92 research outputs found
Prevalence of Migraine in General Spanish Population; Factors Related and Use of Health Resources
No full textMigraine is a common neurological disorder considered the second most disabling condition worldwide. Its prevalence ranges from 2.6% to 21.7% in population studies. This study aimed to know the prevalence of diagnosed and undiagnosed migraine in the general Spanish adult population, their health care use, and factors related. A descriptive cross-sectional study was undertaken with 23,089 individuals >15 years from the 2017 Spanish National Health Survey. Three groups were defined: people diagnosed with migraine (DM), people reporting undiagnosed migraine (UM) and people without migraine. Sociodemographic, clinical and use of health resources data were collected. The scales Duke Social Support Index (DSSI) and General Health Questionnaire (GHQ-12) were used. Prevalence of DM and UM were determined with 95% confidence intervals. To determine the factors associated with DM and UM, a multinomial logistic regression model was used. The prevalence of DM was 8.6% (95%CI: 8.2–9), and UM, 0.9% (95%CI: 0.8–1). People with DM more frequently visited healthcare professionals (47.8%), required more supplementary tests (86.8), had a higher percentage of hospitalization (11.3%), and used emergency services (45.1%). Women had nearly three times the risk of DM and UM. Worse mental health was a risk factor for UM (OR = 1.20) and DM (OR = 1.18). The greater the work stress, the greater the risk of DM (OR = 1.12). An adequate monitoring and management of migraine in people with these characteristics could contribute to improving their quality of life and reducing costs in the system
Changes in health related quality of life 3 months after an acute coronary syndrome
No full textAbstract Background The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes. Methods HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable. Results There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors. Conclusion The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.</p
Prevalence and associated factors of the use of opioids in the treatment of chronic non-cancer pain. Perspective of the general Spanish population and the experience of patients.
No full textAims
The general aim of this thesis was to study the situation of opioid treatments for chronic noncancer pain (CNCP). The specific aims were: first, to determine and synthesize the prevalence of
the therapeutic use of opioids in patients with CNCP, and to analyze the factors associated with
their use through a systematic review of the literature and a meta-analysis; second, to
investigate the evolution of opioid-related mortality and potential years of life lost in the general
population in Spain from 2008 to 2017 and to compare the results by gender and age with the
United States; third, to describe the current perspective of the Spanish population toward opioid
use in the treatment of pain and to identify groups of individuals based on their point of view
on these drugs; and finally, to explore the experiences of patients with chronic non-malignant
low back pain in Spain undergoing long-term treatment (>3 months) with opioids.
Methods
In the first study of the thesis, a systematic review of the current literature and meta-analysis
were performed using two databases (PubMed and SCOPUS). For this purpose, original crosssectional studies published in English or Spanish between 2009 and 2019 with the main objective
of determining the prevalence of opioid use in CNCP patients were included. Search terms and
search strategies were adapted to each database. The articles included in the meta-analysis
were stratified according to the source of the sample, the type of pain, and the duration of the
opioid treatment.
The second paper of the thesis is a descriptive study using retrospective annual data from 2008
to 2017 in the general population of Spain and the United States. Information on the population
and opioid-related deaths stratified by age and sex was obtained from the Spanish National
Statistics Institute and from the Centers for Disease Control and Prevention (CDC) WONDER
Multiple Cause of Death Database, according to the ICD-10 codes. Years of life lost, crude and
standardized mortality rates were calculated and compared with the results in US.
The third article included in the thesis is a cross-sectional study carried out on a nationwide
representative sample of 1,299 Spanish adults. Data and information about beliefs, knowledge,
fears, opinions and, attitudes towards the use of opioids were collected via a computer assisted
telephone interview (CATI). A descriptive analysis of the variables studied and a cluster analysis
were performed to identify groups of people based on these parameters. In addition, a
18
ABSTRACT. 18
multinomial logistic regression model was developed to analyze the variables related to the
clusters.
Finally, in the last part of the thesis, a qualitative study was performed using semi-structured
interviews. Recruitment and data collection were conducted from April to October 2018. Fifteen
participants were recruited from the Pain Clinic in Hospital Puerta del Mar. Inclusion criteria for
the study were: adults suffering from chronic non-malignant low back pain and receiving longterm treatment (>3 months) with opioids. We conducted interviews until very similar
experiences were described in the last interviews as in the previous ones. A constructionist
perspective was adopted. The interviews were analyzed by the qualitative content method
described by Graneheim and Lundman, and developed categories and themes discussed in the
light biomedicalization theoretical framework.
