The Perceived Quality of Life of Older People in Spain Who Care for Grandchildren and Related Variables: A Mixed Methods Study.

Grandparental care of grandchildren is a prevalent social phenomenon. This study explores the perceptions of health-related quality of life of grandparents caring for their grandchildren. A mixed methods design was developed. In the first phase, participants were interviewed using a baseline questionnaire. The second phase consisted of focus groups with 19 of the 100 participants in the quantitative phase. The scores obtained from the quantitative analysis are in line with the qualitative data; they reflect that grandparent carers who are more involved in the care of their grandchildren have more symptoms of depression and stress and have poorer perceptions of physical health-related quality of life. What may at first appear to be a positive aspect, keeping grandparent carers active, can become negative when it comes to shared care and when the grandparents' willingness to provide care is abused.

Affective Impact on Informal Caregivers over 70 Years of Age: A Qualitative Study.

Given today's rapidly ageing society, family members providing informal care to dependent older adults face ever-increasing challenges. The aim of this study was to describe the affective impact on older adults over 70 years of age caring for a dependent older person at home. A qualitative study was designed from a phenomenological perspective. Thirteen in-depth interviews were conducted with caregivers aged 70 or older. A content analysis of the interviews was carried out in five stages. Three themes were identified: "Emotions", "Feelings", and "Looking to the future". Caregivers express negative emotions (sadness, anger, and fear) and feelings of social and emotional isolation, and they feel abandoned by health professionals, family, and friends. In conclusion, prolonged caregiving by older adults has a negative affective impact and creates uncertainty about the future. There is a need to devise social and healthcare policies and actions, creating social support networks to improve their health and emotional wellbeing.

[The perspective of caregivers from a gender analysis.] / La perspectiva de las personas cuidadoras desde un análisis de género.

OBJECTIVE: Gender influences the provision of family caregiving, identifying inequalities in the distribution of care-related tasks. The aim of this study was to analyze the gender influence in family caregiving, provided by elderly while, identifying the sociodemographic characteristics of caregivers. METHODS: Mixed, descriptive and phenomenological study was made. Eight women and five men aged seventy and over participated who cared for dependent people at home, selected by intentional sampling in Valencia. The analysis of the in-depth interviews was carried out in three stages: reading to the participants of the transcripts for their verification; discrimination of units of meaning; eidetic and phenomenological reduction to obtain the statements of meaning. Frequencies and percentages were calculated. RESULTS: The mean age, educational level and years dedicated to care were higher in caregivers. Caregivers had a greater burden related to caregiving. Three categories influenced by androcentric culture were idenfied: vital perspective; reasons that support care; coping strategies. 90% of female caregivers cared out of moral obligation, compassion, reciprocity, and love; and 80% of male caregivers by responsibility and reciprocity, obtaining a satisfactory achievement and learning. Both developed resilience skills, reaching higher levels of adaptation. Male caregivers used more protective coping mechanisms and 50% of female caregivers obtained the most comforting support from religion. CONCLUSIONS: Gender determines the meaning given to the experience of caring. The reasons and coping strategies in men and women are different.

