The legitimacy of pain according to sufferers.

Pain is an unpleasant experience that we will all experience in some form over the course of our lives, with chronic pain affecting a significant proportion of the global population. Given these circumstances, this study investigates whether pain is a legitimated phenomenon and considers the processes involved in the creation of such a status. This is an exploratory investigation based on semi-structured interviews with people suffering from chronic pain as a consequence of physical, psychological, emotional, or social circumstances. Our principal objective is to explore the fundamental elements of legitimacy and the processes that bring it into being-i.e., to understand how it is socially constructed. The main finding, however, is that many sufferers of chronic physical, psychiatric/psychological, emotional and social pain perceive that their pain is not considered legitimate when no clear cause can be identified, when the pain prevents them from developing the norms imposed by social roles or when it inhibits them to make a productive contribution to the society in which they live. This is generally due to the disruptive aspect of pain and its impact on the social structure, specifically on productivity, which nowadays constitutes a key element in the legitimation of any social phenomenon.

Undermine Sufferers' Testimonies to Avoid Social Impacts of Pain.

Pain is a subjective experience that is mediated by the social structure and by the contextual aspects of people in pain. From the point of view of those affected, a sociological analysis has been carried out of why society doubts pain and the impact that the lack of credibility has on people in pain. Qualitative methodology is used. In total, 19 semi-structured interviews have been conducted with men and women in pain. Research has shown that pain produces discredit in all dimensions of individual's social life, from the most intimate to that related to healthcare and production. The lack of credibility takes the form of epistemic injustice, being a reaction produced from the social structure to avoid the impacts that pain could produce on the social system. Epistemic injustice affects anyone in pain, but the form it takes will be related to sufferer's circumstances. Studying this topic is important because it shows the rigidity of expert systems to deal with some old and new situations related to pain. It also shows the frequent lack of fit between the systems and the sufferers. Finally, the article shows that to deal unfairly with the testimony of people in pain has negative consequences on the treatment of pain. A better understanding of these issues could improve the sufferers' living conditions.

The Social Legitimacy of Pain: Protocol for a Systematic Literature Review.

Introduction: Pain is a perception conditioned both by the subjective experience of the sufferer and their social context. A preliminary literature search suggests that, today, information about the social legitimacy of pain is scarce, although it is known that this phenomenon is an element that is closely linked to the type of pain and contributes to the sufferer's experience. Thus, our objective is to explore how the social legitimacy of pain is tackled in the scientific literature. Methods: This study is a protocol for a systematic literature review where six databases were reviewed: Pubmed, Web of Science, Scielo, Scopus, PsycInfo, and CINAHL, were searched for papers dealing with the social legitimacy of pain from any discipline/study design. The obtained papers will be exported to Zotero, where the duplicates will be deleted. Later, the studies of interest will be selected, first on the basis of their titles/abstracts, and, later, on the complete text. This process will be carried out in pairs. Finally, the data of interest will be extracted, analyzing their quality, to finally make a qualitative analysis of the results. Discussion: This will be the first review to systematically explore the available evidence on the social legitimacy of pain. Therefore, it will be able, not only to extend the theoretical knowledge on this phenomenon, but also to extend its visibility, which will make it possible for the social legitimacy of pain to be studied from different disciplines and fields, thus improving the way it is approached.

Avoidant Coping of the Decision-Making Process on the Location of Care in Old Age: A Possible Conspiracy of Silence?

The conspiracy of silence is extremely important due to both its high incidence and its consequences. This process usually occurs in situations of palliative care, or death; however, this concept is also mentioned in the literature linked to other contexts. Therefore, our objective was to study whether the conspiracy of silence may be extrapolated to the context of decision-making on the location of care in old age. To this end, we first analyzed the in-depth semi structured qualitative interviews conducted with older people, caregivers, and professionals, about decision-making on the location of care in old age. Subsequently, a comparative analysis was performed between the basic elements of the conspiracy of silence and this decision-making. Our findings revealed an avoidance process developed by all three groups. Furthermore, this decision-making presents similarities with the conspiracy of silence in the process of avoidance coping and denial that is developed. However, there are significant differences, as information is not withheld from the older person, who has an active attitude in the process of avoidance. Decision-making on the location of care in old age does not exactly match the conspiracy of silence process, but it does seem to correspond to a pact of silence.

