Necesidades y estrategias de participación propuestas por la familia en los cuidados diarios del paciente crítico

Introducción. La asistencia continua y tecnificada que requiere el paciente crítico produce, en ocasiones, una barrera con la familia generando una alteración de sus necesidades. La participación familiar resulta beneficiosa tanto para la familia como para el paciente. Objetivo: 1) conocer los sentimientos y las necesidades de los familiares de pacientes ingresados en una UCI de un hospital de tercer nivel de Cataluña y 2) conocer las estrategias de participación que proponen los familiares. Métodos: Cualitativo fenomenológico. La población de estudio fueron familiares de pacientes ingresados en una UCI de un hospital de tercer nivel catalán entre mayo de 2017 y febrero de 2018. El muestreo fue intencional, considerando diferentes tipologías para garantizar la diversidad del discurso. Se realizaron entrevistas semiestructuradas, analizadas temáticamente. Se aplicaron los criterios de rigor de Guba y Lincoln. Resultados: Se entrevistaron 15 familiares. Los participantes manifestaron sentimientos negativos, positivos y transformadores. La asistencia psicológica, contar con más información y colaborar en los cuidados son algunas de las necesidades manifestadas. Entre las estrategias planteadas ante la falta de participación aparece el aumento de horas de la familia en la UCI y el apoyo de una enfermera educadora del cuidado. Conclusiones: Es necesario reorientar las prácticas profesionales incorporando estrategias que integren aún más a la familia en el cuidado diario del paciente crítico. Ayudar a la familia, priorizando en sus necesidades y guiarla en el aprendizaje es básico y forma parte del cuidado profesional. Introduction. The continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient. Objective: 1) Knowing the feelings and needs of the patients' relative admitted to an ICU of a third level hospital in Catalonia and 2) To study the participation strategies proposed by the relatives. Methods: Phenomenological qualitative study. The sample population selected was the patients' relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied. Results: 15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care. Conclusions: It is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care

El agua regenerada como fuente alternativa sostenible de riego en agricultura en Europa: el caso de Andalucía

En la presente comunicación se resumen los resultados obtenidos en el proyecto SuWaNu-Europe al respecto de las debilidades, amenazas, fortalezas y oportunidades de la regeneración de aguas en Europa y más concretamente en la región de Andalucía. A través de dos encuestas se identifican los principales componentes del DAFO en las ocho regiones analizadas por el proyecto y la relevancia o impacto de éstas sobre la potencial reutilización de agua en agricultura. Los resultados nos destacan que la percepción social, el coste y el marco regulatorio son los principales elementos que abordar si se pretende fomentar el uso del agua regenerada en agricultura. Sin embargo, estos elementos no afectan por igual a todas las regiones. Se pueden reunir las regiones en dos clústeres: el primero formado por Alemania, Bélgica, Bulgaria, Grecia y Portugal, cuyas regiones se han caracterizado por tener una mayor disponibilidad de agua. Las principales preocupaciones de los agentes claves han sido el alto coste de implementar la reutilización, la falta de infraestructuras y la gestión de los riesgos. El segundo clúster, formado por España, Francia e Italia, con mayor concienciación debido a la escasez previa, ha destacado la disponibilidad de infraestructuras y la oportunidad que supone disponer de una fuente de riego alternativa de forma constante todo el año. En cualquier caso, ambos clústeres destacan la necesidad de concienciar a la sociedad para que la reutilización tenga éxito

Differences in Dietary Habits, Physical Exercise, and Quality of Life between Patients with Obesity and Overweight

