Health Access, Health Promotion, and Health Self-Management: Barriers When Building Comprehensive Ageing Communities.

A new intervention model for promoting healthy ageing grounded on integrated value-based care was developed and tested in the city of Valencia (Spain). Its implementation raised relevant barriers for older adults in their access to health, health promotion, and health self-management linked with their health and digital literacy. This new intervention model included several aspects. On the one hand, researchers together with older adults and their informal caregivers participating in the study, designed personalized care plans, based on older adults' specific needs, to be implemented with the support of a digital solution. On the other hand, researchers and health and social professionals implemented a series of workshops in different locations of the city to encourage a sense of community among participants, reinforcing their trust in the new care model and increasing their adherence. Social activities were at the core of the workshops to understand older people's interaction with the health and social services provided in the neighborhood. Qualitative and quantitative methods were combined to extract information from older participants on how to engage them as active actors of their health and understand their values and preferences. In the present manuscript, we focus on the qualitative results, which show that after a post-pandemic situation, they were more concerned about social isolation and desired face-to-face contact with their professional care team; however, feelings of loneliness and/or sadness were not considered among the reasons to visit health professionals. Some of the conclusions revealed that the use of technology as a supportive tool is well received but with a stress on its role as "supportive", and not replacing the close contact with healthcare professionals. Professionals recognized the benefits of this new approach but required more time and incentives to dedicate the effort needed. The main aim of this study was to present these barriers related to health access, health promotion, and health self-management, as well as the actions developed to face them.

A comprehensive urban programme to reduce energy poverty and its effects on health and wellbeing of citizens in six European countries: study protocol of a controlled trial.

BACKGROUND: Nearly 11% of the European population is affected by energy poverty. Energy poverty is defined by the European Commission (2016) as the inability to afford basic energy services to guarantee a decent standard of living. Energy poverty is considered a complex, multidimensional problem that affects environment, housing, urban development, and health. Living in energy poverty conditions is associated with poorer human health and wellbeing. Hence, the WELLBASED intervention programme aims to design, implement and evaluate a comprehensive urban programme, based on the social-ecological model, to reduce energy poverty and its effects on the citizens' health and wellbeing in six European urban study sites: Valencia, Spain; Heerlen, The Netherlands; Leeds, United Kingdom; Edirne, Turkey; Obuda, Hungary, and; Jelgava, Latvia. METHODS: A controlled trial is performed. A total of 875 participants are recruited (125-177 per study site) to receive the WELLBASED intervention programme for 12 months (intervention condition) and 875 participants act as controls (control condition). Data will be collected with a baseline measurement at inclusion (T0), and follow-up measurements after 6 months (T1), 12 months (T2), and 18 months (T3). In both study arms, effects of the WELLBASED intervention programme are measured: health-related quality of life (HR-QoL), mental health, frailty in older adults, self-perceived health, chronic conditions, and care utilization. At the same time points, household expenditure on energy and energy consumption are obtained. In the intervention arm, health-monitoring data (i.e. peak flow, oxygen saturation, blood pressure, and heart rate) are obtained monthly and sleep quality with a three-month interval. Household data with regard to temperature, humidity and air quality are collected near real-time by home sensors. Qualitative interviews are conducted in each study site to evaluate the impacts of the WELLBASED intervention programme and to help explain findings. DISCUSSION: The WELLBASED intervention programme will provide new insights into the effectiveness of a comprehensive urban programme to tackle energy poverty and its effects on health and wellbeing across Europe. Hence, this study can contribute to European-wide replicable solutions for policy-makers and city practitioners to alleviate energy poverty. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN14905838 . Date of registration is 15/02/2022.

Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis through cognitive-behavioral intervention, including hypnosis: a randomized study.

OBJECTIVE: This study evaluated the efficacy of a cognitive-behavioral therapy (CBT), including hypnosis, in patients with temporomandibular disorders (TMDs) with muscular diagnosis. STUDY DESIGN: Seventy-two patients (65 women and 7 men with an average age of 39 years) were selected according to the Research Diagnostic Criteria for TMD, and assigned to the experimental group (n = 41), receiving the 6-session CBT program, and the control group (n = 31). All patients received conservative standard treatment for TMD. The assessment included pain variables and psychologic distress. RESULTS: There were significant differences between the groups, the experimental group showing a higher improvement in the variables evaluated. Specifically, 90% of the patients under CBT reported a significant reduction in frequency of pain and 70% in emotional distress. The improvement was stable over time, with no significant differences between posttreatment and 9-month follow-up. CONCLUSIONS: CBT, including hypnosis, significantly improved conservative standard treatment outcome in TMD patients.

