Conocimientos y preferencias sobre los recursos existentes al final de la vida en una muestra de la Comunidad de Madrid / Knowledge and preferences on end-of-life resources in a sample of professionals of the Community of Madrid

OBJETIVO: La Ley 4/2017 de Derechos y Garantías de las Personas en el Proceso de Morir de la Comunidad de Madrid regula el ejercicio de los derechos de la persona durante el proceso de su muerte. El objetivo principal de este estudio fue medir los conocimientos y preferencias sobre sedación paliativa (SP), eutanasia, suicidio médicamente asistido (SMA) y adecuación del esfuerzo terapéutico (AET). Materiales y métodos: Se diseñó un cuestionario para recoger conocimientos sobre definición y legalidad de los recursos detallados y preferencias o disposición al uso propio o para un familiar. Contestaron 192 asistentes a las Jornadas de Cuidados Paliativos (octubre 2017). RESULTADOS: Del total, 160 (83,3%) eran mujeres, con media de 39 años (DT = 15,8). El 68,2% (131) no conocían la existencia de la Ley. La definición con mayor tasa de acierto fue SP (89,1%; 171) y la de menor AET (50,5%; 97). Sobre legalidad, el más acertado fue eutanasia (94,8%; 182) y el menos AET (63,5%; 122). SP fue considerado el recurso más adecuado (93,2%; 179) y el de mayor disposición de uso tanto en familiares (91,7%; 176) como para ellos mismos (90,6%; 174). SMA fue el menos adecuado (34,4%; 66), y al que menos recurrirían en caso de final de vida de un familiar (29,7%; 57) y de sí mismos (33,3%; 64). CONCLUSIONES: Existe mayor conocimiento de la condición de legalidad o ilegalidad de cada recurso que de la definición de los términos. El uso del SMA y la eutanasia se desaprueba. Se ha de incidir en el esclarecimiento del significado de AET y aclarar la confusión con otras medidas como SP y SMA

OBJECTIVE: The Law (4/2017) on rights and guarantees of persons in the process of dying in Community of Madrid regulates the exercise of the rights of the person during this process. The main objective of this study was to determine the knowledge and preferences about palliative sedation (PS), euthanasia, physician-assisted suicide (PAS), and adequacy of the therapeutic effort (ATE). MATERIALS AND METHODS: A questionnaire was designed to collect knowledge about definition and legality of detailed resources, and disposition for themselves or for a relative. The questionnaire was completed by a total of 192 palliative care Conference attendees (October 2017). RESULTS: Of those that completed the questionnaire, 160 (83.3%) were women, and the mean age was of 39 years (SD = 15.8). More than two-thirds (131; 68.2%) did not know that the law existed. The definition with the highest rate of knowledge was on PS (89.1%; 171) and the lowest was ATE (50.5%; 97). On legality, the most successful was euthanasia (94.8%; 182) and the lowest was ATE (63.5%; 122). PS was considered the most appropriate resource (93.2%; 179), and the greater willingness of use in both relatives (91.7%; 176) as well as by themselves (90.6%; 174). PAS was the least suitable (34.4%; 66), and that less might resort in case of end-of-life of a relative (29.7%; 57), and themselves (33.3%; 64). CONCLUSIONS: There is a greater awareness of the condition of legality or illegality of each resource than of the definition of the terms. The use of the PAS and euthanasia is disapproved. It is important to clarify the meaning of ATE, and clarify its confusion with other measures such as PS and PAS

[Psychometric validation of the brief Humanizar Scale on the meaning of suffering]. / Validación psicométrica de la Escala Humanizar breve sobre el sentido del sufrimiento.

