Tratamiento de las patologías derivadas de los riesgos psicosociales en el derecho español. Situación actual y propuestas de reforma.

El presente trabajo resume la situación actual de la prevención de riesgos psicosociales en el ordenamiento jurídico español. Alude a la prevalencia de estos riesgos, y posteriormente resume la legislación vigente, referencia la jurisprudencia más señalada y hace hincapié en los riesgos psicosociales más difíciles de tratar y conceptualizar, especialmente el estrés y burnout, en relación con las defniciones legales de accidentes de trabajo y enfermedades profesionales. Propone una serie de medidas para la mejora del tratamiento de estos riesgos, que conllevarían una mejora en la salud de los trabajadores, medidas que abarcan desde la mejora desde un punto de vista médico-legal del tratamiento de dichas situaciones, a otras medidas de tipo legislativo, judicial y de tratamiento de estas situaciones. This paper summarizes the current situation of prevention of psychosocial risks at work in the Spanish legal system. It refers to the prevalence of these hazards, and then summarizes the current legislation, with references to the most relevant jurisprudence and emphasizes the most diffcult psychosocial hazards to deal with, especially stress and burnout, in relation to legal defnitions of occupational accidents and occupational diseases and their presumptions. It proposes a bunch of measures to improve the treatment of these risks, which would lead to an improvement in the health of workers, ranging from the improvement from a medical-legal point of view of the treatment of such situations, including other legislative and judicial measures

Variability of the prevalence of depression in function of sociodemographic and environmental factors: ecological model

Major depression etiopathogenesis is related to a wide variety of genetics, demographic and psychosocial factors, as well as to environmental factors. The objective of this study is to analyze sociodemographic and environmental variables that are related to the prevalence of depression through correlation analysis and to develop a regression model that explains the behavior of this disease from an ecological perspective. This is an ecological, retrospective, cross-sectional study. The target population was 1,148,430 individuals over the age of 16 who were registered in Aragon (Spain) during 2010, with electronic medical records in the community’s primary health care centers. The spatial unit was the Basic Health Area (BHA). The dependent variable was the diagnosis of Depression and the ecological independent variables were: Demographic variables (gender and age), population distribution, typology of the entity, population structure by sex and age, by nationality, by education, by work, by salary, by marital status, structure of the household by number of members, and state of the buildings. The results show moderate and positive correlations with higher rates of depression in areas having a higher femininity index, higher population density, areas with a higher unemployment rate and higher average salary. The results of the linear regression show that aging +75 and rural entities act as protective factors for depression, while urban areas and deficient buildings act as risk factors. In conclusion, the ecological methodology may be a useful tool which, together with the statistical epidemiological analysis, can help in the political decision making process

Mental Health Patients' Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study

A health system's responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients' responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, and communication. Data were collected from 215 people over the age of 18 with mental disorders, using the Multi-Country Survey Study (MCSS) developed by the World Health Organization. Of them, 95% reported a good experience regarding the dignity, confidentiality, communication, and autonomy domains. Regarding responsiveness, patients valued the dignity domain as the most important one (25.1%). Among the patients who experienced poor confidentiality, five out of seven earned less than 900 euros per month (X-2 = 10.8, p = 0.004). Among those who experienced good autonomy, 85 out of 156 belonged to the working social class (90.4%), and among those who valued it as poor (16.1%), the highest proportion was for middle class people (X-2 = 13.1, p = 0.028). The two students and 87.5% of retirees experienced this dimension as good, and most patients who valued it as poor were unemployed (43.5%) (X-2 = 13.0, p = 0.011). Patients with a household income higher than 900 euros more frequently valued responsiveness as good, regarding those domains related to communication, with OR = 3.84, 95% CI = 1.05-14.09, and confidentiality, with OR = 10.48, 95% CI = 1.94-56.59. To conclude, as regards responsiveness in primary care, the dignity domain always obtained the best scores by people with mental disorders. Low economic income is related to a poor assessment of confidentiality. Working class patients, students, and retirees value autonomy as good

"Areas of worklife scale" (AWS) short version (Spanish): a confirmatory factor analysis based on a secondary school teacher sample

Background: This study examines the construct validity of the Areas of Worklife Short Scale, a practical instrument to measure employees\u27 perceptions of their work environments in the sample of secondary obligatory education teachers in Spain. Methods: Conducted in 33 centers of secondary obligatory education in Spain (N = 677). Confirmatory Factor analysis for 3 different models for the 29-items version and 1 model for the 18-items version was tested. Results: Results confirmed that the short AWS short version had the best fit to the data than any other model proposed (GFI-Satorra-Bentler scaled chi-squared = 320.19, × 2/df = 2.337) and good fit indices (CFI = 0.911; RMSEA = 0.046). Conclusions: This analysis ultimately supports the appropriateness of AWS short version to explore areas of worklife and therefore can indicate the factors that contribute to burnout in the sample of secondary obligatory education teachers in Spain. Therefore it has been confirmed that this tool is able to assess the 6 domains of work environment of secondary schools teachers

Quantum dynamics of local phase differences between reservoirs of driven interacting bosons separated by simple aperture arrays

We present a derivation of the effective action for the relative phase of driven, aperture-coupled reservoirs of weakly-interacting condensed bosons from a (3+1)-D microscopic model with local U(1) gauge symmetry. We show that inclusion of local chemical potential and driving velocity fields as a gauge field allows derivation of the hydrodynamic equations of motion for the driven macroscopic phase differences across simple aperture arrays. For a single aperture, the current-phase equation for driven flow contains sinusoidal, linear, and current-bias contributions. We compute the renormalization group (RG) beta function of the periodic potential in the effective action for small tunneling amplitudes and use this to analyze the temperature dependence of the low-energy current-phase relation, with application to the transition from linear to sinusoidal current-phase behavior observed in experiments by Hoskinson et al. \cite{packard} for liquid $^{4}$He driven through nanoaperture arrays. Extension of the microscopic theory to a two-aperture array shows that interference between the microscopic tunneling contributions for individual apertures leads to an effective coupling between apertures which amplifies the Josephson oscillations in the array. The resulting multi-aperture current-phase equations are found to be equivalent to a set of equations for coupled pendula, with microscopically derived couplings.Comment: 16 pages, 5 figures v2: typos corrected, RG phase diagram correcte

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Background: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity =50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. Trial registration: ClinicalTrials.gov, NCT03136211. Registered 2 May 2017, “retrospectively registered”. © 2021, The Author(s)

Modelos teóricos de promoción de la salud en la práctica habitual en atención primaria de salud

Objetivo: Comprender a qué modelos teóricos se ajusta la práctica actual de la prevención primaria ypromoción de la salud en atención primaria de salud en diferentes centros de salud de siete comunidadesautónomas de España, según los/las profesionales de distintas disciplinas de este ámbito asistencial. Método: Investigación cualitativa descriptiva en la que participaron 145 profesionales de 14 centros desalud de siete comunidades autónomas de España. El muestreo fue teórico. Se realizaron 14 grupos dediscusión. El análisis de datos se realizó siguiendo procedimientos del análisis de contenido temático y de acuerdo con siete modelos teóricos de promoción de la salud a nivel micro, meso y macro. Resultados: Las prácticas de los profesionales de los centros participantes en relación con las actividadesde prevención primaria y promoción de la salud se adhieren principalmente a modelos intrapersonales, centrándose en ayudar a que las personas se empoderen aumentando la conciencia de riesgo y de los beneficios del cambio en los comportamientos, y guiándolas en la implementación de un comportamientosaludable. Algunos/as profesionales realizan actividades que encajan en modelos interpersonales, implicando a la familia y al propio profesional en las estrategias. Solo en algunos casos las prácticas actualesencajan en modelos comunitarios de promoción de la salud. Conclusiones: Las prácticas de prevención primaria y promoción de la salud de los profesionales de atención primaria siguen principalmente modelos intrapersonales, en algunos casos modelos interpersonalesy más puntualmente modelos comunitarios. Es necesario potenciar la participación de la ciudadanía y laorientación comunitaria de los servicios de atención primaria de salud. Objective: To understand which theoretical models apply to current primary care practice of primary prevention and health promotion in a sample of primary health centres of seven autonomous regions in Spain according to the various professionals involved. Method: Descriptive qualitative research with the participation of 145 professionals from 14 primary health centres of seven autonomous regions in Spain. Theoretical sampling was used and 14 discussion groups were carried out. Data analysis followed thematic contents analysis procedures and was based on seven health promotion theoretical models at micro-, meso- and macro-level. Results: Current practice of primary prevention and health promotion activities mainly follow intrapersonal models, which focus on assisting the empowerment of patients by means of raising awareness of risk and benefits of behavioural change and on guiding the adoption of the new healthy behaviour. To a lesser degree, the activities of some professionals adhere to interpersonal models, which involve also the family and the health professional. In only a few instances community models of health promotion were used. Conclusions: Primary prevention and health promotion practice of primary healthcare professionals follow mainly intrapersonal models, few cases use interpersonal models and community models are only occasionally employed. Advance of public participation and community orientation in primary healthcare services is needed

Deterministic amplification of Schrödinger cat states in circuit quantum electrodynamics

Perfect deterministic amplification of arbitrary quantum states is prohibited by quantum mechanics, but determinism can be achieved by compromising between fidelity and amplification power. We propose a dynamical scheme for deterministically amplifying photonic Schrödinger cat states, which show great promise as a tool for quantum information processing. Our protocol is designed for strongly coupled circuit quantum electrodynamics and utilizes artificial atomic states and external microwave controls to engineer a set of optimal state transfers and achieve high fidelity amplification. We compare analytical results with full simulations of the open, driven Jaynes-Cummings model, using realistic device parameters for state of the art superconducting circuits. Amplification with a fidelity of 0.9 can be achieved for sizable cat states in the presence of cavity and atomic-level decoherence. This tool could be applied to practical continuous-variable information processing for the purification and stabilization of cat states in the presence of photon losses