"Mi sangre está enferma, yo no": narrativas del mundo sida y la gestión del tratamiento

Etnografía basada en la fenomenología cuyo objetivo es estudiar la vivencia de vivir con VIH-sida y gestionar el tratamiento antirretroviral. El sida, es un acontecimiento significativo, distinguido y distinguible de otros de la vida cotidiana. La vida cotidiana de las PVVS está compuesta por una esfera pública, una esfera privada y una esfera íntima como sinónimo de seguridad y de tranquilidad dónde se definirán los cuidados del cuerpo y las relaciones sexuales. La identidad se de-construye ante el diagnóstico para ser re-construida a partir de tres tipos de identidades: las identidades legitimadas, identidades de resistencia e identidades en proyecto. La gestión autónoma del tratamiento antirretroviral resulta de la constante re-interpretación del tratamiento en la arena de la vida cotidiana. En el duro “oficio de vivir con VIH-sida” existe un intento de incorporar el tratamiento en la vida diaria para continuar en la normalidad cotidiana y la normalidad social, para no sentirse estigmatizados, en definitiva para no sentirse enfermos. La autogestión busca la tolerancia farmacológica y mantener la normalidad cotidiana en tanto que la sociogestión busca esta normalidad pero sobretodo, mantener la normalidad social para evitar el estigma. Palabras clave: etnografía, fenomenología, VIH-sida, adherencia al tratamiento, gestión autónoma del tratamiento.This is an Ethnography work based on Phenomenology the objective of which is to study what living with HIV and aids means and the experience of management of HIV treatment. Aids is a significant event, different and distinguishable from others of people’s day-to-day life. The life of people living with HIV includes a public and a private sphere as well as an intimate sphere identified as synonym of safety and calmness where body’s care and sexual relations are defined. Identity is de-constructed in face of the diagnosis and is re-constructed again into three different kinds: legitimated identities, identities of resistance and identities in project. The autonomous management of HIV treatment is a result of the constant re-interpretation of treatment in day-to-day life. In the “hard business of living with HIV” there is an attempt to incorporate treatment in daily life in order to continue life with daily and social normality, in order to avoid feeling stigmatized, and definitely to avoid feeling ill. Self-management aims to achieve pharmacological tolerance and to maintain normality, while socio management, also searching for this normality aims to the maintenance of social normality in order to avoid stigma. Key words: ethnography, phenomenology, HIV-aids, adherence to treatment, self-management of treatment

CUERPO Y PINTURA. RELACIONES DIGITALES

[EN] The human body and painting have been in touch since the beginning of time, a fact that is evident in the oldest artistic expression of humanity, rock art. The human being used his hands as a brush to create, share, communicate information and leave trace of his presence in the world. Throughout history Body and Paint are moving away in favor of fair representation, but in the twentieth century with Pollock a turning point takes place, paint and body contact again, not only does he use his hand, his body whole moves as a brush onto the fabric placed on the ground. The canvas becomes a stage for action where his movements are recorded. Art has always wanted to question and reflect on anything that will become commonplace. With the constant presence of technology in our lives, art has incorporated into his speeches. The movements which Pollock left registered with paint on canvas, will now be replaced by pixels in a digital canvas. Software plotted the movements made with the computer mouse. A tangle of wires and dots are reflected in all directions in the digital format as paint. The robot called Sleep Art paints body movements during sleep. The result is a curious picture depending on everyone’s dreams. A project called ARS MOBILIS presented at the Feria Tecnológica de Buenos Aires captures and explores the body movements as an artistic expression. This project allows digital paint on a canvas with the movement of hands in the air. http://www.lanacion.com.ar/1577482Gen-buenos-aires-una-vincha-para-controlar-la-pc-con-la-mente-y-mucho-mas Althou-h tactile paintin- is replaced by pixels and canvas fabric by di-ital canvas, body movement continues to be linked to the process and to the results of the ima-e.[ES] El cuerpo humano y la pintura han estado en contacto desde el principio de los tiempos, hecho que se evidencia en la expresión artística más antigua de la humanidad, el arte rupestre. El hombre utilizaba sus manos como pincel para generar, compartir, transmitir información y dejar huella de su presencia en el mundo. A lo largo de la historia cuerpo y pintura se van distanciando a favor de la representación fiel, pero en el siglo XX con Pollock se produce un punto de inflexión, la pintura y el cuerpo retoman el contacto, no solo utiliza su mano, su cuerpo entero se mueve como un pincel sobre la tela colocada en el suelo. El lienzo se convierte en un escenario para la acción donde sus movimientos quedan registrados. El arte siempre ha querido interrogar y reflexionar sobre cualquier objeto que se convierta en cotidiano. Con la presencia constante de la tecnología en nuestras vidas, el arte la ha incorporado a sus discursos. Los movimientos que Pollock dejaba registrados con pintura en la tela, serán ahora sustituidos por pixeles en un lienzo digital. Programas informáticos dibujan los movimientos realizados con el ratón de ordenador. Una maraña de hilos y puntos en todas direcciones quedan plasmados en el soporte digital a modo de pintura. El robot llamado Sleep Arte, pinta los movimientos del cuerpo mientras dormimos. El resultado, un curioso cuadro que dependerá del sueño de cada persona. Un proyecto llamado ARS MOBILIS presentado en la Feria Tecnológica de Buenos Aires captura y explora los movimientos del cuerpo como una expresión artística. Este proyecto permite pintar en un lienzo digital con el movimiento de las manos en el aire. http://www.lanacion.com.ar/1577482-en-buenos-aires-una-vincha-para-controlar-la-pc-con-la-mente-y-mucho-mas Aunque tactilidad de la pintura es sustituida por pixeles y el lienzo de tela por un lienzo digital, el movimiento del cuerpo continua vinculado al proceso y a los resultados de la imagen.Feijoo Cid, M. (2015). CUERPO Y PINTURA. RELACIONES DIGITALES. En II CONGRESO INTERNACIONAL DE INVESTIGACIÓN EN ARTE VISUALES. Editorial Universitat Politècnica de València. 257-264. https://doi.org/10.4995/ANIAV2015.1121OCS25726

