Patients' and professionals' views on managing fibromyalgia

BACKGROUND: Managing fibromyalgia is a challenge for both health care systems and the professionals caring for these patients, due, in part, to the fact that the etiology of this disease is unknown, its symptoms are not specific and there is no standardized treatment. OBJECTIVE: The present study examines three aspects of fibromyalgia management, namely diagnostic approach, therapeutic management and the health professional-patient relationship, to explore specific areas of the health care process that professionals and patients may consider unsatisfactory. METHODS: A qualitative study involving semistructured interviews with 12 fibromyalgia patients and nine health professionals was performed. RESULTS: The most commonly recurring theme was the dissatisfaction of both patients and professionals with the management process as a whole. Both groups expressed dissatisfaction with the delay in reaching a diagnosis and obtaining effective treatment. Patients reported the need for greater moral support from professionals, whereas the latter often felt frustrated and of little help to patients. Patients and professionals agreed on one point: the uncertainty surrounding the management of fibromyalgia and, especially, its etiology. CONCLUSION: The present study contributes to a better understanding regarding why current management of fibromyalgia is neither effective nor satisfactory. It also provides insight into how health professionals can support fibromyalgia patients to achieve beneficial results. Health care services should offer greater support for these patients in the form of specific resources such as fibromyalgia clinics and health professionals with increased awareness of the disease.

Social determinants and health effects of low and high severity intimate partner violence

PURPOSE: We sought to analyze whether the sociodemographic profile of battered women varies according to the level of severity of intimate partner violence (IPV), and to identify possible associations between IPV and different health problems taking into account the severity of these acts. METHODS: A cross-sectional study of 8,974 women (18-70 years) attending primary healthcare centers in Spain (2006-2007) was performed. A compound index was calculated based on frequency, types (physical, psychological, or both), and duration of IPV. Descriptive and multivariate procedures using logistic regression models were fitted. RESULTS: Women affected by low severity IPV and those affected by high severity IPV were found to have a similar sociodemographic profile. However, divorced women (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.2-20.3), those without tangible support (OR, 6.6; 95% CI, 3.3-13.2), and retired women (OR, 2.7; 95% CI, 1.2-6.0) were more likely to report high severity IPV. Women experiencing high severity IPV were also more likely to suffer from poor health than were those who experienced low severity IPV. CONCLUSIONS: The distribution of low and high severity IPV seems to be influenced by the social characteristics of the women involved and may be an important indicator for estimating health effects. This evidence may contribute to the design of more effective interventions.

Evaluación de la calidad de vida relacionada con la salud mediante las láminas Coop-Wonca en una población de hemodiálisis

Ante la necesidad de disponer de instrumentos que permitan medir calidad de vida relacionada con la salud (CVRS) de una manera ágil y rápida, nos planteamos estudiar, en un grupo de pacientes en hemodiálisis, las propiedades de medición de las láminas Coop-Wonca con el objetivo de establecer si reúnen las condiciones para su uso rutinario en este tipo de pacientes. Métodos: Estudio transversal en 163 pacientes de hemodiálisis (106 varones y 57 mujeres) procedentes de 3 centros. Para medir la CVRS de la población estudiada se ha utilizado la versión validada española de las láminas Coop-Wonca completa. Este cuestionario comprende nueve dimensiones de función y bienestar de un único ítem: 1.– Forma física; 2.–Sentimientos; 3.–Actividades cotidianas; 4.–Actividades sociales; 5.–Cambio en el estado de salud; 6.–Estado de salud; 7.–Dolor; 8.–Apoyo social; y 9.–Calidad de vida en general. Las posibles respuestas se puntúan de 1 a 5, siendo las puntuaciones mayores las que reflejan una peor salud percibida. El instrumento permite la obtención de un índice (Coop total) que es un sumatorio de las puntuaciones de todas las dimensiones salvo la 5 (Cambio en el estado de salud). Resultados: El tiempo medio de cumplimentación del cuestionario fue inferior a 5 minutos. Las láminas resultaron fácilmente comprensibles para los pacientes y la autoadministración de las mismas no planteó problemas. Las puntuaciones más altas (peor CVRS) se obtuvieron en las dimensiones «forma física» (3,66 ± 0,8) y «estado de salud» (3,43 ± 0,8), y la menor (mejor CVRS) en la dimensión «actividades sociales» (1,98 ± 1,3). Entre los principales factores asociados a un peor estado de salud percibida figuran el sexo (mujer), la comorbilidad (presencia de diabetes y/o hepatopatía), la situación laboral (pensionista) y el medio de transporte (taxi-ambulancia). Un mayor tiempo en hemodiálisis se asoció a peores puntuaciones en las dimensiones «calidad de vida en general» y «Dolor». Los pacientes que se trasladaban en taxi o ambulancia presentaban peores puntuaciones en las dimensiones «Forma física», «Actividades cotidianas» y «Estado de salud». Una mayor se asoció a peor puntuación en «Forma física». Un número elevado de fármacos prescritos (más de seis) se asoció a peor puntuación en las dimensiones «Forma física», «Actividades sociales» y «Apoyo social». Los varones, los viudos y los solteros puntuaron peor en «Apoyo social». Los pacientes con mayor nivel de estudios mostraron puntuaciones más altas (peor CVRS) en la dimensión «Forma física». Conclusiones: Las láminas Coop-Wonca podrían ser un buen instrumento de medida de CVRS en los pacientes de hemodiálisis, por la rapidez de su cumplimentación y por ser de fácil comprensión lo que favorece la autoadministración que evita el posible sesgo del entrevistador. Todo ello favorecería su uso rutinario como indicador par valorar la evolución en el tiempo de la CVRS de los pacientes en hemodiálisis. No obstante, se precisan estudios ulteriores que permitan evaluar en mayor profundidad las propiedades psicométricas del instrumento en este tipo de pacientes.