Background: Overweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity and overweight. Methods: A cross-sectional study was undertaken among participants in a clinical trial on education for healthy eating and physical activity, enrolling non-diabetic patients admitted to Internal Medicine Departments. These were classified by body mass index (BMI) as having overweight (25-29.9 Kg/m2) or obesity (≥30 kg/m2). Data were gathered on sociodemographic characteristics, clinical variables (medication for anxiety/depression, Charlson Comorbidity Index, length of hospital stay), physical exercise and diet (International Physical Activity and Pardo Questionnaires), and HRQoL (EQ-5D-5L). The study included 98 patients with overweight (58.2% males) and 177 with obesity (52% males). Results: In comparison to patients with obesity, those with overweight obtained better results for regular physical exercise (p = 0.007), healthy diet (p = 0.004), and "emotional eating" (p = 0.017). No between-group difference was found in HqoL scores. Conclusion: Patients with overweight and obesity differ in healthy dietary and physical exercise behaviors. Greater efforts are warranted to prevent an increase in the BMI of patients, paying special attention to their state of mind.This research was funded by Carlos III Health Institute and The European Regional Development Fund (ERDF), grant nº PI17/00419.S

Emotions and self-efficacy of high school students when dealing with Biology and Geology content

[Resumen] La investigación en didáctica de las ciencias ha mostrado durante los últimos años un interés creciente en el estudio de los aspectos afectivos (como las emociones o la autoeficacia) de alumnos y profesores hacia la enseñanza y el aprendizaje de las ciencias. El objetivo de esta investigación es diagnosticar las emociones y la autoeficacia de una muestra de 764 alumnos, de 1º, 3º y 4º de Educación Secundaria, ante los contenidos de Biología y Geología, asimismo analizar las causas de esas emociones. Se ha encontrado que los participantes sienten más emociones positivas que negativas, así como alta autoeficacia, en la práctica totalidad de los contenidos. Sin embargo, los ítems de Geología obtienen mayor promedio de emociones negativas y menor de positivas y autoeficacia que los de Biología. Respecto a las causas de las emociones, se aducen tanto afectivas como cognitivas; apuntando a actitudes en el alumno o en el profesor, o a la metodología.[Abstract] Research in science education has shown a growing interest in recent years in the emotional aspects of students’ and teachers’ attitudes towards science teaching and learning. The aim of this article is to diagnose the emotions and self-efficacy of a sample of 764 first, third and fourth-year high school students of Biology and Geology in relation to the content of each subject, and to analyse the causes of those emotions. The study found that participants felt more positive than negative emotions overall, and a high level of self-efficacy in relation to practically all of the contents. With respect to the differences observed between the two subjects, students showed a higher level of negative emotions and a lower level of positivity and self-efficacy towards Geology than towards Biology. Both cognitive and emotional factors were found to be present in the causes of the emotions reported, which may be related to student and teacher attitudes, or to the methodology used

Influencia de la reactividad cardiovascular sobre la discriminación del latido cardíaco: implicaciones en la detección precoz de síntomas

P. 139-156Una respuesta metabólicamente exagerada en personas jóvenes ante situaciones de estrés es considerada como un marcador de riesgo de una futura hipertensión. Este estudio examina concretamente la relación entre reactividad cardiovascular y percepción del latido cardiacoS

Effect of vitamin E administered to men in infertile couples on sperm and assisted reproduction outcomes: a double-blind randomized study

Objective: To evaluate the influence on sperm parameters and invitro fertilization (IVF) outcomes of the administration of 400 mg/day of vitamin E for 3 months to men from infertile couples who are undergoing IVF. Design: Double-blind, placebo-controlled, randomized study. Setting: Human reproduction unit of a university hospital. Patients: A total of 101 couples, 50 in the vitamin E group and 51 in the placebo group, undergoing IVF, among whom 64.4% of cases had an abnormal spermiogram according to World Health Organization (WHO) criteria. Interventions: Vitamin E (alpha-tocopherol), 400 mg daily by mouth for 3 months, with sperm analysis performed immediately before starting the treatment and 3 months later on the day of IVF. Main Outcome Measures: WHO sperm parameters and IVF outcomes. Results: Although there was a statistically significant increase in progressive motility in the vitamin E group compared with before-treatment values, a similar increase occurred in the placebo group. Normal morphology was even better in the placebo group. Regarding IVF outcomes, better fertilization rates were observed in the placebo group, but the live-birth rate per transfer was statistically significantly higher in the vitamin E group: 17 (41.46%) of 41 versus 9 (20.46%) of 44 in the placebo group. Although the clinical pregnancy rates (both per transfer and per cycle started) and the implantation rate were somewhat higher in the vitamin E group (43.9% and 25%; 36.0% and 22.0%; and 24.7% and 14.1%, respectively), the increase was not statistically significant. Conclusions: The effect of vitamin E on classic sperm parameters was not an improvement over placebo. Nonetheless, vitamin E administration was associated with a statistically significantly higher live-birth rate, and there was a trend toward better results in other IVF parameters

