Estrategia de Bioética en el Plan Integral de Salud Mental de Andalucía.

Las personas que padecen un trastorno mental pueden sufrir problemas de exclusión social y sus derechos humanos pueden ser violados en diferentes esferas. Por paternalismo, prejuicio o ignorancia, esta situación puede darse también en la atención que prestan los profesionales.La provisión de servicios profesionales de calidad implica un enfoque que promueva el conocimiento y la protección de los derechos fundamentales de las personas atendidas, facilitándose así la lucha contra el estigma y el desarrollo de un modelo de recuperación.A través del presente artículo de revisión: 1. Se Reflexiona sobre la protección de los derechos y las consecuencias sobre el estigma y la recuperación de las personas que padecen un trastorno mental. 2. Son considerados algunos de los aspectos relacionados con la capacidad, el consentimiento informado y la planificación anticipada de decisiones. 3. Se plantean elementos de discusión sobre el Tratamiento Ambulatorio Involuntario (TAI) y sus posibles alternativas

The Relationship between Social Support and Anxiety Symptoms in Informal Carers: A Systematic Review and Meta-Analysis

Background: Providing care can be challenging for informal carers and increases the risk of mental health problems, such as experiencing clinical symptoms of anxiety. While strengthening social support for informal carers is a common recommendation to reduce this risk, no systematic review or meta-analysis to date has examined the relationship between social support and anxiety symptoms in informal carers. The aim of our study was to systematically review the current evidence on the association between perceived and received social support and anxiety symptoms in informal carers of dependent adults and older people, and to comment on the quality of the evidence. / Methods: We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), Scopus, and LILACS up to 31 March 2021 for articles reporting on the association between caregiver anxiety symptoms and social support. A random-effects model was used to pool estimates, and each study was rated for quality using pre-specified criteria. Publication bias was assessed using a funnel plot and Egger’s regression test, which was adjusted using trim and fill analysis. / Results: From the 2180 identified articles, 35 studies met our inclusion criteria, reporting on 5036 informal carers in total. We found a moderate negative association between perceived social support and caregiver anxiety symptoms (r = −0.31, 95% CI = −0.35, −0.27) and a small, negative association between received social support and caregiver anxiety (r = −0.15, 95% CI = −0.22, −0.08). / Conclusion: The levels of perceived social support showed a significant negative association with caregiver anxiety symptoms. Policymakers and those working directly with informal carers should consider the development of targeted social support interventions that specifically enhance the levels of perceived social support to reduce symptoms of anxiety in informal carers

Association between Social Support and Depressive Symptoms in Informal Caregivers of Adult and Older Dependents: A Systematic Review and Meta-Analysis

Social support is an important determinant of a carer’s mental health. In recent decades, despite many studies reporting on the relationship between social support and depressive symptoms in informal caregivers of adult and older dependents, there are no systematic reviews synthesizing the available evidence. The purpose of the present study was to perform a systematic review and meta-analysis on the relationship between social support and depressive symptoms in informal caregivers of adults and older dependent people. We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), and Scopus, up to 15 January 2023 for studies. We applied no date or language limits to our search. A random-effects model was used to pool effect estimates. The included studies were also independently assessed for quality. Publication bias was evaluated by funnel plots, Egger’s regression test, and the Trim and Fill method. Ninety-three studies were included in the review, reporting on a total of 15,431 informal caregivers. We found a moderate negative association between perceived social support and caregiver depressive symptoms (78 studies; r = −0.35, 95% CI = −0.39, −0.31; low heterogeneity and low risk of publications bias) and a small negative association between received social support and caregiver self-reported depressive symptoms (12 studies; r = −0.14, 95% CI = −0.20, −0.07; low heterogeneity and low risk of publications bias). Our results indicate that social support is a clinically relevant construct for carer well-being and an important protective factor for depressive symptoms in informal caregivers of adult and older dependents

Coping and depressive symptoms in family carers of dependent adults aged 18 and over: A systematic review and meta-analysis

Being a family carer is associated with increased risk of experiencing depressive symptoms. Despite many decades of research investigating the association between coping strategies and depressive symptoms in carers results across studies remain contradictory. The objective of this study was to systematically review evidence on the association between depressive symptoms and coping strategies in carers of dependent people aged 18 and over and investigate potential sources of heterogeneity of findings. The study design was a systematic review and meta-analysis. We searched Pubmed, CINAHL, PsycINFO and LILACS up to April 2021. We performed meta-analyses following the PRISMA statement and several subgroup analyses to investigate whether cause of caring dependency, study design, and controlling for several biases influenced results. Fifty-nine studies met our inclusion criteria. We found a robust and statistically significant association between greater use of dysfunctional coping and higher depressive symptoms. Greater use of emotion-focused coping was associated with fewer depressive symptoms only in studies controlling for confounding bias. Use of problem-focused coping was related to fewer depressive symptoms in carers of frail older people. The combined use of both problem-focused and emotion-focused coping was associated with lower symptoms of depression. Our review concludes that the broad domain of dysfunctional coping is consistently associated with higher levels of depressive symptoms in carers. After controlling for confounders, emotion-focused coping and several of its individual strategies were consistently associated with fewer depressive symptoms. Whilst problem-focused coping and some of its individual strategies are also associated with lower depressive symptoms, these strategies may not be as helpful in all caregiving groups.Clinical Impact Statement: fcBoth broad dimensions of coping and individual coping strategies are important correlates of depressive symptoms in family carers, and should be utilized in informing and improving the effectiveness of future caregiving interventions

La necesaria incorporación del farmacéutico comunitario al equipo interdisciplinar que asiste al enfermo en fase terminal

