Quality of pain treatment after caesarean section: Results of a multicentre cohort study.

BACKGROUND A large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment. METHODS We analysed pain scores, pain-related interferences (with movement, deep breathing, mood and sleep), analgesic techniques, analgesic consumption, adverse effects and the wish to have received more analgesics during the first 24 h after surgery. To better evaluate the severity of impairment by pain, the results of CS patients were compared with those of patients undergoing hysterectomy. RESULTS CS patients (n = 811) were compared with patients undergoing abdominal, laparoscopic-assisted vaginal or vaginal hysterectomy (n = 2406, from 54 hospitals). Pain intensity, wish for more analgesics and most interference outcomes were significantly worse after CS compared with hysterectomies. CS patients with spinal or general anaesthesia and without patient-controlled analgesia (PCA) received significantly less opioids on the ward (62% without any opioid) compared with patients with PCA (p < 0.001). Patients with PCA reported pain-related interference with movement and deep breathing between 49% and 52% compared with patients without PCA (between 68% and 73%; p-values between 0.004 and 0.013; not statistically significant after correction for multiple testing). CONCLUSION In daily clinical practice, pain after CS is much higher than previously thought. Pain management was insufficient compared with patients undergoing hysterectomy. Unfavourable outcome was mainly associated with low opioid administration after CS. Contradictory pain treatment guidelines for patients undergoing CS and for breastfeeding mothers might contribute to reluctance of opioid administration in CS patients.

Quality standards for bone conduction implants.

CONCLUSION Bone conduction implants are useful in patients with conductive and mixed hearing loss for whom conventional surgery or hearing aids are no longer an option. They may also be used in patients affected by single-sided deafness. OBJECTIVES To establish a consensus on the quality standards required for centers willing to create a bone conduction implant program. METHOD To ensure a consistently high level of service and to provide patients with the best possible solution the members of the HEARRING network have established a set of quality standards for bone conduction implants. These standards constitute a realistic minimum attainable by all implant clinics and should be employed alongside current best practice guidelines. RESULTS Fifteen items are thoroughly analyzed. They include team structure, accommodation and clinical facilities, selection criteria, evaluation process, complete preoperative and surgical information, postoperative fitting and assessment, follow-up, device failure, clinical management, transfer of care and patient complaints.

Quality of care for uninsured type 2 diabetic patients in a financial assistance medical home model

The medically uninsured population in the United States is 16% or 42 million people and consists of a significant number of Type 2 diabetic patients which is the predominant form of diabetes with 798,000 new cases diagnosed each year. There is limited health services research on uninsured populations concerning health system measures or specific disease conditions. ^ The purpose of this investigation was to determine the impact a newly implemented health care program had on the quality of care provided to patients with Type 2 diabetes. The primary study objective was to compare the quality of care while controlling for utilization, and health status of patients in the new program to their status during the previous financial assistance program. The research design was a retrospective matched-pairs design. The study population consisted of 225 patients who received medical care during 1996 and 1997 at the University Health System in San Antonio, Texas. ^ Six quality of care measures individually failed to demonstrate a statistically significant difference when compared between the two periods. However, an index measure reflecting the number of patients who received all six of the quality of care measures demonstrated a statistically significant increase in 1997 (p-value < 0.05). In 1996, 8 patients (2.6%) received all six medical management components. In 1997, 38 patients (16.8%) received all six medical management components. Four regression models were analyzed; two out of the four models demonstrated inconsistent results based on the program membership variable. ^ It is concluded that there has been a small effect of the Carelink program demonstrated by an increase from 8 to 38 patients receiving all quality of care components for Type 2 diabetics at the UHS. It is recommended that additional research be conducted in order to evaluate the quality of care provided to Type 2 diabetic patients. ^

QUALITY OF MATERNITY CARE IN RURAL TEXAS (MEXICAN-AMERICAN)