Sylvatic rabies and the perception of vampire bat activity in communities in the Ecuadorian Amazon

An outbreak of sylvatic rabies was reported in indigenous communities located in the Ecuadorian Amazon in November 2011. The objective of this study was to analyze family dwelling characteristics and other sociodemographic factors associated with the perception of an increase in hematophagous bat bites in humans and domestic animals to assist the implementation of intervention policies in the region. A total of 381 households from communities covered by the outbreak response activities were surveyed. Despite being associated with poorer dwelling conditions, the possession of domestic animals is associated with the perception of an increase in bat bites among animals. Better dwelling conditions, use of protective measures, access to electricity, and no domestic animals are variables associated with the perception of a rise in attacks on humans. The analysis of perceptions of bite frequency is fundamental to improve the effectiveness of vaccination programs and strategies to promote the adoption of preventive measures against rabies among the populationEn Ecuador se reportó un brote de rabia selvática en comunidades indígenas amazónicas en noviembre de 2011. El objetivo del trabajo fue analizar las características de las viviendas de las familias, añadiendo aspectos sociodemográficos asociados a la percepción del aumento de mordeduras de murciélagos hematófagos en humanos y en ganado, con el fin de implementar políticas de intervención en la zona. Fueron encuestados 381 jefes de familia de las comunidades incluidas en el programa de primera intervención de vacunación. La posesión de ganado conduce a un aumento en la percepción de las mordeduras de murciélago en los animales y estas personas tienen casas con las peores condiciones de vivienda, donde pueden entrar y habitar murciélagos, mientras que las familias que tienen mejores condiciones de vivienda, con protección, electricidad y sin ganado perciben un aumento en los ataques a humanos. El análisis de la percepción de frecuencia de mordeduras es fundamental para lograr una adhesión a las medidas de prevención y vacunació

Nursing students' care of and attitudes towards lesbian, gay, bisexual, trans, and intersex people in times of COVID-19 in Spain: A cross-sectional study

Objective. The objective of this work is to measure the knowledge and attitudes of Catalan nursing students regarding lesbian, gay, bisexual, trans, and intersex (LGBTI) patients, as well as their perception of specific training in this area, according to their internship modalities, sociodemographic circumstances, and academic background during the COVID-19 pandemic. Background. During the COVID-19 pandemic, the Spanish Government created the “Health-Aid” internship: A paid alternative to curricular internships. There is extensive evidence that paid work environments perpetuate negative attitudes towards LGBTI patients. Method. A cross-sectional survey aimed at Catalan nursing students. The “Attitudes Towards and Knowledge About Lesbian, Gay, Bisexual, Trans and Intersex Patients” questionnaire was adapted. A descriptive study and backward regression models were constructed. Results. Three hundred thirty-seven students, mean age 23.80 years (SD: 5.17) participated; 85% women and 54 (16%) completing the Health Aid internship modality. More than 50% did not attend specific training on the care of the lesbian, gay, bisexual, trans, and intersex population. Differences between internship modalities showed higher values in the curricular internship group: Attitudes (U = 6526.50, p = .031) and training perception (U = 5926.50, p = .008). Conclusions. Nursing students' attitudes towards lesbian, gay, bisexual, trans, and intersex patients and their perception of specific training on care for this population were negatively influenced by the paid Health Aid internship during the pandemic. Implications for Nursing Management. Even under dire circumstances, clinical training must be properly managed to address the specific health needs of vulnerable populations, such as lesbian, gay, bisexual, trans, and intersex patients. Paid internships in emergency scenarios may impede these objectives

