Evaluation of primary care responsiveness by people with mental illness in Spain.

Background: The health system responsiveness is a concept developed by the World Health Organization that measures patients’ expectations for the non-medical care they receive. The aim of this study is to assess primary care responsiveness as seen by people with mental illness and to analyse the factors associated with poor responsiveness. Methods: Cross-sectional descriptive study on 426 people with mental illness who had attended primary care consultations at least once in the previous 12 months. The responsiveness of the health system was determined through the short questionnaire “Multi-country Survey Study on Health and Health Systems Responsiveness”. Differences in responsiveness by sociodemographic characteristics were compared through the Chi-squared test. Logistic regression identified the factors associated with poor responsiveness. Results: Overall responsiveness was measured as good by 77.4% of patients, being this probability higher in the domains: dignity, confidentiality, and communication. The most valued domains by people with mental illness were prompt attention (42.4%), dignity (30.1%), and communication (17%). Only prompt attention scored high importance and poor responsiveness. In patients with an income lower than 900 euros per month and low level of studies, the probability of poor confidentiality responsiveness was multiplied by 3 and 2.7 respectively. Conclusions: People with mental illness perceive good responsiveness from primary care in terms of dignity, confidentiality, and communication. Prompt attention, as the domain of greatest importance and worst valuation, should be prioritised through the implementation of organisational measures in health centres to reduce waiting times, especially in urban areas.post-print968 K

Psychosocial and sociodemographic predictors of attrition in a longitudinal study of major depression in primary care: the predictD-Spain study

Few data exist on the psychosocial factors associated with attrition in longitudinal surveys. This study was undertaken to determine psychosocial and sociodemographic predictors of attrition from a longitudinal study of the onset and persistence of episodes of major depression in primary care

Discourse Analysis and Terminology in Languages for Specific Purposes

Aquest importantíssim recull conté estudis i reflexions sobre temes rellevants en la recerca sobre LSP: anglès mèdic, el llenguatge de la publicitat i periodístic, telecomunicacions i terminologia informàtica, llenguatge comercial i jurídic... Malgrat que gran part dels treballs aplegats es refereixen a l'anglès, també hi ha que tracten l'alemany, francès i altres llengües. Conté textos en anglès, francés, portuguès i castellà

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

El derecho del trabajo y de la seguridad social en españa en 2018

En su quinta edición, el Informe “El Derecho del Trabajo y de la Seguridad Social en España 2018” le ofrece una síntesis, que por concreta no es menos rigurosa, de los principales hitos por los que ha transitado el iuslaboralismo a lo largo del último año. En concreto, en las páginas que siguen, los expertos integrantes de la Sección Juvenil de la Asociación Española de Derecho del Trabajo y de la Seguridad Social (AEDTSS) analizan para usted, en primer lugar, las principales resoluciones europeas y nacionales en materia de igualad y no discriminación, acoso en sus más diversas manifestaciones, liberad religiosa y libertad de expresión. Asimismo, se abordan también las cuestiones relativas al empleo y la contratación, casi monopolizadas por el impacto de las plataformas y las consecuencias del caso de Diego. En materia de vicisitudes, sin perder importancia el despido colectivo, observará un cierto auge de los casos relativos a sucesión empresarial, movilidad funcional y empleo público. En el ámbito del derecho colectivo, además de analizarse el IV AENC, encontrará un estudio pormenorizado de las principales resoluciones en materia de libertad sindical, representación unitaria y ultraactividad. La sección relativa a conciliación y corresponsabilidad incluye este año como novedad un apartado relativo a violencia de género, al hilo de los avances normativos derivados del Real Decreto-ley 9/2018. Los epígrafes concernientes a la protección social y la prevención de riesgos laborales crecen de forma significativa en esta edición, lo que ha permitido abordar la evolución jurisprudencial para buena parte de las prestaciones y riesgos previstos en la Ley. Por último, las expertas del apartado de derecho procesal se han encargado de revisar a fondo los casos más significativos en el marco de las modalidades procesales especiales, con especial hincapié en el ámbito concursal. También han abordado la jurisprudencia constitucional más reciente sobre el de recurso de reposición. En suma, tienen ante usted un trabajo científico consolidado en el tiempo y sólido en cuanto al contenido, fiel reflejo de, a pesar del difícil contexto, el buen hacer de la joven doctrina iuslaboralista española