This work starts from the recognition of the important role that the community pharmacist plays, in health care, to people who suffer from a terminal process and to their family members and / or caregivers. There is no doubt that the advice, treatment and accompaniment of health professionals is essential in any pathology that involves a vital commitment. The community pharmacist, as a health agent, must be involved in these processes. However, on many occasions it is forgotten by a health system that wastes, in this way, one of its most qualified professionals. We are convinced that the terminally ill patient and their family members and / or caregivers would be greatly favored by a greater involvement of pharmacists in their processes. For this reason, this article reflects on the benefits of including the community pharmacist in the healthcare team that cares for people in the terminal phase.En este trabajo se parte del reconocimiento del importante papel que el farmacéutico comunitario desempeña, en la atención sanitaria, a personas que sufren de un proceso terminal y en sus familiares y/o cuidadores. No hay duda de que es fundamental el consejo, tratamiento y acompañamiento de los profesionales sanitarios en cualquier patología que suponga un compromiso vital. El farmacéutico comunitario, como agente sanitario, debe estar implicado en esos procesos. Sin embargo, en muchas ocasiones es olvidado por un sistema sanitario que desaprovecha, de este modo, a uno de sus profesionales más cualificados. Estamos convencidos de que el paciente en fase terminal y sus familiares y/o cuidadores se verían muy favorecidos por una implicación mayor de los farmacéuticos en sus procesos. Por esta razón, en este artículo se reflexiona sobre los beneficios que reporta la inclusión del farmacéutico comunitario en el equipo asistencial que atiende a las personas en fase terminal

Modelos de colaboración para la atención a la salud mental en Andalucía: evaluación tras 9 años de implantación

INTRODUCCIÓN: En 2002 se inicia la implantación del Proceso de Atención Integrado Ansiedad, Depresión, Somatizaciones (PAIADS) en Andalucía (modelo de colaboración asistencial). Se presenta su evaluación después de 9 años. MATERIAL Y METODOS: Análisis cualitativo de un CS urbano1 (entrevistas en profundidad, análisis documental y de registros) que implantó el PAIADS en 2002. Cuestionario telefónico a 380 Centros de Salud (CS) y 76 Unidades de Salud Mental Comunitaria (USMC) (Noviembre 2008-Mayo 2009). Estadística descriptiva de frecuencias y análisis bivariante (paquete SPSS) RESULTADOS: El análisis cualitativo del CS muestra los 4 pilares de la implantación exitosa del PAIADS: comunicación bidireccional entre instituciones y profesionales, organización de consulta conjunta, función de filtroe inclusión de objetivos de salud mental en contrato de gestión. La tasa de respuesta a los cuestionarios fue de 68.9% en CS y 78.9% en USMC. Solamente 2.3% de CS implantaron la totalidad del PAIADS. Sin embargo el 88.2% hace una implantación parcial de alguno de sus elementos: responsable del programa, desplazamiento periódico de especialistas a CS, formación, protocolos, consulta programada de salud mental por los médicos de familia y grupos psicoeducativos en los CS. Los análisis muestran que la satisfacción profesional alta y la menor demora para primeras consultas a atención especializada están asociadas con la implantación del PAIADS (pacientes vistos conjuntamente, formación y protocolos). Adicionalmente encontramos que el mayor número de derivaciones esta asociado a menor masificación de las consultas, ausencia de oferta de grupos psicoeducativos en los CS y no desplazamiento periódico de especialistas. CONCLUSIONES: El PAIADS tiene capacidad de contención no medicalizadora y gestión de la demanda para estas patologías en los CS y genera satisfacción profesional sin costes añadidos de implantación o mantenimiento. Es necesario realizar investigaciones complementarias sobre su impacto en la salud mental de los pacientes

Socio-cultural, historical, political and economic dimensions of health and medicine

Health is one of the most important areas of human development and, along with quality of life, occupies a prominent place in the academic world, being studied from various theoretical perspectives and from different scientific disciplines. These studies try to explain, from the micro to the macro, what it means and what elements are involved in the health of individuals in particular and of society in general. However, given the diversity of perspectives, there is no consensus on the definition of health. At the beginning, the study of health focused on biomedical research into disease. This approach has shown its limits in understanding health in its most complete dimension, as defined by the World Health Organization as early as 1946 : “ health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ” ( preamble to the WHO Constitution, 1946 ). This “ positive ” orientation of health is later taken up as a universal human right ( Declaration of Human Rights, art. 25 ), being considered today not only a right, but also a value in itself, an aspiration and a social demand....Peer reviewe

Evaluating the influence of environmental variables on fish assemblages along Tropical Andes: considerations from ecology to conservation

The lack of knowledge about freshwater biodiversity in remote areas like montane Andean rivers is noticeable and hinder the development of efficient conservation plans for aquatic ecosystems. Habitat requirements of tropical Andean fishes have been poorly analysed, despite the relevance of these ecological features on the fish conservation strategies. The present study aimed to examine fish assemblages along the altitudinal gradient in tropical Andean rivers and their relationship to habitat features to detect the most relevant abiotic factors and their implication on conservation. This study was conducted on a regional scale, along six basins located in tropical Andes (500 to 2,692 m a.s.l.). We studied fish diversity and distribution and their habitats along these elevation gradients. We found 6,320 specimens from 53 genera. Our analysis for the six most common and widely distributed genera (Astroblepus, Brycon, Bryconamericus, Chaetostoma, Pimelodella and Trichomycterus) underlines the relevance of hydromorphological variables on fish community structure in the Andean montane rivers, whereas human alterations seem to be less significant. These findings could be useful for current management and conservation strategies considering present threats over tropical montane rivers