The purpose of the study was to describe regionalized systems of perinatal care serving predominantly low income Mexican-American women in rural underserved areas of Texas. The study focused upon ambulatory care; however, it provided a vehicle for examination of the health care system. The questions posed at the onset of the study included: (1) How well do regional organizations with various patterns of staffing and funding levels perform basic functions essential to ambulatory perinatal care? (2) Is there a relationship between the type of organization, its performance, and pregnancy outcome? (3) Are there specific recommendations which might improve an organization's future performance?^ A number of factors--including maldistribution of resources and providers, economic barriers, inadequate means of transportation, and physician resistance to transfer of patients between levels of care--have impeded the development of regionalized systems of perinatal health care, particularly in rural areas. However, studies have consistently emphasized the role of prenatal care in the early detection of risk and treatment of complications of pregnancy and childbirth, with subsequent improvement in pregnancy outcomes.^ This study has examined the "system" of perinatal care in rural areas, utilizing three basic regional models--preventive care, limited primary care, and fully primary care. Information documented in patient clinical records was utilized to compare the quality of ambulatory care provided in the three regional models.^ The study population included 390 women who received prenatal care in one of the seven study clinics. They were predominantly hispanic, married, of low income, with a high proportion of teenagers and women over 35. Twenty-eight percent of the women qualified as migrants.^ The major findings of the study are listed below: (1) Almost half of the women initiated care in the first trimester. (2) Three-fourths of the women had or exceeded the recommended number of prenatal visits. (3) There was a low rate of clinical problem recognition. Additional follow-up is needed to determine the reasons. (4) Cases with a tracer condition had significantly more visits with monitoring of the clinical condition. (5) Almost 90% of all referrals were completed. (6) Only 60% of mothers had postpartum follow-up, while almost 90% of their newborns received care. (7) The incidence of infants weighing 2500 grams or less was 4.2%. ^

Attitudes toward end-of-life decision making in South Texas

Advance care planning has the potential to create positive outcomes in the realm of end-of-life health care. The completion of advance directives and living wills are vital in equipping patients with autonomy and ensuring that their end-of-life wishes are respected. However, there remains a lack of knowledge and low completion rates of advance directives despite their possible improvements and ramifications on health care at the end of life. This study seeks to determine the knowledge of and attitudes towards end-of-life decision-making in South Texas. The study is designed as a cross-sectional, exploratory survey using a descriptive survey instrument to query 71 subjects in South Texas. The setting for the study includes three distinct groups, two in San Antonio, Texas and one in Brownsville, Texas. Unique differences in demographics between the three groups, such as variability in age, ethnicity, language and religious affiliation allowed for preliminary associations to be concluded in describing the results of the survey instrument. Ultimately, this study describes the attitudes and perceptions of advance care planning in South Texas and reveals the need for further education and awareness of the topic, perhaps indicating the need for a public health initiative in this regard.^

Docencia universitaria en ambientes saludables : diseño ergonómico para espacios y equipamiento

El trabajo plantea el estudio de ‘ambientes saludables’ en edificios de instituciones académicas, particularmente del campus de la Universidad Nacional de Cuyo. Su propósito es mejorar la calidad de vida, salud y seguridad de las personas en el trabajo. Se elaboraron propuestas como ‘guía de recomendaciones’ para el diseño y adquisición de equipamiento universitario. El método aplicado es el propio de la Ergonomía, incluyendo: análisis de tareas, desarrollo de propuestas, experimentación, validación, seguimiento. El resultado puede aplicarse a los edificios del contexto antes señalado y a otros similares, pudiendo transferirse asimismo a la enseñanza de la Ergonomía en diferentes disciplinas.

Mathematical models for the arrangement and the cleaning of the river basin and surroundings of the river sandy grounds to its passage by the city of Salta (Argentina)

