The emotional well-being of Long COVID patients in relation to their symptoms, social support and stigmatization in social and health services: a qualitative study

Background Long COVID patients have experienced a decline in their quality of life due to, in part but not wholly, its negative emotional impact. Some of the most prevalent mental health symptoms presented by long COVID patients are anxiety, depression, and sleep disorders. As such, the need has arisen to analyze the personal experiences of these patients to understand how they are managing their daily lives while dealing with the condition. The objective of this study is to increase understanding about the emotional well-being of people diagnosed with long COVID. Methods A qualitative design was created and carried out using 35 patients, with 17 participants being interviewed individually and 18 of them taking part in two focus groups. The participating patients were recruited in November and December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza (Northern Spain) and from the Association of Long COVID Patients in Aragon. The study topics were emotional well-being, social support networks, and experience of discrimination. All an inductive thematic content analyses were performed iteratively using NVivo software. Results The Long COVID patients identified low levels of self-perceived well-being due to their persistent symptoms, as well as limitations in their daily lives that had been persistent for many months. Suicidal thoughts were also mentioned by several patients. They referred to anguish and anxiety about the future as well as a fear of reinfection or relapse and returning to work. Many of the participants reported that they have sought the help of a mental health professional. Most participants identified discriminatory situations in health care. Conclusions It is necessary to continue researching the impact that Long COVID has had on mental health, as well as to provide Primary Health Care professionals with evidence that can guide the emotional treatment of these patients

Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain

The purpose of this study is to understand the health-related quality of life (HRQoL) in patients with celiac disease (CD) and analyze its main determinants. A transversal descriptive study of 738 patients with celiac disease was carried out. A series of questionnaires were answered related to their HRQoL, adherence to a gluten-free diet (GFD), and self-efficacy beliefs among other relevant variables. Regression analyses were carried out in order to explore the predictive variables in adherence to the GFD and HRQoL. A total of 61.2% showed a good HRQoL, and the main predictors of HRQoL were specific self-efficacy, adherence to the diet, risk perception, time since diagnosis, and age. While 68.7% of participants showed good or excellent adherence to the GFD, and the main predictors of adherence were specific self-efficacy, perceived adoption of recommended behaviors, HRQoL and gender. The HRQoL of patients with CD, and adherence to the GFD in Spain, are good. It is the self-efficacy expectation, measured specifically and not generally, which is the best predictor of both adherence and HRQoL. It is necessary to develop programs to improve the HRQoL of patients with CD that focus on improving specific self-efficacy

Variables associated with a higher awareness of gender-based violence by students of the health sciences and social work

Objective To determine the attitudes towards equality and prevention of gender-based violence, and analyze variables associated with a higher awareness of gender-based violence by students of the health sciences and social work degrees. Method A cross-sectional descriptive study was carried out. The sample consisted of 437 students of the health sciences and social work degrees at the University of Zaragoza (Spain) during 2018 and 2019. The variables of the study were: Socio-demographic variables, academic variables, feminism attitudes towards women''s movement using Feminism and the women''s movement scale (FWMS), attitudes on gender-based violence using the Gender Equality and Prevention of Gender-based Violence Scale (GEPGVS). A correlational study and multiple linear regression were performed, in order to analyze the associated variables. Results Differences in attitudes towards gender-based violence were observed according to sex, age and attitudes in line with the feminist movement. Regarding the linear regression model, the results showed that the FWMS is a predictor of GEPGVS, as well as sex. Conclusions Holding attitudes in line with the feminist movement is a factor that may be promoted in order to increase the awareness of gender-based violence. Objetivo Determinar las actitudes hacia la igualdad y la sensibilización en cuanto a la violencia de género, y analizar las variables asociadas a una mayor sensibilización sobre la violencia de género de los estudiantes de ciencias de la salud y trabajo social. Método Se realizó un estudio descriptivo transversal. La muestra consistió en 437 estudiantes de los grados de ciencias de la salud y trabajo social de la Universidad de Zaragoza (España) durante 2018 y 2019. Las variables del estudio fueron variables sociodemográficas, variables académicas, actitudes hacia el movimiento feminista usando la Feminism and the women''s movement scale (FWMS) y actitudes hacia la violencia de género mediante la Escala sobre Igualdad y Prevención de la Violencia de Género (EIPVG). Se realizaron un estudio correlacional y una regresión lineal múltiple para conocer las variables asociadas a una mayor sensibilización. Resultados Se observaron diferencias en las actitudes hacia la violencia de género en función del sexo, la edad y las actitudes favorables al movimiento feminista. Con respecto al modelo de regresión lineal, los resultados mostraron que la FWMS es un predictor de la EIPVG, así como el sexo. Conclusiones Las actitudes favorables al movimiento feminista son un factor que puede promoverse para incrementar la sensibilización sobre la violencia de género

