Evaluación del modelo de calidad de Donabedian en base a los criterios de Chinn y Kramer / Evaluation of the Donabedian quality model based on the Chinn and Kramer criteria

INTRODUCCIÓN: La evaluación de teorías es un proceso crucial para el desarrollo del conocimiento enfermero, permite seleccionar y utilizar la teoría en función de los problemas y fenómenos del cuidado, sin embargo, es escasamente realizada, especialmente en teorías de otras disciplinas. OBJETIVO: Analizar críticamente el modelo de calidad de la atención de salud de Donabedian, a través de la propuesta metodológica de Chinn y Kramer. DESARROLLO: Se realizó un estudio descriptivo-reflexivo del componente teórico y conceptual del modelo de Donabedian, se explica el propósito, conceptos, relaciones, estructura y supuestos. Se continua con la evaluación crítica del modelo, analizada bajo los criterios de claridad, sencillez, generalidad, accesibilidad e importancia, a través de una revisión narrativa de la literatura. CONCLUSIÓN: el modelo es útil para la gestión, los procesos de mejora, evaluación de estrategias y programas. Con valor para enfermería, puesto que coinciden en el significado e importancia otorgada a la calidad de la atención, reconociendo su contribución en la implementación, desarrollo de intervenciones y mejoramiento de la salud.

NTRODUCTION: The evaluation of theories is a crucial process for the development of nursing knowledge, as it allows the selection and use of such theories to address the problems of patient care. However, it is scarcely performed, especially with theoriesfrom disciplines other than nursing. OBJECTIVE: To critically analyze the Donabedian model of health care quality, through the methodological approach of Chinn and Kramer (1999). METHODOLOGY: A descriptive-reflexive study of the theoretical and conceptualcomponent of the Donabedian model was carried out, explaining its purpose, concepts, relationships, structure, and assumptions. A critical evaluation of the model was then conducted, using the criteria of clarity, simplicity, generality, accessibility, and importance, through a narrative review of the literature. CONCLUSIONS: The model is useful for management, improvement processes, and the evaluation of strategies and programs. It is especially valuable for nursing, since it coincides with the meaning and importance given to the quality of nursing care, recognizing its contribution in the development and implementation of interventions and improvement of health.

El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud / The significance of menopause for Chilean women attending primary health care centers

BACKGROUND: Menopause connects a biological event with social representations related to aging AIM: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIALS AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

Fear of Falling among Community-dwelling Sedentary and Active Older People

Objective. The study sought to compare community-dwelling older people with respect to their level of physical activity and to the fear of falls between a group of sedentary elderly and a group of active elderly. Methods. Cross-sectional descriptive study carried out with 113 community-dwelling older people (45 sedentary and 48 active), users of an outpatient care center of the private health system with a geriatric program in Santiago, Chile. The study measured socio-demographic variables, state of health, comprehensive geriatric assessment, exercise, depression with the Yesavage scale, and fear of falling with the Short Falls Efficacy Scale - International (Short FES-I). Results. Sedentary older people have significantly higher scores in the Yesavage depression scale compared with active older people (4.2 versus 0.8). No statistically significant differences were found when comparing both groups of sedentary and active participants in terms of socio-demographic variables along with health, and functional and cognitive capacity. Regarding the fear of falling, the sedentary had a slightly higher score than the active (12 versus 11), although not significant. Conclusion. This study showed that fear of falling was equal in sedentary and active older people who live in the community, although it was found that sedentary individuals had a higher risk of having a positive screening for geriatric depression in those participants who do not perform physical activity.

Objetivo. Comparar las personas mayores (PM) de un grupo de mayores sedentarios y otro no sedentario con respecto a su nivel de actividad física y al temor a las caídas. Métodos. Se trata de un estudio descriptivo de corte transversal, realizado en 113 personas mayores (45 sedentarios y 48 activos) que viven en la comunidad de usuarios de un centro de atención ambulatoria del sistema privado de salud, el cual disponía de un programa de geriatría en Santiago de Chile. Se midieron variables sociodemográficas, de estado de salud, de Valoración Geriátrica Integral, ejercicio, la depresión con escala de Yesavage y el temor a caer con el Short Falls Efficacy Scale - International (Short FES-I). Resultados. Las PM sedentarias presentan puntuaciones significativamente más altas en la escala de depresión Yesavage comparadas con las PM activas (4.2 versus 0.8). No se encontraron diferencias estadísticamente significativas al comparar ambos grupos en cuanto a variables sociodemográficas, de salud y de capacidad funcional y cognitiva. En cuanto al temor a caer, los sedentarios tuvieron un puntaje ligeramente mayor que los activos (12 versus 11), aunque sin ser significante. Conclusión. Este estudio mostró que el temor a caer fue igual en PM sedentarias y activas, aunque se encontró un mayor riesgo de tener un tamizaje positivo para depresión geriátrica en aquellos participantes que no realizan actividad física.

