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Forcadell-Díez L, Juárez Martínez O, Abiétar DG, López MJ, Sánchez-Martínez F, Perez G. Healthy and Equitable Interpersonal Relationships, Health Inequalities and Socio-Educational Interventions: A Conceptual Framework for Action. THE JOURNAL OF SCHOOL HEALTH 2023; 93:521-532. [PMID: 36917972 DOI: 10.1111/josh.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Interpersonal relationships undoubtedly have a bidirectional connection with the health of individuals and communities. Relational models based on equity contribute to well-being, while asymmetrical relationships based on hierarchies and differences of power negatively impact mental, physical, and social health. METHODS A conceptual framework for understanding the determinants of interpersonal relational models was developed. RESULTS Structural determinants were identified as the combined action of systems of oppression, the socio-historical context that normalizes violence, and social stratification and segregation, consequences which included inequitable access to power, resources, and opportunities. Intermediate determinants include individual, psychosocial, behavioral, and community aspects. Structural and intermediate determinants impact health and health inequalities through multiple relational patterns that are simultaneously established and sustained by individuals and communities. The health impact of inequitable relational patterns includes: Reduced self-esteem; anxiety, stress, and depression; acceptance of violence; physical and sexual harm; suicide; and murder. CONCLUSIONS This conceptual framework allows for the modification of relational models by influencing structural and intermediate determinants. Six areas of intervention have been identified: educative policies, school governance, physical and symbolic space, school curriculum, school-community relations, and socio-educative interventions to promote healthy and equitable relationships. Healthy and equitable relationships are associated with improved subjective well-being, health status and protection from violence. Socio-educational interventions that consider the elements of this conceptual framework may be effective in promoting healthy and equitable relational models.
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Affiliation(s)
- Lluís Forcadell-Díez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Daniel G Abiétar
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Researcher in CIBER de Epidemiología y Salud Pública, Madrid, Spain; Researcher in Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Francesca Sánchez-Martínez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Researcher in Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Gloria Perez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Researcher in CIBER de Epidemiología y Salud Pública, Madrid, Spain; Researcher in Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Mehdipanah R, Briceño EM, Gonzales X, Heeringa SG, Levine DA, Langa KM, Garcia N, Longoria R, Morgenstern LB. Dementia care needs for individuals and caregivers among Mexican Americans and non-Hispanic Whites. Aging Ment Health 2022; 26:1630-1641. [PMID: 34096422 PMCID: PMC8864934 DOI: 10.1080/13607863.2021.1925222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mexican Americans (MA) are more likely to have cognitive impairment and dementia (CID), be diagnosed at an earlier age and live with CID longer, compared to non-Hispanic Whites (NHW). While studies have examined unmet needs of individuals with CID and their caregivers, few have focused on MA populations in the U.S. This paper examines the needs of community-residing individuals with CID and their caregivers in Nueces County, Texas, a county with one of the largest MA populations in the U.S., while exploring ethnic differences in needs identified. Using concept mapping, a mixed-method approach, qualitative input on perceived needs by informal caregivers and health professionals was collected. Participants then sorted and rated perceived needs. Using this information, multidimensional scaling and cluster analyses were conducted to map the relationship between perceived needs and determine their importance and priority. Five clusters were derived for caregivers and four for the health professionals. Themes across both caregivers and health professionals highlighted the need for specialized and team-based medical care, caregiver support and training, along with socio-economic and physical needs that help with day-to-day care of individuals with CID. Among caregivers, MA rated financial resources as more important and of higher priority compared to NHW. The health professionals' perspectives were aligned with those of all caregivers. By understanding the needs of caregivers and individuals with CID, we can help families deal with this disease and let caregivers thrive. This is especially important for minority populations like MAs.