OBJECTIVE: To develop the short version of the brief Humanizar Scale, including reducing the dimensionality and the number of items. METHODS: The Humanizar Scale (24 items with Likert scale), consists of five factors that give meaning to suffering; significance, punishment, catalyst for change, masochism, inherent to life. A parallel analysis and exploratory factor analysis (EFA) were carried out on a first sample (n=529) and, using a different sample (n=182) the two-dimensional structure of the scale was confirmed using confirmatory factor analysis (CFA). RESULTS: The parallel analysis procedure obtained two factors. After the EFA, 15 items were retained with greater than 0.4 commonalities. The CFA confirmed the two-dimensional model including the first factor, the sense of suffering as a change (8 items) and the second, the sense of suffering as a burden (6 items). The goodness of fit were suitable: RMSEA=0.07; SRMR=0.08; CFI=0.96, and GFI=0.99. The weight factor of all items was significant and greater than 0.5. Cronbach Alpha was 0.75 for the first factor, and 0.74 for second. The factors showed a correlation of 0.56 (P<.01). Significant differences were found (P<.05) between the factor means according to beliefs (Christian vs. atheists/agnostics) and practice or not of prayer/meditation, the means being higher for both factors among believers (2 points of difference in each factor) and practitioners of prayer/meditation (3 points for Change factor and 1.5 for Burden factor). CONCLUSIONS: The two-dimensionality and the usefulness of the scale on the meaning of suffering have been well-defined.

[Knowledge and preferences on end-of-life resources in a sample of professionals of the Community of Madrid]. / Conocimientos y preferencias sobre los recursos existentes al final de la vida en una muestra de la Comunidad de Madrid.

OBJECTIVE: The Law (4/2017) on rights and guarantees of persons in the process of dying in Community of Madrid regulates the exercise of the rights of the person during this process. The main objective of this study was to determine the knowledge and preferences about palliative sedation (PS), euthanasia, physician-assisted suicide (PAS), and adequacy of the therapeutic effort (ATE). MATERIALS AND METHODS: A questionnaire was designed to collect knowledge about definition and legality of detailed resources, and disposition for themselves or for a relative. The questionnaire was completed by a total of 192 palliative care Conference attendees (October 2017). RESULTS: Of those that completed the questionnaire, 160 (83.3%) were women, and the mean age was of 39 years (SD=15.8). More than two-thirds (131; 68.2%) did not know that the law existed. The definition with the highest rate of knowledge was on PS (89.1%; 171) and the lowest was ATE (50.5%; 97). On legality, the most successful was euthanasia (94.8%; 182) and the lowest was ATE (63.5%; 122). PS was considered the most appropriate resource (93.2%; 179), and the greater willingness of use in both relatives (91.7%; 176) as well as by themselves (90.6%; 174). PAS was the least suitable (34.4%; 66), and that less might resort in case of end-of-life of a relative (29.7%; 57), and themselves (33.3%; 64). CONCLUSIONS: There is a greater awareness of the condition of legality or illegality of each resource than of the definition of the terms. The use of the PAS and euthanasia is disapproved. It is important to clarify the meaning of ATE, and clarify its confusion with other measures such as PS and PAS.

[Ethical attitudes Scale in residences for the elderly. Development of a tool for social and healthcare professionals]. / Escala de actitud ética en residencias. Desarrollo de un instrumento para profesionales asistenciales sociosanitarios.

INTRODUCTION: In Spain, there is very little institutional training in bioethics for healthcare professionals, and even less tools for measuring ethical attitudes. The objective of this study was the design and validation of a brief measure of ethical attitudes, collecting general attitudes of healthcare professionals in their daily practice with the dependent elderly. MATERIAL AND METHODS: After drawing up a list of 42 items around the principles of bioethical autonomy, beneficence, confidentiality, justice, and non-maleficence, a committee of experts selected 31 items. A total of 191 health care professionals with a mean age of 43.8 years (SD=11.3), including 150 (78.5%) women and 41 (21.5%) men, and with experience in the field of dependence. responded to the online questionnaire. Model fit was studied using confirmatory factor analysis. Cronbach's alpha was used for the analysis of internal consistency. RESULTS: A model of 2independent scales with adjusted goodness-of-fit index was observed. Autonomy scale (4 items related to this principle) explained 83% of the variance (P=.005), with χ2/gl=1.782; RMSEA=0.064; GFI=0.991; CFI=0.958. The beneficence, confidentiality and non-maleficence scale (9 items including these 3principles), explained 82% (P<.001) with goodness-of-fit index: χ2/gl=2.194; RMSEA=0.079; GFI=0.931; CFI=0.627. The Cronbach Alphas were 0.525 and 0.748, respectively. CONCLUSIONS: An ethical attitudes scale (EAS) is presented for professionals in the field of caring for dependent adults, including 13 items related to the observance, in daily practice, of the 4 principles of bioethics, autonomy, beneficence, confidentiality and non-maleficence.

