Estudio descriptivo sobre la aplicación del consentimiento informado en centros sanitarios de Galicia (España) / Descriptive study on the application of informed conset in health centers of Galicia (Spain)

Objetivos: conocer la opinión y el conocimiento general de pacientes sobre el Consentimiento Informado (CI) y su participación en la Toma de Decisiones (TD). Material y métodos: Se diseñó un estudio descriptivo, transversal, observacional, con 120 pacientes encuestados aleatoriamente, en los 8 Complejos Hospitalarios Universitarios de la Comunidad Autónoma de Galicia, España. Resultados y discusión: La media de edad de los pacientes fue de 52,14 años, con un 50% de hombres. El 84,21% de los CI fueron aportados por el personal no médico, que solo se limitó a entregarlo y leerlo. Solo el 50% de los profesionales intentó involucrar al paciente en la TD. El 53,33% de los pacientes participó en la TD y el 45,83% firmó el formulario por haber entendido y aceptado la explicación, estando completamente satisfechos el 95 de los pacientes encuestados (79,17%). Conclusiones: Es indispensable modificar la actitud de los profesionales sanitarios involucrados en el proceso de TD, ya que no se está promoviendo la implicación de los pacientes en el mismo. Aunque menos de la mitad de los encuestados ha firmado el CI por haberlo entendido, el grado de satisfacción y la confianza en el médico no se vio comprometida

Objectives: The aims of this study were to know the opinion and general knowledge of patients about the informed consent (IC), and their participation in the decision-making (DM) process. Material and methods: A descriptive, transversal, observational, qualitative and quantitative study was designed with 120 patients randomly surveyed at the 8 University Hospital Complexes of Galicia, Spain. Results and discussion: The mean age was 52.14 years, with 50% of men. 84.21% of the ICs provided by non-medical personnel were limited to delivering and reading it. 90% of patients after signing the IC, trust their doctor. Only 50% of the professionals tried to involve the patient in DM. 53.33% of the patients participated in DM. 45.83% patients signed for having understood and accepted the explanation, being completely satisfied 95 of the patients surveyed (79.17%). Conclusions: It is essential to change the attitude of non-medical health professionals involved in the DM process, because their involvement is not being promoted. Although less than half of the respondents have signed the IC for having understood, the degree of satisfaction and confidence in the doctor was not compromised

Evaluación del grado de información de los pacientes al ser incluidos en el programa de cuidados paliativos domiciliarios / Evaluation of the degree of patient information to be included in the home-based palliative care program

El hecho de comunicar a un paciente su diagnóstico cuando éste es desfavorable, se convierte en un asunto sumamente humano. La bioética y la legislación protege de este derecho a la información. El objetivo del estudio es evaluar el grado de información de los pacientes al ser incluidos en el programa de cuidados paliativos domiciliarios. Se ha realizado un estudio cuantitativo, descriptivo, retrospectivo, transversal. Año de estudio 2012 en pacientes diagnosticados de procesos de enfermedad avanzada terminal valorados por el Equipo de Soporte de Atención Paliativa Domiciliaria, de la Dirección Asistencial Norte de la Comunidad de Madrid. La muestra fue de 184 pacientes. Analizando la relación entre el grado de información y la edad categorizada, existiendo diferencias estadísticamente significativas (p<0,01) siendo el grupo de edad en el que hay más pacientes correctamente informados el de ≤65 años con un porcentaje del 95,3%. Estaban más informados los pacientes con un Pfeiffer <4 en el 89,3% de los casos (p< 0,01). Más de la mitad de los pacientes habían recibido información acerca de su enfermedad y en mayor proporción completa. Con más frecuencia fueron varones con edad comprendida entre 76 y 85 años, con patología oncológica, presentando mal estado funcional pero no presentaron deterioro cognitivo. La información de la familia era mayor que la del propio paciente y en mayor grado era completa. Los factores relacionados con un mejor nivel de información fueron la edad ≤65años y la ausencia de deterioro cognitivo. El lugar predominante de fallecimiento en el seguimiento fue el domicilio

The fact of communicating to a patient his or her diagnosis when it is unfavourable, this becomes a really human issue. The bioethics and the legislation protect this right of information. The aim of this study is to evaluate the degree of information of patients when they are included in the home palliative care program. This is a quantitative, descriptive, retrospective and transversal study. The year of the study is 2012 in patients diagnosed with advanced terminal illnesses processes valued by the Team of Home Palliative Attention Support, of the North Welfare Direction of the Community of Madrid. The sample size was 184 patients. Analysing the relationship between the degree of information and the age, existing differences statistically significant (p<0,01) being the group in which there are more patients correctly informed the one were the age is ≤65 years old with a percentage of 95,3%. The patients with a Pfeiffer <4 in the 89,3% of the cases (p<0,01) were more informed. More than half the patients had received some information about their illness and within that half there is higher proportion of people who received complete information. The more frequent were male patients with age between 76 and 85 with oncologic pathology, showing a bad functional condition but didn’t present cognitive deterioration. The information received by the family was more complete that the one the own patient knew. The factors related with a better degree of information were being younger than 65 and a lack of cognitive deterioration. The predominant place of the decease in the monitoring of the patient was the their home

Child sexual abuse revisited: a population-based cross-sectional study among Swiss adolescents.