Experiences in the Decision-Making Regarding the Place of Care of the Elderly: A Systematic Review.

The objective of this review was to understand how participants experience the decision-making process regarding the place of care for the elderly. Therefore, we conducted a systematic review of qualitative studies. The articles were included if they were original studies with qualitative/mixed methodology, written in English/Spanish, and that approached the decision-making process regarding the place of care for the elderly, already experienced by the participants. Forty-four articles were included, identifying experiences, both negative and positive. Negative experiences have been the most frequently reported experiences by all population groups; fear was the most relevant experience for the elderly, whereas concern was the most relevant for family members and professionals. This review has not only found a great variability of experiences, but also, it has deepened the differences between groups and the situations motivating/generating these experiences. This review highlights a wide range of experiences of those directly involved in the entire decision-making process on the place of care for the elderly. In future research it would be interesting to carry out qualitative primary studies conducted with professionals and other relevant people involved in this decision-making process, in order to know first-hand how they experience this process.

Reasons for the Place of Care of the Elders: A Systematic Review.

BACKGROUND: Relocation is a very important event in people's lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people. METHODS: Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO, Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826). RESULTS: A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push. CONCLUSION: This differentiation allows for a more detailed and in-depth analysis of the motivations of the different groups involved in this process.

Systematic review of qualitative studies on participants in the decision-making process about the location of care of the elderly.

OBJECTIVES: To understand who are the participants in the decision-making process about the location of care of the elderly. DESIGN: Systematic review of qualitative studies. DATA SOURCES: The following databases were consulted: Web of Science, MEDLINE, Scopus, CINAHL, PsycINFO and SciELO (from the beginning until 29 November 2017). The bibliographical references in the studies that were finally included in the review were also searched. STUDY SELECTION: The studies had to deal with the decision-making process (already experienced by the participants) on the location of care of the elderly (adults who are 65 or older), had to use a qualitative methodology and had to be written in English or Spanish. DATA EXTRACTION AND SYNTHESIS: A data extraction tool was used. Data analysis was conducted through the constant comparative method from Glaser and Strauss' grounded theory. RESULTS: 46 studies were included in this review. Most of them were carried out in the USA, and in 21 of them the study population focused exclusively on the elderly. This review has found that there are many participants, with different roles and degrees of involvement, who may act jointly, separately or sequentially. These participants may be: the elders, family members, professionals and other relevant. CONCLUSIONS: The main result of this review has been the variability found on how this decision is made, even varying the way of acting/perceiving the situation of the involved persons on certain occasions, simply due to the influence of some of the other groups of participants studied. Besides, this review has focused its results on the main participant in this process, the elders and how their family members interact with them when it comes to making this decision. This has allowed relevant results to be obtained about roles and degrees of involvement. PROSPERO REGISTRATION NUMBER: CRD42018084826.

Universalización, paridad y evolución de la demanda de anestesia epidural durante el parto en Andalucía / Universalization, parity and evolution of the demand of epidural analgesia in labor in Andalusia (Spain)

