Cuidar para despedirse: el rol del cuidador principal durante la enfermedad avanzada

Treball de Final de Grau en psicologia. Codi: PS1048. Curs acadèmic 2015-2016Contexto: Los cuidados paliativos tienen su origen en los hospicios y nacen por la necesidad de mejorar la calidad de vida del enfermo y su familia. En la enfermedad avanzada intervienen el cuidador principal, el enfermo y el equipo sanitario. El cuidador informal es el que se hace cargo de realizar los cuidados durante la etapa final de vida del enfermo, el cual comparte un vínculo afectivo con el enfermo por su cercanía (familia, vecino o amigo). Objetivo: identificar el rol del cuidador principal y sus necesidades psicoemocionales durante la enfermedad avanzada desde las contribuciones en la literatura científica. Método: Se realiza una revisión narrativa de la literatura a partir de las bases de datos científicas: PUBMED, Scielo y LILACS. Los datos fueron extraídos y analizados en categorías en base a los objetivos específicos planteados en el estudio. Resultados: Los resultados muestran la relación de datos biográficos con la literatura científica revisada. El sexo femenino es el encargado de realizar los cuidados. La mayoría de ellos no habían pasado por una situación similar. Los aspectos que más se han visto perjudicados en la vida del cuidador fueron el físico, aspectos psicoemocionales, la economía familiar y su vida personal y laboral. Se comprobó la relación de distintos factores con el síndrome de sobrecarga. Los cuidadores se sentían insatisfechos por la ayuda recibida y la insuficiente formación previa. Conclusión: El estudio muestra la importancia del rol del cuidador principal en la enfermedad avanzada con necesidades de atención paliativa. Aporta nuevas evidencias en relación a la figura del cuidador y esclarece la relación entre el cuidador familiar y cómo su vínculo afectivo influye en la realización de los cuidados.Context: Palliative care originated in hospices and born by the need to improve the quality of life of patients and their families. In advanced disease involved the primary caregiver, the patient and the healthcare team. The informal caregiver is the one who takes care of making care during the final stage of life of the patient, which shares a bond with the patient because of it's proximity (family, neighbor or friend). Objective: To identify the role of primary caregiver and psycho-emotional needs for advanced disease from contributions in scientific literature. Method: a narrative review of the literature is performed from the scientific databases PubMed, Scielo and LILACS. Data were extracted and analyzed in categories based on the specific goals outlined in the study. Results: The results show the relationship of biographical data reviewed scientific literature. Woman is responsible for taking care. Most of them had not gone through a similar situation. The aspects that have been hurt in the caregiver's life were the physical, psychological and emotional aspects, the family economy and their personal and work life. the relationship of various factors overload syndrome was confirmed. Caregivers were dissatisfied by the aid received prior training and insufficient. Conclusion: The 1 study shows the importance of the role of primary caregiver in advanced disease with palliative care needs. It provides new evidence in relation to the figure of the caretaker and clarifies the relationship between the family caregiver and how their emotional bond influences the realization of care

Prevalence of Toxoplasma gondii in retail fresh meat products from free-range chickens in Spain

Introduction: Toxoplasma gondii is one of the most prevalent zoonotic protozoan parasites worldwide and affects the vast majority of warm-blooded animal species, including humans. Postnatal infection in humans occurs through the ingestion of sporulated T. gondii oocysts or via the oral intake of parasite tissue cysts during the consumption of raw or undercooked meat. In this regard, given their high exposure to oocysts, chickens (Gallus domesticus) raised on the ground constitute a potential source of T. gondii. Material and Methods: For the first time in Spain, a survey was undertaken in commercial retail free-range poultry. A total of 50 thighs from different animals were analysed. The samples were homogenised and an acid pepsin digestion procedure was applied prior to molecular analysis. Toxoplasma gondii DNA was isolated from meat by qPCR. Two sets of primers were used for DNA amplification targeting the specific sequence of a 529 bp repeat element and another set of primers was utilised for the surface antigen protein-1 gene. Results: DNA extracted from 5 out of 50 tissue samples was positive for both genes by qPCR amplification. Conclusion: The 10% prevalence of Toxoplasma infection found in commercial free-range chickens raises public health issues

Trasplante de membrana amniotica en la reconstrucción de superficie ocular.