Objetivo. Comparar idosos (PM) que vivem na comunidade em relação ao nível de atividade física e medo de cair entre um grupo de idosos sedentários e outro. Métodos. Estudo descritivo transversal realizado com 113 idosos residentes na comunidade (45 sedentários e 48 ativos) usuários de um centro de atenção ambulatorial do sistema privado de saúde com programa geriátrico em Santiago, Chile. Variáveis sociodemográficas, estado de saúde, Avaliação Geriátrica Abrangente, exercício, depressão com a escala de Yesavage e medo de cair foram mensurados com a Short Falls Efficacy Scale - International (Short FES-I). Resultados. PMs sedentários têm pontuações significativamente mais altas na escala de depressão de Yesavage em comparação com PMs ativos (4.2 versus 0.8). Não foram encontradas diferenças estatisticamente significativas ao comparar os dois grupos de participantes sedentários e ativos em termos de variáveis sociodemográficas, saúde e capacidade funcional e cognitiva. Em relação ao medo de cair, os sedentários tiveram uma pontuação ligeiramente superior aos ativos (12 versus 11), embora não tenha sido significativa. Conclusão. Este estudo mostrou que o medo de cair era o mesmo em PM sedentários e ativos que viviam na comunidade, embora pessoas sedentárias tenham um risco maior de ter uma triagem positiva para depressão geriátrica naqueles participantes que não realizavam atividade física.

Fragilidad y su correlación con calidad de vida y utilización de los servicios de salud en personas mayores que viven en la comunidad / Quality of life among frail older people

Background: Frailty has a great impact in the wellbeing of older people. Aim: To evaluate the quality of life of older people with and without frailty. Material and Methods: We assessed sociodemographic variables, health, integral geriatric assessment, quality of life using the WHOQoL-BREF questionnaire and the level of fragility using the Tilburg Frailty Indicator (TFI) in 538 participants. Results: Three hundred and five participants aged 73 ± 7 years (229 women) were classified as fragile and 233 aged 72 ± 6 years (125 women) as not having frailty. Compared with their non-fragile counterparts, frail participants had a lower number of years attending school (5.9 and 7.4 respectively), a lower Barther index (93.6 and 98.3 respectively), a lower mini mental score (21.9 and 22.8 respectively) and a higher Yessavage depression score (2.0 and 0.8 respectively). Also, frail participants had a significantly lower total quality of life score and significantly lower scores in the physical and psychological domains. No differences were observed for the social and environmental domains. Older frail participants used health services more frequently than their non-fragile counterparts. Conclusions: In this sample, frailty was associated with a lower quality of life and worse scores in several geriatric assessment tools.

Evaluación de la funcionalidad y fragilidad de las personas mayores asistentes a centros de día / Changes in social psychological and functional variables among older people attending a day care center

Background: Older people attending day care centers improve their social activities, perception of quality of life and reduce their institutionalization rate and risk of mortality in the medium term. Aim: To evaluate the changes in the integral geriatric assessment and frailty of a group of older people attending a day care center in Santiago. Material and Methods: Health self-perception, integral geriatric assessment, Barthel scale, frailty indicators, mini-mental state scale, Yesavage depression score and a scale about solitude perception were evaluated in 35 participants aged 73 ± 6 years on admission and at discharge from a day care center for older people. Results: At discharge, significant improvements were observed for depression, perception of social support and physical frailty. However, no changes in functional status, cognitive function and perception of solitude were observed. Conclusions: Older people attending improve their perception of social support and decrease their frailty and depression scores.

Menopausia, el inicio del envejecimiento de las mujeres chilenas. Un estudio cualitativo / Menopausa, o inicio do envelhecimento das mulheres chilenas. Um estudo qualitativo / Menopause, the beginning of aging for Chilean women. A qualitative study

Objective. To develop the meaning of menopause of a group of post-menopausal women and their relationship with aging. Methods. Qualitative descriptive study on 15 Chilean women that completed a taped face-to-face in depth interview that were interpreted according to Krippendorff. Results. A qualitative content analysis revealed the presence of two themes: (a) Cessation of women´s reproductive stage and (b) a life transition to aging. Conclusion. Women perceived their menopause as the beginning of aging focusing on the end of fertility and the social connotation that this new role implies. Feeling old 10 years before the customary beginning of old age is an important starting point to be incorporated in women's health education.

Objetivo. Desarrollar el significado de manopausia de un grupo de mujeres posmenopáusicas y su relación con el envejecimiento. Métodos. Estudio cualitativo descriptivo de las grabaciones de 15 mujeres chilenas que completaron una entrevista a profundidad, cara a cara. Los relatos se interpretaron de acuerdo con Krippendorff. Resultados. Un análisis de contenido cualitativo reveló la presencia de dos temas: (a) Cesación de la etapa reproductiva de las mujeres y (b) transición de la vida adulta al envejecimiento. Conclusión. Las mujeres percibieron la menopausia como el principio del envejecimiento que se centraba en el fin de la fertilidad y la connotación social que implicaba este nuevo papel. Sentirse viejo 10 años antes del comienzo habitual de la vejez es un punto de partida importante para ser incorporado en la educación para la salud de la mujer.