Objetivo: Conocer si la universalización de la oferta de la anestesia epidural en los hospitales del Servicio Sanitario Público Andaluz (SSPA) ha acabado con las desigualdades mostradas por otros estudios en su demanda: el porcentaje de mujeres que rechazaban esta prestación era significativamente mayor cuando las usuarias tenían menor nivel de estudios, menor nivel de ingresos y trabajaban como amas de casa. Método: Los datos utilizados provienen de la encuestas de satisfacción de los usuarios de atención hospitalaria del SSPA, estudio realizado por el Instituto de Estudios Sociales Avanzados. Esta encuesta contiene un módulo para usuarias atendidas por parto (N = 21.300). El análisis de segmentación jerárquica ha permitido describir qué variables son las que en mayor medida discriminan en el uso o no de la anestesia epidural. Posteriormente, mediante un modelo de regresión logística binaria se analiza qué variables sociodemográficas son significativas en el año 2012 y su impacto en la elección de la anestesia epidural en el parto. Resultados: En general, las variables sociodemográficas de las usuarias son estadísticamente significativas en la demanda o no de la anestesia epidural durante el parto. No obstante, el análisis exhaustivo del último año (2012) muestra que ninguna de las variables sociodemográficas introducidas en el modelo tiene un efecto significativo en el uso o no de anestesia epidural. Conclusiones: El proceso de universalización de la anestesia epidural en el parto ha terminado con las desigualdades sociales en su uso, es decir, con aquellas diferencias que no se deben a una elección propiamente dicha, sino que son inducidas por características socioculturales de las mujeres

Objective: Assess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper. Method: The data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users. This survey includes a section aimed at women attended in labor (N = 21,300). The hierarchical segmentation analysis shows which variables are the ones that discriminate most in the usage of epidural analgesia. Subsequently, through a model of binary logistic regression we analyze which socio-demographic variables are significant (2012) and how its impact is on the choice of epidural analgesia in childbirth. Results: Overall, the socio-demographic variables of the users are statistically significant in the demand or not of epidural analgesia during labor. However, the detailed analysis of the last year (2012) shows that none of the socio-demographic variables introduced in the model has a significant effect on the decision of using epidural analgesia. Conclusions: The process of universalization of epidural anesthesia in childbirth has ended with social inequalities in their use, that is, with those differences that are not due to a real choice but are induced by socio-cultural characteristics of women

[Universalization, parity and evolution of the demand of epidural analgesia in labor in Andalusia (Spain)]. / Universalización, paridad y evolución de la demanda de anestesia epidural durante el parto en Andalucía.

OBJECTIVE: Assess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper. METHOD: The data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users. This survey includes a section aimed at women attended in labor (N = 21,300). The hierarchical segmentation analysis shows which variables are the ones that discriminate most in the usage of epidural analgesia. Subsequently, through a model of binary logistic regression we analyze which socio-demographic variables are significant (2012) and how its impact is on the choice of epidural analgesia in childbirth. RESULTS: Overall, the socio-demographic variables of the users are statistically significant in the demand or not of epidural analgesia during labor. However, the detailed analysis of the last year (2012) shows that none of the socio-demographic variables introduced in the model has a significant effect on the decision of using epidural analgesia. CONCLUSIONS: The process of universalization of epidural anesthesia in childbirth has ended with social inequalities in their use, that is, with those differences that are not due to a real choice but are induced by socio-cultural characteristics of women.

Social hierarchy of pain and its connection to the memory of previously suffered pain.

BACKGROUND: Pain is a perception conditioned both by the painful experience and by each society's collective imagination. The general objective of the project which this work forms part of it was to discover what citizens think about different aspects of this complex experience. More precisely, this paper's objective is to get to know which is the worst pain that can be suffered according to Spaniards and what determines that hierarchy, bearing in mind that this work has chosen a broad definition of pain, including pains of different origins, namely, physical, psychological, and emotional pain. MATERIALS AND METHODS: The data from the CIS 3137 study "Social perceptions of pain" have been used, which is a survey module designed by the Institute of Advanced Social Studies (IESA) of the Spanish National Research Council (CSIC). A hierarchical multiple factor analysis has been performed, using the SPSS statistical analysis software, where the dependent variable is the citizen's opinion on which is the worst pain that can be suffered, recoded according to the origin of pain (physical, psychological, and emotional pain). Sociodemographic variables and variables linked to the experience of pain have been included as independent variables. RESULTS AND CONCLUSION: Although the most frequent pains among Spanish citizens are those of a physical origin, especially those linked to musculoskeletal problems and pains of an orofacial origin, when they are asked about the worst pain a person can suffer, they do not mention this type of pain, but those of an emotional origin. It has also been possible to confirm that the pain that citizens refer to when asked about the worst pain that can be suffered, and, therefore, the hierarchy of pain held by Spanish citizens as a group, is conditioned, although not determined, by the pain that has previously been suffered - by one's own experience of pain.