The province of Salta is located the Northwest of Argentina in the border with Bolivia, Chile and Paraguay. Its Capital is the city of Salta that concentrates half of the inhabitants of the province and has grown to 600000 hab., from a small active Spanish town well founded in 1583. The city is crossed by the Arenales River descending from close mountains at North, source of water and end of sewers. But with actual growing it has become a focus of infection and of remarkable unhealthiness. It is necessary to undertake a plan for the recovery of the river, directed to the attainment of the well-being and to improve the life?s quality of the Community. The fundamental idea of the plan is to obtain an ordering of the river basin and an integral management of the channel and its surroundings, including the cleaning out. The improvement of the water?s quality, the healthiness of the surroundings and the improvement of the environment, must go hand by hand with the development of sport activities, of relaxation, tourism, establishment of breeding grounds, kitchen gardens, micro enterprises with clean production and other actions that contribute to their benefit by the society, that being a basic factor for their care and sustainable use. The present pollution is organic, chemical, industrial, domestic, due to the disposition of sweepings and sewer effluents that affects not only the flora and small fauna, destroying the biodiversity, but also to the health of people living in their margins. Within the plan it will be necessary to consider, besides hydric and environmental cleaning and the prevention of floods, the planning of the extraction of aggregates, the infrastructure and consolidation of margins works and the arrangement of all the river basin. It will be necessary to consider the public intervention at state, provincial and local level, and the private intervention. In the model it has been necessary to include the sub-model corresponding to the election of the entity to be the optimal instrument to reach the proposed objectives, giving an answer to the social, environmental and economic requirements. For that the authors have used multi-criteria decision methods to qualify and select alternatives, and for the programming of their implementation. In the model the authors have contemplated the short, average and long term actions. They conform a Paretooptimal alternative which secures the ordering, integral and suitable management of the basin of the Arenales River, focusing on its passage by the city of Salta.

El recorrido: evaluación de las cualidades sensoriales y formales del medio urbano como parte de los criterios de caminabilidad. La ciudad de Taipei como caso de estudio