Results
In the first article, we identified that of the 1062 potential articles found in the systematic
review, 23 studies fulfilled the inclusion criteria. In the general population, the prevalence of
long-term (>3 months) opioid use was 2.3% (95%CI:1.5%-3.6%), the prevalence of short-term
opioid use was 7.3% (95%CI:4.3%-11.9%), and 5.8% among people with chronic low back pain
(95% CI:0.5% - 45.5%). The prevalence of opioid use among patients from the health records or
medical surveys was 41% (95%CI:23.3%-61.3%). Finally, in patients with musculoskeletal pain,
the prevalence was 20.5% (95%CI:12.9%-30.9%) and 24.5% among patients with fibromyalgia
(95%CI:22.9%-26.2%). A higher prevalence of opioid use was observed among the following
groups: men; younger people; patients receiving prescriptions of different types of drugs;
smokers and patients without insurance or with non-commercial insurance. In addition, nonwhite and Asian patients were less likely to receive opioids than non-Hispanic white patients.
The results of the second study showed that the crude rate of opioid-related deaths per 10^5
inhabitants has changed from 1.68 in 2008 to 2.25 in 2017 in Spain, with around 30,000 years of
life lost per year. The most affected groups were middle-aged men and women over 65, and the
main cause of death was accidental poisoning. The standardized rates per 10^5 inhabitants
across the years were between 1.19 and 1.62 in Spain and between 11.17 and 20.68 in the US
population.
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ABSTRACT. 19
In the analysis of the beliefs, fears, opinions and attitude towards opioids analyzed in the third
article in the general Spanish population, three groups of subjects were identified: a group with
a positive point of view (N=448) composed of people >65 years who would accept a treatment
if prescribed and were less fearful of these drugs; a group with a moderate point of view (N=337)
formed of younger subjects with university education, and who were better informed about
opioids, afraid of these drugs (OR=2.67), and more frequently associated them with drowsiness
(OR=2.58), nausea (OR=3.04), and tolerance (OR=2.16); a third group with a negative point of
view (N=468), with a lower educational level who would more often reject treatment with
opioids, and were more afraid of them (OR=3.95), considering that they may not be able to stop
the treatment (OR=3.04) and that the opioids may produce tolerance (OR=3.03).
Finally, in the analysis of the experiences of people with chronic pain (CP) taking opioids,
described in the fourth article, we developed one overarching theme - living with opioids:
dependence and autonomy while seeking relief - which crosscut three categories: 1) The long
pathway to opioids due to the invisibility of pain, 2) Opioids: from blind date to a long-term
relationship and 3) What opioids cannot fix. The results show that the long and difficult process
to obtain effective treatment was a fundamental part of the struggle to cope with pain, involving
long-term relationships with the health system. The two first categories refer to the journey
participants made to get a diagnosis and treatment with opioids, and their experiences during
this long and difficult process, which was quite unique for each person. The third category
describes the circumstances and situations experienced by the patients before and after the
painful episode started, and how these influenced the whole process.
Conclusions
The results obtained in the different studies lead to the following conclusions:
- The prevalence of opioid use in patients with CNCP varies depending on the duration
of treatment and the population analyzed, with higher prevalence in clinical studies
based on health registries and occasional users. Age, race, and the access to the
health service delivery system and its characteristics are the factors most related to
the use of opioids.
- Regarding opioid-related mortality, an opioid overuse crisis does not seem a likely
scenario in Spain. However, it is a social problem that requires special health
surveillance, particularly in middle-aged men and women over 65.
20
ABSTRACT. 20
- The different perspectives of patients regarding the use of opioids to treat pain
should be taken into consideration by physicians when designing strategies to
inform patients about the treatment of pain with opioids. This should promote their
correct use, and prevent their misuse in particular.
- The experiences of patients should be considered to a greater extent by healthcare
professionals when giving information about opioids and setting treatment goals.
Greater consideration of the social determinants of health that affect chronic pain
experiences might lead to more effective solutions to chronic pain
¿Se puede prevenir la conducta suicida en los pacientes con dolor crónico?
No full textParece evidente es que la conducta suicida, o al menos la ideación suicida, es más frecuente en los enfermos que padecen dolor crónico que en la población general.2 página
Rosalía de Castro y los albores del turismo en Galicia: hacia una patrimonialización literaria y geográfica en Vales Failde, Meakin y García Martí
No full textThis contribution analyzes the origins of the patrimonialization of Rosalía de Castro at the service of a tourist discourse. The purpose of this article is to address both a historiographical reconstruction, as well as the aesthetic, ideological and propagandistic aspects
that underlie this collective discourse. In this
sense, we will focus on three cultural agents
who lead one of the first allegations of a tourist
character related to the author at the beginning
of the 20th century, specifically, Javier Vales
Failde, Annette Meakin and Victoriano García
Martí. In their hybrid discourses, which oscillate between literary criticism, travel books and
tourist guides, Rosalía de Castro not only appears as a tourist attraction, but also they assume the Galician stereotype of landscape promoted by the author, with a clear ideological
sign. This will pursue the foundational basis for
tourism in Galicia.Cet article examine les origines de la
patrimonialisation de Rosalía de Castro au service d’un discours propre au tourisme. L’objet
de ce travail est d’aborder la reconstruction
historiographique ainsi que des aspects esthétiques, idéologiques et propagandistes qui sont
sous-jacents à ce discours collectif. À ce propos,
nous nous attarderons sur trois agents culturels
porteurs de certaines des premières démarches
de nature touristique liées à Rosalía au début
du xxe
siècle, notamment, Javier Vales Failde,
Annette Meakin et Victoriano García Martí.
