Estudio de mecanismos de tolerancia, persistencia y resistencia en patógenos nosocomiales: Búsqueda de nuevas dianas terapéuticas

Programa Oficial de Doctorado en Ciencias de la Salud. 5007V01[Resumen] Una de las mayores amenazas para la salud pública es el incremento de bacterias resistentes a los antimicrobianos. Dicho incremento se debe a múltiples factores, entre los que comienzan a destacar la existencia de poblaciones bacterianas tolerantes y/o persistentes a las condiciones de estrés, incluyendo el tratamiento antimicrobiano. A lo largo de la presente tesis doctoral se han analizado diversos mecanismos moleculares de persistencia y/o tolerancia bacteriana, destacando la red del quorum (sensing/quenching) y los sistemas toxina-antitoxina (TA) en aislamientos ambientales y clínicos. En relación con la red del quorum, llevamos a cabo estudios genómicos y de expresión ante condiciones de estrés en la cepa aislada de ambiente hospitalario aéreo Acinetobacter sp. 5-2AC02 (cercano a la especie A. towneri) destacando el cluster del metabolismo de la acetoína y caracterizando el regulador negativo, AcoN. Posteriormente, estudiamos la importancia de dicha red del quorum en el desarrollo de bacteriemia secundaria a neumonía en aislamientos clínicos de Acinetobacter baumannii. Finalmente, se realizaron estudios de caracterización funcional y análisis bacteriano de los sistemas toxina-antitoxina (TA) (como el módulo AbkB/AbkA y otros) en aislamientos de A. baumannii y Escherichia coli.[Resumo] Unha das maiores ameazas para a saúde pública é o incremento de bacterias resistentes aos antimicrobianos. Devandito incremento débese a múltiples factores, entre os que comezan a destacar a existencia de poboacións bacterianas tolerantes e/ou persistentes ás condicións de estrés, incluíndo o tratamento antimicrobiano. Ao longo da presente tese doutoral analizáronse diversos mecanismos moleculares de persistencia e/ou tolerancia bacteriana, destacando a rede do quorum (sensing/quenching) e os sistemas toxina-antitoxina (TA) en illamentos ambientais e clínicos. En relación coa rede do Quorum, levamos a cabo estudos xenómicos e de expresión ante condicións de estrés na cepa illada de ambiente hospitalario aéreo Acinetobacter sp. 5-2AC02 (próximo á especie A. towneri) destacando o clúster do metabolismo da acetoína e caracterizando o regulador negativo, AcoN. Posteriormente, estudamos a importancia da devandita rede do quorum no desenvolvemento de bacteriemia secundaria a pneumonía en illamentos clínicos de Acinetobacter baumannii. Finalmente, realizáronse estudos de caracterización funcional e análise bacteriano dos sistemas toxina-antitoxina (TA) (como o módulo AbkB/AbkA e outros) en illamentos de A. baumannii e Escherichia coli.[Abstract] One of the greatest current threats to public health is the rapid increase in the emergence of antibiotic resistant strains of bacteria. This increase is due to multiple factors, including the development of tolerant and/or persistent populations under stress conditions (e.g. antimicrobial treatment). The present thesis reports research investigating several molecular mechanisms of bacterial persistence and/or tolerance, particularly the quorum network (sensing/quenching) and toxin-antitoxin systems (TA), in both clinical and environmental isolates. In relation to the quorum network, we carried out genomic and expression studies with an airborne strain isolated from a hospital environment, Acinetobacter sp. 5- 2AC02 (closely related to A. towneri), and subjected to different stress conditions. We identified the acetoin metabolism cluster and characterized the negative regulator, AcoN protein. We then investigated the importance of the quorum network in clinical isolates of Acinetobacter baumannii in the development of secondary bacteraemia following pneumonia. Finally, we carried out functional characterization studies and examined toxinantitoxin (TA) systems (such as AbkB/AbkA among others) in strains of A. baumannii and Escherichia coli

Quasi liber et pictura: estudio Codicológico del MS. T-I-1 DE LA RBME

Depto. de Historia del ArteFac. de Geografía e HistoriaTRUEpu

Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients

Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night’s rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients’ hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients’ neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients’ neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.Regional Ministry of Health of Andalusia (PI-0259-2017

Cultivating learning in vitro: a meta-ethnography of learning experiences of nursing students regarding high-fidelity simulation

Review[Abstract] Objectives: To synthesise the experience of nursing students in their final years regarding high-fidelity simulation in acute and critical care. Background: For the complex and changing healthcare environment, new tools are required to help health students, educational staff and managers to design and present rewarding educational simulations. Due to the complexity and limited learning opportunities in real settings, high-fidelity simulation enables students to acquire skills for the provision of acute and critical care in a controlled environment that closely imitates reality; however, the literature on students' learning experiences with this education methodology is still limited. Design: This study followed Noblit and Hare's interpretive meta-ethnography, which was written and reviewed for reporting clarity against the EQUATOR checklist using the eMERGe. Data sources: A comprehensive systematic search strategy was carried out in five databases: PubMed, Scopus, CINAHL, Web of Science and PsycINFO. Review methods: Ten studies met the research objective and inclusion criteria. Results: The metaphor 'Cultivating learning in vitro' and four themes were developed to describe the learning experiences of nursing students regarding high-fidelity simulation in acute and critical care. The themes were as follows: Learning roots-Ways to learn during high-fidelity simulation; Learning stimulants-Elements that favour learning; Learning impairments-Elements that hinder learning; and Learning flourishing-Results after high-fidelity simulation. Conclusions: Seeing, doing and reflecting constituted the main sources of learning. Students identified the stimulating and debilitating aspects of learning which could help in the design of simulation sessions and promote their incorporation into nursing curricula. Finally, 'the flowering of the plant' represents the learning outcomes developed in a controlled and safe environment. Relevance to clinical practice: The results of this meta-ethnography provide keys to promote change in teaching planning in relation to acute and critical care

