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Falgueras M.V.,Institute Catala Of La Salut | Munoz C.C.,Institute Catala Of La Salut | Pernas F.O.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | Sureda J.C.,Hospital Universitari Vall dHebron | And 2 more authors.
Atencion Primaria

Objective: To estimate the prevalence of burnout and the perception of teamwork in Primary Care teams from Barcelona. Design: Multicenter cross-sectional. Location: Primary Health Care Teams from Barcelona. Institut Català de la Salut. Participants: All permanent employees or temporary professionals of all categories from 51 teams (N = 2398). A total of 879 responses (36.7%) were obtained. Measurements: The Maslach Burnout Inventory questionnaire, with 3 dimensions, was sent by emotional exhaustion (AE), depersonalization (DP), and personal accomplishment (RP). Burnout is considered present when two or more dimensions scored high marks. Perception of teamwork and evaluation of leaders was evaluated using an ad hoc questionnaire. Results: The prevalence of burnout was17.2% (two or more dimensions affected), and 46.2% had at least one of the three dimensions with a high level. A high level of AE was found in 38.2%, of DP in 23.8%, and 7.7% had low RP. Almost half (49.2%) believe that teamwork is encouraged in their workplace. Social workers overall, have a higher average of dimensions affected at a high level, followed by administrative personnel, dentists, doctors and nurses (p < 0.001). Permanent staff have a greater degree of emotional exhaustion (p < 0.002). Those who rated their leaders worst and least rated teamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (p < 0.001). Conclusions: The level of burnout among professionals is considerable, with differences existing between occupational categories. Teamwork and appreciating their leaders protect from burnout. © 2013 Elsevier España, S.L.U. All rights reserved. Source

Morrison J.,University College London | Morrison J.,CIBER ISCIII | Pons-Vigues M.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | Pons-Vigues M.,University of Girona | And 13 more authors.
BMJ Open

Objective: To describe the knowledge and beliefs of public policymakers on social inequalities in health and policies to reduce them in cities from different parts of Europe during 2010 and 2011. Design: Phenomenological qualitative study. Setting: 13 European cities. Participants: 19 elected politicians and officers with a directive status from 13 European cities. Main outcome: Policymaker's knowledge and beliefs. Results: Three emerging discourses were identified among the interviewees, depending on the city of the interviewee. Health inequalities were perceived by most policymakers as differences in life-expectancy between population with economic, social and geographical differences. Reducing health inequalities was a priority for the majority of cities which use surveys as sources of information to analyse these. Bureaucracy, funding and population beliefs were the main barriers. Conclusions: The majority of the interviewed policymakers gave an account of interventions focusing on the immediate determinants and aimed at modifying lifestyles and behaviours in the more disadvantaged classes. More funding should be put towards academic research on effective universal policies, evaluation of their impact and training policymakers and officers on health inequalities in city governments. Source

Llor C.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | Plana-Ripoll O.,University of Aarhus | Moragas A.,Rovira i Virgili University | Bayona C.,Primary Care Center Valls Urba | And 3 more authors.
Family practice

BACKGROUND: A recent clinical trial could not find differences between anti-inflammatory drugs, antibiotics and placebo in shortening the duration of symptoms in acute bronchitis.OBJECTIVES: To investigate if C-reactive protein (CRP) concentrations at presentation are predictive of symptom resolution in these patients.METHODS: We performed a secondary analysis of the data from a placebo-controlled, randomized clinical trial carried out in primary care. Patients from 18 to 70 years of age presenting a respiratory tract infection of <1 week of evolution, with cough as the predominant symptom and the presence of discoloured expectoration, were enrolled in the study. On the baseline visit, CRP was determined in capillary blood and a five-item symptom diary was given. Patients were followed up to 30 days. The main outcome measure was the number of days with persistent cough.RESULTS: A total of 312 subjects fulfilled all the criteria for the efficacy analysis and had undergone the CRP test; of these, 56.4% presented a CRP value <8 mg/l and 76% presented <20 mg/l. There were no significant differences in the median duration of cough: 10 days among patients with CRP concentrations <8 mg/l [95% confidence interval (CI): 8-11 days], 11 days among those with concentrations ranging from 8 to 19 mg/l (95% CI: 8-16) and 11 days in those with CRP >20 mg/l (95% CI: 9-12) (P = 0.337).CONCLUSION: Among patients with uncomplicated acute bronchitis and discoloured sputum, the CRP concentrations at presentation are not helpful for predicting symptom resolution. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Source

Ferrer A.,Institute Catala Of La Salut | Formiga F.,Hospital Universitari Of Bellvitge | Padros G.,Institute Catala Of La Salut | Badia T.,Institute Catala Of La Salut | And 2 more authors.
Revista Espanola de Geriatria y Gerontologia

This is a review of a prospective, community-based study with a follow-up period of 5. years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijón test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5. years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group. © 2016 SEGG. Source

Codern-Bove N.,Autonomous University of Barcelona | Pujol-Ribera E.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | Pla M.,Autonomous University of Barcelona | Gonzalez-Bonilla J.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | And 3 more authors.
BMC Public Health

Background: Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS). Methods: Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction. Results: Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed. Conclusions: Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing. © 2014 Codern-Bové et al.; licensee BioMed Central Ltd. Source

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