Epidural Analgesia in Labour from a Sociological Perspective - A Case Analysis of Andalusia, Spain

In this chapter we analyse health as a social concept, focusing specifically on the role of women in medicine as subjective and passive elements of medical practice. This approach will serve as the basis of our analysis of the use of epidural analgesia during childbirth, which is explored in the second part of the chapter. In the first part we deal with pain as a social element and provide an overview of the history of pain and the evolution of treatment for pain.Peer Reviewe

Health : the main ally for support of the anti-tobacco law in Spain

Objective: To determine the sociodemographic characteristics and opinions that predict citizens' attitudes towards the anti-tobacco law in Spain. Methods: Data was analyzed from a telephone survey on smoking habits conducted among citizens of Spain in 2008 by the Centro de Investigaciones Sociológicas (CIS). The sample was stratified by region and size of habitat, establishing age and sex quotas. A descriptive analysis is provided of the main results. A forward stepwise logistic regression analysis was performed with opinions about the anti-tobacco law as a dependent variable and sociodemographic characteristics of the respondents as independent variables. Results: The perceived effectiveness of the law in terms of health benefits and reduction in number of smokers and cigarettes consumed has the greatest predictive power on support for the anti-tobacco law. Conclusion: Policies aimed at improving public health must meet with the support of citizens. In order to garner this support it is essential that citizens be informed about the effectiveness and health benefits of restrictive legislation such as anti-tobacco laws.Analizar qué características sociodemográficas y de opinión predicen el respaldo de los ciudadanos a la Ley antitabaco en España. Métodos: Se han analizado los datos de una encuesta telefónica realizada en 2008 por el Centro de Investigaciones Sociológicas (CIS) sobre hábitos relacionados con el tabaco a población española, estableciendo cuotas de sexo y edad y con distribución por comunidades autónomas y tamaño de hábitat. Se ha realizado un análisis descriptivo de los principales resultados y un análisis de regresión logística (stepwise forward). La variable dependiente es la posición ante la ley antitabaco, y las variables independientes, las características sociodemográficas del entrevistado y las opiniones sobre la ley. Resultados: Lo que más predice la posición favorable a la ley es la apreciación de su efectividad, es decir, la percepción de que la ley ayuda a mejorar la salud de la población y a reducir el número de fumadores y la cantidad de cigarrillos fumados. Conclusión: Es necesario que la población apoye políticas sanitarias que son claramente beneficiosas para la salud pública en general. En este sentido, la información sobre la efectividad de la ley se postula como un elemento decisivo para conseguir el respaldo popular necesario para llevar a cabo políticas restrictivas y/o prohibitivas

Medicación y dolor: el dolor más intenso es el menos medicado

El dolor, un problema de primer orden en salud, es la primera causa de consulta médica en atención primaria y del consumo de medicamentos de la población general. Mientras a nivel mundial se asume que el principal problema es la falta de acceso a medicamentos de importantes sectores de población en ciertos países, en otros puntos geográficos se pone el acento en un posible abuso o utilización inadecuada de los mismos. El objetivo principal de este artículo es conocer qué características influyen en el consumo de medicamentos para el dolor de la población española. Para ello se han analizado, por un lado, los datos de la Encuesta Nacional de Salud del año 2017 y, por otro, la Encuesta sobre Percepción Social del Dolor del año 2016. Hemos encontrado que las mujeres, así como las personas de mayor edad y con estudios básicos son las que mayor consumo de medicamentos presentan, pero también que el dolor de origen emocional, que es el que mayor intensidad dolorosa reporta, es el menos medicado de los dolores padecidos, siendo al mismo tiempo un dolor que sufren principalmente las mujeres