[Validation of the Scale of Hope in Terminal Illness for relatives brief version (SHTI-b). Validity and reliability analysis.] / Validación de la Escala de Esperanza en Enfermedad Terminal (EEET-fb). Análisis de validez y fiabilidad.

BACKGROUND: Bermejo and Villacieros' Scale of Hope in Terminal Disease (SHTD) specifically collects meanings of hope facing terminal disease, including considerations relating to psycho-emotional support and that have a transcendental sense. The objective of this paper is to validate the SHTD abbreviated and rephrased to adapt all the items to a single domain. METHODS: Starting from the published SHTD, an exploratory factor analysis (EFA) was carried out with a sample of 177 valid questionnaires. In a second study, with another sample of 180 valid questionnaires, a confirmatory factor analysis (CFA) and a correlation analysis with other measurements of spiritual wellbeing (Functional Assessment of Chronic Illness Therapy-Sp) and hope (Herth Hope Index) were done. RESULTS: A bidimensional model with satisfactory goodness of fit index values was obtained (GFI = 0.991; CFI = 0.984; SRMR = 0.08; RMSEA = 0.057); the Relations of Transcendence factor obtained a Cronbach's alpha of 0.872 and Personal Relations an alpha of 0.762. The correlations of the SHTI-rb with external measures were: r = 0.527with FACIT; r = 0.266 with HHI; r = 0.667 with the Spirituality subscale of FACIT; and r = 0.348 with the Interrelation factor of HHI. The Relations of Transcendence subscale correlated with both Layout and Expectation and Interrelation of HHI (r = 0.162 and r = 0.329 respectively), while the scale of Personal Relations only correlated with Interrelation of HHI (r = 0.244). CONCLUSIONS: The Scale of Hope in Terminal Illness for relatives (brief version) is a valid and reliable specific instrument for terminal patients.

Validación de la Escala de Esperanza en Enfermedad Terminal para familiares breve (EEET-fb). Análisis de validez y fiabilidad / Validation of the Scale of Hope in Terminal Illness for relatives brief version (SHTI-b). Validity and reliability analysis

Fundamento: La Escala de Esperanza en Enfermedad Terminal (EEET) de Bermejo y Villacieros recoge específicamente significados de la esperanza ante la terminalidad, incluyendo consideraciones relativas al apoyo psicoemocional y de sentido trascendente. El objetivo de este trabajo fue la validación de la escala EEET abreviada y reformulada (EEET-fb) para adaptar todos los ítems a un solo epígrafe. Material y métodos: Se partió de la EEET publicada para realizar un análisis factorial exploratorio con una muestra de 177 cuestionarios válidos. En una segunda fase, con otra muestra de 180 cuestionarios válidos, se realizó un análisis factorial confirmatorio y un análisis de correlación con medidas externas de bienestar espiritual (Functional Assessment of Chronic Illness Therapy- Sp) y esperanza (Herth Hope Index). Resultados: Se obtuvo un modelo bidimensional con índices de ajuste satisfactorios (GFI = 0,991; CFI = 0,984; SRMR = 0,08; RMSEA = 0,057); el factor Relaciones de trascendencia obtuvo un alfa de Cronbach de 0,872 y el de Relaciones personales un alfa de 0,762. Las correlaciones de la EEET-fb con las medidas externas fueron: r = 0,527 con FACIT, r = 0,266 con HHI, r = 0,667 con el factor Espiritualidad de FACIT y r = 0,348 con el factor Interrelación de HHI. La subescala Relaciones de trascendencia correlaciona tanto con Disposición y expectativa (r = 0,162) como con Interrelación de HHI (r = 0,329), mientras que la escala Relaciones personales solamente lo hace con Interrelación de HHI (r = 0,244). Conclusiones: La EEET-fb es un instrumento válido y fiable, específico para ámbitos de terminalidad (AU)