RESUMEN Las indicaciones del empleo de placenta para el tratamiento de patología oftálmica están reevaluándose y redefiniéndose. Esta tesis ha desarrollado su investigación en una doble vertiente, una experimental y otra clínica, para valorar la utilidad de la membrana amniótica en la reconstrucción de la superficie ocular. En la primera parte, se ha aplicado un modelo experimental de causticación corneal con compromiso límbico a 40 ojos de conejo albinos de la raza New Zealand, estableciéndose dos grupos de estudio (control y trasplante de membrana). La evolución espontánea de las lesiones provocadas en el grupo control es hacia la opacidad corneal, neovascularización y tendencia a la conjuntivalización de la córnea. Se demuestra la utilidad del trasplante de membrana amniótica en la regeneración de la superficie ocular en el modelo experimental propuesto, mejorando tanto la opacidad y úlcera corneales como la menor tendencia a la neovascularización de los ojos de conejo trasplantados respecto a los no trasplantados. El estudio clínico se ha realizado en 64 ojos de 63 pacientes con diversas alteraciones de la superficie ocular. De los pacientes intervenidos incluidos en este estudio a los que se les ha practicado trasplantes de membrana amniótica, concluimos que hemos obtenido mejores resultados, especialmente con 2 patologías: descompensaciones corneales (queratopatía bullosa) y microperforaciones corneales. Sin embargo, en otras patologías de la superficie ocular con mayor implicación conjuntival, hemos encontrado ligeramente superior a la membrana amniótica, el empleo de injertos conjuntivales libres tanto del ojo contralateral como del mismo ojo afecto. ____________________________________________________________________________________________________Current indications for amniotic membrane transplantation in ophthalmic pathology are stablishing. We have developed this thesis doctoralis in a double way: one investigative and one clinic, to evaluate the usefullness of amniotic membrane transplantation for the reconstruction of the ocular surace. In the first way, we have applied an experimental model of coneal alkali injury wth limbus compromise in 40 rabbit eyes. Spontaneous evolution of lesions in control group without amniotic membrane is to corneal opacity, neovascularization and corneal conjunctivalization. We have demostrated amniotic membrane transplantation in ocular surface regenaration in the experimental model we have proposed, improving both corneal opacity and neovascularization in rabbit eyes with amniotic membrane transplantation comparing with control group. Clinical study was developed in 64 eyes of 63 patients with various ocular surface pathologies. Among patientes included in this study that we have operated with amniotic membrane, we conclude we have obtained best results especially in two pathologies: corneal decompensation (bullous keratopathy) and corneal microperforations. However, in other ocular surface diseases with more conjunctival implication, we have found that conjunctival implants, are more effective than amniotic membrane transplantation

