Services In Spain Research Articles

The mental state inferences in healthcare professionals scale: a psychometric study.

Empathizing with patients is an essential component of effective clinical care. Yet, a debate persists regarding how healthcare professionals' emotions and performance are impacted when they engage in empathetic behaviors and attempt to discern patients' mental states during clinical interactions. To approach this issue, this study explores the psychometric properties of the Mental State Inferences in Healthcare Professionals Scale (MSIHPS), a novel eight-item scale to evaluate healthcare professionals' perceptions of their own disposition to infer patients' mental states during clinical interactions. The study was conducted across various units within a regional hospital and primary care units affiliated with the Canarian Public Health Service in Spain. Data collection took place over the course of 2022, spanning from February to November. The psychometric properties of the scale were analyzed, including an exploratory and a confirmatory factor analysis, to test reliability and validity. Additionally, an item response model was run to test potentially biased items. The study collected data from a sample of 585 healthcare professionals. Overall, the results indicate that the psychometric properties of the tool are adequate. Furthermore, the unidimensionality of the scale was confirmed using the item response model, wherein the eight-items significantly contribute to predicting the latent construct. The MSIHPS offers the opportunity to explore the role of mentalizing in a diversity of healthcare settings. This measure can be useful to explore the relationship between healthcare professionals' disposition to infer patients' mental states and other relevant variables in clinical interactions, such as empathy and clinical performance.

Different impact of chronic kidney disease in older patients with heart failure according to frailty

Abstract Introduction Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the impact of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF. Methods Our data come from the FRAGIC study ("Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of older outpatients with heart failure"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Results We included 499 patients, mean age 81.4 ± 4.3 years, 38% women. Mean estimated glomerular filtration rate (eGFR) was 52.1±17.5 ml/min/1.72 m2. Patients were classified in three groups: eGFR ≥60 ml/min/1.72m2 (normal: 182 patients, 36%), eGFR 30-59 ml/min/1.72m2 (moderately impaired: 261 patients, 52.7%), and eGFR < 30 ml/min/1.72m2 (severely impaired: 56 patients, 11.3%). Patients with severe renal dysfunction were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. Baseline variables according to eGFR group are depicted in Table 1. After a median follow up of 371 days, 58 patients (11.6%) died. One year mortality was higher in patients with worse renal function (8.8%, 11% and 21% according to normal, moderate and severe renal dysfunction respectively, p=0.036) and in frail patients (Figure 1). In multivariate analysis, frailty, but not severe renal dysfunction, was associated with one year mortality (frailty HR 2.05 95%CI 1.11-3.78 p 0.021, eGFR < 30 and 30-60 ml/min/1.72m2 HR 1.39 95%CI 0.62-3.09 p0.424 and 1.09 95%CI 0.58-2.09 p0.793 respectively). Conclusions Most HF patients ≥75 years have renal dysfunction. The association between renal function and clinical outcomes is different according to frailty status. CKD is related to worse prognosis only in non-frail patientsCumulative incidence of 1-year mortalityTable 1.Baseline characteristics

Areas for Improvement and Barriers Identified in Measuring the Quality of Nursing Care: Perceptions of Patients and Professionals.

Quality indicators in healthcare are essential to raising awareness about the appropriateness of nursing care. However, identifying the key indicators continues to pose a challenge, above all if one wants to include users and professionals. Identify which aspects of nursing care should be measured to assess the results of nursing care and how to do so. Interpretive qualitative exploratory study. The participants were users and professionals of an autonomous regional health service in Spain. The information was collected by means of two focus groups and eight semi-structured interviews conducted between November 2022 and March 2024. The data were analysed thematically using the Braun and Clarke process. The users and professionals agreed on the need to measure emotional skills and attitudes such as empathy, respect, and warmth when dealing with patients. The professionals highlighted workload and inefficiency of the current record system as barriers to adequately reflecting their work. They proposed improvements in the recording tool and the need for more human resources, as well as leadership that is more focused on quality. It is crucial to develop indicators that reflect both the emotional and technical aspects of nursing care. The participation by patients and professionals alike in this design and selection will make it possible to improve the quality of care and advances in the nursing profession. This study was not registered.

Discharge Follow-Up of Patients in Primary Care Does Not Meet Their Care Needs: Results of a Longitudinal Multicentre Study.

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners' (GPs) and community nurses' (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain.