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Affiliation(s)
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation
| | - Xavier Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences
| | | | - Deborah A. Levine
- University of Michigan Medical School, Department of Internal Medicine
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research,University of Michigan Medical School, Department of Internal Medicine,Veterans Affairs Ann Arbor Center for Clinical Management Research
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology
| | - Ruth Longoria
- University of Michigan Medical School, Department of Neurology
| | - Lewis B. Morgenstern
- University of Michigan, School of Public Health,University of Michigan Medical School, Department of Neurology
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A Comprehensive Assessment of Informal Caregivers of Patients in a Primary Healthcare Home-Care Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111588. [PMID: 34770102 PMCID: PMC8583293 DOI: 10.3390/ijerph182111588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022]
Abstract
Studies of the characteristics of informal caregivers and associated factors have focused on care-receiver disease or caregiver social and psychological traits; however, an integral description may provide better understanding of informal caregivers’ problems. A multicenter cross-sectional study in primary healthcare centers was performed in Barcelona (Spain). Participants were a random sample of informal caregivers of patients in a home-care program. Primary outcomes were health-related quality of life and caregiver burden, and related factors were sociodemographic data, clinical and risk factors, social support and social characteristics, use of healthcare services, and care receivers’ status. In total, 104 informal caregivers were included (mean age 68.25 years); 81.73% were female, 54.81% were retired, 58.65% had high comorbidity, and 48.08% of care receivers had severe dependence. Adjusted multivariate regression models showed health-related quality of life and the caregivers’ burden were affected by comorbidity, age, time of care, and dependency of care receiver, while social support and depression also showed relative importance. Aging, chronic diseases, and comorbidity should be included when explaining informal caregivers’ health status and wellbeing. The effectiveness of interventions to support informal caregivers should comprehensively evaluate caregivers when designing programs, centering interventions on informal caregivers and not care receivers’ conditions.
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Velasco Sanz TR, Pinto Pastor P, Moreno-Milán B, Mower Hanlon LF, Herreros B. Spanish regulation of euthanasia and physician-assisted suicide. JOURNAL OF MEDICAL ETHICS 2021; 49:medethics-2021-107523. [PMID: 34330794 DOI: 10.1136/medethics-2021-107523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals' right to conscientious objection and the specification that it makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short.
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Affiliation(s)
- Tamara Raquel Velasco Sanz
- Departamento Enfermería, Complutense University of Madrid, Madrid, Spain
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
| | - Pilar Pinto Pastor
- Medicina Legal, psiquiatría y patología, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Moreno-Milán
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
- Departamento de Psicología Clínica. Facultad de Psicología, Complutense University of Madrid, Madrid, Spain
| | - Lydia Frances Mower Hanlon
- Departamento Enfermería, Complutense University of Madrid, Madrid, Spain
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
| | - Benjamin Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
- Unidad de Medicina Interna, Hospital Universitario Fundacion Alcorcon, Alcorcón, Madrid, Spain
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Timonet-Andreu E, Morales-Asencio JM, Alcalá Gutierrez P, Cruzado Alvarez C, López-Moyano G, Mora Banderas A, López-Leiva I, Canca-Sanchez JC. Health-Related Quality of Life and Use of Hospital Services by Patients with Heart Failure and Their Family Caregivers: A Multicenter Case-Control Study. J Nurs Scholarsh 2020; 52:217-228. [PMID: 32141224 DOI: 10.1111/jnu.12545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Heart failure (HF) causes high rates of hospital admissions. It is known that disease progression impacts the health-related quality of life (HRQoL) of both patients and caregivers, yet to date, this finding is based on cross-sectional studies with limited samples. OBJECTIVES The study aim is to analyze the relationship between HF patients' use of hospital services (a proxy for disease progression) and the HRQoL of their family caregivers. METHODS This work is a multicenter nested case-control study on a population of patients admitted to hospitals in southern Spain due to heart failure. The sample comprised 530 patient-caregiver dyads. Hospital admission data were retrospectively collected for the 5 years prior to inclusion in the study. Bivariate analyses and multivariate logistic regression were used to determine associations between patient deterioration and caregivers' quality of life. RESULTS Patients' use of hospital services was associated with worsened quality of life for family caregivers, with an overall OR of 1.48 (95% CI: 1.23-1.79). A positive correlation was found between patients' perceptions of their physical health and the perceived mental health of caregivers (r = 0.127, p = 0.004) and between the perceived mental health of both (r = 0.291; p <0.0001). CONCLUSIONS Greater use of hospital services by patients with HF is an independent predictor of deterioration of family caregivers' HRQoL. The physical and mental components of patients' and their family caregivers' HRQoL interact and influence each other. Additional factors, such as the nature and intensity of care provided, also determine the worsening of a family caregiver's HRQoL. CLINICAL RELEVANCE These results can be used to identify family caregivers of people with heart failure at risk of suffering a deterioration in their health-related quality of life. Increased use of hospital services is an independent predictor of the deterioration of the family caregivers' health-related quality of life. Since clinical nurses are the main provider who gives support and education to family caregivers, they should be alert to this situation and individualize interventions to prevent this deterioration.