Emotional suppression and breast cancer: validation research on the Spanish Adaptation of the Courtauld Emotional Control Scale (CECS).

Emotional suppression has played an important role in the research on psychosocial factors related to cancer. It has been argued to be an important psychological factor predicting worse psychosocial adjustment in people with cancer and it may mediate health outcomes. The reference instrument in the research on emotional suppression is the Courtauld Emotional Control Scale (CECS). The present study analysed construct validity of a new Spanish adaptation of the CECS in a sample of 175 breast cancer patients. The results confirmed the proposal by Watson and Greer claiming that the CECS is composed of three subscales that measure different dimensions, but not independent, from emotional control. The present Spanish version of the CECS showed high internal consistency in each subseale as well as the total score. According to Derogatis (BSI-18) criteria, emotional suppression predicts clinically significant distress. In short, our results support the reliability, validity and utility of this Spanish adaptation of the CECS in clinical and research settings.

Emotional suppression and breast cancer: validation research on the spanish adaptation of the Courtauld Emotional Control Scale (CECS)

Emotional suppression has played an important role in the research on psychosocial factors related to cancer. It has been argued to be an important psychological factor predicting worse psychosocial adjustment in people with cancer and it may mediate health outcomes. The reference instrument in the research on emotional suppression is the Courtauld Emotional Control Scale (CECS). The present study analysed construct validity of a new Spanish adaptation of the CECS in a sample of 175 breast cancer patients. The results confirmed the proposal by Watson and Greer claiming that the CECS is composed of three subscales that measure different dimensions, but not independent, from emotional control. The present Spanish version of the CECS showed high internal consistency in each subscale as well as the total score. According to Derogatis (BSI-18) criteria, emotional suppression predicts clinically significant distress. In short, our results support the reliability, validity and utility of this Spanish adaptation of the CECS in clinical and research settings (AU)

La supresión emocional ha jugado un papel importante en la investigación de los factores psicosociales relacionados con el cáncer. Se ha discutido que es un importante factor psicológico que predice un peor ajuste psicosocial en las personas que sufren cáncer y que puede mediar los resultados médicos. El instrumento de referencia en la investigación acerca de la supresión emocional es el Courtauld Emotional Control Scale (CECS). El presente estudio analiza la validez de constructo de una nueva adaptación española del CECS en una muestra de 175 pacientes con cáncer de mama. Los resultados confirman la estructura propuesta por Watson y Greer para el instrumento, compuesta de tres subescalas que evalúan distintas dimensiones no independientes, del control emocional. La presente versión española del CECS mostró una elevada consistencia interna de cada una de las subescalas y de la puntuación total. Además la supresión emocional predice el distrés clínico significativo, según criterios de Derogatis (BSI-18). En resumen, nuestros resultados respaldan la fiabilidad, validez y utilidad de la adaptación española del CECS en contextos clínicos y de investigación (AU)

Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer sample.

OBJECTIVE: The objective of this work was to study the psychometric and structural properties of the Brief Symptom Inventory-18 (BSI-18) in a sample of breast cancer patients (N=175). METHODS: Confirmatory factor analyses were conducted. Two models were tested: the theoretical model with the original structure (three-dimensional), and the empirical model (a four-factor structure) obtained through exploratory factor analysis initially performed by the authors of the BSI-18. RESULTS: The eligible structure was the original proposal consisting of three dimensions: somatization, depression, and anxiety scores. These measures also showed good internal consistency. CONCLUSION: The results of this study support the reliability and structural validity of the BSI-18 as a standardized instrument for screening purposes in breast cancer patients, with the added benefits of simplicity and ease of application.

Psychometric properties of the Brief Symptoms Inventory-18 (Bsi-18) in a Spanish sample of outpatients with psychiatric disorders.