La presente investigación aborda el análisis de las cualidades del entorno urbano que inciden en la experiencia perceptiva de su recorrido. Los intereses que la motivan tienen que ver con la recuperación de la ciudad para el viandante y se sitúa dentro de un marco de intereses más amplio como es el de la ciudad sostenible. En primer lugar, se contextualiza el tema de la experiencia del recorrido a través de disciplinas diferentes como son el cine, la literatura, la arquitectura, el urbanismo, la arquitectura del paisaje, la psicología y la estética ambiental. De este modo, se refuerza el argumento en torno al papel que desempeñan la forma y otros estímulos sensoriales en la experiencia del espacio, ya sea éste urbano, arquitectónico o natural. La experiencia que las personas viven al desplazarse por un entorno viene definida por infinitos factores que van desde la configuración física del entorno recorrido, hasta el aprendizaje cultural de la persona que camina; desde los estímulos sensoriales que se reciben, hasta las condiciones físicas que posibilitan la funcionalidad del recorrido; desde las sutilezas de índole secuencial que se desvelan a medida que avanzamos, hasta las condiciones higrotérmicas en el momento en que se lleva a cabo el desplazamiento. Sin embargo, factores como las motivaciones y atenciones personales del que anda, así como sus recuerdos de experiencias anteriores, deseos, imaginación y estado de ánimo, también definen nuestra experiencia al caminar que, indudablemente, se encuentra ligada a nuestra personalidad y, por lo tanto, no puede ser exacta a la de otra persona. Conscientes de que todos estos factores se funden en un fenómeno global, y que no se dan en la vida por separado, nos hemos esforzado por independizar las cualidades sensoriales y formales, únicamente a efectos de investigación. La importancia del tema a investigar reside en las conexiones que existen entre las cualidades del medio construido y la experiencia cotidiana de su recorrido, en la medida en que dicha vinculación establece relaciones con la calidad de vida, la salud de los ciudadanos y sus sentimientos de identidad. En este sentido, el problema clave encontrado es que si la definición de la experiencia del recorrido urbano es demasiado amplia, se vuelve nebulosa e inoperativa, pero si se precisa demasiado, se pueden excluir variables importantes. Hemos concentrado nuestros esfuerzos en buscar un medio que permita hacer operativo el estudio de aspectos que, por su propia naturaleza, son difíciles de controlar y aplicar en la práctica. En este sentido, el campo de estudio que aúna interés en el tema, producción científica y vocación práctica, es el de la caminabilidad de las ciudades. Por esta razón, hemos situado nuestro trabajo dentro del marco de criterios que este campo establece para valorar un entorno caminable. Sin embargo, hemos detectado que los trabajos sobre caminabilidad tienden a desarrollarse dentro de la disciplina del planeamiento de transporte y, con frecuencia, siguiendo las mismas pautas que la investigación sobre el transporte motorizado. Además, la tendencia a proporcionar datos numéricos producto de la medición controlada de variables, para respaldar iniciativas dentro de los ámbitos de toma de decisiones, lleva consigo un progresivo alejamiento de los aspectos más sutiles y próximos de la experiencia de las personas y la especificidad de los lugares. Por estas razones, hemos estimado necesario profundizar en la experiencia peatonal explorando otras líneas de trabajo como son la habitabilidad de las ciudades, políticas llevadas a cabo para mejorar la calidad del espacio público o las certificaciones de sostenibilidad en el ámbito del urbanismo. También se han estudiado las aproximaciones gráficas a la representación y simulación de recorridos urbanos por su importancia en la comunicación y promoción de caminar. Para detectar las problemáticas implicadas en la definición de una herramienta que permita valorar, de manera operativa, la calidad de la experiencia del recorrido urbano, la metodología de valoración propuesta se ha basado en la combinación de distintos métodos y en la conjugación de tres aproximaciones: valoración por parte del investigador en calidad de experto, valoración realizada por el investigador en el papel de usuario y valoración por el ciudadano. El desarrollo de esta investigación se ha visto condicionado por la intención de aplicar lo estudiado en un caso práctico. El marco de criterios que los trabajos sobre caminabilidad de las ciudades establecen para que se dé un entorno caminable, se puede resumir en que concurran los siguientes factores: mezcla de usos, densidad de población y edificación relativamente altas, destinos públicos accesibles a pie, un alto grado de seguridad con respecto al tráfico y actos delictivos, alta funcionalidad (dimensiones, pendientes, etc.) y atractivo. Una vez definido el modelo de ciudad en que es pertinente realizar una investigación sobre las cualidades del entorno urbano responsables de que éste se perciba como atractivo, se escogió la ciudad de Taipei, entre otras razones, por cumplir con los requisitos restantes. Con respecto al caso práctico, el objetivo es detectar fortalezas y debilidades del área central de la ciudad de Taipei en cuanto a la experiencia perceptiva que proporciona a los viandantes. ABSTRACT This research addresses the analysis of the qualities of the urban environment that affect the perceptual experience of walking. The interests lying behind it are related to the recovery of the city for pedestrians, and is framed within the sustainable city framework of interests. Firstly, the issue of the experience of walking is contextualized through different disciplines such as film, literature, architecture, urban planning, landscape architecture, environmental psychology and aesthetics. This way, the argument about the role that form and other sensory stimuli play in the experience of space, whether it is urban, architectural or natural, is strengthened. The walking experience of people is defined by factors ranging from the physical configuration of the environment to the cultural background of the person who walks, from the sensory stimuli that are perceived to the physical conditions that enable the functionality of the walk, from the subtleties of sequential nature that are revealed as we move around to hygrothermal conditions at the specific time of walking. Nevertheless, factors such as personal motivations and attentions of the walker, as well as memories of past experiences, desires, imagination and mood, also define our walking experience that is undoubtedly linked to our personality and, therefore, it cannot be exactly the same as other people's experience. Being aware that all these factors come together in a total phenomenon and that, in real life, they do not exist separately, we focused on separating sensory and formal qualities only for research purposes. The importance of the research topic lies in the connections between the qualities of the built environment and the quotidian experience of walking through it, to the extent that such link establishes relationships with the quality of life, health and feelings of identity of citizens. In this sense, the key problem encountered is that, if the definition of urban walking experience is too broad, it becomes nebulous and non‐operational, but if it is too precise, important variables can be excluded. We concentrated our efforts on finding a way to operationalize the study of questions that, by their very nature, are difficult to control and apply in practice. In this regard, the field of study that combines interest in the topic, scientific production and practical purpose, is the walkability of cities. For this reason, we placed our work within the framework of the set of criteria that this field establishes for assessing an environment as walkable. However, we found that works on walkability tend to be developed within the discipline of transportation planning and often following the same guidelines that research on motorized transport. Furthermore, the tendency to provide numerical data as a result of the controlled measurement of variables in order to support initiatives in decision making areas, involves a progressive distancing from the proximity and the most subtle aspects of the experience of people, and from the specificity of places. For these reasons, we considered it was necessary to deepen into the study of pedestrians experience, by exploring other lines of work such as the livability of cities, implemented policies to improve the quality of the public space or sustainability certifications in urbanism. Graphic representation and simulation of urban walks are also studied due to their important role in communication and promotion of walking. In order to find the issues involved in defining a tool to assess, in an operational way, the quality of urban walking experience, the proposed assessment methodology is based on the combination of different methods and the synthesis of three approaches: assessment by the researcher as expert, assessment by the researcher playing the role of user and assessment by the citizens. The development of this research has been conditioned by our intention of applying it in a case study. The framework of criteria that works on walkability of cities set to define a walkable environment, can be summarized in the following factors: mix of uses, population and building density rather high, public destinations accessible on foot, high levels of safety in terms of traffic and crime, high functionality (dimensions, slopes, etc.) and attractiveness. After defining the model of city in which it is relevant to conduct an investigation on the qualities that are responsible of the attractiveness of the environment; Taipei City was selected because it meets the remaining requirements, among other reasons. Regarding the case study, the goal is to identify strengths and weaknesses in the central area of Taipei City in terms of the perceptual experience of pedestrians.