Objetivo. Desenvolver o significado de menopausa de um grupo de mulheres pós-menopáusicas e sua relação com o envelhecimento. Métodos. Estudo qualitativo descritivo das gravações de 15 mulheres chilenas que completaram uma entrevista a profundidade, cara a cara; os relatos se interpretaram de acordo com Krippendorff. Resultados. Uma análise de conteúdo qualitativo revelou a presença de dois assuntos: (a) Cessação da etapa reprodutiva das mulheres e (b) transição da vida ao envelhecimento. Conclusão. As mulheres perceberam sua menopausa como o princípio do envelhecimento que se centrava no fim da fertilidade e a conotação social que implicava este novo papel. Sentir-se velho 10 anos antes do começo habitual da velhice é um ponto de partida importante para ser incorporado na educação para a saúde da mulher.

Criterios de fragilidad en personas mayores que viven en la comunidad: una actualización de la literatura / Frailty criteria among older people living in the community: an update

Frailty is an important concept in aging research and care. Awareness of frailty signs allows healthcare workers to identify older adults at risk and design interventions to prevent their functional decline, therefore preventing adverse health outcomes. This literature review allows to identify predictors of frailty considering its physical, psychological and social domains. From the evidence found, it is possible to formulate a profile of fragile older people. Finally, future research should focus on the description of psychological and social fragility profiles, on the detection of persons likely to be fragile and finally to define precise instruments to detect fragile people, which should become the gold standards in future research.

Optimizando el acceso oportuno al test de ELISA para el diagnóstico del VIH: Recomendaciones desde los usuarios y profesionales de la Atención Primaria de Salud / Recommendations of health care users and professionals to achieve a timely access to HIV diagnosis

Background: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. Aim: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. Material and Methods: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. Results: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. Conclusions: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.

Prevención de cáncer cérvicouterino: ¿qué nos señala la literatura en relación a la educación dirigida a los profesores de educación básica/media? / Prevention of cervical cancer: education aimed at teachers of primary / secondary education

Antecedentes: el cáncer cérvicouterino (CC) es uno de los cánceres más comunes en la mujer cuyo factor etiologico principal es la infección por el virus papiloma humano (VPH). Dada la epidemiología de esta infección es necesario buscar estrategias a nivel primario para disminuir la incidencia del CC. Objetivos: conocer la evidencia existente sobre los programas de intervención educativa en educación sexual, prevención del CC e infección por VPH impartida a profesores de educación básica/media. Metodología: búsqueda en bases de datos Medline/Pubmed, ProQuest, SciELO, Eric, CINHAL, PsycINFO y metabuscador Tripdatabase entre mayo-junio 2012. Análisis del tema: las intervenciones educativas relacionadas a la educación sexual dependen de factores como es el respaldo político-legislativo del país, contexto sociocultural y familiar y contexto general del colegio. Son los profesores los más idóneos en la entrega de estos contenidos en colegios de educación básica o secundaría, ya que son percibidos por niños y jóvenes como fuentes creíbles y confiables en la entregar de información sexual. Los principios de aprendizaje social son recomendados como estrategias educativas porque permiten aprenden por medio de técnicas participativas. Conclusiones: los docentes mejor preparados para entregar contenidos de índole sexual son aquellos que han recibido capacitación. Los profesores identifican como dificultad en la entrega de contenidos la falta de experiencia para desarrollar con sus estudiantes programas de índole sexual y el desconocimiento sobre cuánto decir.

Background: cervical cancer is one of the most common cancers in women whose main etiological factor Is infection with the human papilloma virus (HPV). Given the epidemiology of this infection is necessary to search at the primary strategies to reduce the incidence of cervical cancer. Objective: to determine the evidence on educational interventions in sexual education, prevention of cervical cancer and HPV infection imparted for basic education teachers/media. Method: search in Medline/PubMed, ProQuest, SciELO, Eric, CINAHL, PsycINFO and metasearch Tripdatabase between May-June 2012. Analysis of the theme: educational interventions related to sex education is based relay on factors such as political and legislative support of the country, family and socio-cultural context and general context at the school. Teachers are most suitable persons in delivering this content at schools of basic and secondary education. They are perceived by children and young people as credible and reliable sources of information on the sexual. Social learning principles are recommended to teach this content because they allow learning through participatory techniques. Conclusions: teachers who are better equipped to deliver sexual content are those who have been trained. Teachers identified inexperience with their students to develop programs of a sexual nature and ignorance about how to say, as difficulty to deliver the program.