Open innovation: past, present and future trends

[EN] Purpose The purpose of this paper is to provide interested parties with the means of grasping how the literature on open innovation has evolved over the course of time. In this way, the authors furthermore contribute towards a better understanding, scaling and positioning of this field of research. Design/methodology/approach This study applies a combination of bibliometric techniques, such as citations, co-citations and social network analysis in order to map the scientific domain of open innovation. Currently, bibliometric analysis represents a methodology in effect on a global scale to evaluate the existing state of fields of research (Mutschke et al., 2011). This spans the application of quantitative and statistical analysis to publications such as articles and their respective citations and serving to evaluate the performance of research through returning data on all of the activities ongoing in a scientific field with summaries of these data generating a broad perspective on the research activities and impacts, especially as regards the researchers, journals, countries and universities (Hawkins, 1977; Osareh, 1996; Thomsom Reuters, 2008). Findings This research aims to map and analyse the intellectual knowledge held on open innovation. To this end, the authors carried out a bibliometric study with recourse to co-citations. Based on cluster and factorial analyses, it is possible identify and classify the several theoretical perspectives on open innovation across six areas: open innovation concept, open innovation and networks, open innovation and knowledge, open Innovation, and innovation spillovers, open innovation management and open innovation and technology.JoAo J. Ferreira and Cristina I. Fernandes acknowledge the financial support from NECE - Research Unit in Business Sciences funded by the Multiannual Funding Programme of R&D Centres of FCT - Fundacao para a Ciencia e a Tecnologia (Project UID/GES/04630/2013).Fernandes, C.; Ferreira, J.; Peris-Ortiz, M. (2019). Open innovation: past, present and future trends. Journal of Organizational Change Management. 32(5):578-602. https://doi.org/10.1108/JOCM-09-2018-0257S578602325Ahn, J. M., Minshall, T., & Mortara, L. (2017). Understanding the human side of openness: the fit between open innovation modes and CEO characteristics. 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Depresión, baja autoestima y ansiedad como factores de riesgo de dismorfia muscular: revisión sistemática

La dismorfia muscular es la preocupación patológica por no estar suficientemente musculados, la cual produce gran malestar. Se ha relacionado con otras patologías como los trastornos de depresión y ansiedad o baja autoestima. Se estima que su prevalencia es mayor entre los hombres y los que se dedican a realizar ejercicios de desarrollo de masa muscular. El objetivo es analizar la relación de la dismorfia muscular con los trastornos de ansiedad, depresión y autoestima, en culturistas y otros atletas de mayor riesgo. Se ha realizado una revisión sistemática siguiendo las directrices PRISMA durante el proceso, incluyendo 16 investigaciones encontradas en diferentes bases de datos (ProQuest y Scopus principalmente). Los resultados parecen confirmar una relación significativa entre la presencia de dismorfia muscular y las poblaciones dedicadas al ejercicio físico relacionado con el desarrollo de masa muscular. También parece plausible la relación entre este trastorno y los síntomas de depresión y ansiedad, así como baja autoestima. Por tanto, la presencia de estos síntomas podrían ser factores de riesgo de la dismorfia muscular, a pesar de que serían necesarios estudios de causalidad para poder concluir, con mayor seguridad, la verdadera relación entre estas variables

Mejoras y valoración tras un programa de ejercicio específico para adultos mayores crónicos/paliativos

After analysing the impact of a cognitively oriented multicomponent home-based exercise training program on independence, perceived health status, and lower limb strength in a group of multimorbid and/or palliative older patients (MPO-P), we studied the associations between improvements following training and the participants and health personnel’s opinion of the program. 13 MPO-P, (80.15+4.20 years) completed four months of training progressing in autonomy (from two supervised sessions and one autonomous weekly -60min session-, to two autonomous and one supervised). This was followed by fourautonomous (detraining) weeks with a recommendation to continue the exercises. Volume and intensity were increased by introducing more global exercises, with a greater neuromuscular load and double tasks, and a shorter resting interval. No exercise was repeated during the session (EFAM-UV©). Independence (Barthel) and perceived health (physical SF-36, with no changes in the mental domain), were improved after supervised training, with a tendency to improve in strength (sitting and standing for 30-s) and perceived health (total SF-36). This effect was maintained after the autonomous detraining phase, with a very favourable final perception by both patients and health personnel, as indicated in questionnaires. The gain in independence correlated negatively with the users’perception, but this requirement ensured the improvement. There was no association between perceived health and the evaluation of the program.Tras analizar el impacto de un programa de entrenamiento domiciliario multicomponente, con orientación cognitiva, sobre independencia, percepción subjetiva de salud, y fuerza del miembro inferior en un grupo de adultos mayores crónicos multimórbidos y/o paliativos (MCM-Ps), se estudiaron las asociaciones entre las mejoras obtenidas y la valoración del programa de participantes y personal sanitario. 13 MCM-Ps (80.15+4.20 años) completaron cuatro meses de entrenamiento progresando en autonomía (de dos sesiones supervisadas y una autónoma semanalmente -60 min/sesión-, a dos autónomas y una supervisada). Le siguieron cuatro semanas autónomas (desentrenamiento) con recomendación de ejercicio. El volumen y la intensidad se aumentaron introduciendo más ejercicios integrales, con mayor carga neuromuscular y doble tarea, y menor tiempo de descanso entre ellos, sin repetirlos en la sesión (EFAM-UV©). Independencia (Barthel) y salud percibida (SF-36 físico, sin cambios en dominio mental) mejoraron tras el entrenamiento supervisado, con tendencia a la mejora de fuerza (sentarse y levantarse 30-s) y la salud percibida (SF-36total). El efecto permaneció tras la fase autónoma/desentrenamiento, con una percepción final muy favorable de pacientes y personal sanitario-determinada mediante cuestionarios-. La ganancia en independencia correlacionó negativamente con la valoración del usuario, pero esta exigencia aseguró su mejora. No hubo asociación entre salud percibida y valoración del programa.The study was financed by Vali+D Grant Nº ACIF/2014/137)