Antibacterial and antifungal activity of the human endometrial fluid during the natural cycle

[EN] Purpose. Some microbiota patterns have been associated with favorable IVF prognosis and others with pathological conditions. The endometrial fluid aspirate (EFA) contains antibacterial proteins that are enriched in implantative IVF cycles, but the antimicrobial effect of EFA has not been addressed. We aimed to evaluate the antimicrobial activity of the human endometrial fluid during the natural cycle. Methods. EFA was obtained through an embryo transfer catheter in 38 women, aged 18-40 years, with regular cycles attending to a fertility clinic. The antimicrobial activity of EFAs was tested against two strains of Staphylococcus aureus; one strain each of Streptococcus agalactiae, Enterococcus faecalis, Escherichia coli, and Klebsiella pneumoniae; and three yeasts (Candida albicans, Candida glabrata, and Candida krusei). Results. All samples exhibited antibacterial activity against S. aureus. In addition, 32.4% of EFAs were active against one of the other microorganisms assayed, 16.2% against two, and 5.4% against four of them. In contrast, none exhibited antibacterial activity against E. coli or K. pneumoniae. The antimicrobial activity differs considerably between EFA samples, and we failed to observe a cycle-related pattern. Conclusions. EFA presented two antimicrobial activity patterns: (a) one common to all the samples, exhibiting activity against S. aureus and lack of activity against E. coli and K. pneumoniae, and (b) an individualized pattern, showing activity against some of the other microorganisms tested. The intensity of antibacterial activity differs between EFA samples. Our data suggest that the uterine microbiota is controlled by means of endometrial fluid components.This study was partially supported by a Grant for Fertility Innovation (GFI, 2011) from Merck, Darmstadt, Germany. M. Bregón-Villahoz is recipient of a predoctoral grant from the Universidad del País Vasco-Euskal Herriko Unibertsitatea (UPV/EHU) (PIF19/316). The authors thank the technical and human support provided by DNA Bank Service (SGIker) of the University of the Basque Country (UPV/EHU) and European funding (ERDF and ESF). CIC bioGUNE is accredited with the Severo Ochoa Excellence award by the Spanish Ministerio de Economía y Competitividad, MINECO (SEV-2016-0644)

Evaluation of Burnout Syndrome and Resilience in Jaén Physical Therapists during the COVID-19 Pandemic. Pilot Study

