Del empoderamiento a la certificación. Una aportación al campo de la promoción, la difusión y la convocatoria social

En este trabajo se realiza la sistematización de una intervención al amparo de un Programa de Capacitación auspiciado por la iniciativa privada destinado a la profesionalización y mejoramiento de las condiciones económicas y de vida de mujeres latinoamericanas. El trabajo en campo se llevó acabo en diferentes municipios de Jalisco entre ellos: Zapotlán el Grande, Zapopan, Guadalajara y Tlajomulco de Zúñiga entre otros en el periodo de tiempo comprendido del 28 de agosto de 2018 al 16 de enero de 2019. La temática analizada fue: la relación existente entre el despliegue de las potencialidades personales y las condiciones relacionales, en el encuentro entre un facilitador que promovió la relevancia de las condiciones vinculantes del Enfoque Centrado en la Persona (ECP) y un grupo de mujeres adultas jóvenes, con edades que oscilaban entre 18 y 65 años de edad, mismas que participaron de un plan de estudio y trabajo que persigue el objetivo de inculcar una actitud solidaria entre mujeres emprendedoras que, mediante experiencias de aprendizaje significativo, adquirido a partir de su participación en una serie de talleres a fin de mejorar sus condiciones de vida. Entre las afirmaciones epistemológicas que sustentan este emprendimiento académico se encuentran: a) La experiencia como constitutivo del desarrollo de la capacidad de agencia; b) la reflexividad se vincula indisolublemente con la capacidad de autodistanciamiento para atestiguar el inquebrantable vínculo entre persona y mundo; c) las relaciones interpersonales son constitutivo de la condición humana. La perspectiva desde la que se abordan las cuestiones planteadas es la metodología cualitativa y el método hermenéutico para la interpretación de la información recolectada. El andamiaje teórico-conceptual es de corte interdisciplinar, pues para su conformación se precisó de la superación de lindes disciplinares. Se sostiene en aportaciones de Rogers (2009), desde el Enfoque Centrado en la Persona, Gómez-Gómez (2007), en cuanto al desarrollo de la capacidad de agencia, en De La Cuesta-Benjumea (2011), respecto a reflexividad, en Chiavola, Cendrós Parra, & Sánchez (2008) en lo referente a Empoderamiento y Watzlawick, Beavin, y Jackson (1989) en lo relativo a la relación comunicante. El trabajo cuenta con las siguientes características: a) el foco de la intervención se orientó hacia una característica psicoevolutiva, específicamente, el desarrollo de la capacidad de agencia, b) se ajusta a un marco teórico-conceptual y legal en términos del resguardo confidencial de identidades institucionales y personales, c) se concibe como instrumento de cambio y justicia social, dado que concibe obligatorio el reparto equitativo del conocimiento y del bienestar económico y social

Short-term memory, attention, and temporal orientation as predictors of the cognitive impairment in older adults: A cross-sectional observational study

Late-life cognitive decline ranges from the mildest cases of normal, age-related change to mild cognitive impairment to severe cases of dementia. Dementia is the largest global burden for the 21st century welfare and healthcare systems. The aim of this study was to analyze the neuropsychological constructs (temporal orientation (TO), spatial orientation (SO), fixation memory (FM), attention (A), calculation (C), short-term memory (STM), language (L), and praxis (P)), semantic fluency, level of functionality, and mood that reveal the greatest deficit in the different stages ranging from normal cognition (NC) to cognitive impairment in older adults in a primary healthcare setting. The study included 337 participants (102 men, 235 women), having a mean age of 74 ± 6 years. According to their scores on the Spanish version of the Mini-Mental State Examination (MEC-35), subjects were divided into 4 groups: no deterioration (ND) (score 32-35), subtle cognitive impairment (SCI) (score 28- 31), level deterioration (LD) (score 24-27) and moderate deterioration (MD) (score 20-23). The ND group revealed significant differences in TO, STM, C, A, L, P, and S-T as compared to the other groups. The MD group (in all the neuropsychological constructs) and the ND and SCI groups showed significant differences on the Yesavage geriatric depression scale (GDS-15). All except the FM neuropsychological construct were part of the MEC-35 prediction model and all of the regression coefficients were significant for these variables in the model. Furthermore, the highest average percentage of relative deterioration occurs between LD and MD and the greatest deterioration is observed in the STM for all groups, including A and TO for the LD and MD groups. Based on our findings, community programs have been implemented that use cognitive stimulation to prevent cognitive decline and to maintain the neuropsychological constructs. © 2021 Gómez-Soria et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Disability, support and long-term social care of an elderly Spanish population, 2008-2009: An epidemiologic analysis

