Trastornos neuropsiquiátricos y estrategias de afrontamiento emocionales en pacientes postictus. Estudio longitudinal / Neuropsychiatric disorders and emotional coping strategies in post-stroke patients. A longitudinal study

Introducción: Entre un tercio y la mitad de la población que ha padecido un ictus presenta un trastorno neuropsiquiátrico (TNp), el cual suele estar infradiagnosticado. Objetivo: Estudiar la asociación entre la presencia de TNp y las estrategias de afrontamiento en pacientes con ictus. Sujetos y métodos: Estudio prospectivo, longitudinal y comparativo en una muestra de pacientes con ictus isquémico con y sin presencia de TNp. Se recogieron variables sociodemográficas y clínicas. Se evaluó la afectación neurológica (National Institute of Health Stroke Scale) y el afrontamiento (Brief Coping Orientation to Problems Experienced) a los tres y a los 12 meses. El período de estudio fue de 2013 a 2017. Resultados: Se analizó a 82 pacientes, con una edad media de 67,6 ± 10,4 años, y eran hombres el 52,4%. De ellos, 14 con TNp y 36 sin TNp respondieron a la escala de afrontamiento Brief Coping Orientation to Problems Experienced, y los 32 restantes fueron excluidos por afasia/disfasia. A los tres meses se observaron dimensiones de afrontamiento activo, apoyo social, negación y desconexión conductual en el grupo TNp, y a los 12 meses persistió la negación y la desconexión conductual, y aparecieron dimensiones de planificación, autodistracción y autoinculpación. Conclusiones: Los resultados muestran la necesidad de motivar a los pacientes a buscar estrategias más eficaces, identificando los problemas cuando aparecen, de considerarlos superables y de inhibir respuestas impulsivas o inadecuadas, sustituyéndolas por respuestas emocionales y conductas adecuadas.(AU)

Introduction: Between one third and one half of the population that has suffered a stroke present with a neuropsychiatric disorder (NPD), which often goes underdiagnosed. Aim: To study the association between the presence of NPDs and coping strategies in stroke patients. Subjects and methods. Prospective, longitudinal and comparative study in a sample of patients with ischaemic stroke with and without the presence of NPDs. Both sociodemographic and clinical variables were collected. Neurological impairment (National Institute of Health Stroke Scale) and coping (Brief Coping Orientation to Problems Experienced) were assessed at three and 12 months. The period studied was from 2013 to 2017. Results: A total of 82 patients were analysed, with a mean age of 67.6 ± 10.4 years, 52.4% of whom were male. Of them, 14 with NPD and 36 without NPD answered the Brief Coping Orientation to Problems Experienced coping scale, and the remaining 32 were excluded because of aphasia/dysphasia. At three months, dimensions of active coping, social support, denial and behavioural disengagement were observed in the NPD group, and at 12 months, denial and behavioural disengagement persisted, and planning, self-distraction and self-incrimination dimensions appeared. Conclusions: Results show the need to motivate patients to seek more effective strategies, to identify problems when they arise, to consider them as surmountable and to inhibit impulsive or inappropriate responses, replacing them with emotional responses and appropriate behaviours.(AU)

[Neuropsychiatric disorders and emotional coping strategies in post-stroke patients. A longitudinal study]. / Trastornos neuropsiquiátricos y estrategias de afrontamiento emocionales en pacientes postictus. Estudio longitudinal.

INTRODUCTION: Between one third and one half of the population that has suffered a stroke present with a neuropsychiatric disorder (NPD), which often goes underdiagnosed. AIM: To study the association between the presence of NPDs and coping strategies in stroke patients. SUBJECTS AND METHODS: Prospective, longitudinal and comparative study in a sample of patients with ischaemic stroke with and without the presence of NPDs. Both sociodemographic and clinical variables were collected. Neurological impairment (National Institute of Health Stroke Scale) and coping (Brief Coping Orientation to Problems Experienced) were assessed at three and 12 months. The period studied was from 2013 to 2017. RESULTS: A total of 82 patients were analysed, with a mean age of 67.6 ± 10.4 years, 52.4% of whom were male. Of them, 14 with NPD and 36 without NPD answered the Brief Coping Orientation to Problems Experienced coping scale, and the remaining 32 were excluded because of aphasia/dysphasia. At three months, dimensions of active coping, social support, denial and behavioural disengagement were observed in the NPD group, and at 12 months, denial and behavioural disengagement persisted, and planning, self-distraction and self-incrimination dimensions appeared. CONCLUSIONS: Results show the need to motivate patients to seek more effective strategies, to identify problems when they arise, to consider them as surmountable and to inhibit impulsive or inappropriate responses, replacing them with emotional responses and appropriate behaviours.