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review

BACKGROUND: Shared decision making (SDM) is a process within the physician-patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients'' and health professionals'' satisfaction with the intervention. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration''s tool. RESULTS: Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. CONCLUSIONS: DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care

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

Le barrage de Muel (Zaragoza, España): une étude interdisciplinaire

CONTEXTE GÉOGRAPHIQUE ET RECHERCHES DANS LA VALLÉE MOYENNE DE L’ÈBRE Dans la vallée moyenne de l’Èbre, une série de territoires aux climats variés se combine. Ils ont tous deux éléments en commun : des caractéristiques géologiques particulières et de faibles précipitations qui engendrent des débits hydriques insuffisants pour l’approvisionnement urbain. Ces singularités s’illustrent par l’abondance des systèmes de stockage de l’eau et par des moyens techniques spécifiques liés à ces systèmes dans chacun des centres urbains d’époque romaine (fig. 1).La retenue romaine de Muel (Saragosse) se trouvait à l’origine dans le lit de La Huerva, bien qu’aujourd’hui ce fleuve, en raison de l’augmentation de la sédimentation subie au cours des siècles postérieurs à sa construction, coule à quelques mètres à l’ouest de son lit primitif.Le barrage se trouve dans la zone d’étranglement d’une largeur inférieure à 100 m, formée par une falaise calcaire dans la zone orientale et par la colline où s’élevait le château des Marquis de Camara dans la zone occidentale. Ces deux formations calcaires massives furent exploitées afin d’y adosser la construction de la retenue qui repose sur un terrain rocheux. Un indice supplémentaire témoigne de la robustesse du site : cette structure constitue le soubassement de l’ermitage de Nuestra Señora de la Fuente construit en 1770, à l’intérieur duquel se trouvent les pendentifs peints par F. de Goya

Low intensity vs. self-guided Internet-delivered psychotherapy for major depression: A multicenter, controlled, randomized study

Background: Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system. Methods: The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed. Discussion: The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting

Geographic factors associated with poorer outcomes in patients diagnosed with covid-19 in primary health care

Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidi-ties, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prog-nosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols

Effectiveness and cost-effectiveness of a lifestyle modification programme in the prevention and treatment of subclinical, mild and moderate depression in primary care: A randomised clinical trial protocol

Introduction Major depression is a highly prevalent pathology that is currently the second most common cause of disease-induced disability in our society. The onset and continuation of depression may be related to a wide variety of biological and psychosocial factors, many of which are linked to different lifestyle aspects. Therefore, health systems must design and implement health promotion and lifestyle modification programmes (LMPs), taking into account personal factors and facilitators. The main objective of this protocol is to analyse the clinical effectiveness, cost-effectiveness and cost utility of an LMP and an LMP with information and communication technologies (ICTs) as adjunctive treatment for depression in primary care patients. The secondary objectives are to analyse the clinical effectiveness in the subgroup that presents comorbidity and to analyse the correlation between personal factors on health behaviour and lifestyle patterns. Methods and analysis A randomised, multicenter pragmatic clinical trial with three parallel groups consisting of primary healthcare patients suffering from subclinical, mild or moderate depression. The following interventions will be used: (1) Usual antidepressant treatment with psychological advice and/or psychotropic drugs prescribed by the general practitioner (treatment as usual (TAU)). (2) TAU+LMP. A programme to be imparted in six weekly 90-minute group sessions, intended to improve the following aspects: behavioural activation+daily physical activity+adherence to the Mediterranean diet pattern+sleep hygiene+careful exposure to sunlight. (3) TAU+LMP+ICTs: healthy lifestyle recommendations (TAU+LMP)+monitoring using ICTs (a wearable smartwatch). The primary outcome will be the depressive symptomatology and the secondary outcomes will be the quality of life, the use of health and social resources, personal factors on health behaviour, social support, lifestyle patterns and chronic comorbid pathology. Data will be collected before and after the intervention, with 6-month and 12-month follow-ups. Ethics and dissemination This study has been approved by the Clinical Research Ethics Committee of Aragón (approval number: C.P.-C.I. PI18/286) and the Research Ethics Committee of the Balearic Islands (IB3950/19 PI). Data distribution will be anonymous. Results will be disseminated via conferences and papers published in peer-reviewed, open-access journals. Trial registration number ClinicalTrials.gov Registry (NCT03951350)