Evidence-Based Practices in an Early Intervention service in Spain: the voice of families

This study was carried out at the Centro de Atención Temprana y Escuela Infantil L'Alqueria, Universidad Catolica de Valencia, as part of the Observatorio Internacional de Atención Temprana y Desarrollo Infantil (International Observatory of Early Childhood Intervention and Development), and its aim was to identify the families' perceptions and role in the intervention process, the child's development, the quality of family life and their own empowerment. It involved the participation of a final sample of five families accompanied by four professionals for 11 months. The source of data used was audio recordings of the families, transcribed by the researcher, and the application of instruments before and after six months of intervention, which were analysed qualitatively. The analysis focused on the families' perceptions of the intervention process, child development, family quality of life and empowerment. The results indicate that families perceive the intervention as support, feel empowered to act in the contexts, learn strategies for child development and identify learning opportunities in their routines. Communication is valued, showing that families have a voice in the intervention process. The responses to the instruments indicate that families have a positive view of their children's development and perceive an improvement in the quality of family life. These findings point to the importance of evidence-based practices in Early Intervention.

Measuring Home Activities and Participation of Children Receiving Early Childhood Intervention Services in Spain

Measuring Home Activities and Participation of Children Receiving Early Childhood Intervention Services in Spain

Effects of the 2001 draft suspension in Spain on educational attainment

Following the fall of the Berlin Wall and the end of the Cold War, multiple European countries abolished compulsive military service to opt for a professional military. These reforms may have positive or negative effects on young men's educational attainment. On one hand, these individuals may have more time to pursue their education without the interruption caused by compulsive military service. On the other, if young men were using their education as a way to delay or prevent compulsive military service, then they may pursue less education in the absence of such an incentive. In this study, we ask how the 2001 reform to abolish compulsive military service in Spain affected educational attainment of young men. Using a difference-in-differences approach along time and gender, we find that there was a significant increase in university education and a significant decrease in secondary education after the reform. Next, we use a triple difference model along time, gender and a binary variable indicating whether both of the young man's parents were low educated in order to analyze the potential heterogenous effects of the reform depending on the education level of an individual. We find that an average young man born after 1982 was 7.6% more likely to obtain university education and 9.7% less likely to obtain secondary education after the reform. Finally, we control for time, year, and province of birth fixed effects to mitigate omitted variable bias. Our results remain similar except that the positive effect of the reform on university education becomes marginally significant.

Consular Complications: The Appointment and Rejection of Swedish Consuls in Eighteenth-Century Spain

The early modern consul was an important economic and diplomatic institution. By the end of the eighteenth century, the number of consuls had increased drastically. However, previous research has failed to appreciate how bilateral relations between states could have a significant impact on how one state’s consular service expanded. Appointments could get rejected or take a long time to secure, not least because the sender state wanted to avoid provoking tensions with the receiving state. In this article, the author explores these themes through the appointment of Swedish consuls in Spain in the eighteenth century. The article shows that the Spanish reticence to accept Swedish appointments had a severe effect on the Swedish consular service in Spain in terms of the speed and scope of its expansion. The Swedish diplomatic corps played a key role in trying to sway the Spanish authorities, and when that failed they circumvented the Spanish state’s rejections of consular appointments by authorizing agents. These agents must also be treated as part of the expansion of the early modern consular service. Their existence begs the question of what a consul really was and if we have underestimated the number of consuls in the eighteenth century.

Accessibility of intimate partner violence-related services for young women in Spain. Qualitative study on professionals' perspectives.

Intimate partner violence (IPV) is common among young people, but the use of IPV resources among young adult women and teenagers is limited. This study aims to analyze professionals' perceptions about the main barriers and facilitators encountered by young women (16-29 years old) exposed to intimate partner violence (IPV) when accessing formal services in Spain. Qualitative study based on 17 in depth interviews carried out in 2019 with professionals who manage resources for IPV care in Madrid (Spain) from different sectors (social services, health care, security forces, women or youth issues offices, associations). A qualitative content analysis was conducted. The professionals interviewed perceive the following barriers: 1) Time it takes for young women to recognize IPV because the social construction of sexual-affective relationships is permeated by gender inequality; 2) The process of leaving a situation of abuse; 3) Barriers inherent to IPV services. The key aspects to improve access to these resources are related to care services, professional practice, and the young women themselves. There are both psychosocial barriers, derived from the process of leaving a situation of violence, as well as structural barriers for young women to access and properly use the recognized services specifically aimed at them or comprehensive IPV care. Services need to be tailored to the needs of young women so they can be truly effective in order to escape IPV.