TITLE: Trastornos neuropsiquiátricos y estrategias de afrontamiento emocionales en pacientes postictus. Estudio longitudinal.Introducción. Entre un tercio y la mitad de la población que ha padecido un ictus presenta un trastorno neuropsiquiátrico (TNp), el cual suele estar infradiagnosticado. Objetivo. Estudiar la asociación entre la presencia de TNp y las estrategias de afrontamiento en pacientes con ictus. Sujetos y métodos. Estudio prospectivo, longitudinal y comparativo en una muestra de pacientes con ictus isquémico con y sin presencia de TNp. Se recogieron variables sociodemográficas y clínicas. Se evaluó la afectación neurológica (National Institute of Health Stroke Scale) y el afrontamiento (Brief Coping Orientation to Problems Experienced) a los tres y a los 12 meses. El período de estudio fue de 2013 a 2017. Resultados. Se analizó a 82 pacientes, con una edad media de 67,6 ± 10,4 años, y eran hombres el 52,4%. De ellos, 14 con TNp y 36 sin TNp respondieron a la escala de afrontamiento Brief Coping Orientation to Problems Experienced, y los 32 restantes fueron excluidos por afasia/disfasia. A los tres meses se observaron dimensiones de afrontamiento activo, apoyo social, negación y desconexión conductual en el grupo TNp, y a los 12 meses persistió la negación y la desconexión conductual, y aparecieron dimensiones de planificación, autodistracción y autoinculpación. Conclusiones. Los resultados muestran la necesidad de motivar a los pacientes a buscar estrategias más eficaces, identificando los problemas cuando aparecen, de considerarlos superables y de inhibir respuestas impulsivas o inadecuadas, sustituyéndolas por respuestas emocionales y conductas adecuadas.

Valoración del dolor en el ámbito de las emergencias extrahospitalarias en Cataluña / Assessment of pain in the area of out-of-hospital emergencies in Catalonia

Objetivo: Conocer la valoración y el manejo del dolor que utilizan los profesionales del Sistema de Emergencias Médicas (SEM) en Cataluña. Metodología: Estudio descriptivo, observacional y transversal en el ámbito de la asistencia extrahospitalaria, desde agosto a octubre de 2015 en Cataluña. La muestra ha sido no probabilística de conveniencia como técnica de recogida de datos se utilizó una encuesta on line ad hoc enviada por la empresa SEM SA a todos los trabajadores del SEM. El proyecto fue aprobado por la dirección de la empresa. Se estudiaron variables demográficas, lugar de trabajo: Soporte Vital Avanzado Médico (SVA Mike), Soporte Vital Avanzado Enfermero (SVA India), soporte Vital Básico (SVB); categoría profesional (Médico/a, Enfermero/a, Técnico/a), años de experiencia en el SEM, tipo de paciente a quien se valora el dolor, escalas de dolor utilizadas, percepción de los profesionales sobre el abordaje del dolor y el manejo de la analgesia dentro de la asistencia. El análisis de los datos se realizó con el paquete estadístico SPSS versión 20.0 para IBM. Resultados: A partir de una población total de 932 trabajadores del SEM que pertenecen a las categorías profesionales de médico, enfermera y técnico en emergencias sanitarias (TES), se han analizado 152 respuestas (la tasa de respuesta fue del 16,30 %). El 95,4 % de los participantes manifestaron valorar el dolor en la anamnesis inicial del paciente, el 94,1 % expresaron utilizar escalas para medir el dolor. Los médicos y enfermería usaban la escala EVA (54,6 %) y los técnicos la escala numérica (45,4 %) (p < 0,001). El 46,7 % aplicaban la analgesia que consideraron oportuna y el 96,7 % de médicos y enfermeras explicaron que realizaban revaloración del dolor posterior a la analgesia. Conclusiones: La mayoría de participantes manifestaron valorar el dolor de manera sistemática y mediante una escala. Sería de gran interés unificar criterios de valoración y manejo del dolor, así como disponer de protocolos específicos actualizados en el ámbito prehospitalario