Decision-making on the location of care of the elderly: protocol for a systematic review of qualitative studies.

INTRODUCTION: The elderly must take part in the management of their own health. One of the aspects they should be able to decide on is the place where they want to live. The aim of this review is to synthetise qualitative evidence in order to understand how decisions are made on the location of care of the elderly. METHODS AND ANALYSIS: Systematic review of qualitative studies. Six databases have been consulted: Web of Science, PubMed, Scopus, CINAHL Complete, PsycINFO and SciELO Citation Index (from the beginning to 29 November 2017). The inclusion criteria will be: studies that deal with the decision-making process on the location of care of the elderly (already experienced by the participants), original studies, qualitative or mixed-method studies and studies written in English or Spanish. The obtained results will be exported to the Zotero bibliography manager. The references will be reviewed by title and abstract and, later, the complete texts will be reviewed for their inclusion. A tool created for this study will be used to extract the data. The quality will be assessed with Critical Appraisal Skills Programme Español. The data synthesis will be carried out using the constant comparative method. All this process will be performed independently by two reviewers. Enhancing transparency in reporting the synthesis of qualitative research has been used to draw up this protocol. ETHICS AND DISSEMINATION: This protocol did not require ethical approval, since it is a protocol for a systematic review. The plans to disseminate our results include publishing a research paper in a high-impact journal in our study area. Also, if possible, our results will be presented in scientific conferences. Besides, the obtained results will complement and discuss the doctoral thesis of one of the authors of the review. PROSPERO REGISTRATION NUMBER: CRD42018084826.

Influence of clinical and psychological variables upon the oral health-related quality of life in patients with temporomandibular disorders

Background: To analyze the association between the OHIP-14 and the different subtypes making up the clinical and psychological axis obtained using the RDC/TMD. Material and Methods: 407 patients treated at the TMD unit of the Andalusian Healthcare Service were administered the Spanish version of the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire (RDC/TMD), together with the Oral Health Impact Profile questionnaire (OHIP-14). The degree of association between the patients' score in the OHIP-14 and the clinical and biopsychosocial variables was analyzed through bivariate and multivariate analyses, specifically through linear regression. Results: 89.4% of the treated patients were women, while 10.6% were men, with an average age of 42.08 ± 14.9 years. The mean score and standard deviation for the OHIP-14 was 20.57 ± 10.73. A significant association (p < 0.05) was observed with the following variables: Axis I, jaw disability checklist, depression, somatization, perceived pain duration, and pain interference with activities of daily living Conclusions: The analysis of the relation between self-perceived health in patients with TMD, as measured by the OHIP-14, showed a R2 of 0.3979, with a higher Beta value for the association between the OHIP and patients with both myofascial pain and arthopathy, jaw disability, depression, a higher pain duration and a higher pain interference with activities of daily living (AU)

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Los debates se concretan: la universalidad revertida en el sistema español de salud / The debates are concretized: the reverted universality in the national health system

El Modelo Social Europeo vigente en las economías avanzadas, ha sido hasta ahora un marco fundamental para los sistemas de protección social en su conjunto y para los sistemas sanitarios en particular. Su existencia no ha estado exenta de debate en torno a su vigencia y su sostenibilidad para enfrentar viejos y nuevos riesgos sociales en el marco político y económico de la globalización y del proceso de construcción europea. En el artículo nos proponemos analizar si el Decreto 16/2012, de 20 de abril responde a los objetivos declarados o si existe alguna discrepancia entre dichos objetivos y la realidad y sentido del Decreto. Para ello se han comparado las declaraciones de la Ministra responsable de su aprobación en la prensa de aquellos días con el texto del Decreto, llegando a la conclusión de que este sienta las bases de un modelo corporativo

