Evaluating the impact of existing legislation in Europe with regard to Female Genital Mutilation

The Spanish Report on the evaluation of existing legislation with regard to Female Genital Mutilation (FGM) is the result of a research project supported by the European Commision Daphne Programme. The project Evaluating the impact of existing legislation in Europe with regard to female genital mutilation, has been coordinated by the International Centre for Reproductive Health of Ghent University (Belgium) from january 2003 to march 2004. The project included as partners the Foundation for Women’s Health, Research and Development (FORWARD, United Kingdom); Lund University (Sweden); Commission pour l'Abolition des Mutilations Sexuelles, (CAMS, France), the Centre of Studies on Citizenship, Migration and Minorities of the University of Valencia (GECIM, Spain), and the above mentioned ICRH (Ghent University, Belgium) . The Spanish report is an interdisciplinary research done by the Centre of Studies on Citizenship, Migration and Minorities (University of València), directed by professor Javier De Lucas, and which counts with researchers and collaborators both, from the University of Valencia and other Universities such as University of Barcelona and University Rovira i Virgili of Tarragona; in the fields of Law (Penal Law, Constitutional Law, Theory and Philosophy of Law), Sociology and Antropology. The Group of researchers includes as well lawyers and public prosecutors. Practice of Female Genital Mutilation in Spain, like other european countries, address this rite that is introduced by immigrants from countries where the practice is prevalent (as we may see in chapter 3), as a violation of women’s rights and consider that such violation cannot be justified by respect of cultural traditions or initiation ceremonies. The increasing of immigration in Spain, has been a fact in last years, and it would be an important issue in future, increasing too the number of girls at risk in our country. In Spain, since october 2003, we have anew specific legislation, but before Female Genital Mutilation was liable too under the general offence of injuries in the Penal Code. In this Report, like in the other of the project, we have examined the possibilities and difficulties in the implementation of the spanish national legislation, in order to recommend a legislative and political strategy through Europe. page4image1440 The research methodology, common to all reports, was designed by the ICRH in its cooordination task, but was as well discussed by all the partners along the six steering commitee meetings we have had. The structure and content of report reflects the answers to following questions: 1. What is the legislation with regard to FGM in your country? Description of the legislation.; 2. What is the number of published court cases/suspected cases related to FGM in your country? What is the number of “hearsay” cases?; 3. Brief description of the practising community and the corresponding jurisdiction: number of Africans per country in the geographic area where the cases that you describe are located; 4. What is the procedure to be followed in case of a legal intervention to prevent or to penalise the performance of FGM?; 5. Is legislation applicable on FGM being implemented?; 6.What are the obstructing (favouring) factors for the implementation of legislation applicable to FGM? First of all we have compiled information about legislation applied with regard to FGM: not only general or specific criminal law, (in the case of Spain both because we have a change of law since october 2003), but also child protection procedures. In chapter 1, you may find the result: a Constitutional analysis, changes in Criminal Law, ans an introduction to Minor protection Laws. The second issue was the knowledge of court cases, police and judicial investigation in order to study how justice works. In this part, we contact key-informants, review archival records and study other reports: usually sociological, anthropological and health reports. In chapter 2 we have selected and summarized seven court cases in which we hace found enough relevant information to other parts of the report. At the same time, we need to identify the practicing communities to estimate the prevalence of women with FGM and the number of girls at risk of FGM. This was interesting not only to limit the research but to focus on a territory where there was a probability of cases in Court. We have choosen Catalonia: a community with court cases (in Barcelona and Girona) and prevalence of FGM; and Valencia, a territory without known cases and with no prevalence of FGM. This analysis is shown in chapter 3. In order to detect factors that hamper the implementation of existing legisaltion we need to know how procedures works at different levels: health services, social assistance, police, prosecution office and courts. Examining procedure laws, referral procedures, guidelines or ruled practices was not enough. We had to know what happen, who know a case, which institution examine it, which real mens they have.... To complete this, we have performe a study, interviewing key-informants with an standard interview: police, prosecutors, judges, doctors, nurses, social assistants and immigrants. Interviews were fulfilled in Valencia, Tarragona, Barcelona and Girona. Results are in Chapter 4 (procedure followed); Chapter 5 (implementation of appllicable legislation) and Chapter 6 (obstructing and favouring factors for the implementation of legislation). We had three main meetings to design the research and discuss texts and provissional results. Some of conclusions of provissional spanish report were discused in two seminars: “Ciudadania europea y conflictos culturales”, [european citizenship and cultural conflicts] (Valencia, 29, 30 and 31 october 2003); and “Violencia de género: instrumentos jurídicos en la lucha contra la discriminación de las mujeres”[Gender violence: legal instruments fighting agains women discrimination] (Valencia, 26, 27 and 28 november 2003) The study was financed by the European Commission, Daphne programme, and ran from January 2003 to March 2004 (EC-CONTRACT no 02/058/WYC). In additon, in the period we have done this study, the Centre of Studies on Citizenship, Migration and Minorities was financed with other projects related: “Indicadores y medidas para el desarrollo de políticas públicas de integración social de los inmigrantes y la garantía de sus derechos en la Comunidad Valenciana”, [indicators and measures to develop public policies for social integration of immigrants and the protection of their fundamental rights in the Land of Valencia], Project I+D “Generalitat Valenciana”; 2002-2003; "Los derechos fundamentales en las sociedades multiculturales" [fundamental rights in multicultural societies], project I+D, Subdirección General de Proyectos de Investigación, Dirección General de Investigación, Ministerio de Ciencia y Tecnología, november 2002-october 2005; “Los derechos de participación como elemento de integración de los inmigrantes” [participation rights as a element of the integration of immigrants], II Convocatoria de Ayudas a la Investigación en Economía, Demografía y Estudios de Población y Estudios Europeos de la Fundacion BBVA; 2004-2005. We wish to thank all who have collaborated in this study, specially we remark the collaboration and contributions of Elena Gascón Sorribas (Sociology of Law Laboratory; University of Zaragoza); María Heras García (Public Prosecutor); Dolores Gisbert Millet (Doctor, Health Service, Valencia); Ignacio de Lucas (Public Prosecutor); Laura Matilla (Lawyer, city council of Cullera); Joan Mayoral Simón (Justice Evaluating the impact of existing legislation with regard to Female Genital Mutilation..Spanish National Report. Daphne Programme Department, Regional Government of Catalonia); Xavier Montagud (Social Services, Regional Government of Valencia); and Dolores Sabater Collado (Court Secretary). With the results of the five National Report analysis and the information about legislation in all European Union member States, the coordinators, Els Leye and Jessika Deblonde, have elaborated A comparative analysis of the different legal approaches in the 15 EU Member States, and the respective judicial outcomes in Belgium, France, Spain, Sweden and the United Kingdom (ICRH, 2004)

Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19

Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68–121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8–31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable populationThis study did not receive any funding or fnancial support. JMA and JV are funded by Grants from the Instituto de Salud Carlos III, Spain (CB06/06/1088, PI19/00141)

Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients

PurposeAlthough the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia.MethodsWe carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations.ResultsBetween 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT & GE; 0.12 ng/mL was associated with higher 90 days mortality.ConclusionOur study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Pronóstico y coste de los pacientes con insuficiencia respiratoria crónica en tratamiento con oxigenoterapia domiciliaria sometidos a ventilación mecanica en la UCI por reagudización

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía, 1-3-199

Una herramienta para el estudio funcional de las matemáticas: los Recorridos de Estudio e Investigación (REI)

Este trabajo pretende, a partir de una propuesta inicial y abierta del concepto de recorrido de estudio e investigación (REI), elaborada por Chevallard, diseñar un modelo teórico particular de REI para utilizarlo en la creación de secuencias de enseñanza y aprendizaje para desarrollar en el aula que permitan actuar sobre la actividad matemática institucional y donde la modelación y la tecnología tengan un fuerte protagonismo. Después, presentamos el esbozo de un proceso de estudio, que no está experimentado todavía, el cual sitúa el estudio funcional de las matemáticas en el corazón de la actividad matemática que desarrollarán los alumno

Nutrición artificial en la insuficiencia respiratoria Artificial nutrition in respiratory failure

Los pacientes con insuficiencia respiratoria crónica presentan con frecuencia alteraciones nutricionales que hacen necesario el soporte nutricional. Ello es más importante en presencia de episodios de descompensación aguda, dado que en esta situación se incrementa el riesgo de desnutrición y puede comprometerse la recuperación. Con el fin de evitar la sobrecarga ventilatoria, el soporte nutricional debe ser normocalórico o discretamente hipocalórico (recurriendo a la calorimetría indirecta, si es posible) y contener una proporción de grasa cercana al 50% del aporte calórico. El aporte de micronutrientes debe ser considerado debido a los efectos de algunos de ellos (P, Mg, Se) sobre la función ventilatoria. El objetivo del soporte nutricional en los pacientes con insuficiencia respiratoria aguda (SDRA) es el de aportar los requerimientos al mismo tiempo que se procede a la modulación de la respuesta inflamatoria y a la estimulación de los mecanismos de recuperación ante la agresión aguda. La modificación cualitativa del aporte lipídico (disminuyendo el aporte de ácido linoleico e incrementando el de otros lípidos precursores de eicosanoides con menor capacidad proinflamatoria) y el empleo de antioxidantes, parecen ser los mecanismos más importantes en este sentido.Patients with chronic respiratory failure frequently have nutritional impairments that prompt nutritional support. This is more important during acute exacerbation episodes since, in this situation, the risk for hyponutrition is increased and recovery may be compromised. In order to prevent ventilatory overload, nutritional support should be normocaloric or mildly hypocaloric (using indirect calorimetry, if possible) with a fat content ratio of around 50% of the caloric intake. Micronutrients supply should be considered due to the effects of some of them (P, Mg, Se) on respiratory function. The aim of nutritional support in patients with acute respiratory failure (ARDS) is the requirements provision meanwhile the inflammatory response is modulated and repair mechanisms against acute damage are stimulated. Qualitative modification of lipids supply (by decreasing the intake of linoleic acid and increasing other eicosanoids-precursor lipids with a lesser inflammatory capability) and the use of antioxidants seem to be the most important mechanisms in this regard