Objective: To know the assessment and pain management used by the professionals of the Medical Emergency System (EMS) in Catalonia. Methodology: Descriptive, observational and transversal study in the field of out-of-hospital care, from August to October 2015 in Catalonia. The sample was non-probabilistic of convenience, as an information collection technique was used an online survey sent by the company SEM SA to all workers of SEM. The project was approved by the management of the company. It was studied demographic variables, workplace (SVA Mike, SVA India, SVB), professional category (Physician, Nurse, Technician), years of experience in the type of patient to whom the pain is assessed, the scales of pain used, the professionals’ perception about the pain approach and the management of the analgesia within the care. Data analysis has been done with the SPSS version 20.0 per IBM statistical package. Results: From a total population of 932 EMS workers belonging to the professional categories of physician, nurse and technician in health emergencies (TES), 152 responses were analyzed (the response rate was 16.30 %). 95.4 % of the participants assessed the pain in the patient's initial anamnesis, 94.1 % used scales. Physicians and nurses used the EVA scale (54.6 %) and medical emergency technicians used the numerical scale (45.4 %) (p < 0.001). The 46.7 % one applied the analgesia they considered opportune and 96.7 % of doctors and nurses did a subsequent revaluation the pain. Conclusions: The majority of participants assessed pain systematically and on a scale. It would be of great interest to unify criteria of evaluation and pain management, as well as to have specific protocols updated in the prehospital setting

[Influence of waiting time on patient and companion satisfaction]. / Influencia del tiempo de espera en la satisfacción de pacientes y acompañantes.

OBJECTIVE: To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. METHODOLOGY: Prospective, observational study. SETTING: Hospital de Figueres Emergency Department (Girona, Spain). STUDY VARIABLES: sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. RESULTS: A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n=257) was 54.6years (SD=18.3). The mean overall satisfaction (n=273) was 7.6 (SD=2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ)=-0.242, P<.001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ=-0.304; P<.001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P=.001). CONCLUSIONS: Perceived waiting time and the information about estimated waiting time determined overall satisfaction.

Influencia del tiempo de espera en la satisfacción de pacientes y acompañantes / Influence of waiting time on patient and companion satisfaction

Objetivo: Evaluar la satisfacción de pacientes y acompañantes de un servicio de urgencias hospitalario y su relación con el tiempo de espera. Método: Estudio observacional transversal. Ámbito de estudio: Servicio de Urgencias del Hospital de Figueres (Girona). Variables estudiadas: características sociodemográficas, nivel de satisfacción, tiempo de espera real y percibido hasta el triaje y la visita médica. Resultados: Se recibieron 285 respuestas. La edad media (n = 257) fue de 54,6 años (DE = 18,3). La puntuación media de la satisfacción global con la visita (n = 273) fue de 7,6 (DE = 2,2) y la mediana, de 8 (rango intercuartílico [RIC] = 2). Se observó, a menor tiempo de espera percibido hasta ser atendidos por la enfermera de triaje, mayor satisfacción global (ρ = −0,242, p < 0,001), y a menor tiempo de espera percibido hasta la visita médica, mayor satisfacción global (ρ = −0,304; p < 0,001). Los usuarios que fueron informados sobre el tiempo de espera hasta la visita médica mostraron mayor satisfacción que los que no fueron informados (p = 0,001). Conclusiones: La satisfacción de los usuarios del servicio de urgencias es elevada. La percepción del tiempo de espera y la información sobre este tiempo influyó en la satisfacción de los usuarios (AU)

Objective: To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. Methodology: Prospective, observational study. Setting: Hospital de Figueres Emergency Department (Girona, Spain). Study variables: sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. Results: A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n = 257) was 54.6 years (SD = 18.3). The mean overall satisfaction (n = 273) was 7.6 (SD = 2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ) = −0.242, P < .001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ = −0.304; P < .001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P = .001). Conclusions: Perceived waiting time and the information about estimated waiting time determined overall satisfaction (AU)

Health literacy y salud / Health literacy and health

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Burnout and quality of life among Spanish healthcare personnel.