OBJETIVO: El género influye en la prestación de cuidados familiares, identificándose desigualdades en la distribución de tareas relacionadas con el cuidado. El objetivo de este estudio fue analizar la influencia del género en los cuidados familiares, identificando las características sociodemográficas de los/as cuidadores/as. METODOS: Se realizó un estudio mixto, descriptivo y fenomenológico. Participaron ocho mujeres y cinco hombres de setenta y más años que cuidaban en el domicilio a personas dependientes, seleccionadas por muestreo intencional en Valencia. El análisis de las entrevistas en profundidad se realizó en tres etapas: lectura a los/las participantes de las transcripciones para su comprobación; discriminación de unidades de significado; reducción eidética y fenomenológica para obtener las declaraciones de significado. Se calcularon frecuencias y porcentajes. RESULTADOS: La edad media, el nivel de estudios y los años dedicados al cuidado fue mayor en los cuidadores. Las cuidadoras tenían una mayor carga relacionada con los cuidados. Se idenficaron tres categorías influenciadas por la cultura androcéntrica: perspectiva vital; motivos que sustentan el cuidado; estrategias de afrontamiento. Un 90 % de las cuidadoras lo hacían por obligación moral, compasión, reciprocidad y amor; y un 80 % de los cuidadores por responsabilidad y reciprocidad, obteniendo un logro y un aprendizaje satisfactorio. Ambos desarrollaron habilidades de resiliencia, alcanzando mayores niveles de adaptación. Los cuidadores utilizaron más mecanismos protectores de afrontamiento y un 50% de las cuidadoras obtuvieron en la religión el apoyo que más les reconfortaba. CONCLUSIONES: El género determina el significado que se otorga a la experiencia de cuidar. Los motivos y las estrategias de afrontamiento en hombres y mujeres son distintos.

La perspectiva de las personas cuidadoras desde un análisis de género / The perspective of caregivers from a gender analysis

Fundamentos: El género influye en la prestación de cuidados familiares, identificándose desigualdades en la distribución de tareas relacionadas con el cuidado. El objetivo de este estudio fue analizar la influencia del género en los cuidados familiares, identificando las características sociodemográficas de los/as cuidadores/as.Métodos: Se realizó un estudio mixto, descriptivo y fenomenológico. Participaron ocho mujeres y cinco hombres de setenta y más años que cuidaban en el domicilio a personas dependientes, seleccionadas por muestreo intencional en Valencia. El análisis de las entrevistas en profundidad se realizó en tres etapas: lectura a los/las participantes de las transcripciones para su comprobación; discriminación de unidades de significado; reducción eidética y fenomenológica para obtener las declaraciones de significado. Se calcularon frecuencias y porcentajes. Resultados: La edad media, el nivel de estudios y los años dedicados al cuidado fue mayor en los cuidadores. Las cuidadoras tenían una mayor carga relacionada con los cuidados. Se idenficaron tres categorías influenciadas por la cultura androcéntrica: perspectiva vital; motivos que sustentan el cuidado; estrategias de afrontamiento. Un 90 % de las cuidadoras lo hacían por obligación moral, compasión, reciprocidad y amor; y un 80 % de los cuidadores por responsabilidad y reciprocidad, obteniendo un logro y un aprendizaje satisfactorio. Ambos desarrollaron habilidades de resiliencia, alcanzando mayores niveles de adaptación. Los cuidadores utilizaron más mecanismos protectores de afrontamiento y un 50% de las cuidadoras obtuvieron en la religión el apoyo que más les reconfortaba. Conclusiones: El género determina el significado que se otorga a la experiencia de cuidar. Los motivos y las estrategias de afrontamiento en hombres y mujeres son distintos.(AU)

Background: Gender influences the provision of family caregiving, identifying inequalities in the distribution of care-related tasks. The aim of this study was to analyze the gender influence in family caregiving, provided by elderly while, identifying the sociodemographic characteristics of caregivers.Methods: Mixed, descriptive and phenomenological study was made. Eight women and five men aged seventy and over participated who cared for dependent people at home, selected by intentional sampling in Valencia. The analysis of the in-depth interviews was carried out in three stages: reading to the participants of the transcripts for their verification; discrimination of units of meaning; eidetic and phenomenological reduction to obtain the statements of meaning. Frequencies and percentages were calculated.Results: The mean age, educational level and years dedicated to care were higher in caregivers. Caregivers had a greater burden related to caregiving. Three categories influenced by androcentric culture were idenfied: vital perspective; reasons that support care; coping strategies. 90% of female caregivers cared out of moral obligation, compassion, reciprocity, and love; and 80% of male caregivers by responsibility and reciprocity, obtaining a satisfactory achievement and learning. Both developed resilience skills, reaching higher levels of adaptation. Male caregivers used more protective coping mechanisms and 50% of female caregivers obtained the most comforting support from religion. Conclusions: Gender determines the meaning given to the experience of caring. The reasons and coping strategies in men and women are different.(AU)

Validation and cross-cultural adaptation of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-15 (MSISQ-15) into Spanish.