Background: Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity. Methods: We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008-2009, which provided data on disability, morbidity, and service use among 1216 residents aged =50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit. Results: Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86-38.16), declared non-professional care 10.99 (1.28-94.53), and publicly-funded, non-professional care 26.30 (3.36-205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer. Conclusions: Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons

Correlación entre el diagnóstico de depresión y la sintomatología presentada en pacientes de atención primaria

La depresión mayor es una enfermedad crónica con una alta prevalencia que cursa habitualmente de manera episó- dica, con una duración media del episodio de 16 semanas. No se han encontrado análisis que evalúen la concordancia entre la aparición de los mismos y la evolución del episodio. El objetivo de este estudio es analizar la concordancia entre la evolución sintomática (aparición, mantenimiento, remisión de los diversos síntomas) y la evolución del diagnóstico de depresión mayor (aparición, mantenimiento y remisión) en una cohorte de personas con y sin diagnóstico de depresión mayor. Se realizó un estudio de cohortes prospectivo a un año de seguimiento en el que se entrevistó a una muestra aleatoria de 741 sujetos que acudían a consultas de atención primaria, se elaboró el diagnóstico de depresión según criterios del DSM-IV y se analizó la sintomatología que presentaba. Estos sujetos fueron re-evaluados a los 6 meses y 12 meses. El estado de ánimo deprimido, la disminución del interés o anhedonia y los síntomas relacionados con el sueño (insomnio o hipersomnia), la agitación, el sentimiento de culpa y la fatiga o pérdida de energía son concordantes con el diagnóstico. El resto de los síntomas muestran una evolución independiente de la evolución del diagnóstico. En Atención Primaria, es importante conocer qué síntomas son claves en la evolución del diagnóstico con la finalidad de conseguir la remisión total de la depresión y evitar mantenimiento de sintomatología residual que puede dar lugar a pródromos

Implementation of the eira 3 intervention by targeting primary health care practitioners: Effectiveness in increasing physical activity

The World Health Organization (WHO) estimated that physical inactivity (PI) is responsible for 20 to 30% of all non-communicable diseases. We aimed to analyze the effectiveness of a multiple health behavior change (MHBC) intervention to increase physical activity (PA) in patients 45 to 75 years old who had at least 2 of 3 unhealthy behaviors (tobacco use, reduced fruit and vegetable consumption, and insufficient PA). The MHBC intervention is based on the Transtheoretical Model and the conceptual framework of the “5 A’s” and includes an individually tailored intervention, group sessions, and the use of community resources. We included 3062 participants, 1481 in the intervention group and 1581 in the control group. After 12 months, there were no differences in PA intensity measured by metabolic_equivalent_of_task_minutes/week (adjusted mean difference: 284.093, 95% CI: -298.24, 866.42) nor in the proportion of participants who increased PA levels to moderate or high (OR: 1.02, 95% CI: 0.85, 1.23; p = 0.822), and no differences in blood pressure, weight loss, or waist circumference. We found an increased proportion of patients in the intervention group who followed the WHO recommendations for PA (OR: 1.29; 95% CI: 1.04, 1.60; p = 0.02). We concluded that the intervention did not lead to a significant increase in PA. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

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)

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

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

Perception of the primary health care response capacity by patients with and without mental health problems, and health professionals: qualitative study

BACKGROUND: The objective of this study is to deepen our understanding of perceptions towards Primary Health Care Response Capacity by specifically using patients with and without mental disorders, as well as family doctors and a manager, in order to compare and endorse perspectives. For it, a qualitative study was performed. In-depth interviews were conducted with 28 patients with and without mental health disorders and focus groups were held with 21 professionals and a manager. An inductive thematic content analysis was performed in order to explore, develop and define the emergent categories of analysis. RESULTS: The fundamental domains for patients are dignity, communication, and rapid service. People with mental health problems also highlight the domain of confidentiality as relevant, while patients who do not have a mental health problem prioritize the domain of autonomy. Patients with mental health disorders report a greater number of negative experiences in relation to the domain of dignity. Patients do not consider their negative experiences to be a structural problem of the system. These findings are also endorsed by health care professionals. CONCLUSIONS: It is necessary to take these results into account as responsive systems can improve service uptake, ensure adherence to treatment, and ultimately enhance patient welfare