Ethnic differences in pathways to obtain care, maintain care and engage to Early Intervention Service in Spain

IntroductionEthnicity and migration have an impact on illness models and consequently how, when and where people seek and obtain care. Early Intervention Psychosis (EIP) teams attend high rates of migrant and ethnic diverse populations but the study of ethnic differences in pathways to obtain and maintain care is still scarce . The most consistent findings are that minorities are less involved with primary services, have a higher risk of being treated in a coercive way and are at higher risk of early disengagement. Despite the increasing migration rates there has been very little investigation in Spain.ObjectivesTo investigate ethno-racial differences in pathways to obtain care, adherence and engagement during their first year of follow-up of subjects who start treatment at EIP of Reus, Catalonia, SpainMethodsParticipantsThis is an observational 12 months follow-up retrospective study including all consecutively subjects with First Episode of Psychosis (FEP) referred to the EIP from January 2015 to January 2019. Visible ethno-racial status was self-reported being grouped as belonging to minority ethno-racial group if they were coded “any other than White regardless of country of origin”. ‘White’ was the majority groupStudy variables:At program entry:Source of referralAt 12- months:Adherence to the service:Admissions to in-patient unitDisengagementResults184 FEP subjects (mean age 22.8 years and 66.1% of males) were included. Nearly 31% belonged to a minority ethno-racial group being the Maghrebi (60.4%) followed by the Latin-American (20.1%) the most frequent minority groups. The 81.2% of the minority group were first-generation migrants and 7.5% second generation migrants. The 52.2 % were referred from community services, 18.5% from emergency unit and 29.3% from inpatient unit. At follow up 64.5%, were highly adherent to EIP (> 75% of attended appointments), 16.7% required hospitalization and 11% disengaged. Multivariate analysis showed that the minority group was 2.19 times more likely to be low adherent [(95% CI 0.78-3.17; p=0.03], 2.89 times more likely to be hospitalised [(95% CI 1.20-6.98); p=0.01], and 4 times more likely to disengage from the EIP [(95% CI 1.35-11.90); p= 0.01] during follow-up than the majority group. No group differences were found in pathways to obtain care or in causes of disengagement.ConclusionsIn agreement with previous studies from other countries we found high rates of ethno-racial diversity in the EIP of Reus. In addition, we also found inequalities in the use of services, being minorities more likely to disengage, to be low adherent to the program and at greater risk of hospitalization. On contrary to other studies we did not find significant differences between groups in the source of referral to EIPDisclosure of InterestNone Declared

The constitutional guarantee of the provision of local Social Services in Spain: a comparative regional study

The constitutional guarantee of the provision of local Social Services in Spain: a comparative regional study

A clinical utility evaluation of dual HIV/Syphilis point-of-care tests in non-clinical settings for screening for HIV and syphilis in men who have sex with men

BackgroundDual point-of-care tests (POCTs) for the simultaneous detection of antibodies to HIV and syphilis have been developed. Since community-based organisations (CBO) are effective providers of HIV and syphilis testing among men who have sex with men (MSM), evaluation of the utility of these dual tests at CBO testing services is a high priority. The aim of this study is to determine the feasibility of performing dual HIV-syphilis POCT testing among both users and providers at these non-clinical sites.MethodsThis evaluation assessed the utility of two lateral flow immunochromatographic antibody technologies for dual screening for HIV/syphilis among MSM seeking testing in four CBO testing services in Spain, Slovenia, Latvia, and Ukraine. The study’s conceptual framework divides the concept of feasibility into two inter-related domains, acceptability, and usability and further breaks it down into six subdomains: learnability, willingness, suitability, satisfaction, efficacy, and effectiveness. The feasibility analysis was performed by calculating the median score in 3 stages (for individual questions, subdomains, and domains), using a summated scores method.ResultsThe final sample included 844 participants, 60 of which were found to be HIV test positive (7.1%) and 61 (7.2%) positive on testing for syphilis. There was a small difference (1.1%) when comparing the results of the two dual POCTs under evaluation to the tests routinely used at each site. The inter-rater agreement showed a high concordance between two independent readings. The analysis of the feasibility for the users of the services indicated good satisfaction, suitability, and willingness. In addition, among 18 providers the total mean score showed good acceptability and usability, good willingness, easy learnability, high suitability, and good efficacy, but lower satisfaction and effectiveness. The operational characteristics of both dual study POCTs were well evaluated by providers.ConclusionsThe introduction of dual HIV and syphilis POCTs in CBO testing services for screening of MSM is feasible, with a high acceptability and usability both for users and providers. Implementation of dual POCTs for HIV and syphilis in CBO testing services is an opportunity for scaling up integrated HIV/syphilis testing for MSM.