Medication and pain: the most intense pain is the least medicated

El dolor, un problema de primer orden en salud, es la primera causa de consulta médica en atención primaria y del consumo de medicamentos de la población general. Mientras a nivel mundial se asume que el principal problema es la falta de acceso a medicamentos de importantes sectores de población en ciertos países, en otros puntos geográficos se pone el acento en un posible abuso o utilización inadecuada de los mismos. El objetivo principal de este artículo es conocer qué características influyen en el consumo de medicamentos para el dolor de la población española. Para ello se han analizado, por un lado, los datos de la Encuesta Nacional de Salud del año 2017 y, por otro, la Encuesta sobre Percepción Social del Dolor del año 2016. Hemos encontrado que las mujeres, así como las personas de mayor edad y con estudios básicos son las que mayor consumo de medicamentos presentan, pero también que el dolor de origen emocional, que es el que mayor intensidad dolorosa reporta, es el menos medicado de los dolores padecidos, siendo al mismo tiempo un dolor que sufren principalmente las mujeres.Pain is the leading cause of medical consultation in primary care and also of drug use in the general population. In some countries, the main problem is the lack of access to pain medication for large sectors of the population. In other countries, the problem is the abuse or misuse of painkillers and other drugs. The main objective of this article is to know the social factors that influence the consumption of pain medication in the Spanish population. For this purpose, we analyzed data from the 2017 National Health Survey on the one hand and the 2016 Survey on Social Perception of Pain on the other. We have found, among other relevant issues, that women, the elderly age and people with basic education have the highest drug use. Additionally, we found that emotional pain is both the most intense and the least medicalized pain, and it is a pain more women than men suffer from

Partos en Andalucía. Revisión de fuentes secundarias

Bajo el título “Percepción y discursos sociales del dolor en el trabajo de parto” (LABORPAIN) se está desarrollando la primera fase del proyecto de investigación subvencionado por el Ministerio de Economía y Competitividad para los años 2015 y 2016 correspondiente al Programa Estatal de Investigación, Desarrollo e Innovación orientada a los Retos de la sociedad, en su convocatoria de 2014. El objetivo fundamental de este proyecto es analizar la percepción social del dolor durante el parto y trabajo de parto, entendiendo que el dolor es un concepto socialmente construido, en el que intervienen procesos biológicos, pero también elementos psicológicos, educativos, culturales y sociológicos. Debido a la naturaleza del dolor se consideró que la forma más adecuada de abordar su estudio era mediante un diseño metodológico cualitativo que centrado en los discursos sociales diese voz a las mujeres que habían dado a luz en Andalucía en los dos últimos años. De esta forma se trata de abordar la percepción subjetiva y contextual del dolor en el parto y el trabajo de parto, y las técnicas cualitativas se consideran las más adecuadas para profundizar en ello. No obstante, para poder ubicar dichos discursos en su contexto, se consideraba necesario conocer distributivamente, cuantificar, cómo se desarrollan los partos en Andalucía y, en la medida de lo posible, comparar dichos datos con los del conjunto de España y otras comunidades autónomas, para que tengan un verdadero significado. Con ello tendríamos la información necesaria para posteriormente contrastar si la forma en que se desarrollan los partos “mayoritariamente” es o no la forma en que a las mujeres les gustaría que se desarrollaran, según su discurso y percepciones subjetivas. Este es el sentido de realizar el presente documento de trabajo: responder a uno de los objetivos de la investigación (O6) que proponía “Analizar cómo se desarrollan de forma general los partos en Andalucía”, para lo cual se ha realizado una revisión de las fuentes de datos secundarios y de la bibliografía existente, tanto a nivel autonómico, como a nivel nacional y en lo posible internacional, para su posible comparación.INVESTIGACIÓN SUBVENCIONADA POR EL MINISTERIO DE ECONOMÍA Y COMPETITIVIDAD EN EL AÑO 2015 POR CONCESIÓN DE AYUDA A PROYECTO DE I+D+I CORRESPONDIENTE AL PROGRAMA ESTATAL DE INVESTIGACIÓN, DESARROLLO E INNOVACIÓN ORIENTADA A LOS RETOS DE LA SOCIEDAD, EN EL MARCO DEL PLAN ESTATAL DE INVESTIGACIÓN CIENTÍFICA Y TÉCNICA Y DE INNOVACIÓN 2013-2016. CONVOCATORIA 2014.N

