la enfermedad es algo meramente biológico - y 2) la incorporación de un nuevo repositorio humanístico en las prácticas contemporáneas. La creciente importancia de las Humanidades en la moderna medicina con la irrupción de la Medicina Basada en Narrativas, movimiento heredero de lo que se ha conocido como "Narrative Turn" en el campo de la Medicina - aquí ofrecemos un estudio de caso alrededor del Trastorno Límite de Persona lidad - cuestiona las aseveraciones que insisten en su falta de productividad y eficacia. Proponemos aquí un movimiento de apertura hacia definiciones de evidencia más incluyentes - en la epistemología y la academia, pero también en la práctica clínica.

This article explores the "productive" importance of the Humanities and Social Sciences - Anthropology particularly - through the revision of the "impact" produced in an eminently empirical field: Medicine, particularly after the hegemony of Evidence Based Medicine (EBM). The impact of the Humanities in general and Anthropology in particular has a two fold meaning: 1) as a critical foundation against the "fundamentalistic" positivist view - disease is something purely biological - and 2) the incorpora tion of a new humanistic repository - maybe better the recovery of many of contemporary practices. The increasing relevance of Humanities on modern medicine with the emergence of Narrative-Based Medicine (NBM), movement of what has become known as "Narrative Turn" in the field of medicine - we offer here a case-study about Borderline Person ality Disorder - challenges the assertions that insist on their lack of productivity and effectiveness. We suggest here an opening movement towards more inclusive definition of evidence-in epistemology and academia, but also in clinical practice.

Maternidad temprana: percepciones e implicaciones de las madres de las adolescentes / Early motherhood: perceptions and implications for adolescent mothers

OBJETIVO: Explorar y analizar el rol desempeñado por las madres en el proceso de adaptación a la maternidad de sus hijas adolescentes. Personas, material y método: Diseño cualitativo fenomenológico. Complejo Hospitalario de Jaén (España). Muestreo intencional de madres de adolescentes que fueron madres entre los 14 y los 17 años, usando el nivel educativo, el hábitat de residencia y el nivel social de la familia como criterios de heterogeneidad. Se recogió la información mediante una entrevista semiestructurada a las madres de las adolescentes(8 madres de adolescentes que fueron madres antes de los 17años), con audio grabación (60 minutos), entre marzo y septiembre de2011. Análisis de contenido: codificación, triangulación de categorías y obtención/verificación de resultados. RESULTADOS: El apoyo de las madres de las adolescentes en todos los ámbitos se configura como un elemento esencial para una adecuada adaptación de la adolescente a su nuevo papel de madre y para optimizarlas oportunidades que la maternidad puede otorgar a las jóvenes en determinados contextos de vida. Sin embargo, los costes físicos y psicológicos de este apoyo son excesivos para las abuelas, pues prolongan su etapa de maternidad o incluso se auto adjudican una segunda maternidad en un periodo en el que deberían desarrollar otras facetas de su vida. CONCLUSIONES: El desempeño del rol de abuela en los casos de maternidad adolescente supone una sobrecarga de tareas con efectos negativos para la salud, así como cambios sociales, económicos y familiares que las instituciones sanitarias y sociales deberían abordar para evitar el deterioro en la salud y la calidad de vida de dichas mujeres

OBJECTIVE: To explore and analyse the role played by mothers in the process of adaptation to motherhood of their teen daughters. People, material and method: Phenomenological qualitative design. Hospital of Jaen (Spain). Purposive sampling of mothers of teenagers who became mothers between 14 and 17 years old, using educational level, residence habitat and social level of the family as heterogeneity criteria. Audio-recording of life stories were made (8 mothers of teenagers who became mothers before age 17, 60 minutes of mean duration),between March and September 2011. Content analysis: coding, triangulation of categories and obtaining/verification of results. RESULTS: The support of mothers of adolescents in all areas is configured as an essential element for proper adaptation of the teen to his new role as a mother and for optimizing the opportunities that motherhood can give young people in certain life contexts. But physical and psychological costs of this support for grandmothers are excessive because they prolong their time of motherhood or even they assume a second maternity in a period in which they should be developing other facets of his life. CONCLUSIONS: The performance of the grandmother role in cases of teenage pregnancy supposes an overload of tasks with negative effects on your health, as well as social, economic and family changes, that social and health institutions should address to prevent deterioration in the health and quality life of these women

Motivaciones para el embarazo adolescente / Motivations for adolescent pregnancy

Objetivos: Conocer las motivaciones (creencias, valores) de las mujeres menores de 17 años para el embarazo adolescente.MétodoDiseño cualitativo fenomenológico con audiograbación de entrevistas en profundidad (12 adolescentes embarazadas), entre marzo y septiembre de 2008. Muestreo intencional de adolescentes embarazadas (14-16 años) de la consulta de alto riesgo obstétrico del Complejo Hospitalario de Jaén (España), usando nivel educativo, voluntariedad del embarazo, hábitat de residencia y nivel social de la familia como criterios de heterogeneidad. Análisis de contenido: codificación, triangulación de categorías y obtención/verificación de resultados.ResultadosEl contexto sociocultural de la adolescente tiene un peso considerable en la toma de decisiones sexuales y reproductivas. Las adolescentes que no planearon su embarazo perciben que su responsabilidad es relativa, y muestran una actitud de conformismo y resignación, resultando posteriormente una tendencia a la racionalización de los acontecimientos en la que afirman que el hijo/a es deseado/a e incluso planeado/a. Las adolescentes que deseaban su embarazo no tienen una imagen definida ni valoran las consecuencias que éste supone. Las ideas previas sobre una gestación están básicamente referidas a cambios físicos, sin tener en cuenta otros cambios que ocurren durante y tras el embarazo.ConclusionesEl contexto familiar y de socialización de las chicas se basa en una distribución tradicional de roles en función del género, en el cual posicionamiento y rol tradicional de mujer cuidadora está muy interiorizado. Las motivaciones para el embarazo adolescente no están claras; hay una falta de sentido de la autodeterminación y son las circunstancias las que deciden (AU)

Objectives: To identify the motivations (beliefs, values) for adolescent pregnancy among girls aged lessthan 17 years old.Method: We performed a phenomenological qualitative study with audio recording of in-depth interviewswith12pregnant adolescents betweenMarchandSeptember 2008. Purposive sampling ofpregnantadolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed,using education, voluntariness of pregnancy, urban-rural setting of the family residence and familysocioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results.Results: The adolescent’s sociocultural context was of considerable weight in sexual and reproductivedecisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showingan attitude of acceptance and resignation, which later became a tendency to rationalize the events andclaim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear ideaof the consequences of having a child. Previous ideas about pregnancy were mainly related to physicalchanges without taking into account other changes that occur during and after pregnancy.Conclusions: The family context and socialization of girls are based on a traditional division of genderroles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenagepregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their liveswere determined by circumstances (AU)