Background: The Multiple Sclerosis Intimacy and Sexuality Questionnaire-15 (MSISQ-15) is a valid and reliable tool to assess the sexuality of people with multiple sclerosis. The objectives of this study were: 1) to cross-culturally adapt and examine the psychometric properties of the MSISQ-15 in the Spanish context and 2) to examine the association between sexual dysfunction and other related factors. Methods: We conducted a instrumental study. People diagnosed with multiple sclerosis and members of multiple sclerosis associations in Spain were included. The linguistic adaptation of the questionnaire was performed through a translation-back translation procedure. For the psychometric validation, the confirmatory factor analysis was used while the internal consistency was examined by the ordinal alpha test. The construct validity was examined by correlating the results with the Male Sexual Function (FSH), Female Sexual Function-2 (FSM-2), Dyadic Adjustment Scale-13 (EAD-13) and Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL) questionnaires. Results: A total of 208 participants were included. Both the fit of the Spanish version of the MSISQ-15 to the original scale and the internal consistency were adequate (α = 0.89). The construct validity showed correlations with the FSH, FSM-2, and MusiQoL but not with the EAD-13. Conclusions: The Spanish version of the MSISQ-15 is a valid and reliable tool to assess the sexuality of people with multiple sclerosis in the Spanish context.

Experience of Operating Room Health Care Providers in the Management of Patients With Dementia.

The management of hospitalized patients with dementia is more complicated compared to patients without dementia, specifically in the surgery ward. The aim of the current study was to explore the experiences of operating room health care providers in the management of patients with dementia. A descriptive qualitative study was designed. Twenty semi-structured interviews were conducted with surgical professionals. Content analysis was performed. Four main themes emerged: Communication Issues, Experience-Based Protocol, Emotions, and Perceived Needs. Health care providers in a surgical ward face numerous challenges when attending to patients with dementia and tend to use strategies based on their own experience due to lack of specific action protocols. Therefore, specific training of the surgical team and protocols are needed to ensure quality care. [Research in Gerontological Nursing, 16(3), 125-133.].

Barriers to Accessing Eye Health Services in Suburban Communities in Nampula, Mozambique.

Globally, an estimated 2.2 billion people are visually impaired (VI) or blind, and a large proportion (90%) of those affected live in low- and middle-income countries (LMICs), where access to eye health services is limited. This study aimed to identify barriers to accessing eye health services and associated factors in suburban communities of Nampula. A cross-sectional community-based study was carried out on adults ≥18 years old. A total of 338 adults were randomly selected from three communities (Muthita, Piloto, and Nthotta). Individual interviews were carried out and socio-demographic data, eye symptoms, date of last eye examination, and barriers to access to eye health services were extracted. Among participants, 49.4% had eye symptoms and 41.7% did not have their eye examinations up to date. The most cited barriers were crowding in hospitals (40.7%), financial difficulties (30.0%), self-medication (20.5%), traditional treatment (17.8%), and buying eyeglasses on the street (11.6%). Barriers limited the service target to 33%. Lower levels of schooling and monthly family income and farmer occupation were statistically associated with the most barriers as risk factors. The use of eye health services was lower due to barriers to accessing eye services. More specific intervention plans and greater cooperation between sectors are needed to improve these indicators.

Feeding Difficulties Associated with IBD during the Working Day: Qualitative Study, Alicante Spain.