Patrones de aprendizaje en estudiantes universitarios del Máster en Educación Secundaria : variables personales y contextuales relacionadas

En este trabajo analizamos los patrones de aprendizaje (Vermunt, 1998; 2005) en una muestra de estudiantes universitarios del Máster en Formación del Profesorado de Educación Secundaria, y la relación que tienen con ciertas variables personales, contextuales y el rendimiento académico. Participan 101 estudiantes de Formación del Profesorado de una universidad española con una edad media de 27.57, de los cuales 71.30% son mujeres. Los resultados indican que no se reproducen, fielmente, los patrones propuestos por Vermunt, aunque si se aprecia una mayor semejanza con los resultados que otros trabajos han hallado empleando el ILS con muestras de estudiantes de Educación Secundaria. Igualmente, hallamos relaciones significativas entre el género femenino y mayores puntuaciones en creencias y orientaciones de aprendizaje y entre la edad con mayores puntuaciones en los indicadores del patrón reproductivo y la orientación a calificaciones y certificados. Además, hallamos que los estudiantes de orientación educativa tienen menor puntuación en el patrón reproductivo que los estudiantes de ciencias naturales. Estos resultados se discuten en el marco de la formación universitaria del profesorado de Educación Secundaria en una universidad española.In this study we analysis patterns of learning (Vermunt, 1998; 2005) in a sample of Master Teaching Education program, and its relationships with personal and contextual variables, and the academic performance. Participants were 101 teacher education students from a Spanish university with an average ages of 27.57, of which 71.30% were women. The results show that patterns of learning do not reproduce according to Vermunt, though these if it shows to be a certain similarity with the obtained ones in other studies with secondary students. Likewise, we found significance relationships between female and higher scores in beliefs and learning orientations, and between age with higher score in a reproductive pattern and certificate orientation. Moreover, we found that education counseling students have lower score in a reproduction pattern than natural sciences students. These results are discussed in the field of teacher education program in a Spanish university

Violencia de género

Traballo fin de grao (UDC.DER). Dereito. Curso 2017/201

Active Ageing : case-management guidelines for social intervention

En el artículo se analizan las tendencias demográficas del envejecimiento de la población española, las necesidades sociales derivadas de las mismas y los recursos sociales disponibles para atenderlas, teniendo en cuenta la teoría del envejecimiento activo. Según los datos, el 17% de la población total es mayor de 65 años, y el 5% tiene más de ochenta. La independencia, autonomía, seguridad, pertenencia, competencia y relación social se consideran las principales necesidades de las personas mayores, ante las cuales los trabajadores sociales deberán enfocar su intervención desde la prevención del deterioro físico, psíquico y social; movilizando recursos sociales capaces de garantizar el mantenimiento de la independencia y el rol activo de los mayores. Uno de los modelos de intervención que mejor se adapta a estos objetivos es el de gestión de casos, porque permite poner a disposición de los usuarios la utilización del catálogo de prestaciones básicas de Servicios Sociales de Atención Primaria y ofrecer asesoramiento sobre otros recursos como los programas de aprendizaje a lo largo de la vida, cuya combinación permite completar la gestión de recursos desde una perspectiva existencialista y fenomenológica positiva y activa, orientando los proyectos vitales de los usuarios hacia un envejecimiento exitoso. Los beneficios que se obtienen con esta combinación son principalmente un aumento de la satisfacción vital, motivación, autoestima, estado de ánimo y percepción de la salud; y en definitiva, una mejora de la calidad de vida, lo que puede ayudar a prevenir y retrasar la dependencia, con el consiguiente ahorro para la Administración.This article provides an analysis of global trends in the ageing of the Spanish population that are based on demographic characteristics as well as social needs and social resources from the perspective of active aging. In Spain, the 22% of the population is aged 65 and over whereas 5% is aged over 80. Independence, autonomy, security, belonging, competence and social relationships are considered the principle requirements for the elderly. Social Work needs to concentrate on these necessities in order to prevent physical, psychological and social deterioration as well as to stimulate active aging. One of the most successful strategies that social workers should be promoting is the focus on social resources in order to achieve the above-mentioned objective using the “Case Management” model. The present article analyzes the catalogue of the basic benefits of “Primary Social Services” and “Life Learning Programs,” since this combination permits the complete management of facilities and basic equipment, along with counseling for positive and active life, using phenomenological and existentialist models. The vital projects are focused towards meeting the needs and promoting the personal empowerment of users. The results suggest that maintaining autonomy and activity with social resources increases life satisfaction, motivation, self-esteem, a better mood as well as a higher perception of health. Finally, all these factors contribute towards improving the quality of life of our elderly, delay dependence and thus offer budgetary savings for the Administration