Colaboração interprofissional na Estratégia Saúde da Família e a produção do cuidado em saúde durante o pré-natal

Introdução: Uma das mudanças mais importantes na produção do cuidado à saúde é a reorganização do processo de trabalho para a atuação de equipes multiprofissionais com abordagens interdisciplinares. A colaboração interprofissional tem sido apontada como um recurso que pode ser mobilizado para elevar a efetividade dos sistemas de saúde, e como estratégia inovadora, ela pode desempenhar um importante papel para enfrentar problemas do modelo de atenção e da força de trabalho em saúde. Objetivo: Descrever as percepções e atitudes de profissionais de saúde da Estratégia de Saúde da Família sobre as relações interprofissionais na atenção ao pré-natal, construir coletivamente e testar um protocolo de atenção à gestante para impulsionar as competências no trabalho colaborativo com vistas ao incremento da qualidade do cuidado. Métodos: Para isso, realizou-se previamente um estudo observacional descritivo para seleção de duas unidades de saúde. Na sequência foi realizado um estudo de intervenção do tipo antes e depois, com um grupo de controle pós-teste, incluindo métodos mistos. A população do estudo compreendeu oito profissionais de saúde (médicos, dentistas, enfermeiros e técnicos em saúde bucal) e 60 gestantes cadastradas em duas unidades de saúde da família do município de Uberlândia, sendo 36 incluídas no grupo intervenção e 24 no grupo controle. Dados numéricos, narrativas provenientes de entrevistas e registros de diário de campo foram usados para identificar mudanças na autoavaliação da saúde bucal, na qualidade de vida relacionada à saúde bucal medida pelo OHIP-14, na percepção das gestantes sobre o trabalho em equipe e nas práticas profissionais. Testes estatísticos para detectar diferenças de significância e análise temática de conteúdo foram empregados para interpretar os desfechos. Resultados: Em geral, observou-se percepção/atitude favorável dos profissionais em relação à colaboração interprofissional. Diferenças entre as categorias profissionais podem representar uma barreira subjetiva à implementação de protocolos que demandariam maior grau de trabalho colaborativo. Diferenças entre as unidades de atenção primária mostraram que a interação entre membros das equipes multiprofissionais pode sobrepujar dificuldades decorrentes do modo isolado e distinto no qual cada categoria profissional é formada. Foi produzido um Protocolo de Atenção à Gestante abrangendo o fluxo e a dinâmica dos processos de trabalho dentro de uma perspectiva de colaboração interprofissional. Segundo os profissionais, a intervenção apesar do seu caráter desafiador, estimulou o comprometimento da equipe para reorientar o processo de trabalho resultando em maior interação profissional colaborativa. Em relação às gestantes, a maioria era jovem (menos de 26 anos de idade) e tinha ensino médio incompleto ou completo sem diferenças significativas entre os grupos teste e controle. Gestantes do grupo intervenção perceberam que os profissionais trabalhavam mais em equipe do que as gestantes do grupo controle. De modo geral, as gestantes avaliaram que a saúde bucal e a qualidade de vida decorrente da saúde bucal melhoraram após a intervenção. Conclusões: Concluiu-se que apesar da percepção geral dos profissionais favorável à colaboração interprofissional, recursos formais e organizacionais não estavam sendo empregados. O método ZOPP se mostrou flexível e adequado para o desenvolvimento de competências para o trabalho colaborativo e para a construção de um protocolo de organização de serviços na atenção primária à saúde. O Protocolo de Atenção à Gestante testado provocou tensões e produziu efeitos positivos na colaboração interprofissional e na qualidade de vida relacionada à saúde bucal contribuindo para qualificar a atenção ao pré-natal oferecido.