Background: Bermejo and Villacieros' Scale of Hope in Terminal Disease (SHTD) specifically collects meanings of hope facing terminal disease, including considerations relating to psycho-emotional support and that have a transcendental sense. The objective of this paper is to validate the SHTD abbreviated and rephrased to adapt all the items to a single domain. Methods: Starting from the published SHTD, an exploratory factor analysis (EFA) was carried out with a simple of 177 valid questionnaires. In a second study, with another sample of 180 valid questionnaires, a confirmatory factor analysis (CFA) and a correlation analysis with other measurements of spiritual wellbeing (Functional Assessment of Chronic Illness Therapy-Sp) and hope (Herth Hope Index) were done. Results. A bidimensional model with satisfactory goodness of fit index values was obtained (GFI = 0.991; CFI = 0.984; SRMR = 0.08; RMSEA = 0.057); the Relations of Transcendence factor obtained a Cronbach's alpha of 0.872 and Personal Relations an alpha of 0.762. The correlations of the SHTI-rb with external measures were: r = 0.527with FACIT; r = 0.266 with HHI; r = 0.667 with the Spirituality subscale of FACIT; and r = 0.348 with the Interrelation factor of HHI. The Relations of Transcendence subscale correlated with both Layout and Expectation and Interrelation of HHI (r = 0.162 and r = 0.329 respectively), while the scale of Personal Relations only correlated with Interrelation of HHI (r = 0.244). Conclusions: The Scale of Hope in Terminal Illness for relatives (brief version) is a valid and reliable specific instrument for terminal patients (AU)

Diseño y validación de una escala de actitudes de los profesionales asistenciales hacia la liberación del uso de sujeciones en personas dependientes / Development and validation of a scale of healthcare professional attitudes to the liberation from restraint use with dependent people

Fundamento. En nuestro entorno ya existen estudios sobre prevalencia y uso de sujeciones pero no un instrumento de medida que elimine la subjetividad del evaluador para su uso en clínica y en investigación. Objetivo: diseño y validación de una escala de medida de la actitud del profesional asistencial hacia el uso de las sujeciones físicas y farmacológicas. Método. Estudio descriptivo y correlacional de validación de escala. Tras revisión bibliográfica, se elaboró un listado de ítems que se sometieron a análisis de validez; de contenido mediante jueces, de criterio mediante contraste con variable externa y de constructo mediante análisis factorial exploratorio. La fiabilidad mediante coeficiente alfa de Cronbach. Resultados. Contestaron al cuestionario 276 personas, 224 mujeres (82,4%) y 48 hombres (17,6%), media de edad de 38,65 años. La escala con 40 ítems ofreció un alfa de Cronbach 0,90. Se obtuvieron 4 dimensiones que explicaban un 46,76% de la varianza total. Se nombraron los factores Autonomía (15,08% de la varianza), Seguridad (12,23%), Entorno (8,46%) y Evitación (6,06%). Salvo la última, todas las subescalas obtuvieron un alfa superior a 0,72. Se obtuvieron diferencias debido a la experiencia en el cuidado del Alzheimer. El personal con experiencia puntúa significativamente más bajo en Factor 1 y Factor 3 y más alto en Factor 2, pero sin diferencias en el cómputo global. También por género, las mujeres puntuaron en Factor 1 más alto. Conclusión. Esta escala constituye un paso significativo en el estudio de las actitudes de los profesionales asistenciales profundizando en las causas subyacentes (AU)