Artículos originales[ES] Introducción: Aunque el síndrome del quemado (burnout) se ha estudiado profusamente en los trabajadores sanitarios,existen pocos estudios que lo aborden específicamente en los fisioterapeutas y cuando esto se ha hecho se ha encontrado que los índices varían desde un nivel bajo hasta un nivel medio-alto. La reciente pandemia COVID-19 ha supuesto y supone un reto notable para el sistema sanitario. En este escenario, puede ser de interés evaluar el índice de burnout en el colectivo de fisioterapeutas.Objetivo: El objetivo de este estudio es medir la prevalencia de burnout en el colectivo de fisioterapeutas de Jaén y provincia, así como estudiar posibles fenómenos asociados a la misma. Material y Métodos: Se remitió una encuesta con datos sociodemográficos, una escala de medición de la resiliencia y una escala de medición del burnout (incluyendo sus tres aspectos: cansancio emocional, despersonalización y realización personal) por medio grupos de WhatsApp de ámbito profesional a los fisioterapeutas de la provincia de Jaén. La encuesta fue anónima, voluntaria y autocumplimentable. Resultados: La prevalencia de burnout entre los fisioterapeutas de la provincia de Jaén es superponible a la publicada en otros estudios. Los fisioterapeutas que no trabajan en la capital sufren más de cansancio emocional (p=0,038) y existe una tendencia a que los hombres sufran más despersonalización. Entre las subescalas de resiliencia que más se asocian al burnout está la de “adaptabilidad y redes de apoyo”.Conclusiones: La frecuencia de burnout en los fisioterapeutas de Jaén es superponible a la publicada por otros autores, no siendo posible establecer si el contexto de pandemia COVID juega algún papel. No trabajar en la capital de la provincia parece favorecer el burnout. El perfil de burnout se concreta sobre todo en los aspectos “cansancio emocional” y “despersonalización”, siendo esto especialmente frecuente en los que presentan un bajo nivel de resiliencia en la subescala “adaptabilidad y redes de apoyo” [EN] Introduction: Although burnout syndrome has been extensively studied in health care workers, there are few studies that specifically address it in physical therapists, and when this has been done, the rates have been found to range from low to medium-high. The recent COVID-19 pandemic has been and continues to be a significant challenge for the healthcare system. In this scenario, it may be of interest to evaluate the burnout index in the group of physical therapists. Objective: The objective of this study is to measure the prevalence of burnout in the group of physical therapists in Jaén and province, as well as to study possible phenomena associated with it. Material and Methods: A survey with sociodemographic data, a resilience measurement scale and a burnout measurement scale (including its three aspects: emotional exhaustion, depersonalization and personal fulfillment) was sent by means of WhatsApp groups of professional scope to the physical therapists of the province from Jaén. The survey was anonymous, voluntary, and self-filling.Results: The prevalence of burnout among physiotherapists in the province of Jaén is superimposable to that published in other studies. Physiotherapists who do not work in the capital suffer more from emotional fatigue (p = 0.038) and there is a tendency for men to suffer more depersonalization. Among the resilience subscales that are most asso ciated with burnout is “adaptability and support networks”. Conclusions: The frequency of burnout in Jaén physiotherapists is superimposable to that published by other authors, and it is not possible to establish whether the context of the COVID pandemic plays any role. Not working in the provincial capital seems to favor burnout. The burnout profile is specified above all in the “emotional fatigue” and “depersonalization” aspects, this being especially frequent in those with a low level of resilience in the “adaptability and support networks” subscale.N

Cervical pregnancy in assisted reproduction: an analysis of risk factors in 91,067 ongoing pregnancies

OBJECTIVE: To assess the frequency of cervical pregnancy (CP) in women undergoing assisted reproductive techniques (ART) and to ascertain its risk factors DESIGN: Case-control study. Two control groups were established: tubal ectopic pregnancies and intrauterine pregnancies. SETTING: 25 private assisted reproduction clinics run by the same group in Spain PATIENT(S): Women undergoing ART (artificial insemination, or IVF with own or donor oocytes). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Frequency of CP. Ascertainment of demographic and clinical risk factors. Assessment of the influence of IVF parameters on CP risk. RESULT(S): There were 32 CPs out of 91,067 ongoing pregnancies, yielding a rate of 3.5/10,000. CPs represented 2.02% of all ectopic pregnancies (32/1582). The main risk factors were: ≥ 2 previous pregnancies (OR= 2.68; CI=1.18-6.07), ≥2 previous miscarriages (OR= 4.21, CI=1.7- 10.43), ≥ 2 previous curettages (OR=4.71; CI= (1.19-18.66) and smoking (OR= 2.82 (1.14-6.94). History of cesarean sections and tubal pregnancy were not associated with an elevated CP risk. Infertility conditions and endometrial thickness were similar across the three groups. The proportion of women from whom < 10 oocytes were retrieved was higher in the CP group than in either of the control groups. CONCLUSION(S): In ART, the main risk factors for ectopic pregnancy are a history of at least 2 pregnancies/miscarriages/curettages, and smoking. IVF parameters do not seem to influence the development of CP. CP is less common in ART than previously reported, likely attributable to improvements in ART, although a publication bias cannot be ruled out in early IVF reports