Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial.

BACKGROUND: Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions. OBJECTIVE: The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting. METHODS: A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment. RESULTS: Positive effects were found in the intervention group (T2-T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (-0.72 vs 0.1; P=.002), rumination (-1.59 vs -0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs -0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs -0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; -0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (-0.65 vs 0.01; P=.07), rumination (1.23 vs -0.59; P=.04), and magnification (0.1 vs 0.86; P=.02). CONCLUSIONS: The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154.

[Sex Differences of Perceived Health before and During the Economic Crisis (2007 and 2011). Spain]. / Diferencias por sexo de la salud percibida antes y durante la crisis económica (2007 y 2011).

OBJECTIVE: Several studies show the association between economic crises, unemployment and health income. However, it is necessary to differentiate their impact according to gender. The objective of this study was to analyze the effect that the economic crisis, unemployment and income may have had on the perceived health of men and women in Spain. METHODS: A cross-sectional study was conducted combining data from the 2007 and 2011 Living Conditions Surveys, which collect data from 43,900 adult individuals up to 65 years of age. A multivariate logistic regression analysis was performed, for the whole population as for each sex. The dependent variable was perceived health and the independent variables were income level, employment status, education level, chronic illness, and the year in which the survey was performed. RESULTS: Perceived health improved over the period under consideration, from 75.1% in 2007 to 83%,0 in 2011. Unemployment significantly increased the chances of reporting perceived bad health in men [OR=1.45; CI95%:1.26-1.67] but not in women [OR=1.20; CI95%:0.99-1.47]. ORs of perceived bad health were higher for women than for men in the lower-income [1.81; IC95%1,56-2,11 against 1.70; IC95%:1,46-1,97. 2011] was related to a lower probability of poor perceived health in both men [OR=0.41, CI95%: 0.37-0.46] and women [OR=0.39 ; CI95%:0.35-0.44]. CONCLUSIONS: The association of the economic crisis with perceived health was similar in men and women. Unemployment was a risk factor for perceived bad health in the case of men. Available income, education level, and the presence of chronic illness had a larger influence as determinants of perceived bad health for women than they did for men.

OBJETIVO: Diversos estudios muestran la asociación entre las crisis económicas, el desempleo y la renta con la salud. Sin embargo, se precisa diferenciar su impacto en función del sexo. El objetivo de este estudio fue analizar el efecto que la crisis económica, el desempleo y la renta pueden haber tenido en la salud percibida de hombres y mujeres en España. METODOS: Se realizó un estudio transversal que combinó las Encuestas de Condiciones de Vida de 2007 y 2011, incluyendo a 43.900 personas adultas de hasta 65 años. Se realizó análisis estratificado y regresión logística multivariante. La variable dependiente fue la salud percibida y las variables independientes la renta, la situación laboral, la educación, la enfermedad crónica y el año de la encuesta. RESULTADOS: La buena salud percibida se incrementó del 75,1 % en 2007 al 83% en 2011. El desempleo se relacionó con mayor probabilidad de mala salud percibida en hombres: OR de 1,45; IC95%:1,26-1,67, mientras que en mujeres las diferencias fueron OR=1,20; IC95%:0,99-1,47. La probabilidad de mala salud percibida fueron mayores para mujeres (OR=1,81; IC95%:1,56-2,11) que para hombres (OR=1,7; IC95%:1,46-1,97). El año 2011 se relacionó con tener menor probabilidad de mala salud percibida tanto en hombres (OR=0,41; IC95%: 0,37-0,46) como en mujeres (OR=0,39; CI95%:0,35-0,44). CONCLUSIONES: La asociación de la crisis económica con la salud percibida fue similar en hombres y mujeres. El desempleo fue un factor de riesgo para la mala salud percibida en hombres mientras que la influencia del nivel de renta, del educativo y la enfermedad crónica fue mayor en mujeres que hombres.