PURPOSE: Child sexual abuse (CSA) is one of the most serious public health problems among children and adolescents, owing to its widespread prevalence and serious health consequences. The present study aimed to assess the prevalence of, and characteristics and circumstances associated with, CSA. METHODS: An epidemiological survey was conducted on a nationally representative sample of 6,787 ninth-grade students (15.5 ± .66 years of age) in Switzerland. Self-reported computer-assisted questionnaires were administered between September 2009 and May 2010. Various forms of sexual victimization were assessed using the newly developed Child Sexual Abuse Questionnaire. RESULTS: Overall, 40.2% and 17.2% of girls and boys, respectively, reported having experienced at least one type of CSA event. Lifetime prevalence rates were 35.1% and 14.9%, respectively, for CSA without physical contact, 14.9% and 4.8% for CSA with physical contact without penetration, and 2.5% and .6% for CSA with penetration among girls and boys. The most frequently experienced event was sexual harassment via the Internet. More than half of female victims and more than 70% of male victims reported having been abused by juvenile perpetrators. Depending on the specific event, only 44.4%-58.4% of female victims and 5.8%-38% of male victims disclosed CSA, mostly to peers. CONCLUSIONS: The present study confirms the widespread prevalence of CSA. The high prevalence of CSA via the Internet and the frequent reports of juvenile perpetrators suggest emerging trends in CSA. Low disclosure rates, especially among male victims, and reluctance to disclose events to family members and officials may impede timely intervention.

Dimensiones que conforman el constructo de calidad de vida en pacientes con cáncer / Dimensions of quality of life construct for cancer patients

Objetivo: En el presente trabajo se evaluaron los componentes del constructo "Calidad de vida" a partir de la respuesta dada por 707 pacientes a la pregunta: Para usted, ¿qué es calidad de vida? Los pacientes tenían diagnóstico de cáncer de cuello uterino, colorrectal o de próstata. Métodos: Se efectuó un análisis lexicográfico para ubicar las respuestas características utilizando como criterio el valor test. Resultados: Se encontró que hay ocho dimensiones subyacentes: espiritualidad, familia, sistema de salud, social, funcional, síntomas, componente económico y componente emocional. Dichas dimensiones son representadas de manera diferente según el sexo o el diagnóstico del paciente. Conclusiones: Se destaca la importancia de considerar las dimensiones de espiritualidad y sistema de salud para efectuar una medición más válida y confiable de la calidad de vida de los pacientes.

Objective: To evaluate the components which constitute a "quality of life" construct based upon answers given by 707 patients to the question: "In your opinion, what makes up quality of life?". Participating patients had been diagnosed with cervical, colorectal or prostate cancer. Methods: Lexicographic analysis was used to locate characteristic responses based upon the values test. Results: Eight underlying dimensions were pinpointed: spirituality, family, health care system, social structure, functional ability, symptoms, economic factors, and coping with emotions. Each dimension is represented differently according to gender or patient´s diagnosis. Conclusions: Emphasis should be given to the importance of spirituality and the health care system in order to carry out a more valid and precise measure of patients´ quality of life criteria.

Method for identifying eligible individuals for a prevalence survey in the absence of a disease register or population register.

BACKGROUND: Identifying eligible individuals for a prevalence survey is difficult in the absence of a disease register or a national population register. AIM: To develop a method to identify and invite eligible individuals to participate in a national prevalence survey while maintaining confidentiality and complying with privacy legislation. METHODS: A unique identifier (based on date of birth, sex and initials) was developed so that database holders could identify eligible individuals, notify us and invite them on our behalf to participate in a national multiple sclerosis prevalence survey while maintaining confidentiality and complying with privacy legislation. RESULTS: Several organisations (including central government, health and non-governmental organisations) used the method described to assign unique identifiers to individuals listed on their databases and to forward invitations and consent forms to them. The use of a unique identifier allowed us to recognise and record all the sources of identification for each individual. This prevented double counting or approaching the same individual more than once and facilitated the use of capture-recapture methods to improve the prevalence estimate. Capture-recapture analysis estimated that the method identified over 96% of eligible individuals in this prevalence survey. CONCLUSIONS: This method was developed and used successfully in a national prevalence survey of multiple sclerosis in New Zealand. The method may be useful for prevalence surveys of other diseases in New Zealand and for prevalence surveys in other countries with similar privacy legislation and lack of disease registers and population registers.