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Affiliation(s)
- Eva Timonet-Andreu
- Clinical Nursing Supervisor of Cardiology, Costa del Sol Public Health Agency, Marbella, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA
| | - José Miguel Morales-Asencio
- Professor. Instituto de Investigación Biomédica de Málaga, IBIMA, Universidad de Málaga, Faculty of Health Sciences, Spain
| | | | | | | | - Ana Mora Banderas
- Clinical Nursing Supervisor, Costa del Sol Public Health Agency, Marbella, Spain
| | - Inmaculada López-Leiva
- Assistant Professor, Universidad de Málaga, Faculty of Health Sciences, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA
| | - José Carlos Canca-Sanchez
- Costa del Sol Public Health Agency. Associate Professor, Universidad de Málaga, Faculty of Health Sciences, Marbella, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA
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Del Pozo-Rubio R, Moya-Martínez P, Ortega-Ortega M, Oliva-Moreno J. Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain. HEALTH ECONOMICS REVIEW 2020; 10:12. [PMID: 32430791 PMCID: PMC7236927 DOI: 10.1186/s13561-020-00272-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A large part of the long-term care is provided by non-professional caregivers, generally without any monetary payment but a value economic of time invested. The economic relevance of informal caregivers has been recognized in Spain; however, public provision may still be scarce. The objective of this paper is to estimate the economic burden associated with informal long-term care that should assume the families through a new concept of cost sharing that consider opportunity costs of time provided by informal caregivers. METHODS The study sample includes all dependent adults in Spain. Socioeconomic information and the number of hours of informal care was collected through the Spanish Disability and Dependency Survey. The terms of shadow and extended shadow cost sharing were defined as the difference between the maximum potential amount of money that families could receive for the provision of informal care and the amount that actually they received and the value of informal care time with respect to the amount received, respectively. RESULTS 53.87% of dependent persons received an economic benefit associated to informal care. The average weekly hours of care were 71.59 (92.62 without time restrictions). Shadow cost sharing amounted to, on average, two thirds, whereas the State financed the remaining third. In terms of extended shadow cost sharing, the State financed between 3% and 10% of informal care provided by caregivers. CONCLUSIONS This study reveals the deficient support received for the provision of informal care in Spain. More than 90% of informal care time is not covered by the economic benefits that families receive from the State.
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Affiliation(s)
- Raúl Del Pozo-Rubio
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44 16.071, Cuenca, Spain
| | - Pablo Moya-Martínez
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44 16.071, Cuenca, Spain
| | - Marta Ortega-Ortega
- Department of Applied Economics, Public Economics and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n. 28.223 Pozuelo de Alarcón, Madrid, Spain
| | - Juan Oliva-Moreno
- Department of Economics and Finance, University of Castilla-La Mancha, Calle San Pedro Mártir, 7, 45002 Toledo, Spain
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7
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Timonet-Andreu E, Canca-Sanchez JC, Sepulveda-Sanchez J, Ortiz-Tomé C, Rivas-Ruiz F, Toribio-Toribio JC, Mora-Banderas A, Morales-Asencio JM. Overestimation of hours dedicated to family caregiving of persons with heart failure. J Adv Nurs 2018; 74:2312-2321. [PMID: 29808478 DOI: 10.1111/jan.13727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/19/2018] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study is to profile the family caregivers of people living with heart failure, to determine the perceived and real time devoted to daily care and to identify the factors associated with caregivers' overestimation of time dedicated to care. BACKGROUND The time spent by family caregivers on daily care is related to overload, but there are differences between real and perceived time spent. The reason for this difference is unknown, as is its impact on the caregiver. DESIGN Multicentre, cross-sectional study. METHODS This study forms part of a longitudinal, multicentre, ambispective cohort investigation. The study population was composed of 478 patient-family caregiver dyads and the data were collected over 2 years from 2014 - 2016. RESULTS The mean time perceived to be spent on daily care was 8.79 hr versus a real value of 4.41 hr. These values were positively correlated. A significant correlation was also found between the overestimation of hours spent and the age of the caregiver, the duration of the caregiving relationship and the number of people providing support and with the patient's level of dependence and self-care. CONCLUSION The overestimation of time dedicated to care seems to be related to patients' and caregivers' characteristics, such as functional status, caregiver burden, age and cohabitation. These patterns should be considered by nurses when carrying out assessment and care planning with these patients and their caregivers.