The current European Social Model in the advanced economies has so far been an essential framework for social protection systems as a whole and for health systems particularly. Their existence has not been without debate on its validity and sustainability in order to cope old and new social risks under the political and economic context of globalization and European integration process. In this paper we analyze whether the Decree responds to the stated goals or whether there is any discrepancy between these goals and the facts and meaning of the Decree 16/2012, April 20. To this end statements for the minister with responsibility on the approval of the Decree in newspapers in that time and the text of the Decree have been compared. We come the conclusion that It lays the foundations for a Corporate Model

Prevalence of the different Axis I clinical subtypes in a sample of patients with orofacial pain and temporomandibular disorders in the Andalusian Healthcare Service

BACKGROUND: The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender. MATERIAL AND METHODS: To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD. RESULTS: The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a pmore or equal 0.05 value for the muscle and arthralgia subtypes. CONCLUSIONS: The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent

Prevalence of the different Axis I clinical subtypes in a sample of patients with orofacial pain and temporomandibular disorders in the Andalusian Healthcare Service.

BACKGROUND: The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender. MATERIAL AND METHODS: To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD. RESULTS: The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a p≥ 0.05 value for the muscle and arthralgia subtypes. CONCLUSIONS: The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent.

Application of an oral health-related quality of life questionnaire in primary care patients with orofacial pain and temporomandibular disorders

OBJECTIVES: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study DESIGN: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community - the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients' OHIP-14 score and pain duration, pain intensity, and various sociodemographic variables. RESULTS: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p < 0.05) was found for gender, age, marital status, chronic pain grade, self-perceived oral health status and pain duration. CONCLUSIONS: The analysis of self-perceived oral health status in patients with OP and TMD, as measured by the OHIP-14, showed that oral health is perceived more negatively by women. Moreover, a one-point increase in the Chronic Pain Grade indicator increases the OHIP-14 indicator by 4.6 points, while chronic pain, defined as pain suffered by patients for one year or more, increases the OHIP-14 indicator by 3.2 points

Influence of sociodemographic factors upon pain intensity in patients with temporomandibular joint disorders seen in the primary care setting

Objective: A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP).Design: A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used.Results: The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men (p<0.05). A lower educational level, and separation or divorce, were correlated to an increased intensity of pain. Social support, depression and general and oral health also explained part of pain intensity. The regression model established with these variables accounted for 13.3% of the variability of pain (R2 = 0.133).Conclusions: Women suffer more intense pain than men. Perceived health partially explains the variability of the CPI score. However, it is empirically seen that the variables gender, educational level and marital status exert an important and independent influence upon pain intensity (AU)

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Dissatisfaction with residency: a discrepancy between preferences and expectations?

BACKGROUND: Medical residents play two roles that enter into conflict during their educational period: trainees and workers. This dual role can lead to dissatisfaction among residents that can affect both the quality of the services they provide to citizens and the proper functioning of the health services model itself. AIM: To analyse discrepancies between the preferences and expectations of first-year medical residents and whether these differences affect satisfaction with the residency. METHOD: A questionnaire was administered on-line to the entire population of first-year medical residents of the Autonomous Community of Andalusia (Spain) in 2008. We performed a means contrast test between the indicator discrepancy (difference between preferences and expectations during the residency as a training or a working period), overall satisfaction with the residency and their relationship to other expectations of medical residents. RESULTS: Respondents showing greater discrepancy have a more negative opinion about the residency. CONCLUSION: There is a gap between what residents prefer and what they expect from the residency, giving rise to dissatisfaction. This gap must be bridged to improve the quality of training received by these new physicians, their satisfaction and hence the delivery of health services to citizens.