Background. There are studies on the prevalence and use of restraints but not a measuring instrument to eliminate subjectivity in evaluation of their use in clinical practice and research in our environment. Objective. Design and validation of a scale of measurement of attitudes of health care professionals towards the use of physical and pharmacological restraints. Methods. Descriptive and correlational study for scale validation. Following a literature review, we developed a list of items that were subjected to a validity analysis: validity of content through judges, validity of criterion through external variable contrast, and validity of construct using exploratory factor analysis. Reliability was analysed using the Cronbach alpha coefficient. Results. Two hundred and seventy-six people answered the questionnaire, 82.4% (224) women and 17.6% (48) men, average age 38.65 years. The 40 item scale provided a Cronbach alpha of 0.897. Four dimensions were obtained explaining 46.758% of the total variance. The factors were named: Autonomy (15.084% of the variance), safety (12.228%), environment (8.463%) and avoidance (6.062%). Except for the last one, all the subscales obtained an alpha superior to 0.717. There were differences due to the experience in Alzheimer care. Staff with experience score significantly lower in Factor 1 and Factor 3, and higher in Factor 2, but there is no difference in the overall computation. Moreover, by gender, women scored higher in Factor 1.Conclusions. This scale is a significant step forward in the study of the attitudes of health care professionals as it enquires into underlying causes (AU)

[Development and validation of a scale on sense of suffering: the "Humanizar" Scale]. / Desarrollo y validación de una escala sobre el sentido del sufrimiento: Escala Humanizar.

BACKGROUND: There are studies on the causes and sense of suffering, but not a measuring instrument for clinical and research use that eliminates the subjectivity of the evaluator. The aim of this article is to analyse the meaning that people give to suffering and its underlying factors by developing a measuring scale. METHODS: Descriptive and correlational study for scale validation. Following a review of the literature, a list of items was developed that were subjected to a validity analysis: content through judges, criterion through external variable contrast, and construct using exploratory factor analysis. Reliability using Cronbach alpha coefficient. RESULTS: The questionnaire was answered by 253 people, 83% (207) women and 17% (42) men, average age 41.37 years. The 24 item scale offered a Cronbach alpha of 0.871. Seven dimensions were obtained that explained 62.42% of total variance. Five factors were named Transcendence (26.367% of the variance), Punishment (9.929%), Catalyst of change (6.498%), Masochism (5.691%) and Inherent to life (5.254%). Except the last one, all the subscales obtained an alpha superior to 0.67. No gender differences were found, although they were found depending on the existence or absence of religious beliefs. CONCLUSIONS: The "Humanizar" Scale is a valid and reliable scale with a coherent structure of five factors. It collects the meaning that a person gives to suffering, leaving open the possibility of exploration depending on populations and on whether or not there are religious beliefs.

Desarrollo y validación de una escala sobre el sentido del sufrimiento: Escala Humanizar / Development and validation of a scale on sense of suffering: The “Humanizar” Scale

Fundamento. Existen estudios sobre causas y sentido del sufrimiento, pero no un instrumento de medida que elimine la subjetividad del evaluador para su uso en clínica y en investigación. El objetivo del presente trabajo es analizar el sentido que las personas damos al sufrimiento y los factores que subyacen desarrollando una escala de medida. Material y método. Estudio descriptivo y correlacional de validación de escala. Tras revisión bibliográfica, se elaboró un listado de ítems que se sometieron a análisis de validez; de contenido mediante jueces, de criterio mediante contraste con variable externa y de constructo mediante análisis factorial exploratorio. La fiabilidad mediante coeficiente alfa de Cronbach. Resultados. Contestaron al cuestionario 253 personas, 83% (207) mujeres y 17% (42) hombres, con una media de edad de 41,37 años. La escala con 24 ítems ofreció un alfa de Cronbach 0,871. Se obtuvieron 7 dimensiones que explicaban un 62,42% de la varianza total. Se nombraron los factores Trascendencia (26,367% de la varianza), Castigo (9,929%), Catalizador de cambio (6,498%), Masoquismo (5,691%) e Inherente a la vida (5,254%). Salvo la última, todas las subescalas obtuvieron un alfa superior a 0,67. No existieron diferencias de género, pero sí en función de la existencia o no de creencias religiosas. Conclusiones. La Escala Humanizar se plantea fiable y en principio válida con una estructura coherente de cinco factores, que recoge el sentido que la persona da al sufrimiento, dejando abierta la posibilidad de la exploración según poblaciones y en función de que existan o no creencias religiosas (AU)