Factors affecting SMEs' strategic decisions to approach international markets

[EN] The internationalisation challenges that face all companies are no longer the exclusive concern of multinationals. Participation in the international marketplace has become a reality for large firms and small and medium-sized enterprises (SME) alike. This kind of participation can be rewarding for both companies and employees. The markets that SMEs enter and the success of this entry depend on several factors such as cultural differences, company tradition, venture capital, products and competitors. The goal of this study is therefore to understand whether the characteristics of the external market, the characteristics of the company itself and the barriers to internationalisation influence the strategic approach that SMEs adopt in their internationalisation processes. Using data on 320 Portuguese SMEs, we apply multivariate analyses to test the dimensions of internationalisation. We find that the decision of SMEs to internationalise involves an institutional change in response to external pressures in the home country. SMEs under greater institutional pressure not only tend to expand further but also engage in their initial international activities more radically.This work is supported by FEDER funds from COMPETE 2020 and Portuguese funds - PORTUGAL 2020. Project IEcPBI - Interactive Ecosystem for Portuguese Business Internationalization - POCI-01-0145-FEDER-032139.Azevedo Lobo, C.; Fernandes, CI.; Ferreira, JJ.; Peris-Ortiz, M. (2020). Factors affecting SMEs' strategic decisions to approach international markets. European J of International Management. 14(4):617-639. https://doi.org/10.1504/EJIM.2020.107607S61763914

Lentes de contato corneoesclerais adaptadas em córneas irregulares após cirurgia LASIK