Tout au long de leurs discours hybrides qui oscillent entre la critique littéraire, le carnet de
voyage et le guide touristique, Rosalía de Castro
n’apparaît pas seulement comme un attrait touristique, mais comme le stéréotype du paysage
galicien dont la portée idéologique est assumée
par l’autrice et également promu. Cela participera à la fondation du tourisme en GaliceEl presente artículo analiza los orígenes de la patrimonialización de Rosalía de
Castro al servicio de un discurso de índole turística. La finalidad de este trabajo es abordar tanto una reconstrucción historiográfica como los
aspectos estéticos, ideológicos y propagandísticos que subyacieron a este discurso colectivo.
En este sentido, estudiaremos tres agentes culturales que protagonizaron algunos de los primeros testimonios de índole turística relacionados con la autora a principios del siglo xx, en
concreto, Javier Vales Failde, Annette Meakin y
Victoriano García Martí. En sus discursos híbridos, que oscilan entre la crítica literaria, el libro de viajes y la guía turística, Rosalía de Castro no solo aparece como reclamo turístico, sino que tales discursos asumen el estereotipo paisajístico galaico promovido por la poeta, de claro
signo ideológico. Este servirá de base fundacional del turismo en Galicia
Rosalía de Castro y los albores del turismo en Galicia: hacia una patrimonialización literaria y geográfica en Vales Failde, Meakin y García Martí
No full textEl presente artículo analiza los orígenes de la patrimonialización de Rosalía de Castro al servicio de un discurso de índole turística. La finalidad de este trabajo es abordar tanto una reconstrucción historiográfica como los aspectos estéticos, ideológicos y propagandísticos que subyacieron a este discurso colectivo. En este sentido, estudiaremos tres agentes culturales que protagonizaron algunos de los primeros testimonios de índole turística relacionados con la autora a principios del siglo xx, en concreto, Javier Vales Failde, Annette Meakin y Victoriano García Martí. En sus discursos híbridos, que oscilan entre la crítica literaria, el libro de viajes y la guía turística, Rosalía de Castro no solo aparece como reclamo turístico, sino que tales discursos asumen el estereotipo paisajístico galaico promovido por la poeta, de claro signo ideológico. Este servirá de base fundacional del turismo en Galicia.Cet article examine les origines de la patrimonialisation de Rosalía de Castro au service d’un discours propre au tourisme. L’objet de ce travail est d’aborder la reconstruction historiographique ainsi que des aspects esthétiques, idéologiques et propagandistes qui sont sous-jacents à ce discours collectif. À ce propos, nous nous attarderons sur trois agents culturels porteurs de certaines des premières démarches de nature touristique liées à Rosalía au début du xxe siècle, notamment, Javier Vales Failde, Annette Meakin et Victoriano García Martí. Tout au long de leurs discours hybrides qui oscillent entre la critique littéraire, le carnet de voyage et le guide touristique, Rosalía de Castro n’apparaît pas seulement comme un attrait touristique, mais comme le stéréotype du paysage galicien dont la portée idéologique est assumée par l’autrice et également promu. Cela participera à la fondation du tourisme en Galice.This contribution analyzes the origins of the patrimonialization of Rosalía de Castro at the service of a tourist discourse. The purpose of this article is to address both a historiographical reconstruction, as well as the aesthetic, ideological and propagandistic aspects that underlie this collective discourse. In this sense, we will focus on three cultural agents who lead one of the first allegations of a tourist character related to the author at the beginning of the 20th century, specifically, Javier Vales Failde, Annette Meakin and Victoriano García Martí. In their hybrid discourses, which oscillate between literary criticism, travel books and tourist guides, Rosalía de Castro not only appears as a tourist attraction, but also they assume the Galician stereotype of landscape promoted by the author, with a clear ideological sign. This will pursue the foundational basis for tourism in Galicia
A review of chronic pain impact on patients, their social environment and the health care system
No full textMaría Dueñas,1 Begoña Ojeda,2 Alejandro Salazar,2 Juan Antonio Mico,3 Inmaculada Failde,2 1Nursing Faculty “Salus Infirmorum”, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 2Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 3Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Mental Health, CIBERSAM, Institute of Health Carlos III, University of Cádiz, Cádiz, Spain Abstract: Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives. Keywords: pain, everyday problems, social relationships, family environment, health service
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