Inflammatory bowel disease (IBD) is a chronic disease characterized by inflammation of the gastrointestinal tract. Nutrition is a key aspect as it can modulate much of the symptomatology. People affected by IBD often experience difficulties at work in all areas, including adapting their dietary management to workplace situations. The aim of this study is to identify the difficulties associated with eating during the working day in people diagnosed with IBD. A qualitative study was conducted through a nominal and focus group with people affected by IBD. After the thematic analysis of the data, three main themes emerged: management of food during the working day, searching for strategies to live with the disease, and the importance of visibility and support. This study shows that IBD influences the working life of people with IBD and makes it difficult to maintain an adequate diet. The institutions in charge of the treatment of IBD patients should consider the support of multidisciplinary teams, including nutrition professionals, as a fundamental part of the pathology control and dietary treatment to minimize its repercussions at work.

Experience of women with multiple sclerosis during the period of compulsory home confinement due to COVID-19 in Spain.

Compulsory home confinement due to COVID-19 pandemic has had an influence on the physical and emotional health. Nevertheless, it has been more prevalent in women and in people with chronic illness such as multiple sclerosis, so the aim of this study was to know the experience of women with multiple sclerosis during the home confinement period in Spain. Seven women aged over 18 years, with a definitive diagnosis of multiple sclerosis and who belonged to multiple sclerosis associations completed semi-structured interviews. Two main themes and multiple subthemes were identified. The first them was "living with multiple sclerosis during home confinement" which included the physical and emotional impact, confinement coping ability and time for reflection. The second theme was "the environment during confinement" and it included solidarity and support, family cooperation, importance of peer contact and adjustments in the health environment during the pandemic. The period of compulsory home confinement in Spain did not worsen the physical and emotional symptoms of these women. This might be related to the increased support they had received as well as the continuity of their rehabilitation activities at home. Regarding changes in health system, the participants referred the necessity to return to face-to-face visits.

Experience of women with multiple sclerosis about their sexuality.

PURPOSE: To understand how women with multiple sclerosis (MS) experience their sexuality. MATERIAL AND METHODS: This was a qualitative study in which eight women belonging to MS associations in Elche or Alicante (Spain) completed semi-structured interviews. We subsequently carried out a thematic analysis of this data. RESULTS: Four main themes and multiple sub-themes were identified. The first theme was the 'influence of stereotypes on sexual expression', which included social and gender perspectives; the second theme was 'physical and emotional causes of sexual dysfunction', which were classified as primary, secondary, and tertiary; the third theme was 'experiencing sexuality in a personalised way', which included relationships with a partner, the concept of sexuality, and resources for improving sexual function; and the final theme was 'external support', which included sexual assistance, professional care, and peer support. CONCLUSIONS: Sexual needs change in women with MS after diagnosis of the disease. However, this is not addressed routinely by health professionals. In their search for resources, women with MS highlighted that support from partners and from associations, could constitute a support network for the expression of their sexuality.IMPLICATIONS FOR REHABILITATIONWomen with MS refer changes in their sexual function, and these changes are not addressed routinely by healthcare providers.Inclusion of the sexual partners of women with MS in consultations regarding the treatment of sexual dysfunctions should be considered with previous consent.The positive experience of a woman with MS who used sexual assistant services may justify further research.MS associations can also play an important role in the sexual field as a meeting place for peers with shared experiences.

Efficacy of a Standardised Patient Simulation Programme for Chronicity and End-of-Life Care Training in Undergraduate Nursing Students.

BACKGROUND: Standardised patient simulations seem to be useful for improving the communication skills of health sciences students. However, it is important to define the effectiveness of these types of interventions in complex scenarios linked to disease chronicity and end-of-life contexts. METHODS: A quasi-experimental study with pre- and post-intervention measures was carried out in a single group. A total of 161 nursing students completed different assessment instruments to measure their attitudes towards communication (Attitude Toward Communication Scale), self-efficacy (Self-Efficacy of Communication Skills, SE-12), and communication skills (Health Professionals Communication Skills Scale, EHC-PS) before and after simulation training with standardised patients. The objective of the program was to train students in non-technical skills for complex situations involving chronicity and end-of-life care. It comprised eight sessions lasting 2.5 h each. RESULTS: The results showed notable baseline gender differences in attitudes towards communication and in the informative communication dimension, with women obtaining higher scores. The participants' self-efficacy and communication skills significantly improved after completing the intervention, with no significant differences being found for the attitudes towards communication variable. CONCLUSION: The standardised patient simulation programme for complex scenarios related to chronicity and end-of-life contexts improved communication self-efficacy and communication skills in these nursing students. In future work it will be important to analyse the influence of gender and attitudes towards communication as variables in the learning of communication skills in nursing students.

