Aging in a methadone maintenance program: A perspective from the framework of social determinants of health

Fundamentos: Las personas en tratamiento con metadona han aumentado su esperanza de vida, envejeciendo de una forma prematura con comorbilidades. El objetivo de este estudio fue conocer el perfil sociodemográfico y clínico de estas personas en el Centro de Atención a las Adicciones del distrito de Latina (perteneciente a Madrid Salud), así como la percepción de la influencia del tratamiento en su envejecimiento. Se tuvo como marco el Modelo de los Determinantes Sociales de Salud. Métodos: Se utilizó una metodología mixta en dos fases: una cuantitativa, para describir las características sociodemográficas y clínicas de la población de estudio; y otra cualitativa, mediante entrevistas semiestructuradas a una muestra intencional, para explorar el historial de vida y la percepción de necesidades futuras respecto de la salud de los participantes. Resultados: En los resultados destacó que la edad media de la muestra era de 48,28 años, que eran en su mayoría hombres (81,25%), de origen español, con un nivel de estudios y económico bajos y con una estancia media en tratamiento con metadona de ±13 años. Se encontró un aumento de patologías mentales cuantos más años llevaban en el programa, así como que, a menor edad de inicio en el consumo, aumentaba la presencia de VIH y virus de la Hepatitis C. En sus discursos se halló que los determinantes sociales de la salud han condicionado su historia vital. Conclusiones: Tanto el consumo como la metadona contribuyen a su estigmatización, no favoreciendo su inclusión normalizada en la sociedad y determinando un estado elevado de vulnerabilidad. Ésta aumenta a medida que lo hace su edad, no recibiendo los recursos adecuados para atender a sus futuras necesidadesBackground: People on methadone treatment have increased their life expectancy, aging prematurely with comorbidities. The objective of this study was to know the sociodemographic and clinical profile of these people in the Center for Addiction Care in the district of Latina (belonging to Madrid Salud), as well as the perception of the influence of the treatment on their aging. The Social Determinants of Health Model was used as a framework. Methods: A mixed methodology was used in two phases: a quantitative one, to describe the sociodemographic and clinical characteristics of the study population; and another qualitative one, through semi-structured interviews to an intentional sample, to explore the history of life and the perception of future needs regarding the health of the participants.Results: The results highlighted that the average age of the sample was 48.28 years, that they were mostly men (81.25%), of Spanish origin, with a low level of education and economics and with a medium stay in treatment with methadone of ± 13 years. An increase in mental pathologies was found the more years they had been in the program, as well as, at a lower age of onset in consumption, the presence of HIV and Hepatitis C virus increased. In their speeches it was found that the social determinants of Health have conditioned its vital history. Conclusions: Both consumption and methadone contribute to its stigmatization, not favoring its normalized inclusion in society and determining a high state of vulnerability. This increases as age does, not receive adequate resources to meet their future need

Adultos mayores en tratamiento con metadona: posición socioeconómica y cronicidad

People on methadone treatment are aging, becoming chronic and increasing the presence of chronic diseases. Aim: To examine the characteristics of older adults in treatment with methadone in relation to determine socio-economic status, chronic diseases and how to tackle this chronicity. Method: A scoping review was conducted for articles published since 2004 up to May 2020, in English and in Spanish. Results: This process left twenty-five documents. The 66,6 % were from the North America. Fourteen publications referred to the factors determining so- cio-economic status: increase in mean age, economic instability, social exclusion, and stigma. Only one had a gender perspective approach. Nineteen publications referred to chronic physical and mental diseases. In relation to tackling chronicity, were found sixteen publications: multidisciplinary care and participation in the treatment were apprecia- ted as something important. Conclusions: The increasing age of people who are on methadone treatment and their specific needs is evident, so it will be necessary to adapt care and resources. Owing to the scarcity of studies found, especially beyond the North American continent, this phenomenon requires further study, most particularly from a qualitative approach and a gender perspective, to benefit from the point of view of those receiving the treatmentLas personas en tratamiento con metadona están envejeciendo, cronificándose y aumentando las en- fermedades crónicas. Objetivo: Examinar las características de los adultos mayores en tratamiento con metadona en relación con los determinantes del estatus socioeconómico, las enfermedades crónicas y el abordaje de esta cronici- dad. Método: Se realizó una revisión de artículos publicados desde 2004 hasta mayo de 2020, en inglés y en español, obteniendo veinticinco documentos. Resultados: El 66,6% eran de América del Norte. Solo uno con enfoque de género. Catorce referían determinantes del estatus socioeconómico: aumento de edad media, inestabilidad econó- mica, exclusión social y estigma. Diecinueve se refirieron a enfermedades físicas y mentales crónicas. Con relación al abordaje de la cronicidad, se encontraron dieciséis publicaciones: la atención multidisciplinar y la participación en el tratamiento como se consideró como importante. Conclusiones: La edad cada vez mayor de las personas que están en tratamiento con metadona y sus necesidades específicas es evidente, será necesario adaptar su atención y los recursos. Debido a la escasez de estudios encontrados, especialmente fuera de EEUU, este fenómeno requiere un mayor estudio, particularmente desde un enfoque cualitativo y perspectiva de género, para tener en cuenta el punto de vista de quienes reciben el tratamiento

Factors associated to clinical learning in nursing students in primary health care: An analytical cross-sectional study

Objective: to identify the students’ perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. Methods: analytical crosssectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. Results: the response rate was 91.8%. The most commonly identified tutoring process was “preceptor-professor” (45.2%). The clinical placement was assessed as “optimal” by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables “Academic year” (beta coefficient = 1.042 for third-year students), “Primary Health Care Area (PHC)” (beta coefficient = 0.308 for Area B) and “Clinical placement perception” (beta coefficient = - 0.204 for a suboptimal perception). Conclusions: timeframe within the academic program, location and clinical placement perception were associated with students’ clinical learning. Students’ perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance

Impact of primary care nursing workforce characteristics on the control of high-blood pressure: A multilevel analysis

Objective: To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). Design: Cross-sectional analytical study. Setting: Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. Participants: 76 797 hypertensive patients in two health zones within the Community of Madrid, North- West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. Primary outcome measure: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and selfperceived CPE. Results: The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). Conclusions: A CPE, perceived by PHC nurses as more favourable, and more patient–nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are neededThe results presented here form part of a study that has been funded partially with the First Prize for National Research in Nursing (12th edition) from Hospital Universitario Marqués de Valdecilla (Santander) in 2010

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study

Objective: to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. Methods: analytical crosssectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. Results: the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = -0.204 for a suboptimal perception). Conclusions: timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance

Bayesian spatio-temporal models for mapping TB mortality risk and its relationship with social inequities in a region from Brazilian Legal Amazon

publishersversionpublishe

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research