Apoyo social formal a un grupo de madres con hijos menores de un año

Objetivo: este trabajo pretende analizar el apoyo social formal a un grupo de madres con hijos menores de un año. Método: estudio cualitativo, descriptivo interpretativo, en el cual participaron diez mujeres en un grupo focal que se reunió en siete ocasiones. Resultados: a partir del análisis de contenido de las dinámicas grupales se detecta que el apoyo formal informativo es el más frecuente y resulta difícil separarlo del emocional. Los profesionales, a través del apoyo informativo, tratan temas relacionados con la promoción de la salud y prevención de la enfermedad y acompañan a las madres en este rol. Conclusión: para las madres el apoyo formal brindado por el personal de enfermería es positivo y percibido como un refuerzo en su vivencia de la maternidad, y debe estar enmarcado en un contexto cultural.

Satisfacción en la provisión de redes de apoyo social en grupos de acompañamiento a la maternidad

Objetivos: Conocer la percepción del grado de satisfacción que tienen las madres, con hijos menores de un año y que participan en las dinámicas grupales que los CAP ofrecen, en relación al contenido y redes de provisión del Apoyo Social (AS) así como las causas que disminuyen la satisfacción en el receptor de este apoyo. Material y métodos: Estudio con diseño cualitativo y enfoque fenomenológico. La población objeto de estudio estaba constituida por madres participantes en dinámicas grupales de cinco CAP de la provincia de Barcelona. Como instrumento de recogida de datos se empleó la entrevista semiestructurada, entre julio de 2011 y julio de 2012; todas fueron grabadas, transcritas y analizadas. Resultados: AS informal: la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional y evaluativo procedente de las enfermeras; identificándose 4 categorías que contribuyen en esta percepción: contacto profesional/accesibilidad, disparidad y/o actualización, confianza y no procede. AS formal, la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional, evaluativo y técnico procedente de la pareja y madre (abuela materna); identificándose 8 categorías en esta percepción: disparidad y/o actualización en los consejos, exigencia, empatía, confianza, inseguridades, tiempo, distancia y no procede. Conclusiones: Los factores identificados deberían considerarse en los planes de mejora de la satisfacción y acompañamiento de las madres en este momento de profundos cambios en su vida; dado que aportar un AS satisfactorio repercute en la promoción de la salud y prevención de la enfermedad.

Psychometric properties of the School Anxiety Inventory-Short Version in Spanish secondary education students

Background: The School Anxiety Inventory (SAI) can be applied in different fields of psychology. However, due to the inventory’s administration time, it may not be useful in certain situations. To address this concern, the present study developed a short version of the SAI (the SAI-SV). Method: This study examined the reliability and validity evidence drawn from the scores of the School Anxiety Inventory-Short Version (SAI-SV) using a sample of 2,367 (47.91% boys) Spanish secondary school students, ranging from 12 to 18 years of age. To analyze the dimensional structure of the SAI-SV, exploratory and confirmatory factor analyses were applied. Internal consistency and test-retest reliability were calculated for SAISV scores. Results: A correlated three-factor structure related to school situations (Anxiety about Aggression, Anxiety about Social Evaluation, and Anxiety about Academic Failure) and a three-factor structure related to the response systems of anxiety (Physiological Anxiety, Cognitive Anxiety, and Behavioral Anxiety) were identified and supported. The internal consistency and test-retest reliability were determined to be appropriate. Conclusions: The reliability and validity evidence based on the internal structure of SAI-SV scores was satisfactory.

Social and immigration factors in intimate partner violence among Ecuadorians, Moroccans and Romanians living in Spain

Background: Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics. Methods: Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different women’s personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by women’s country of origin. Results: Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39–25.62)] and low religious involvement [AOR 2.17 (1.06–4.43)]. The likelihood of current IPV was lower among women without children or other dependants in this subgroup [AOR 0.29 (0.093–0.92)]. Conclusion: The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women.