Psychometric properties of the Attitudes towards Medical Communication Scale in nursing students.

BACKGROUND: Adequate communication skills in healthcare professionals are one of the key elements required for achieving high-quality healthcare. Thus, measurement instruments able to assess the dimensions related to these skills, including attitudes towards communication, are useful and convenient tools. OBJECTIVES: To (a) cross-culturally adapt and validate a scale to measure attitudes towards communication in a sample of nursing students in the Spanish environment; (b) describe the perceived attitudes of nursing degree students towards communication. METHODS: We conducted an instrumental study. First, we adapted the scale by applying a standardised linguistic validation procedure. After that, we determined its structural equivalence and evaluated its psychometric properties. PARTICIPANTS: A total of 255 students participated; their average age was 22.66 years (SD = 4.75) and 82% were female. RESULTS: The internal consistency of the scale was adequate (0.75), and the data fit well with the model (CFI = 0.99; TLI = 0.99; RMSEA = .01 95% CI [.00-.05]). The overall instrument score poorly correlated with the self-efficacy in communication skills variable. CONCLUSIONS: The attitudes towards communication scores for these nursing students were high. The Spanish version of the Attitudes Towards Health Communication scale had adequate psychometric properties and this tool could quickly and easily be applied to assess the attitudes of health profession students.

Mixed-method study on the satisfaction of a high-fidelity simulation program in a sample of nursing-degree students.

BACKGROUND: Training emotionally complex communication skills with standardized patients brings realism to simulation scenarios, and moreover, is associated with high levels of satisfaction among the students. OBJECTIVES: (1) To measure the satisfaction of nursing students and factors related to their satisfaction and (2) to explore the effects perceived by nursing students after having a high-fidelity simulation training program using standardized patients. DESIGN AND PARTICIPANTS: Mixed design. Pre-post quasi-experimental phase in which the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation was administered in 156 students; a second, semi-structured interview qualitative phase was completed by 11 students. RESULTS: Nursing students showed high satisfaction scores. The scores for utility and communication were correlated with the students' attitudes towards communication. In the second phase, two main themes and four sub-themes emerged. CONCLUSIONS: Teachers could implement high-fidelity simulation programs with standardized patients for training emotionally complex communication skills to nursing students. These programs allow students to participate in their own learning processes and help them to feel motivated and satisfied about the usefulness of their learning experiences.

Levels and Determinants of Place-Of-Death Congruence in Palliative Patients: A Systematic Review.

Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010-2021. Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, and IBECS. Information was extracted on research characteristics, congruence, and associated factors. Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors (functional status, treatments and diagnosis), individual factors (age, gender, marital status, and end of life preferences), and environmental factors (place of residence, availability of health, and palliative care services). Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life.

Experience of People in Mild and Moderate Stages of Alzheimer's Disease in Spain / Experiencia de personas con Alzheimer en fases leves y moderadas en España / A experiência de pessoas com Alzheimer na Espanha nas fases leve e moderada

Objetivo: analizar el significado que adquiere la enfermedad para las personas afectadas por Demencia, proporcionándoles voz. Material y métodos: aproximación a la fenomenología descriptiva a través de entrevistas a personas de ambos sexos y mayores de 50 años residentes en Tarragona (España) con un diagnóstico de Demencia leve o moderada, principalmente enfermedad tipo Alzheimer. Resultados: surgieron tres grandes temáticas: 1) normalización de la pérdida de memoria en fases incipientes en relación al proceso natural de envejecimiento; 2) autopercepción de que existe un problema de memoria instaurándose que se disimula frente a su entorno y 3) procesos de adaptación y aprendizaje de estrategias para convivir con su condición tras el diagnóstico. Conclusiones: la falta de infraestructuras especializadas dentro del sistema sanitario en materia de cuidados, programas de prevención y detección precoz son los aspectos más evidentes remarcados.