Prevalence of the different Axis I clinical subtypes in a sample of patients with orofacial pain and temporomandibular disorders in the Andalusian Healthcare Service

Background: The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender. Material and Methods: To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD. Results: The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a p≥ 0.05 value for the muscle and arthralgia subtypes. Conclusions: The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent

Influence of clinical and psychological variables upon the oral health-related quality of life in patients with temporomandibular disorders

To analyze the association between the OHIP-14 and the different subtypes making up the clinical and psychological axis obtained using the RDC/TMD. 407 patients treated at the TMD unit of the Andalusian Healthcare Service were administered the Spanish version of the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire (RDC/TMD), together with the Oral Health Impact Profile questionnaire (OHIP-14). The degree of association between the patients? score in the OHIP-14 and the clinical and biopsychosocial variables was analyzed through bivariate and multivariate analyses, specifically through linear regression. 89.4% of the treated patients were women, while 10.6% were men, with an average age of 42.08 ± 14.9 years. The mean score and standard deviation for the OHIP-14 was 20.57 ± 10.73. A significant association (p<0.05) was observed with the following variables: Axis I, jaw disability checklist, depression, somatization, perceived pain duration, and pain interference with activities of daily living. The analysis of the relation between self-perceived health in patients with TMD, as measured by the OHIP-14, showed a R2 of 0.3979, with a higher Beta value for the association between the OHIP and patients with both myofascial pain and arthopathy, jaw disability, depression, a higher pain duration and a higher pain interference with activities of daily living

Application of an oral health-related quality of life questionnaire in primary care patients with orofacial pain and temporomandibular disorders

Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diag - nosed following the standard criteria accepted by the scientific community - the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the de - gree of association between the patients` OHIP-14 score and pain duration, pain intensity, and various sociode - mographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p<0.05) was found for gender, age, marital status, chronic pain grade, self-perceived oral health status and pain duration. Conclusions: The analysis of self-perceived oral health status in patients with OP and TMD, as measured by the OHIP-14, showed that oral health is perceived more negatively by women. Moreover, a one-point increase in the Chronic Pain Grade indicator increases the OHIP-14 indicator by 4.6 points, while chronic pain, defined as pain suf - fered by patients for one year or more, increases the OHIP-14 indicator by 3.2 points

The Legitimacy of Pain as an Object of Study

[EN] Pain, as a multidimensional phenomenon, must be tackled from different perspectives. The sociological perspective is one of the less frequent approaches in the bibliography. The main results of a pioneering study about the social legitimacy of pain are set forth in this paper, analyzing citizens’ pain today, the feelings it causes in them, the type of pain they suffer, and how this type of pain has an influence on the perception of their own pain and that of others. A quantitative design was adopted, through a cross-sectional survey of general population living in Spain (n = 1600) conducted online in 2021. The results point out that a high percentage of citizens were in pain when they took the survey, even if they stated that they were in good health. In general, feeling pain means having a worse quality of life. Having pain of a psychological origin involves higher levels of shame or guilt, as well as the feeling of being judged by others, than the other types of pain. The pain caused by cancer is the one with the highest social support, followed by the grief caused by the death of a loved one, while the pain with the lowest support is the one caused by alcoholism or obesity. Feeling that one’s pain is understood and legitimized by others is fundamental to being able to face it, that is why it is important to carry out studies analyzing pain from this perspective.SIRTI2018-099483-B-I0

Influence of sociodemographic factors upon pain intensity in patients with temporomandibular joint disorders seen in the primary care setting

Objective: A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP). Design: A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/ TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used. Results: The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men Objective: A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP). Design: A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/ TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used. Results: The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men (p<0.05). A lower educational level, and separation or divorce, were correlated to an increased intensity of pain. Social support, depression and general and oral health also explained part of pain intensity. The regression model established with these variables accounted for 13.3% of the variability of pain (R2 = 0.133). Conclusions: Women suffer more intense pain than men. Perceived health partially explains the variability of the CPI score. However, it is empirically seen that the variables gender, educational level and marital status exert an important and independent influence upon pain intensity