Estância Hidromineral de Águas de São Pedro (SP) e a construção de um espaço voltado ao termalismo

Este trabalho discorre sobre como o município de Águas de São Pedro, situado no centro do Estado de São Paulo, constituído na década de 1930 como um espaço voltado à atividade turística, destaca-se pelo potencial termal. Até hoje a estância hidromineral tem no turismo a principal atividade econômica; entretanto, nossa pesquisa busca compreender se o atrativo primordial do Município está atrelado às águas medicinais, ou se outras características singulares da pequena cidade, como tranquilidade, beleza paisagística e segurança, o tornam um lugar propício ao passeio. Buscamos entender por que, dentre tantas opções de cidades interioranas disponíveis em São Paulo, Águas de São Pedro é escolhida como local de residência fixa, lugar de estabelecimento de casas de veraneio, sendo palco de um grande crescimento imobiliário; assim, desvendamos quais fatores da estância são responsáveis por atrair os turistas e veranistas/turistas de segunda residência. Os dados da pesquisa foram obtidos por meio de pesquisa bibliográfica, observação direta, conversas informais, aplicação de questionários e entrevistas com vários atores socioeconômicos, tais como moradores, turistas, veranistas, rede hoteleira, comércios, imobiliárias e gestores municipais. Os resultados apontam que o município já passou por vários ciclos turísticos e, apesar de a estância hidromineral de Águas de São Pedro ser uma referência regional e até nacional de águas termais, e do poder público estar investindo para apresentar à sociedade um lugar cheio de qualidade de vida, símbolo de bem-estar, grande parcela dos turistas procura a cidade pelo passeio, gastronomia e compras, caracterizando um turismo excursionista, sem pernoite. Este é o motivo pelo qual a cidade vem passando por grande reestruturação paisagística, orquestrada pelo poder público e porque recebe incrementos do poder privado no que se refere à variedade de produtos e serviços ofertados. Percebemos que a maior parcela de moradores e turistas não têm o hábito de utilizar as águas medicinais, mesmo sabendo que a água sulfurosa, também chamada de \"Fonte da Juventude\", utilizada para ingestão e banhos terapêuticos, é a segunda melhor do mundo, superada apenas pela fonte de Pergoli, em Tabiano, na Itália (CAMARGO, 1990), porém o reconhecimento da Cidade como cidade das águas, cidade termal, cidade saúde, é resiliente.

Evaluación del bienestar espiritual en pacientes en hemodiálisis

Introducción: Se define la espiritualidad como la búsqueda personal de propósito y significado en la vida, pudiendo incorporar o no la religión. En este artículo se presenta el desarrollo y la aplicación de una medida de bienestar espiritual a una muestra de pacientes en hemodiálisis. Material y métodos: El instrumento básico empleado se denomina Cuestionario del Sentido de la Vida (Meaning in Life Scale, MiLS), con 21 ítems y cuatro escalas: Propósito, Falta de significado, Paz y Beneficios de la espiritualidad. También se proporciona una puntuación global de espiritualidad. Además, se registraron variables de tipo clínico (tiempo en hemodiálisis, índice de comorbilidad de Charlson) y sociodemográfico (edad, género), así como estimaciones del estado de salud, calidad de vida (general y actual), felicidad personal, el grado de religiosidad y la creencia en la existencia de vida ultraterrena. Se ha utilizado un diseño transversal con 94 pacientes en hemodiálisis. Resultados: Los resultados muestran que la versión española de este instrumento (MiLS-Sp) es una medida de bienestar espiritual con garantías psicométricas de calidad (fiabilidad, validez), adecuada para evaluar las complejas exigencias generadas por la problemática de salud del paciente en hemodiálisis. El bienestar espiritual se relaciona significativamente con diversas variables de calidad de vida, percepción de salud, felicidad personal o religiosidad. No existe una relación significativa entre las puntuaciones de espiritualidad y la edad, el sexo, el tiempo en diálisis o el índice de comorbilidad. El grado de bienestar espiritual de estos pacientes es relativamente bajo. Conclusión: La espiritualidad parece desempeñar un papel importante en el bienestar psicológico, el estado de salud y la calidad de vida percibidos por el paciente en hemodiálisis. El grado de bienestar espiritual de estos pacientes es relativamente bajo. Estos resultados sugieren que considerar y evaluar el grado de bienestar espiritual en los pacientes en hemodiálisis puede ser de utilidad para la práctica clínica.