Transformative learning experience among nursing students with patients acting as teachers: Mixed methods, non-randomized, single-arm study

Expert patient; Nursing education; People living with HIVPaciente experto; Educación en enfermería; Personas que viven con el VIHPacient expert; Educació en infermeria; Persones que viuen amb el VIHAim To examine the effects of expert HIV patients acting as teachers to Spanish nursing students both on their HIV-related knowledge, attitudes and practices and on their approach to the care model as well as to explore their learning experience. Design Non-randomized, single-arm study with quantitative before and after measurements and qualitative data. Methods The intervention consisted of five 90-min workshops led by two women living with HIV. Thirty-four nursing students participated, and quantitative and qualitative data were gathered from February to June 2018. We used the Patient-Practitioner Orientation Scale (PPOS) and the KAP questionnaire on HIV/AIDS to collect quantitative data. Results Statistically significant differences were found in the global score for care orientation and its two dimensions, caring and sharing. About the changes resulting from the workshops, the quantitative results—more patient-centred care perception and better attitudes towards people living with HIV—match the qualitative findings in all the aspects studied, except in sharing. Conclusion Incorporating expert patients as teachers in the nursing bachelor's degree resulted in more patient-centred care and improved knowledge, attitudes and practices. The workshops conducted by qualified expert patients showed transformative learning power, as the participants improved professional and personal aspects.This study was supported by a Community Grant ‘Cuidados de, por y para las personas que viven con VIH. personas que viven con VIH como docentes en la formación de estudiantes de enfermería’ from Gilead Sciences, S.L., Spain, in 2017 Community Grants & Donations Program

Intercultural communication between long-stay immigrants and Catalan Primary Care Nurses : a qualitative approach to rebalancing power

There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz's approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication

Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy : A qualitative study

Acord transformatiu CRUE-CSICAims and Objectives: To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. Background: Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. Design: We conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. Methods: We carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. Results: We identified an overarching theme, 'factors that influenced participants' decision to be vaccinated or not', which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants' decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. Conclusions: The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. Relevance to clinical practice: Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse-midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns

Influenza and Pertussis Maternal Vaccination Coverage and Influencing Factors in Spain : a Study Based on Primary Care Records Registry

The purpose was to determine the coverage of maternal vaccination against influenza and pertussis, and the characteristics associated with being vaccinated, in a health area of Catalonia, Spain. Some 36,032 anonymized and computerized clinical records registries of pregnant women from Primary Care Centres (e-CAP database) were analysed, from between 2015 and 2018. Vaccination coverage and the association with sociodemographic variables and clinical conditions were estimated using a Poisson regression model. Maternal vaccination coverage against influenza ranged between 11.9% in 2015 and 6.8% in 2018, following a decreasing trend (p < 0.001). Coverage with the tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine varied between 49.8% in 2016 and 79.4% in 2018, following an increasing trend (p < 0.001). Having living children and suffering from obesity were factors associated with not being vaccinated against both infections. The predictive variables of vaccination against influenza were diabetes (IRR: 2.17, 95% CI: 1.42-3.30) and asthma (IRR: 2.05, 95% CI: 1.76-2.38); and for pertussis, it was asthma (IRR: 1.10, 95% CI: 1.03-1.17). Different socio-demographic factors and chronic conditions in pregnant women were associated with maternal vaccination, and which will have to be taken into account in clinical practice when implementing strategies to improve the coverage of the programme

Gender differences in the decision-making process for undergoing total knee replacement

Acord transformatiu CRUE-CSICThis project was supported by Instituto de Salud Carlos III, Ministry of Health, Spain (grant number PI15/01264).Objective: To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA). Methods: A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors. Results: Women showed less knowledge (MD = −7.68, 95% CI: −13.9, −1.46, p = 0.016), reported less satisfaction (MD = −6.95, 95% CI: −11.7, −2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016). Conclusion: The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed. Practice implications: A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases

Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru : a cross-sectional study

Altres ajuts: This study was partially funded by a research Grant from the Fundació Autònoma Solidària (Resolució Convocatòria FSXXXIII-Peru); and the Oficina de Investigación y Creatividad Intelectual from the Universidad María Auxiliadora (OICI-001-2017).There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America