The purpose of this study was to analyse the relationship between perceived quality of life and levels of burnout among healthcare personnel. A sample of 1095 participants (nurses, physicians, nursing assistants and orderlies) from five hospitals in the province of Girona (Spain) were studied (78% women, mean age=36.6 years, SD=8.8) using the 36-item short-form health questionnaire (SF-36) and the Maslach Burnout Inventory. The results showed that health-related quality of life reported by this sample of healthcare personnel was lower than the reference population values, especially in those SF-36 dimensions that comprise the mental component. In comparing the dimensions of the SF-36 by profession, we found that physicians had better perceived health in the dimensions of the physical component than nurses and other professionals (P< 0.01). No statistical differences were observed between profession and the dimensions of the mental component (P>0.05). Moreover, perceived health was worse among those that reported a high level on any of the components of burnout. These results should be taken account when designing a burnout prevention programme in the workplace.

[Nursing students voice their opinions regarding their profession]. / Los estudiantes de enfermería opinan sobre su profesión.

The authors research the opinions of first year nursing students about why the nursing profession does not receive the same degree of consideration which similar academic professionals receive. At the same time, the authors studied to see if this lower professional consideration is due to the predominant presence of females in the nursing profession. To collect data, the authors ran a transversal, descriptive, qualitative study by means of nominal group and discussion group techniques. Among the main results, the authors highlight that Nursing is considered a socially unknown profession and receives little acknowledgment inside the new health care model; furthermore, the fact that the majority of nurses are female does bear an influence on the vision of the nursing field and this female predominance harms competitiveness in the profession since nurses must conciliate their family lives with their professional lives.

Los estudiantes de enfermería opinan sobre su profesión / Nursing students voice their opinions regarding their profession

Se indaga la opinión de los estudiantes de primer curso de Enfermería sobre por qué el colectivo no está considerado al mismo nivel que otras profesiones académicamente similares. Así mismo, se ha estudiado si tiene que ver con la presencia mayoritaria de la mujer dentro de la profesión. Para recoger información se ha llevado a cabo un estudio transversal, descriptivo y cualitativo mediante las técnicas de grupo nominal y de discusión. Entre los principales resultados destacar que se considera la Enfermería una profesión socialmente desconocida y poco reconocida en su nuevo modelo asistencial; también, que la mayoría de los profesionales sean mujeres influye en la visión del entorno y dificulta la competitividad del colectivo al tener que conciliar la vida familiar con la laboral(AU)

The authors research the opinions of first year nursing students about why the nursing profession does not receive the same degree of consideration which similar academic professionals receive. At the same time, the authors studied to see if this lower professional consideration is due to the predominant presence of females in the nursing profession. To collect data, the authors ran a transversal, descriptive, qualitative study by means of nominal group and discussion group techniques. Among the main results, the authors highlight that Nursing is considered a socially unknown profession and receives little acknowledgment inside the new health care model; furthermore, the fact that the majority of nurses are female does bear an influence on the vision of the nursing field and this female predominance harms competitiveness in the profession since nurses must conciliate their family lives with their professional lives(AU)

[Urinary incontinence in patients with acute ictus]. / Incontinencia urinaria en el paciente con ictus agudo.

This project won the "Ausonia" Incontinence First Prize among those projects submitted during 1999. This article analyzes the prevalence of urinary incontinence among patients diagnosed as suffering acute ictus after 3 months, 6 months and 12 months. The authors also investigate those factors associated with acute ictus incontinence, how incontinence influences a patient's evolution, and how incontinence affects the environment where recuperation occurs, at home or in an institution, while the patient is recovering. The results confirm that acute urinary incontinence is a forecasting factor, independent of the poor middle and long range functional prognosis, and that the potential prognosis is superior than the seriousness of the neurological deficit at the moment a patient enters a hospital.