Objective: To analyze the meaning of dementia by those affected by it, and to give them a voice. Material and methods: Descriptive phenomenology through interviews with people of both genders who are over 50 years old and living in Tarragona (Spain), with a diagnosis of mild or moderate dementia, mainly related to Alzheimer's disease. Results: Three main themes emerged: 1) normalization of memory loss in early stages as part of the natural aging process; 2) self-awareness of progressive memory decline, which is concealed from others, and 3) adaptation processes and strategies to coexist with their condition after diagnosis. Conclusions: The most evident features were the lack of specialized infrastructures within the health system in terms of care, prevention programs, and early detection.

Objetivo: Analisar o significado que a doença adquire para as pessoas afetadas pela demência, dando voz a elas. Material e Métodos: Abordagem da fenomenologia descritiva por meio de entrevistas com pessoas residentes em Tarragona (Espanha) com diagnóstico de demência leve ou moderada, principalmente doença do tipo Alzheimer de ambos os sexos e com mais de 50 anos. Resultados: Surgiram três grandes temas: 1) Normalização da perda de memória em fases incipientes relacionadas ao processo natural de envelhecimento; 2) Autopercepção de que existe um problema de memória que se esconde do ambiente; 3) Processo de adaptação e estratégias de aprendizado para conviver com sua condição após o diagnóstico. Conclusões: A falta de infra-estruturas especializadas no sistema de saúde, programas de prevenção e detecção precoce são os aspectos mais evidentes.

El Documento de Voluntades Anticipadas como instrumento de planificación ético-jurídico: especial atención a la salud mental / Advance Directives as an ethic-legal planning tool in a mental health context / El Document de Voluntats Anticipades com a instrument de planificació ètico-jurídic: especial atenció a la salut mental

La relación médico-paciente se encuentra en un proceso de cambio y evolución hacia un tratamiento más humano, sustentado sobre el principio de autonomía, con el objetivo de respetar los derechos del paciente y no sólo imponer la voluntad del médico. Un instrumento que salvaguarda esta situación es el Documento de Voluntades Anticipadas, como extensión del consentimiento informado. A pesar de su regulación internacional y nacional, en ciertos contextos, como el de la salud mental, el modelo hegemónico-paternalista sigue imperando y nos preguntamos por qué

The doctor-patient relations are undergoing a process of change and evolution towards a more humane approach, based on the principle of autonomy , with the aim of respecting the rights of patients and not just imposing the will of the phyisician. Advance Directives, as an extension of Informed Consent documents, can further safeguard such rights. Despite its international and national regulation, in certain contexts, such as mental health, the hegemonic-paternalistic model persists, and the authors question the underlying motive

La relació metge-pacient es troba en un procés de canvi I evolució cap a un tractament més humà basat en el principi d'autonomia, amb l'objectiu de respectar els drets del pacient I no només imposar la voluntat de metge. Un instrument que salvaguarda aquesta situació és el Document de Voluntats Anticipades, com a extensió del consentiment informat. Malgrat la seva regulació internacional I nacional, en certs contextos, com el de la salut mental, el model hegemònic-paternalista segueix imperant I ens preguntem per què

Knowledge and attitudes of Spanish mental health professionals towards advance healthcare directives.

WHAT IS KNOWN ON THE SUBJECT?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences. AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities. However, the use of AHDs as described above is not yet a reality in Spain. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice. Although providers had a moderate-low level of knowledge about AHDs, they presented positive attitudes towards them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up-to-date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process. More in-depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation. The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. ABSTRACT: Introduction Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method We cross-sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing-care technician was associated with stronger positive attitudes. Discussion Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented.

Effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis: a systematic review.

OBJECTIVE: To evaluate the effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Embase and the Cochrane Library, as well as doctoral thesis databases Teseo and ProQuest Dissertations & Theses Global and the grey literature database Opengrey were searched, last on 15 October 2019. Journals related to the topic were also consulted. The bibliographic references of the articles included were reviewed. METHOD: Studies were selected if they included women with multiple sclerosis in whom interventions aimed at reducing sexual dysfunction were applied. Data extraction was carried out by two independent reviewers. The Jadad scale was used to evaluate the methodological quality of the studies included. RESULTS: In total, 12 clinical trials were selected, and 611 patients were examined. Studies were classified into six interventions: sexual therapy (4), pharmaceutical drugs (3), pelvic floor exercises (2), yoga (1), mindfulness (1) and vaginal devices (1). Most of them improved some primary outcomes of sexual dysfunction such as lubrication, arousal, desire or orgasm. Pain was the most common secondary outcome evaluated and it became better in two studies including sexual therapy and in one intervention with pelvic floor exercises. Tertiary outcomes such as anxiety or depression were rarely examined, and they improved with sexual therapy and with OnabotulinumtoxinA. CONCLUSION: Sexual therapy, administration of OnabotulinumtoxinA, pelvic floor muscles exercises alone or combined with electrostimulation and the use of clitoral devices could be the most recommended interventions to improve the sexuality in women with multiple sclerosis.

Level of Burden and Health-Related Quality of Life in Caregivers of Palliative Care Patients.

The complexity of palliative care means that the emotional distress and burden that primary family caregivers suffer under can be particularly high. The objective of this study was to determine the level of burden endured by these primary family caregivers and to identify the variables that predict it in the caregiving relatives of people who require home-based palliative care. A descriptive-correlational cross-sectional study was conducted. Socio-demographic and clinical data were collected from caregivers through a self-administered questionnaire that included questions from the 12-Item Short Form Health Survey (SF-12), Zarit Caregiver Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS), Brief Resilient Coping Scale (BRCS), Post Traumatic Growth Inventory (PTGI), and Fatigue Assessment Scale (FAS). A total of 77 caregivers participated; 66.2% were women, and the mean age was 61.5 years. Most (62.3%) were providing care to cancer patients. From among these data, the presence of anxiety as a clinical problem (48.1%), a high average fatigue score (FAS) of 23.0 (SD = 8.5), and the prevalence of intense overload (41.6%) stood out. We found statistically significant correlations between the variables of burden, fatigue, post-traumatic growth, anxiety, and depression, with the latter two being the main predictive variables of burden. In addition, caregiver burden was associated with a worsening of health. Identifying the factors that influence the appearance of overburden will allow the specific needs of careers to be assessed in order to offer them emotional support within the healthcare environment.

Enteral Nutrition in Patients with Inflammatory Bowel Disease. Systematic Review, Meta-Analysis, and Meta-Regression.

Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and is characterized by inflammation of the gastrointestinal tract. One of the possible treatments for this pathology is a change in the type of diet, of which enteral nutrition (EN) is one. This study is to understand how the use of EN can affect the adult population diagnosed with IBD. We conducted a systematic review, meta-analysis, and a meta-regression. On the different databases (MEDLINE, Scopus, Cochrane, LILACS, CINAHL, WOS), we found 363 registers with an accuracy of 12% (44 registers). After a full-text review, only 30 research studies were selected for qualitative synthesis and 11 for meta-analysis and meta-regression. The variables used were Crohn's disease activity index (CDAI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). EN has been shown to have efficacy for the treatment of Crohn's disease and is compatible with other medicines. As for the CDAI or rates of remission, there were no differences between enteral and parenteral nutrition. Polymeric formulas have shown better results with respect to the CRP. The long-term treatment could dilute the good CDAI results that are obtained at the start of the EN treatment.