User violence prevention and intervention measures to minimize and prevent aggression towards health care workers: A systematic review.

Workplace violence in the health care setting is a social problem of great interest both at the health care level and in research in recent decades. The most common type of violence is the one coming from the user towards the professional. Although the bibliography includes multiple preventive actions focused on working with professionals, there are hardly any studies that explore and collect actions aimed at the user. The aim of this study is to analyze the results of the literature to provide an overview of the current evidence. Specifically, it aims to describe the various user-directed strategies or interventions aimed at reducing workplace violence experienced by professionals within the healthcare sector. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), methodology of publications published up to December 2022 in the main databases. Studies that met the previously established eligibility criteria were identified. A peer review of the risk of bias was performed and the data were extracted from a previously elaborated template. The search yielded 5231 articles of which 11 were finally included in the review. Of these, 3 had a quantitative design, 7 had a qualitative design and one had a combined design. Of these, 38 measures or actions aimed at the user were compiled, grouped into four blocks according to the attitudinal objective pursued: Improvement of communication and creation of links, involvement of the user in joint decisions with the staff, informing and training the user, and other independent proposals. This study makes it possible to explore actions aimed at users with the objective of reducing violence towards health professionals. It collects and makes available to the scientific community a set of measures aimed at making a change of attitude in the perpetrator themselves, with the involvement of the perpetrator in the health system. This set of collected measures provides researchers with a basis to be taken into account for the implementation of future prevention plans according to the new multicomponent prevention models and with the involvement of the perpetrator themselves.

Sources of Conflict and Prevention Proposals in User Violence Toward Primary Care Staff: A Qualitative Study of the Perception of Professionals.

Background: Some studies indicate that at least one in four cases of workplace violence occurs in the health sector, with a higher incidence in Emergency Departments, Mental Health Services or Primary Care. Unlike other professional groups, healthcare workers perceive this type of behavior mainly from users or patients. This is the reason why both the detection of conflict between users and professionals and the ways to face and reduce these conflicts has been and is one of the main fields of study in this population. The aim of this study was to delve into the sources of conflict between users and professionals in Primary Care from the perspective of the professionals themselves. In addition, the aim was to explore the proposals for intervention/prevention of this conflict that the professionals perceived as necessary to improve the work environment. Methods: This study uses qualitative methodology conducting 8 focus groups with professionals related to Primary Health Care. The final sample was composed of 44 workers who were part of the regional management, labor unions, area coordinators, center coordinators and representatives of the professional groups of these centers (medicine, nursing and administration). Thematic analysis was used to extract topics and subtopics. Results: The results are divided into areas of conflict and intervention proposals. The professionals detect a lack of training or education in themselves, absence of functional multidisciplinary teams or competencies to improve the patient-professional relationship, among others. To address these shortcomings, they propose the creation of protocols for action in the face of aggression, the formation of spaces and channels of communication both among the center's own workers and between them and other organizations (e.g., hospitals), fostering a positive relationship with the user community and ongoing training in various topics such as self-safety, management of emotions, empathy or interpersonal communication. Conclusions: This study allows to highlight specific areas of user-professional conflict in Primary Care. Furthermore, the inclusion of intervention proposals by the professionals allows to propose starting points for the development of complete plans.

Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study.

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals. Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided. Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data. Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation. Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.

Estudio de la incidencia de ampollas en el trekking y sus factores asociados / Foot Blister Incidence in Trekking and Associated Factors

Objetivo: Determinar los factores asociados con la presencia de ampollas durante el senderismo. Método: La población de estudio fueron 1155 peregrinos que recibieron asistencia podológica. La información fue obtenida mediante una anamnesis y una exploración podológica. Los factores analizados fueron: edad, sexo, entrenamiento previo, nacionalidad, tipo de calzado, antigüedad del mismo y kilómetros realizados. Resultados: Las ampollas se encontraron en el 71,9 % de los peregrinos y se distribuyeron de manera similar en ambos pies, afectando principalmente el talón (20%) y el quinto dedo (14,6 %). Se encontró asociación con el sexo (p < 0,05). Las deportivas fueron las menos asociadas con ampollas (p = 0,03). No hubo relación significativa con el entrenamiento previo y el uso de calzado nuevo. Conclusiones: La incidencia de ampollas entre los senderistas fue del 80 %, y se asoció con el sexo (mayor en la mujer) y el tipo de calzado (AU)