Influencia de variables del entorno social sobre la ocurrencia de situaciones problemáticas asociadas al consumo de alcohol en adolescentes / Social context variables and their influence on the occurrence of problematic situations associated with alcohol use in adolescents

Este estudio se centra en las situaciones problemáticas que los menores de edad enfrentan en relación al consumo propio de alcohol. Se caracterizaron dichas situaciones según su tipo y frecuencia y se exploraron posibles variables explicativas. En particular, se analizó el efecto de la percepción de consumo por parte de los pares, la permisividad social y familiar, los patrones de consumo de los menores y las normas familiares. Para ello se utilizó una muestra compuesta por 9276 estudiantes de secundaria, con una edad promedio de 14 años, en nueve ciudades y municipios de Colombia. Embriagarse, vomitar, tener problemas en casa por beber y pelear con la pareja por estar bebiendo alcohol, son las situaciones problemáticas más comúnmente experimentadas por los adolescentes. Al igual que en estudios anteriores, se encontró que el número de problemas relacionados con el consumo de alcohol es mayor si se considera que los amigos consumen alcohol. Así mismo, la facilidad de acceder al alcohol tiene una clara relación con la percepción de que sus pares consumen y parece estar más asociado a la posibilidad de acceder a éste en fiestas y entre amigos, que con la facilidad de comprar alcohol. También se encontró que tener hábitos de consumo excesivos se asocia a una mayor posibilidad de sufrir consecuencias negativas, que en Colombia la presencia de consumo en la familia se asocia con un reporte menor de situaciones problemáticas extremas, y que tener problemas en casa por beber alcohol se asocia a un mayor número de problemas como embriagarse y vomitar, entre otros (AU)

This study focuses on the problematic situations adolescents have to face resulting from their own alcohol use. These situations were described according to their type and frequency of occurrence, and possible explanatory variables were explored. In particular, we considered the effect of perceived peer intake of alcohol, social and family permissiveness, patterns of use and parental norms. The sample comprised 9276 adolescents from nine cities and municipalities in Colombia, with an average age of 14. Results indicate that the most common problematic situations experienced by the adolescents are: getting drunk, vomiting, and having problems at home or with one’s boyfriend or girlfriend because of the drinking. As in previous studies, the behavior of peers is associated with severity of the drinking-related problems experienced by the adolescents. The study also suggests that easy access to alcohol is related to the perception that their peers use it, and appears to be more closely associated with the possibility of accessing alcohol at parties and among friends than with the perception that it is easy to buy it. It was also found that excessive drinking habits were associated with greater likelihood of negative consequences, that in Colombia the presence of alcohol use in the family is associated with fewer reports of extreme and difficult situations, and that having problems at home because of alcohol use is associated with a larger number of problems such as drunkenness and vomiting, among others (AU)

United States-Mexico Border Diabetes Prevalence Survey: lessons learned from implementation of the project.

This paper reviews and discusses the main procedures and policies that need to be followed when designing and implementing a binational survey such as the United States of America (U.S.)-Mexico Border Diabetes Prevalence Study that took place between 2001 and 2002. The main objective of the survey was to determine the prevalence of diabetes in the population 18 years of age or older along U.S.-Mexico border counties and municipalities. Several political, administrative, financial, legal, and cultural issues were identified as critical factors that need to be considered when developing and implementing similar binational projects. The lack of understanding of public health practices, implementation of existing policies, legislation, and management procedures in Mexico and the United States may delay or cancel binational research, affecting the working relation of both countries. Many challenges were identified: multiagency/multifunding, ethical/budget clearances, project management, administrative procedures, laboratory procedures, cultural issues, and project communications. Binational projects are complex; they require coordination between agencies and institutions at federal, state, and local levels and between countries and need a political, administrative, bureaucratic, cultural, and language balance. Binational agencies and staff should coordinate these projects for successful implementation.

[U.S.-Mexico cross-border cooperation in research on diabetes mellitus type 2]. / Cooperación transfronteriza en investigación sobre diabetes mellitus tipo 2: México-Estados Unidos.

OBJECTIVE: To describe and analyze, utilizing a case study approach, the U.S.- Mexico Border Diabetes Prevention and Control Project, a health research cooperation initiative incorporating the participation of federal, state, and local institutions of both countries. METHODS: A model of equal representation, participation, consensus, and shared leadership was used, with the participation of more than 130 institutions. A sample of 4 020 people over 18 years of age was obtained by a random, multistage, stratified, clustered design. A questionnaire about diabetes mellitus type 2 (DM2) and health was applied. The statistical analysis took into account the design effect. RESULTS: The prevalence of diagnosed DM2 was 14.9% (95% confidence interval [95% CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5% (95% CI: 16.8-22.6) on the Mexican side of the border and 16.1% (IC95%: 13.5-19.2) on the U.S. border side. There were differences between the DM2 prevalence and risk factors along the border. CONCLUSIONS: The U.S.-Mexico Border Diabetes Prevention and Control Project allowed the border zone between the two countries to be considered, for the first time ever, as a unit for epidemiological research. A shared understanding among all participating institutions and entities of sociopolitical structures and procedures is required for effective border health cooperation initiatives.