Transparency and Digitalization in Water Services: Reality or Still a Dream?

The provision of public services, mostly by local governments, has been widely analyzed in the scientific literature. The relevance of these services has generated an incipient demand for information on the part of citizens, which makes it necessary for the bodies responsible for their provision to present adequate levels of transparency. In this context, digitalization is a crucial tool for providing information to citizens and, therefore, contributing to improving the levels of transparency of those organizations that provide public services. Among these, the drinking water supply service stands out, which is crucial for well-being and sustainable progress, and whose analysis is of vital importance, especially in countries such as Spain affected by factors such as climate change and urbanization. In this way, the aim of this paper is to analyze the degree of transparency of the companies providing water supply services in Spain, as well as their degree of digitalization. To this end, a relationship will be established between the Transparency Index of Public Enterprises (INDEP) and the Strategic Project for Economic Recovery and Transformation (PERTE), which measure the degree of transparency and digitalization, respectively. This relationship will be established for a sample of 59 companies responsible for water supply. The main results derived from this study show a wide margin for improvement on the part of the companies analyzed, both in terms of transparency and digitalization, as the vast majority of these companies show a medium–low degree of compliance in both aspects.

Street-level bureaucrats in the professional context of primary care social services in Spain

PurposeThis study aims to identify the street-level approaches of professional workers in complex public social service organisations when attending to social assistance claimants.Design/methodology/approachThe study employed a multifaceted approach comprising documentary analysis, semi-structured individual interviews (17) and focus group discussions (8) with qualified frontline social workers from primary care social services in Tarragona.FindingsSocial workers embodied three specific sets of cognitive, normative and emotional dispositions when attending to people with low incomes. First, the compassionate approach conceives clients as defensive regarding social services and emotionally vulnerable because of deprivation. Second, the instructional approach frames clients as being baffled by a new, precarious, institutional and economic context. They also lack information, abilities and the proper mindset to conceive of and attain available welfare and occupational resources. Third, the enforcement approach tends to define clients as suspicious, trying to obtain an excessive and unfair advantage of the welfare system that would eventually hamper their social opportunities.Originality/valueResearch thus far has tended to define public social assistance programmes in Southern welfare state contexts as mostly inefficient and hardly relevant residual social policies. The street-level approach shows that social workers try to resist the mere administrative processing of benefits, which is a professionally troubling and organisationally unsustainable way to proceed. They attempt to help clients by providing inclusive content in order to implement their benefits.

Comportamiento colusorio en el sector del automóvil en España. Cuantificación de los daños al consumidor

On July 23, 2015, the Spanish National Markets and Competition Commission (CNMC) passed judgement (S/0482/13) against 20 automotive sector companies for alleged restrictive competition practices between March 2004 and August 2013. The exchange of information among the different companies would have had repercussions on the fixing of vehicle sale prices, homogenization of conditions and future commercial plans for the automobile sale and post-sale services in Spain. This paper estimates the loss suffered by consumers as a result of these collusive practices using the Before and After method. We have reconstructed the prices that would have prevailed in the absence of the collusive practice. The analysis reveals an increase of 10.16 percent. The observation of the prices and the production of automobiles during the period exhibits an anomalous behaviour with respect to GDP evolution and prices in the economy as a whole.

Analisis de la evolución de la atención farmacéutica al paciente externo en los servicios de farmacia hospitalaria en España tras la puesta en marcha y desarrollo de la iniciativa MAPEX

Introduction and objectiveIn 2015, the Spanish Society of Hospital Pharmacy (SEFH) launched the Strategic Map for Outpatient Pharmaceutical Care (MAPEX), with the purpose of adapting the activity offered in Hospital Pharmacy outpatient clinics to the new healthcare context.The aim of the present study was to analyse the evolution of outpatient pharmaceutical care in Hospital Pharmacy Services in Spain in the period 2016-2021 after the implementation and development of the MAPEX initiative. Material and methodThe implementation and development of the project was carried out by a group of experts from SEFH and consisted of five phases: creation of the structure, consensus conference, situation analysis, development of strategic initiatives and evolutionary analysis.To analyse the evolutionary development, a specific 43-item questionnaire was developed that addressed aspects related to structure, context, integration, processes, outcomes and research and was answered in 2016 and 2021 (in the latter case by adding 3 additional questions). Results141 hospitals participated in the status survey in 2016 and 138 in 2021. Significant differences were found in all dimensions analysed. None of the aspects assessed suffered a setback in this period.The most highly rated aspects at the general level were the improvement of the care model (65.0%) and at the local level, the incorporation of non-face-to-face pharmaceutical care (42.8%). Further progress in the coming years in the expansion and practical application of the methodology proposed in the project was considered a priority. ConclusionsThe implementation and development of the MAPEX initiative has had a positive impact in terms of quality of care for outpatient pharmaceutical care in Hospital Pharmacy services in Spain.