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Affiliation(s)
| | - José Carlos Canca-Sanchez
- Nursing Unit, Costa del Sol Public Health Agency, Marbella, Spain.,School of Health Sciences, Universidad de Málaga, Málaga, Spain
| | | | - Celia Ortiz-Tomé
- Nursing Unit, Costa del Sol Public Health Agency, Marbella, Spain
| | | | | | | | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain.,Research and Evidence-Based Practice, School of Health Sciences, Universidad de Málaga, Málaga, Spain
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Malmusi D, Muntaner C, Borrell C. Social and Economic Policies Matter for Health Equity: Conclusions of the SOPHIE Project. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 48:417-434. [PMID: 29895205 DOI: 10.1177/0020731418779954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 2011, the SOPHIE project has accumulated evidence regarding the influence of social and economic policies on population health levels, as well as on health inequalities according to socioeconomic position, gender, and immigrant status. Through comparative analyses and evaluation case studies across Europe, SOPHIE has shown how these health inequalities vary according to contexts in macroeconomics, social protection, labor market, built environment, housing, gender equity, and immigrant integration and may be reduced by equity-oriented policies in these fields. These studies can help public health and social justice advocates to build a strong case for fairer social and economic policies that will lead to the reduction of health inequalities that most governments have included among their policy goals. In this article, we summarize the main findings and policy implications of the SOPHIE project and the lessons learned on civil society participation in research and results communication.
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Affiliation(s)
- Davide Malmusi
- 1 Ajuntament de Barcelona, Barcelona, Catalonia, Spain.,2 CIBER Epidemiology and Public Health, Barceloa, Catalonia, Spain.,3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Catalonia, Spain
| | | | - Carme Borrell
- 2 CIBER Epidemiology and Public Health, Barceloa, Catalonia, Spain.,3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Catalonia, Spain.,5 Agencia de Salut Publica de Barcelona, Barcelona, Catalonia, Spain
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Crespo-Maraver M, Doval E, Fernández-Castro J, Giménez-Salinas J, Prat G, Bonet P. [Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)]. GACETA SANITARIA 2018; 33:348-355. [PMID: 29627117 DOI: 10.1016/j.gaceta.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/06/2017] [Accepted: 12/19/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity. METHOD Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied. RESULTS The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale. CONCLUSIONS The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context.
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Affiliation(s)
- Mariacruz Crespo-Maraver
- División de Salud Mental, Grupo SaMIS, Fundació Althaia de Manresa - Xarxa Assistencial i Universitària de Manresa, Manresa (Barcelona), España; Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), España.
| | - Eduardo Doval
- Departamento de Psicobiología y de Metodología en Ciencias de la Salud, Facultad de Psicología, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), España
| | - Jordi Fernández-Castro
- Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), España
| | - Jordi Giménez-Salinas
- División de Salud Mental, Grupo SaMIS, Fundació Althaia de Manresa - Xarxa Assistencial i Universitària de Manresa, Manresa (Barcelona), España
| | - Gemma Prat
- División de Salud Mental, Grupo SaMIS, Fundació Althaia de Manresa - Xarxa Assistencial i Universitària de Manresa, Manresa (Barcelona), España
| | - Pere Bonet
- División de Salud Mental, Grupo SaMIS, Fundació Althaia de Manresa - Xarxa Assistencial i Universitària de Manresa, Manresa (Barcelona), España
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