Professionals’ Perceptions of Support Resources for Battered Immigrant Women Chronicle of an Anticipated Failure

The aim of this study was to explore the experience of service providers in Spain regarding their daily professional encounters with battered immigrant women and their perception of this group’s help-seeking process and the eventual abandonment of the same. Twenty-nine in-depth interviews and four focus group discussions were conducted with a total of 43 professionals involved in providing support to battered immigrant women. We interviewed social workers, psychologists, intercultural mediators, judges, lawyers, and public health professionals from Spain. Through qualitative content analysis, four categories emerged: (a) frustration with the victim’s decision to abandon the help-seeking process, (b) ambivalent positions regarding differences between immigrant and Spanish women, (c) difficulties in the migratory process that may hinder the help-seeking process, and (d) criticisms regarding the inefficiency of existing resources. The four categories were cross-cut by an overarching theme: helping immigrant women not to abandon the help-seeking process as a chronicle of anticipated failure. The main reasons that emerged for abandoning the help-seeking process involved structural factors such as economic dependence, loss of social support after leaving their country of origin, and limited knowledge about available resources. The professionals perceived their encounters with battered immigrant women to be frustrating and unproductive because they felt that they had few resources to back them up. They felt that despite the existence of public policies targeting intimate partner violence (IPV) and immigration in Spain, the resources dedicated to tackling gender-based violence were insufficient to meet battered immigrant women’s needs. Professionals should be trained both in the problem of IPV and in providing support to the immigrant population.

Life Experiences of People Affected by Crohn’s Disease and Their Support Networks Scoping Review

This scoping review identifies and describes relevant studies related to the evidence published on life experiences and perceived social support of people affected by Crohn’s disease. Twenty-three studies were definitely selected and analyzed for the topics explored. The overall findings show patients’ needs and perceptions. There is a lack of evidence about patients’ perceived needs as well as the understanding of social support that has contributed to improve their life experiences with that chronic illness. Lack of energy, loss of body control, body image damaged due to different treatments and surgeries, symptoms related to fear of disease, feeling burdened loss related to independence, and so on are some of the concerns with having to live with those affected by the Crohn. To underline those experiences through this scoping review provides valuable data for health care teams, especially for the nursing profession, considered by those affected as one of the main roles along the whole pathological process. This review provides the basis for developing broader research on the relatively underexplored topics and consequently improves specific programs that could address patients’ needs.

Percepciones de pacientes con fibromialgia sobre el impacto de la enfermedad en el ámbito laboral

Objetivo: Explorar las percepciones de pacientes con fibromialgia (FM) sobre los problemas que experimentan en el ámbito laboral, para analizar cómo se enfrentan a ellos y se adaptan a las limitaciones derivadas de los síntomas de esta enfermedad. Diseño: Estudio cualitativo exploratorio realizado en 2009. Emplazamiento: Asociaciones de pacientes con FM de la Comunidad Valenciana (España). Participantes: Dieciséis personas (13 mujeres y 3 hombres) diagnosticadas de FM por un reumatólogo, de distintas edades y ocupaciones, seleccionadas a partir de informantes clave y por la técnica de bola de nieve. Método: Muestreo pragmático. Entrevistas semiestructuradas hasta alcanzar la saturación de la información cuando no emergían contenidos nuevos. Análisis de contenido cualitativo utilizando el software informático Atlas.ti-5 para generar y asignar códigos, formar categorías e identificar un tema latente. Resultados: Se identificaron 4 categorías: las dificultades para cumplir las exigencias laborales, la necesidad de apoyo social en el entorno laboral, las estrategias adoptadas para continuar trabajando y la resistencia a abandonar el mercado de trabajo. De forma transversal a estas categorías emergió un tema: la disposición de permanecer o reincorporarse al mercado laboral. Conclusiones: Se requiere atender las necesidades específicas de los pacientes con el fin de que logren permanecer en el mercado laboral, de acuerdo a sus capacidades. Para ello, emerge la necesidad de programas de sensibilización sobre las consecuencias de la FM en el entorno laboral para lograr la colaboración de los directivos, empresarios, profesionales de Atención Primaria y médicos del trabajo.

School Anxiety Inventory: Reliability and Validity Evidence in a Sample of Slovenian Adolescents

The purpose of this study was to examine the reliability and validity of the School Anxiety Inventory (SAI) using a sample of 646 Slovenian adolescents (48% boys), ranging in age from 12 to 19 years. Single confirmatory factor analyses replicated the correlated four-factor structure of scores on the SAI for anxiety-provoking school situations (Anxiety about School Failure and Punishment, Anxiety about Aggression, Anxiety about Social Evaluation, and Anxiety about Academic Evaluation), and the three-factor structure of the anxiety response systems (Physiological Anxiety, Cognitive Anxiety, and Behavioral Anxiety). Equality of factor structures was compared using multigroup confirmatory factor analyses. Measurement invariance for the four- and three-factor models was obtained across gender and school-level samples. The scores of the instrument showed high internal reliability and adequate test–retest reliability. The concurrent validity of the SAI scores was also examined through its relationship with the Social Anxiety Scale for Adolescents (SASA) scores and the Questionnaire about Interpersonal Difficulties for Adolescents (QIDA) scores. Correlations of the SAI scores with scores on the SASA and the QIDA were of low to moderate effect sizes.