Objective: The study objective was to determine the factors associated with presence of blisters during hiking. Methods: The study population included 1155 pilgrims who received podiatry care. The information sources used to obtain the study variables were history by a previously devised questionnaire and foot examination. The analyzed factors were age, gender, prior training, nationality, footwear type, worn versus new shoes and kilometers hiked. Results: Blisters were found in 71.9% of pilgrims. Blisters were distributed similarly on both feet, mostly on the heel (20%) and the 5th toe (14.6%). Gender was an associated variable (p<0.05).The sport shoes were the least associated with presence of blisters (p=0.03). We found no significant relationship with prior training and use of worn shoes. Conclusions: The incidence of blisters among hikers is almost 80%, and is associated with gender (more in woman) and footwear type (AU)

Dimetiléter-propano; una alternativa para el tratamiento de las verrugas plantares en podología. Parte II / No disponible

En esta segunda parte, se revisa el procedimientode aplicación y descripción de la técnica, estandoindicada tanto en niños, como en adultos y ancianos.También se revisa el coste económico de latécnica, y las posibles complicaciones que puedenaparecer(AU)

In this second part, there is checked the procedureof application and description of the skill, beingindicated so much in children, since in adultsand elders. Also the economic cost of the skill ischecked, and the possible complications that canappear(AU)

Dimetiléter-propano; una alternativa para el tratamiento de las verrugas plantares en podología. Parte I / No disponible

Existen múltiples tratamientos para la verruga plantar.Encontramos que la primera línea terapéutica esel ácido salicílico, aunque puede existir alguna situaciónen la que no sea de utilidad. Por ello, se presentacomo alternativa, el dimetiléter-propano (DMEP),como tratamiento dentro la segunda línea terapéuticaen el manejo de las verrugas plantares, englobadoen el grupo de las técnicas propias de la criocirugía.Dentro de la crioterapia, existen diversos agentes conocidoscomo criógenos, con diferente capacidad decongelación, donde se encuentra el DMEP, con unatemperatura de congelación de -57º, por lo que esutilizado con frecuencia en las consultas de AtenciónPrimaria, como alternativa a otros criógenos como elnitrógeno líquido, y de elección en las consultas depodología. Está considerada como una técnica de altaeficacia, además de segura, de fácil aprendizaje y buenaaceptación por parte de los pacientes, lo cual hacedel DMEP una alternativa válida de uso podológico.A su vez, se revisan las bases de la criocirugía, comosu mecanismo de acción, encontrando que variosciclos de congelación-descongelación, presentan unefecto más destructivo que un solo ciclo de congelación-descongelación. Así como las indicaciones ycontraindicaciones de la crioterapia, siendo una técnicade elección en las verrugas plantares, y estandototalmente contraindicadas ante la sospecha de unaposible malignidad de la lesión o duda diagnóstica(AU)

There are multiple treatments for the plantar wart.The first therapeutic line is the salicilic acid, thoughsome situation can exist in the one that is not ofutility. For it, appears as alternative, the dimetiléterpropane(DMEP), as treatment inside the secondtherapeutic line in the managing of the plantar warts,inside the group of the proper cryosurgery skills.Inside the cryotherapy, diverse agents exist knownlike cryogens, with different capacity of freezing, whereone finds the DMEP, with a temperature of freezingof -57 º, by what it is used often in the consultations ofprimary care, as alternative to other cryogens as theliquid nitrogen, and of election in the consultations ofpodiatry. It is considered to be a skill of high efficiency,besides sure, of easy learning and good acceptance onthe part of the patients, which does of the DMEP avalid alternative of podiatry use.In turn, the bases of the cryosurgery are checked, as itmechanism of action, finding that several cycles offreezing-release, they present an effect more destructivethan an alone cycle of freezing-release. As well as theindications and contraindications of the cryotherapy,being a skill of election in the plantar warts, and beingtotally counter indicated before the suspicion of apossible malice of the injury or diagnostic doubt(AU)