Background. There are studies on the causes and sense of suffering, but not a measuring instrument for clinical and research use that eliminates the subjectivity of the evaluator. The aim of this article is to analyse the meaning that people give to suffering and its underlying factors by developing a measuring scale. Methods. Descriptive and correlational study for scale validation. Following a review of the literature, a list of items was developed that were subjected to a validity analysis: content through judges, criterion through external variable contrast, and construct using exploratory factor analysis. Reliability using Cronbach alpha coefficient. Results. The questionnaire was answered by 253 people, 83% (207) women and 17% (42) men, average age 41.37 years. The 24 item scale offered a Cronbach alpha of 0.871. Seven dimensions were obtained that explained 62.42% of total variance. Five factors were named Transcendence (26.367% of the variance), Punishment (9.929%), Catalyst of change (6.498%), Masochism (5.691%) and Inherent to life (5.254%). Except the last one, all the subscales obtained an alpha superior to 0.67. No gender differences were found, although they were found depending on the existence or absence of religious beliefs. Conclusions. The “Humanizar” Scale is a valid and reliable scale with a coherent structure of five factors. It collects the meaning that a person gives to suffering, leaving open the possibility of exploration depending on populations and on whether or not there are religious beliefs (AU)

[Development and validation of a scale of healthcare professional attitudes to the liberation from restraint use with dependent people]. / Diseño y validación de una escala de actitudes de los profesionales asistenciales hacia la liberación del uso de sujeciones en personas dependientes.

BACKGROUND: There are studies on the prevalence and use of restraints but not a measuring instrument to eliminate subjectivity in evaluation of their use in clinical practice and research in our environment. OBJECTIVE: Design and validation of a scale of measurement of attitudes of health care professionals towards the use of physical and pharmacological restraints. METHODS: Descriptive and correlational study for scale validation. Following a literature review, we developed a list of items that were subjected to a validity analysis: validity of content through judges, validity of criterion through external variable contrast, and validity of construct using exploratory factor analysis. Reliability was analysed using the Cronbach alpha coefficient. RESULTS: Two hundred and seventy-six people answered the questionnaire, 82.4% (224) women and 17.6% (48) men, average age 38.65 years. The 40 item scale provided a Cronbach alpha of 0.897. Four dimensions were obtained explaining 46.758% of the total variance. The factors were named: Autonomy (15.084% of the variance), safety (12.228%), environment (8.463%) and avoidance (6.062%). Except for the last one, all the subscales obtained an alpha superior to 0.717. There were differences due to the experience in Alzheimer care. Staff with experience score significantly lower in Factor 1 and Factor 3, and higher in Factor 2, but there is no difference in the overall computation. Moreover, by gender, women scored higher in Factor 1. CONCLUSIONS: This scale is a significant step forward in the study of the attitudes of health care professionals as it enquires into underlying causes.

PCR use of highly conserved DNA regions for identification of Sinorhizobium meliloti.

A PCR identification method in which four primers that recognize homologous conserved regions in the Sinorhizobium meliloti genome are used was developed and tested. The regions used for identification were the nodbox 4 locus, which is located in one of the symbiotic megaplasmids, and the mucR gene, which is located in the chromosome. The new method was used to establish a collection of S. meliloti strains from polluted soils.