This study analyzes the psychometric and structural properties of the BSI-18 in a sample of Spanish outpatients with psychiatric disorders (N = 200), with three basic objectives: (a) to study the structural validity of the instrument; (b) to analyse reliability (internal consistency and test-retest stability) and validity (convergent and discriminant) of the instrument, and (c) to evaluate sensitivity to change in a therapeutic context. Using confirmatory factor analysis, two models were tested: the three-dimensional theoretical model proposed by its authors, and the empirical four-factor model obtained by the same authors through exploratory factor analysis. Our results showed that the best structure was a four-dimensional model, with the General Distress index and Somatization, Depression, General Anxiety and Panic scores. These four scales showed good internal consistency, test-retest reliability, validity and sensitivity to therapeutic change. The BSI-18 has been shown to be a reliable and useful tool for psychiatric assessment of patients, with the added advantage provided by its simplicity and ease of application.

Psychometric properties of the Brief Symptoms Inventory-18 (BSI-18) in a Spanish sample of outpatients with psychiatric disorders / Propiedades psicométricas del Brief Symptoms Inventory 18 (BSI-18) en una muestra española de pacientes ambulatorios con trastornos psiquiátricos

This study analyzes the psychometric and structural properties of the BSI-18 in a sample of Spanish outpatients with psychiatric disorders (N= 200), with three basic objectives: (a) to study the structural validity of the instrument; (b) to analyse reliability (internal consistency and test-retest stability) and validity (convergent and discriminant) of the instrument, and (c) to evaluate sensitivity to change in a therapeutic context. Using confirmatory factor analysis, two models were tested: the three-dimensional theoretical model proposed by its authors, and the empirical four-factor model obtained by the same authors through exploratory factor analysis. Our results showed that the best structure was a four-dimensional model, with the General Distress index and Somatization, Depression, General Anxiety and Panic scores. These four scales showed good internal consistency, test-retest reliability, validity and sensitivity to therapeutic change. The BSI-18 has been shown to be a reliable and useful tool for psychiatric assessment of patients, with the added advantage provided by its simplicity and ease of application

Este trabajo analiza las propiedades psicométricas y estructurales del BSI-18 en una muestra española de pacientes ambulatorios con trastornos psiquiátricos (N= 200) con tres objetivos: (i) estudiar la validez estructural del mismo; (ii) analizar su fiabilidad (consistencia interna y estabilidad test-retest) y validez (convergente y discriminante); y (iii) evaluar su sensibilidad al cambio en el contexto terapéutico. Utilizando análisis factorial confirmatorio, se pusieron a prueba dos modelos estructurales: el modelo trifactorial propuesto teóricamente por los autores del instrumento, y el modelo empírico obtenido por los mismos a través de un análisis factorial exploratorio que arrojó cuatro factores. Nuestros resultados mostraron que la estructura óptima era un modelo de cuatro dimensiones que diferencia entre Somatización, Depresión, Ansiedad general y Pánico. Estas cuatro escalas mostraron índices adecuados de consistencia interna, fiabilidad test-retest, validez convergente y discriminante, y sensibilidad al cambio terapéutico. El BSI-18 ha mostrado ser un instrumento fiable y válido para la evaluación de pacientes con trastornos psiquiátricos, con la ventaja adicional de su simplicidad y brevedad de aplicación

An examination of the psychometric structure of the Multidimensional Pain Inventory in temporomandibular disorder patients: a confirmatory factor analysis.

BACKGROUND: This paper seeks to analyse the psychometric and structural properties of the Multidimensional Pain Inventory (MPI) in a sample of temporomandibular disorder patients. METHODS: The internal consistency of the scales was obtained. Confirmatory Factor Analysis was carried out to test the MPI structure section by section in a sample of 114 temporomandibular disorder patients. RESULTS: Nearly all scales obtained good reliability indexes. The original structure could not be totally confirmed. However, with a few adjustments we obtained a satisfactory structural model of the MPI which was slightly different from the original: certain items and the Self control scale were eliminated; in two cases, two original scales were grouped in one factor, Solicitous and Distracting responses on the one hand, and Social activities and Away from home activities, on the other. CONCLUSION: The MPI has been demonstrated to be a reliable tool for the assessment of pain in temporomandibular disorder patients. Some divergences to be taken into account have been clarified.

Multidimensional approach to the differences between muscular and articular temporomandibular patients: coping, distress, and pain characteristics.