Educational Mismatch and Gender: A Comparison between Industry and Services in Spain

This study analysed the presence and influence of educational mismatch in the service and industry sectors in Spain, due to the lack of studies of this phenomenon in the latter sector. We also analyse its effect on wages and its role in creating a gender wage gap in the returns to a set of professional and personal characteristics. The heterogeneity in the improvement of workers’ qualifications between sectors in Spain and the lack of studies of this phenomenon in the industrial sector motivates interest in this comparative research between industry and services, which includes a gender perspective, given the interest of this topic in wage studies. To this end, an extension of the Mincer wage equation was applied to data from the 2018 Wages Structure Survey conducted by the Spanish National Statistics Institute. The results suggest that educational mismatch has a greater impact on women’s wages in the service sector than on those in the industrial sector and on men’s wages in both sectors. We also found wage differences in the returns to a set of professional and personal characteristics that suggest that the gender wage gap is greater in the service sector than in the industrial sector.

The implementation of the Guaranteed Minimum Income in times of COVID19: implications for Social Services in Spain

Minimum income policies are one of the social measures that have the greatest impact on social protection systems. After a year and a half since the implementation of the Guaranteed Minimum Income (IMV in Spanish) in Spain, this article aims at analyzing the perception of social workers on the effects of this new economic benefit on public Social Services. For this purpose, a qualitative methodology is followed, through a total number of six rounds of interviews in fifty-two social services centers located in different territories of the Spanish context. A total of 364 telephone interviews of 52 social service centers were conducted between July 20200 and September 2021. The results of this research point out to the unfulfilled expectations generated, the subordination of the social services to other institutional spheres, the bureaucratization of tasks and oversight in the social intervention processes, as well as the lack of recognition of social services' professionals regarding the management of this provision.

P128: The Valladolid Multicentre Study: Delirium characteristics in patients attended in seven liaison psychiatry services in Spain.

Introduction and objective:Delirium is an acute and fluctuating disorder characterized by a disturbance in attention and cognition that is commonly observed in hospitalized older adults; being present in up to 23% of patients admitted to a general medical service and as many as 85% of patients in the intensive care unit. Delirium causes complications such as increased morbidity, persistent functional decline, mortality, increased frailty and increased length of hospital stay. Nonetheless, it is often underdiagnosed, especially when it occurs in its hypoactive form. The objective of this study is to describe characteristics and factors associated with the presence of delirium in patients ≥65 years treated by the liaison psychiatric units in seven general hospitals.Methods:This is an observational, cross-sectional, multicentre study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.Results:We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Delirium was diagnosed in 20% of the consultations. A multivariate analysis was developed with the presence of delirium as the independent variable. The nature of the underlying pathology, the presence of a previous mental disorder, functionality using the Barthel and Lawton Brody Indexes and the prescribed pharmacological treatments were used as dependent variables. Cohen’s kappa statistics were used to estimate the agreement between delirium diagnose made by psychiatrists and the diagnoses considered by the referring doctors. Low agreement was found for the presence of delirium (Kappa= 0,2341). We also explored the relationship between the presence of delirium and the mean length of stay, as well as the discharge destination of these patients.Conclusions:There are still many difficulties in the diagnosis and treatment of patients with delirium. Better knowledge of the factors associated with its appearance would improve the management of these patients.

Parenting Competences Among Migrant Families Living at Psychosocial Risk in Spain

The impact of parenting competences on child well-being is well-established. During the last years, parenting support initiatives have increased in several countries, namely in Spain, offering support to promote parents’ childcare resources and competences, particularly for families at psychosocial risk. Recognizing the specificities of different subgroups of families, such as migrant families, allows the development of more tailored and effective interventions in the field of family support. However, there is a gap in the literature about parenting competences in migrant families. This article explores differences and similarities in parenting competences among 492 migrant and non-migrant parents involved in family preservation services in Spain, as well as examines the impact of these competences on children’s well-being. Our findings revealed that migrant and non-migrant vulnerable families face similar needs in terms of parenting competences in domains covered by the existing family support interventions. However, we found a few differences in parenting competences between both populations, as well as in the impact of several parenting competences in children’s well-being. Implications for research and practice are discussed.