Aspectos formales y visuales en los cuestionarios de salud y calidad de vida

Una falta de atención en el formato de los cuestionarios de salud y calidad de vida ocasiona que muchas preguntas no se contesten porque no se pueden leer bien. Se hace aquí una reflexión sobre tales aspectos visuales, analizando siete de los cuestionarios genéricos en lengua inglesa más utilizados en el mundo y comparándolos, a su vez, con sus traducciones al español. Los resultados que se obtienen subrayan la idea de la importancia que tiene la presentación del cuestionario para conseguir la máxima información.

Evaluación del bienestar espiritual en pacientes en cuidados paliativos

Objetivo: La evaluación del bienestar espiritual del paciente es un aspecto crítico y fundamental en la atención holística y multidisciplinar. Disponer de un instrumento válido de evaluación de la espiritualidad con finalidad tanto investigadora como clínica es muy conveniente. En este estudio se examina la presencia de bienestar espiritual, o sentido de la vida, en pacientes en cuidados paliativos a través de un cuestionario con garantías psicométricas de calidad. Pacientes y Métodos: Han participado en este estudio con diseño transversal un total de 60 pacientes en cuidados paliativos. El instrumento básico empleado ha sido la versión española del Cuestionario del Sentido de la Vida (Meaning in Life Scale), de 21 ítems y 4 escalas: Propósito, Falta de significado, Paz, y Beneficios de la espiritualidad. Se proporciona, también, una puntuación global de espiritualidad. Se registraron, además, variables de tipo clínico y sociodemográfico, así como estimaciones del estado de salud, calidad de vida (general y actual), felicidad personal, el grado de religiosidad y la creencia en la existencia de vida ultraterrena. Resultados: Los resultados muestran que la versión española de este instrumento (Cuestionario del Sentido de la Vida [Meaning in Life Scale]) es una medida de bienestar espiritual con garantías psicométricas de calidad (buena fiabilidad y validez), adecuada para evaluar la complejas exigencias generadas por la enfermedad crónica del paciente en cuidados paliativos. El bienestar espiritual se relaciona significativamente con diversas variables de calidad de vida, percepción de salud, felicidad personal o religiosidad. No existe una relación significativa entre las puntuaciones de espiritualidad y variables sociodemográficas como la edad o el sexo. La presencia de bienestar espiritual en estos pacientes es más baja de la esperada. Conclusión: Este cuestionario de espiritualidad resulta un instrumento válido para valorar las 4 dimensiones básicas del bienestar espiritual. Los resultados sugieren que considerar y evaluar el bienestar espiritual de los pacientes en cuidados paliativos puede ser de ayuda para la práctica clínica. La presencia de espiritualidad parece desempeñar un papel importante en el bienestar psicológico, el estado de salud y la calidad de vida percibidos por el paciente en cuidados paliativos. El grado de bienestar espiritual de estos pacientes es relativamente bajo.

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Outcomes of hearing aid fitting for older people with hearing impairment and their significant others

As hearing impairment affects communication. it seems intuitive that both the person with hearing impairment and the significant other (SO) will experience effects as a result of the impairment and subsequent rehabilitation. The present study examined the effect that hearing impairment and aural rehabilitation has on the person with hearing impairment and the SO's quality of life (QOL). Ninety-three people with hearing impairment completed a measure of hearing-specific QOL (Hearing Handicap Inventory for the Elderly) and health-related QOL (Short Form-36), while 78 SOs completed a modified version of the Quantified Denver Scale and the Short Form-36. prior to and 3 months following hearing aid fitting. The results emphasize the significant impact of hearing impairment on both the person with hearing impairment and the SO. The results also demonstrate the effective role that hearing aids play in reducing Such negative effects for both parties.