Aceptabilidad lingüística en la comprensión de cuestionarios de valoración de servicios de salud en Iberoamérica

The use of questionnaires as measuring tools involves the use of language. Spanish intralinguistic variation entails differences in the ways of perceiving the world, analyzing events and behaving, which must be taken into account when designing and adapting questionnaires. The IA-PCAT (Primary Care Assessment Tools for Iberomerica) harmonization process differs from the cross-cultural adaptation scenarios described in the scientific literature, since it intends to obtain a single Spanish product suitable for multiple target populations, that emanates from questionnaires previously adapted in several populations. Hence, this work requires the use of new analysis categories. The aim of this methodological note is to propose discriminant definitions of conceptual equivalence, practical equivalence and linguistic acceptability as analysis categories of the data collected during cognitive interviews to assess the questionnaires’ comprehension, carried out with health professionals and users of healthcare services.     

Violencia de pareja y depresión en mujeres que trabajan en una institución de salud de México

ObjectiveTo assess the effect of intimate partner violence on the risk of depression and depressive symptoms among adult women.MethodWe analyzed data from the Mexican Health Workers’ Cohort study (n = 470). Type and severity of intimate partner violence was ascertained between 2004 and 2011. Self-reported medical diagnosis of depression (2011) was the main outcome; depressive symptoms ascertained with the Centre for Epidemiologic Studies-Depression (CES-D) scale was the secondary outcome. Random-effects regressions were run to model the risk of depression (logistic) and depressive symptoms (linear) in relation to intimate partner violence.Results41.9% women experienced intimate partner violence at baseline. The incidence of depression was 7.2%. The risk of depression increased with any type of IPV (adjusted odds ratio [aOR] = 2.9; 95% confidence interval [95%CI]: 1.4–6.2) and with physical (aOR = 4.3; 95%CI: 1.8–10.1), psychological (aOR = 3.1; 95%CI: 1.4–6.6) and sexual (aOR = 3.1; 95%CI: 1.2–8.2) violence. Depressive symptoms (CES-D) increased slightly with physical and sexual intimate partner violence.ConclusionsIntimate partner violence was associated with a higher risk of depression in this sample of women working in a Mexican health facility. Our results indicate the need to develop infrastructure, to implement strategies of attention and counselling, and to provide a safe environment in the workplace for women who experience intimate partner violence.     

Diversité des prises en charge des patients atteints de sclérose en plaques entre régions françaises

Background

The aim of this study is to analyze and to compare data from 2015, focusing on hospital care for patients with multiple sclerosis from three French regions with different characteristics in terms of prevalence, size and number of multiple sclerosis competencies and resource centers.

Comparación entre tres métodos de medida de la multimorbilidad en función del uso de recursos sanitarios en atención primaria

ObjectiveTo compare three methods of measuring multiple morbidity according to the use of health resources (cost of care) in primary healthcare (PHC).DesignRetrospective study using computerized medical records.SettingThirteen PHC teams in Catalonia (Spain).ParticipantsAssigned patients requiring care in 2008.Main measurementsThe socio-demographic variables were co-morbidity and costs. Methods of comparison were: a) Combined Comorbidity Index (CCI): an index itself was developed from the scores of acute and chronic episodes, b) Charlson Index (ChI), and c) Adjusted Clinical Groups case-mix: resource use bands (RUB). The cost model was constructed by differentiating between fixed (operational) and variable costs. Statistical analysis: 3 multiple lineal regression models were developed to assess the explanatory power of each measurement of co-morbidity which were compared from the determination coefficient (R²), p< .05.ResultsThe study included 227,235 patients. The mean unit of cost was €654.2. The CCI explained an R² = 50.4%, the ChI an R² = 29.2% and BUR an R² = 39.7% of the variability of the cost. The behaviour of the ICC is acceptable, albeit with low scores (1 to 3 points), showing inconclusive results.ConclusionsThe CCI may be a simple method of predicting PHC costs in routine clinical practice. If confirmed, these results will allow improvements in the comparison of the case-mix.     

Los problemas de salud también explican la utilización de servicios sociales en atención domiciliaria

ObjectiveTo identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law.DesignCross-sectional study.Setting72 primary health care teams in Catalonia.PatientsPatients over 64 years old with chronic diseases in home care programmes in Catalonia.MeasurementsHealth status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital.ResultsA total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care.ConclusionsTo be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care.     

Adecuación de la utilización de benzodiazepinas en ancianos desde la oficina de farmacia. Un estudio de colaboración médico-farmacéutico

AimsTo improve the use of benzodiazepines (BZD) in the elderly by a pharmacist-physician collaboration, and to insure that BZD are effective, safe, and used as long as necessary.DesignA single blind controlled study was conducted on 11 pharmacies in the Community of Valencia.SettingEleven pharmacies in the Community of Valencia.ParticipantsPatients older than 65 years treated with BZD attending the participating pharmacies.InterventionsInterviews and pharmaceutical care for a year.Main measurementdetection of duplications, adverse drug reactions, drug interactions and measuring the effectiveness of the treatment.ResultsWe studied 314 patients, randomised to control or intervention and who used 346 BZD. The majority (67 %) of patients used BZD for more than 1 year. Only 5 % patients with anxiety knew the duration of treatment should be one month. Long-acting BZD were used by 20 % of the patients, 76 % used medium-acting (39 % lorazepam and 37 % other BZD) and 4 % short-acting BZD. A total of 132 drug interactions were detected and 278 adverse drug reactions: 32 % memory loss, 21 % drowsiness, 12 % lack of coordination, 8.3 % dizziness and confusion, 8,3 % disorientation and 10 % others. A total of 426 pharmacist interventions were performed, 30 accepted by the doctor and 78 were resolved at the end of the year of study. Eleven per cent of cases were considered satisfactory in the control group and 30 % in the intervention group.ConclusionThe use of benzodiazepines in the Community of Valencia exceeds the recommendations of the Spanish Medicines Agency.     

Le paludisme grave de l’enfant en milieu hospitalier sénégalais

Objectives: The authors had for aim to establish the frequency of severe malaria in pediatric medical emergencies, the distribution of its various clinical forms, and its lethality in hospital settings.Method: A prospective study was carried out from July 1st, 1998 to December 31st, 1999 at the Dakar Albert Royer Children’s Hospital. All the children admitted in the ICU with a positive thick blood drop and at least one WHO criterion of malaria gravity was included.Results: Severe malaria accounted for 16% of the medical emergencies. Neurological manifestation were the most frequent (75% to 97%). Anemia was significantly higher in younger patients (24.5%) and lethality reached 14.5%.Comments: The incidence of severe malaria in Dakar has not changed in the last 30 years. However the disease occurs earlier during the transmission period.Thus, it is necessary to promote an early management of severe malaria and to improve the technical level of assistance in order to reduce the lethality of this disease in Senegal.