El Derecho del Trabajo y de la Seguridad Social en España en 2016. Sección Juvenil de la Asociación Española de Derecho del Trabajo y de la Seguridad Social

En su quinta edición, el Informe “El Derecho del Trabajo y de la Seguridad Social en España 2018” le ofrece una síntesis, que por concreta no es menos rigurosa, de los principales hitos por los que ha transitado el iuslaboralismo a lo largo del último año. En concreto, en las páginas que siguen, los expertos integrantes de la Sección Juvenil de la Asociación Española de Derecho del Trabajo y de la Seguridad Social (AEDTSS) analizan para usted, en primer lugar, las principales resoluciones europeas y nacionales en materia de igualad y no discriminación, acoso en sus más diversas manifestaciones, liberad religiosa y libertad de expresión. Asimismo, se abordan también las cuestiones relativas al empleo y la contratación, casi monopolizadas por el impacto de las plataformas y las consecuencias del caso de Diego. En materia de vicisitudes, sin perder importancia el despido colectivo, observará un cierto auge de los casos relativos a sucesión empresarial, movilidad funcional y empleo público. En el ámbito del derecho colectivo, además de analizarse el IV AENC, encontrará un estudio pormenorizado de las principales resoluciones en materia de libertad sindical, representación unitaria y ultraactividad. La sección relativa a conciliación y corresponsabilidad incluye este año como novedad un apartado relativo a violencia de género, al hilo de los avances normativos derivados del Real Decreto-ley 9/2018. Los epígrafes concernientes a la protección social y la prevención de riesgos laborales crecen de forma significativa en esta edición, lo que ha permitido abordar la evolución jurisprudencial para buena parte de las prestaciones y riesgos previstos en la Ley. Por último, las expertas del apartado de derecho procesal se han encargado de revisar a fondo los casos más significativos en el marco de las modalidades procesales especiales, con especial hincapié en el ámbito concursal. También han abordado la jurisprudencia constitucional más reciente sobre el de recurso de reposición. En suma, tienen ante usted un trabajo científico consolidado en el tiempo y sólido en cuanto al contenido, fiel reflejo de, a pesar del difícil contexto, el buen hacer de la joven doctrina iuslaboralista española. The fifth edition of the report, "Labour and Social Security Law in Spain in 2018" analyses the key issues in the changing scenario of Labour Law and Social Security during last year. Elaborated by the Young Scholars’ Section of the Spanish Association of Labour and Social Security Law focuses on the following thematic blocks: non-specific fundamental rights; employment contracts and employment; issues related to employment relationship; collective rights; equality and co-responsibility; occupational risks prevention; and procedural law. In conclusion, you may find here a concrete but detailed analysis of the the main legal and case law novelties of Spanish Social Law

Variables psicológicas implicadas en la actitud e iniciativa emprendedora (II): personalidad, cognición y emoción

El proyecto titulado: Variables implicadas en la actitud e iniciativa emprendedora (II): personalidad, cognición y emoción, es la continuidad de otro presentado en la convocatoria anterior (2016-2017) cuyo objetivo era evaluar variables psicológicas en la actitud emprendedora de los estudiantes universitarios de la Universidad Complutense de Madrid (UCM). Este segundo proyecto ha tenido por objetivo principal ampliar la evaluación a otras facultades y áreas de conocimiento de nuestra universidad a fin de obtener el mapa y perfil de la iniciativa emprendedora del universitario UCM

Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain

In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe