A multifaceted provider-centred intervention versus usual care to improve the recognition and diagnosis of depression in primary health care: a hybrid study

Background: The aim of this study was to evaluate the impact of a multifaceted intervention to implement an adapted guideline for the management of depression in primary health care. Methods: A hybrid trial was carried out to determine the effect of a multicomponent provider centred intervention to improve the detection and diagnosis of depression in primary care, as part of the guideline implementation process, and to collect information about barriers and facilitators in a real-world context. Before the multicomponent intervention, a descriptive cross-sectional study was performed to assess the population prevalence of depression in the participating health centres and to detect possible differences. Subsequently, a quasi experimental two-phase study was carried out with a concurrent control group to assess the impact of the multicomponent intervention on the main outcomes (detection of depression, evaluation of its severity and the use of structured methods to support the diagnosis). Results: Nine-hundred seventy-four patients took part in the first phase. According to their clinical records, the prevalence of depression ranged from 7.2% to 7.9%, and there were no significant differences between the health centres scheduled to receive the intervention and those in the control group. In the experimental phase, 797 randomly selected participants received the multicomponent intervention. Adjusted multivariable analysis performed before the implementation revealed no significant differences in depression between the experimental and control groups. However, after the intervention, modest but significant differences were observed, which persisted at 1 year after the intervention. Conclusions: A multicomponent intervention for the implementation of a clinical guideline for the management of depression in primary care produced improvements in the identification of depression and in the degree of severity recorded.Funding for open access charge: Universidad de Málaga

Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: a cross-sectional study in a Spanish primary care setting

Objective To determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared with participants free of shoulder pain. Setting Three different primary care centres. Participants A sample of 73 patients with SAPS in their dominant arm was recruited, with a final sample size of 54 participants. Primary outcome measures The scapular upward rotation (SUR), the pectoralis minor and the levator scapulae muscles length tests were carried out. Results When symptomatic shoulders and controls were compared, an increased SUR at all positions (45°, 90° and 135°) was obtained in symptomatic shoulders (2/3,98/8,96°, respectively). These differences in SUR surpassed the minimal detectable change (MDC95) (0,91/1,55/2,83° at 45/90/135° of shoulder elevation). No differences were found in SUR between symptomatic and contralateral shoulders. No differences were found in either pectoralis minor or levator scapulae muscle length in all groups. Conclusions SUR was greater in patients with chronic SAPS compared with controls at different angles of shoulder elevation

Establishing normative foot posture index values for the paediatric population: a cross-sectional study

Antecedentes: el índice de postura del pie (FPI) es una herramienta de observación diseñada para medir la posición del pie. Su fiabilidad está bien establecida y proporciona valores de referencia normativos para la población en general. Sin embargo, esto no es así para la población pediátrica. El objetivo de este estudio es determinar los valores de referencia de FPI en la infancia, teniendo en cuenta la edad y el sexo. Métodos: este estudio transversal incluyó a 1.762 escolares (863 niños y 899 niñas) de 6 a 11 años, de Málaga, Granada y Plasencia (España). En todos los casos, dos podólogos experimentados obtuvieron las mediciones de FPI en ambos pies. Luego se realizó un análisis descriptivo y se determinaron los percentiles de las variables, con un nivel de significancia de P <0.05. Resultados: Los resultados del FPI consolidado para la población de muestra arrojaron valores medios de 3.74 (SD 2.93) puntos para el pie derecho y 3.83 (SD 2.92) para el izquierdo. El percentil 50 fue de 4 puntos para ambos sexos y para ambos pies, a excepción del pie derecho entre las chicas, que fue ligeramente inferior, en 3 puntos. El percentil 85, que se considera que representa el límite entre el pie normal y el pronado entre los niños, fue de 6 puntos, uniformemente entre los sujetos. Conclusiones: como valor normativo de FPI para la población pediátrica, recomendamos el percentil 50, es decir, 4 puntos, para niños, de ambos sexos, con edades comprendidas entre los 6 años. Este valor disminuye progresivamente con la edad, hasta 3 puntos FPI para niños de 11 años. El percentil 85 para el pie pronated y el percentil 4 para el pie supinado se puede considerar el límite patológico.Background: The Foot Posture Index (FPI) is an observational tool designed to measure the position of the foot. Its reliability is well established, and it provides normative reference values for the general population. However, this is not so for the paediatric population. The aim of this study is to determine FPI reference values in childhood, taking into account age and gender. Methods: This cross-sectional study included 1,762 school children (863 boys and 899 girls) aged 6–11 years, from Málaga, Granada and Plasencia (Spain). In every case, FPI measurements were obtained for both feet by two experienced podiatrists. A descriptive analysis was then conducted and the percentiles of the variables determined, with a significance level of P < 0.05. Results: The consolidated FPI results for the sample population produced mean values of 3.74 (SD 2.93) points for the right foot and 3.83 (SD 2.92) for the left. The 50th percentile was 4 points for both genders and for both feet, except for the right foot among the girls, which was slightly lower, at 3 points. The 85th percentile, which is considered to represent the boundary between the normal and the pronated foot among children, was 6 points, uniformly among the subjects. Conclusions: As a normative FPI value for the paediatric population, we recommend the 50th percentile, i.e. 4 points, for children, of both genders, aged 6 years. This value progressively falls with age, to 3 FPI points for children aged 11 years. The 85th percentile for the pronated foot and the 4th percentile for the supinated foot can be considered the pathological boundary.peerReviewe

Sedation in pediatric palliative care: The role of pediatric palliative care teams

Objectives. Palliative sedation (PS) consists of the use of drugs to alleviate the suffering of patients with refractory symptoms, through a reduction in consciousness.The aim of this study is to describe the incidence of and indications for PS in patients treated by pediatric palliative care teams (PPCT), and the relationship between PS, the place of death, and the characteristics of the care teams. Methods. Ambispective study with the participation of 14 PPCT working in Spain. Results. From January to December 2019, a total of 164 patients attended by these PPCT died. Of these, 83 (50.6%) received PS during their last 24 hours. The most frequent refractory symp toms were terminal suffering (n = 40, 48.2%), dyspnea (n = 9, 10.8%), pain (n = 8, 9.6%), and convulsive state (n = 7, 8.4%). Sedation in the last 24 hours of life was more likely if the patient died in hospital, rather than at home (62.9% vs. 33.3%, p < 0.01); if the parents had not expressed their preference regarding the place of death (69.2% vs. 45.2%, p = 0.009); and if the PPCT had less than 5 years’ experience (66.7% vs. 45.5%, p = 0.018). Significance of results. PS is a real possibility in pediatric end-of-life care and relates to care planning and team expertise.Funding for open access charge: Universidad de Málaga/CBU

End of life in patients attended by pediatric palliative care teams: what factors influence the place of death and compliance with family preferences?

Each year, more than 8 million children worldwide require specialized palliative care, yet there is little evidence available in pediatrics on the characteristics of the end of life in this context. Our aim is to analyze the characteristics of patients who die in the care of specific pediatric palliative care teams. This is ambispective, analytical observational, multicenter study conducted between 1 January and 31 December 2019. Fourteen specific pediatric palliative care teams participated. There are 164 patients, most of them suffering from oncologic, neurologic, and neuromuscular processes. The follow-up time was 2.4 months. The parents voiced preferences in respect of the place of death for 125 of the patients (76.2%). The place of death for 95 patients (57.9%) was at the hospital and 67 (40.9%) was at home. The existence of a palliative care team for over 5 years is more likely to be related to families voicing preferences and their fulfillment. Longer follow-up times by pediatric palliative care teams were observed in families with whom preferences regarding the place of death were discussed and in patients who died at home. Patients who did not receive home visits, when the pediatric palliative care team did not provide full care and when preferences regarding the place of death were not discussed with parents, were more likely to die in the hospital. Conclusions: Advance planning of end-of-life care is one of the most important aspects of pediatric palliative care. The provision of services by the teams and the follow-up time are related to parents’ expressed preferences and the place of death.Funding for open access charge: Universidad de Málaga / CBU

Consequences of the Covid-19 pandemic on complex multimorbid elderly: Follow-up of a community-based cohort. SAMAC3 Study

©2023. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Accepted version of a Published Work that appeared in final form in Journal of Nursing Scholarship. To access the final edited and published work see https://doi.org/10.1111/jnu.12860Background: The restrictions imposed during the management of the pandemic led to lack of care of other health problems. Purpose: To assess changes in the health status of complex multimorbidity elderly, functional and cognitive capacities, perception of the social surroundings, care pro vided by the nurses, including nursing diagnosis and interventions, use of health ser vices, adverse events, and use of devices and technical help during the first 6 months of the Covid-19 pandemic. Design: A 1-year longitudinal cohort study was conducted. Methods: Ninety-seven complex multimorbid elderly attended in primary care were evaluated every 3 months in a health area of the Spanish National Health System (SNHS). The research was called “SAMAC3 study”. Results: Significant negative changes were observed in the functional and cognitive ca pacity of the elderly, and in several nursing diagnoses. A decrease was observed in the frequency of visit to the nurses, hospital admittance, length of hospital stays, and falls. Conclusions: The functional and cognitive capacities of the cohort became worse. However, a significant decrease in the frequency of use of health services was ob served. The nurses detected significant changes in activity-exercise, cognitive perception, and roles-relationships, but their interventions were mostly centered on resolving clinical matters that required immediate attention. Clinical Relevance: The present study allowed us to observe that a situation of social and health stress has worsened the health indicators of multimorbid elderly, and the clinical care of community nurses was insufficient to providing care for the deteriora tion of the physical and cognitive domains

Nursing workforce characteristics and control of diabetes mellitus in primary care: A multilevel analysis. Spain