OBJECTIVE: This study analyzes the differences in psychological variables and symptomatology between temporomandibular disorder diagnosis subgroups. STUDY DESIGN: The sample included 114 temporomandibular disorder patients that were evaluated in coping, distress, and temporomandibular characteristics. Diagnostic muscular (n = 58) and articular (n = 56) subgroups were compared in these variables through a MANCOVA. RESULTS: Muscular patients show a higher level of general distress, specifically in the anxiety and somatization subscales and a more active coping style, with a tendency of a minor use of humor and a higher number of parafunctional habits, specifically, biting nails, hangnails, and lips. CONCLUSION: We discuss the differences found in order to design the targets of the psychological intervention of temporomandibular patients.

Psychological assessment of patients with temporomandibular disorders: confirmatory analysis of the dimensional structure of the Brief Symptoms Inventory 18.

OBJECTIVE: This article analyzes the psychometric and structural properties of the Brief Symptoms Inventory 18 in a sample of patients with temporomandibular disorders (TMDs), given the convenience of a brief evaluation of distress in these patients. METHODS: Confirmatory factor analysis was carried out in a sample of 114 patients with TMDs. Two models were tested: the theoretical model with the original structure proposed--which considers three dimensions--and the empirical model obtained through the exploratory factor analysis initially carried out by Leonard R. Derogatis--which consists of the four-factor structure. RESULTS: Both models reached satisfactory indexes in confirmatory factor analysis. Empirical and theoretical reasons led us to prefer the original proposal of three dimensions: somatization, depression and anxiety, and general distress. CONCLUSION: The Brief Symptoms Inventory 18 has been demonstrated to be a reliable and valid tool for the assessment of distress in patients with TMDs, with the advantage of its simplicity and ease of application.

Los factores psicológicos en el trastorno temporomandibular / Psychological factors intemporomandibular disorder

Este trabajo analiza el estado actual de la investigación sobre el papel de los factores psicológicos en los trastornos temporomandibulares. Se considera la problemática asociada a la manifestación clínica y criterios diagnósticos de estos trastornos, así como los diferentes planteamientos en torno a su etiología. El artículo incluye los principales hallazgos encontrados sobre la contribución de los factores psicológicos en los trastornos temporomandibulares, describiendo los problemas metodológicos en este campo. Entre estos resultados se analiza la evidencia respecto a la hipótesis psicofisiológica -que relaciona el estrés con la etiología de los trastornos temporomandibulares-; se destaca la existencia de mayores niveles de psicopatología en pacientes temporomandibulares, fundamentalmente en el subtipo muscular; y, finalmente, se considera la contribución de los factores psicológicos cuando los trastornos temporomandibulares se analizan desde la perspectiva del dolor crónico

This paper discusses the current situation of the research about the role of psychological factors in temporomandibular disorders. It is considered the controversy related to the clinical manifestation and diagnostic criteria of these disorders and the different approaches to their etiology. The article includes the more important results found in the research about the role of psychological factors in temporomandibular disorders are commented, describing the metodological problems in this field. Between these results, we analyze the evidence regarding to the psycophysiological hypothesis -that relates stress to the temporomandibular disorders etiology-; it is pointed out the existence of higher levels of psychopatology in temporomandibular disorder patients, specially in the muscular subtype; and finally, it is considered the contribution of psychological factors when the temporomandibular disorder is analyzed from the chronic pain approach

Psychological variables and temporomandibular disorders: distress, coping, and personality.

OBJECTIVE: This study analyzes the psychological variables of distress, personality, and coping that are related to the diagnosis based on the Research Diagnostic Criteria for temporomandibular disorder. Study design An age and sex-matched controlled study conducted with a convenience sample (n=89) in a tertiary care facility. RESULTS: The MANCOVA between the muscular (n=47), articular (n=42), and control groups (n=100) showed that the muscular group differed from the control group, obtaining higher levels of distress, anxiety, and depression, and minor use of positive reinterpretation and humor as coping strategies; the articular group also showed higher distress, less positive reinterpretation, and a lower interest in the search of instrumental social support than the control group. The coping predictor of distress in both temporomandibular groups was behavioral disengagement; however, the personality predictors differed. Neuroticism and depression were present in the muscular group, whereas conscientiousness and self-discipline were in the articular group. CONCLUSION: Temporomandibular disorder patients have different psychological features than control subjects. There are also some differences between the diagnostic groups that should be considered to address the treatment of these patients.