Purpose: We aimed to describe the outcomes of corneoscleral contact lens fitting with multi-aspherical geometry designs in patients with irregular corneas after laser-assisted in situ keratomileusis (LASIK). Methods: This was a retrospective series of 18 patients (age, 26-38 years) selected from an eye clinic database. Participants were required to have unsatisfactory visual acuity with their current contact lenses or spectacles after LASIK for myopia correction. All patients were fitted with corneoscleral contact lenses designed to correct corneal surface irregularities. A diagnostic trial set was used for fitting, and assessments were performed according to a standardized methodology. Subjective comfort, visual acuity, central corneal thickness, endothelial cell count, and corneal-compensated intraocular pressure were evaluated. The follow-up period was one year. Results: Contact lens use was discontinued in 3 patients, thus leaving 24 eyes from 8 females and 7 males for analysis. The fitting characteristics were optimal in terms of lens position and movement. Statistically significant improvements were found in the best spectacle-corrected vision from before fitting to the visual acuity after fitting (p<0.001). Moreover, the patients reported high subjective comfort ratings and usage times (12.98 ± 2.3 hours/day). After one year of wear, visual acuity, subjective comfort, and usage time were maintained. No statistically significant adverse changes developed in the corneas over this period. Conclusion: Corneoscleral contact lenses with a multi-aspherical geometry design provide optimal visual acuity, improved comfort, and prolonged usage times in patients with irregular corneas after LASIK.Objetivo: Descrever os resultados do ajuste de lentes de contato corneoesclerais com geometria multiasférica em pacientes com córneas irregulares após cirurgia de ceratomileuse in situ assistida por laser (LASIK). Métodos: Esta foi uma série retrospectiva de 18 pacientes (idade, 26-38 anos) selecionados a partir de um banco de dados de uma clínica oftalmológica. Os participantes foram escolhidos ao manifestaram acuidade visual insatisfatória com suas lentes de contato ou óculos atuais depois de terem sido submetidos à LASIK para correção de miopia. Todos os pacientes receberam lentes de contato corneoesclerais projetadas para corrigir irregularidades na superficie da córnea. Um conjunto diagnóstico de prova foi usado para a adaptação e as avaliações foram feitas de acordo com uma metodologia padronizada. O conforto subjetivo, a acuidade visual, a espessura central da córnea, a contagem de células endoteliais e a pressão intraocular compensada da córnea foram avaliados. O período de acompanhamento foi de um ano. Resultados: O uso de lentes de contato foi descontinuado em 3 pacientes, deixando 24 olhos de 8 mulheres e 7 homens para análise. As características de adaptação foram ótimas em termos de posição e movimento da lente. Melhorias estatisticamente significativas foram encontradas na melhoria da visão corrigida por óculos antes de se ajustar a acuidade visual após a adaptação (p<0,001). Além disso, os pacientes relataram altos índices subjetivos de conforto e tempo de uso (12,98 ± 2,3 horas/dia). Após um ano de uso, a acuidade visual, o conforto subjetivo e o tempo de uso foram mantidos. Não houve alterações adversas estatisticamente significativas nas córneas ao longo deste período. Conclusão: As lentes de contato corneoesclerais com projeto geométrico multiasférico proporcionam acuidade visual ideal, maior conforto e tempo de uso prolongado em pacientes com córneas irregulares após o LASIK.Medicin

Visual Outcomes After Cataract Surgery:Multifocal Versus Monofocal Intraocular Lenses

PURPOSE: To evaluate visual outcomes, spectacle independence, and quality of life among nonastigmatic and astigmatic patients who received AcrySof IQ ReSTOR toric or nontoric multifocal intraocular lenses (IOLs) (Alcon Laboratories, Fort Worth, TX) compared with those who received commercially available nontoric monofocal IOLs after bilateral cataract removal. METHODS: This randomized, patient- and observer-technician-masked study was conducted at 20 sites in Europe. Patients were randomized to receive monofocal (nontoric only) or multifocal (nontoric or toric, as needed) IOLs. Primary efficacy endpoints included percentage of patients achieving binocular uncorrected distance and near acuity of 0.1 logMAR or better (20/25 Snellen), spectacle independence, and scores on the National Eye Institute Refractive Error and Quality of Life questionnaire domains. Safety endpoints included adverse events and refractive error within 0.5 and 1.0 diopters. RESULTS: In the multifocal group (n = 108) versus the monofocal group (n = 100), significantly more patients achieved uncorrected distance and near acuity of 0.1 logMAR or better (45.7% vs 2.1%; P < .0001) and spectacle independence (73.3% vs 25.3%; P < .0001) at 6 months. The percentage of patients who achieved uncorrected distance visual acuity of 20/40 or better at 6 months was 92% in the multifocal group and 97% in the monofocal group. National Eye Institute Refractive Error and Quality of Life scores were significantly better for dependence on correction in the multifocal group (P < .0001) and for glare in the monofocal group (P = .0157); other domain scores were similar between groups. No significant trends in study device-related adverse events were observed. CONCLUSIONS: Monofocal and multifocal IOLs provided good clinical outcomes. More patients receiving multifocal IOLs attained better uncorrected visual acuity at a range of distances and spectacle independence compared with patients who received monofocal IOLs. Monofocal IOLs were associated with better patient-reported scores for glare compared with multifocal IOLs; however, scores for patient satisfaction were significantly better in the multifocal group