Fundamentos: La actividad de enfermería está condicionada por las características de la plantilla. El objetivo fue determinar cómo afectan las características de la plantilla de enfermería de atención primaria (AP) al control de la diabetes mellitus (DM) en personas adultas. Método: Estudio analítico transversal. Instrumentos para la recogida de datos: sistemas de información de AP y cuestionario PES-Nursing Work Index. Participantes: 44.214 pacientes diabéticos en dos zonas de salud de la Comunidad de Madrid: Zona Noroeste (ZNO) con mejor situación socioeconómica y Zona Suroeste (ZSO) con peor situación socioeconómica y los 507 profesionales de enfermería de referencia. Se realizaron análisis multivariantes multinivel de regresión logística. La variable dependiente fue la DM estaba mal controlada (cuando los valores de Hb1Ac eran ≥ a 7%) Resultados: La prevalencia DM mal controlada fue de 40,1% (IC95%:38,2-42,1). Existía un riesgo de un 25% más de peor control si el paciente cambiaba de centro de salud y de un 27% si cambiaba de pareja médico de cabaecera y enfermera. En los modelos de regresión logística multivariante multinivel: para la ZSO a mayor ratio de pacientes mayores de 65 años aumentaba el riesgo de mal control (OR=1,00008 [IC95%:1,00006-1,001]); a mayor proporción de pacientes sin seguimiento por centro de salud peor control (OR=5,1 [IC95%:1,6-15,6]). En los dos modelos por zona de salud, la condición de ser inmigrante económico aumentó el riesgo de mal control, ZSO (OR=1,3 [IC95%:1,03-1,7]); y ZNO (OR=1,29 [IC95%:1,03-1,6]). Conclusiones: Son factores de riesgo de tener mal controlada la diabetes mellitus la mayor proporción de pacientes mayores de 65 años por enfermera, ser inmigrante y la proporción de pacientes sin seguimientoBackground: Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. Method: Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. Primary outcome measure: Poor DM control (figures ≥ 7% HbA1c) Results: The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). Conclusions: Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM controlLos resultados presentados en este manuscrito forman parte de un proyecto financiado parcialmente por el Premio Nacional Marqués de Valdecilla (Santander) 2010 (12ª edición

Perfusión tisular periférica en talones de sujetos sanos expuestos a presión continua

Objetivos: 1) Observar los cambios que se producen en el flujo microvascular periférico de talones de sujetos sanos expuestos a patrones de presión continuo, 2) Observar los cambios que se producen en la temperatura periférico de talones de sujetos sanos expuestos a patrones de presión continuo. Metodología: Estudio experimental no controlado, no aleatorizado en fase preclínica. La población diana fueron los alumnos sanos de la Facultad de Ciencias de la Salud. El procedimiento a seguir fue protocolizado y se llevó a cabo por igual en todos los sujetos: se evaluó el flujo capilar sanguíneo y la temperatura local de los talones de los sujetos, mediante láser Doppler. Los datos se analizaron con el software informático SPSS. Resultados: Los valores iniciales de flujo capilar sanguíneo y temperatura local obtenidos fueron: 5,06 UA (unidad arbitraria) y 26,24 ºC, respectivamente; después de las dos horas de medición los valores fueron: 6,91 UA y 26,84 ºC. Por tanto, el flujo vascular sanguíneo incrementó un 36,51% y la temperatura local un 2,29%. Discusión/ Conclusión: Los resultados obtenidos muestran un ligero aumento de los valores de la microcirculación capilar sanguínea y de la temperatura local después de una exposición continua a presión durante dos horas.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Living with an intestinal stoma: a qualitative systematic review

The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy

Quality of Life, Physical and Mental Health, and Economic Evaluation of Family Caregivers of Chronic Dependent Children: INFAPRINT Cohort Study Protocol.

Background: Caregivers for children with complex chronic illnesses may experience emotional and physical strain, especially as concerns attention overload and the perceptions of their own psychosocial situation. These concerns, together with the additional financial cost and the socioeconomic inequalities that arise from caregiving responsibilities, create major challenges to the health status of this population group. Methods: A prospective analytical longitudinal study will be conducted, based on an exposed cohort of adult caregivers (parents or guardians) for children with complex chronic processes, to evaluate the impact of caregiving responsibilities on the health status of this population group. Conclusions and implications: The practical implications of this study are of great significance for clinical practice. The results of this study have the potential to inform the decision-making process in the healthcare sector and guide future research initiatives. The findings of this study will provide crucial insights into the health-related quality of life of caregivers of children with complex chronic illnesses, which will be valuable in addressing the challenges faced by this population group. This information can be used to improve the availability and accessibility of appropriate health services and to facilitate the development of more equitable health outcomes for caregivers of children with complex chronic illnesses. By highlighting the extent to which this population is affected both physically and mentally, the study can contribute to the development of clinical practices that prioritize the health and well-being of caregivers in the care of children with complex chronic illnesses.Funding for open access charge: Universidad de Málag