Diferencias por sexo de la salud percibida antes y durante la crisis económica (2007 y 2011) / Sex differences of perceived health before and during the economic crisis (2007 and 2011). Spain

Fundamentos: Diversos estudios muestran la asociación entre las crisis económicas, el desempleo y la renta con la salud. Sin embargo, se precisa diferenciar su impacto en función del sexo. El objetivo de este estudio fue analizar el efecto que la crisis económica, el desempleo y la renta pueden haber tenido en la salud percibida de hombres y mujeres en España. Métodos: Se realizó un estudio transversal que combinó las Encuestas de Condiciones de Vida de 2007 y 2011, incluyendo a 43.900 personas adultas de hasta 65 años. Se realizó análisis estratificado y regresión logística multivariante. La variable dependiente fue la salud percibida y las variables independientes la renta, la situación laboral, la educación, la enfermedad crónica y el año de la encuesta. Resultados: La buena salud percibida se incrementó del 75,1 % en 2007 al 83% en 2011. El desempleo se relacionó con mayor probabilidad de mala salud percibida en hombres: OR de 1,45; IC95%:1,26-1,67, mientras que en mujeres las diferencias fueron OR=1,20; IC95%:0,99-1,47. La probabilidad de mala salud percibida fueron mayores para mujeres (OR=1,81; IC95%:1,56-2,11) que para hombres (OR=1,7; IC95%:1,46-1,97) en el caso de menor renta. El año 2011 se relacionó con tener menor probabilidad de mala salud percibida tanto en hombres (OR=0,41; IC95%: 0,37-0,46) como en mujeres (OR=0,39; CI95%:0,35-0,44). Conclusiones: La asociación de la crisis económica con la salud percibida fue similar en hombres y mujeres. El desempleo fue un factor de riesgo para la mala salud percibida en hombres mientras que la influencia del nivel de renta, del educativo y la enfermedad crónica fue mayor en mujeres que hombres (AU)

Background: Several studies show the association between economic crisis, unemployment and health income. However, it is necessary to differentiate their impact according to gender. The objective of this study was to analyze the differential effect that the economic crisis, unemployment and income may had on the perceived health of men and women in Spain. Methods: A cross-sectional study was conducted combining data from the 2007 and 2011 Living Conditions Surveys, which collect data from 43,900 adult individuals up to 65 years of age. A multivariate logistic regression analysis was performed, for the whole population as for each sex. The dependent variable was perceived health and the independent variables were income level, employment status, education level, chronic illness, and the year in which the survey was performed. Results: Perceived health improved over the period under consideration, from 75.1% in 2007 to 83%,0 in 2011. Unemployment significantly increased the chances of reporting perceived bad health in men [OR=1.45; CI95%:1.26- 1.67] but not in women [OR=1.20; CI95%:0.99-1.47]. ORs of perceived bad health were higher for women than for men in the lower income bracket [OR: 1.81; IC95%1,56-2,11 against 1.70; IC95%:1,46-1,97]. 2011 was related to a lower probability of poor perceived health in both men [OR=0.41, CI95%: 0.37-0.46] and women [OR=0.39 ; CI95%:0.35-0.44]. Conclusions: The association of the economic crisis with perceived health was similar in men and women. Unemployment was a risk factor for perceived bad health in the case of men. Available income, education level, and the presence of chronic illness had a larger influence as determinants of perceived bad health for women than they did for men (AU)

El hospital como activo en salud. El papel del especialista en Medicina Preventiva y Salud Pública. ¿Cómo ofertar servicios de salud pública en un espacio donde predominan las actividades asistenciales? / No disponible

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The impact of the economic crisis on unmet dental care needs in Spain.

OBJECTIVES: To analyse the impact that the economic crisis and the evolution of socioeconomic inequality before (2007) and during (2011) the current crisis have had on unmet dental care needs in Spain. METHODS: The Living Conditions Surveys from the years 2007 and 2011 were used, including 44 138 adults aged under 65 years. A descriptive and stratified analysis was carried out along with the calculation of the concentration index and a multivariate logistic regression jointly and separately by gender. The dependent variable was unmet dental care needs and the independent variables were income, employment status, gender, age, education and chronic disease. A dummy variable was created for the year of survey completion as a proxy measure for the economic crisis. The SPSS V.20 software was used. RESULTS: During the period under analysis, the unmet needs for dental services increased (from 6.2% to 7.2%) along with the concentration index (from -0.1412 to -0.189). The main correlations with unmet needs were: unemployment (OR=1.46), lower income (OR=2.44 for the income quintile) and the year 2011 with respect to 2007 (OR 1.13). For women, the OR is greater according to income level (2.44 compared with 1.77 in men) and the year 2011 (1.21 compared with 1.06), while for men unemployment had a greater effect (OR=1.52 compared with 1.46). CONCLUSIONS: There has been an increase in unmet dental care needs as well as in the social gradient for service access. The most vulnerable groups are those with less purchasing power and the unemployed. The economic crisis has also increased this unmet need.