The mentally ill. History and care since Medieval times

El presente trabajo plasma la evolución de la locura en España, en un contexto histórico, social y cultural. La sucesión de acontecimientos y la interrelación de los sistemas sociales han hecho que "el trato", "el cuidado" y "la atención médica" caminen hacia una mejora en la comprensión de las necesidades del paciente y en la aplicación de nuevas teorías médicas. La labor de enfermería, existente desde el principio de los tiempos, refleja una disciplina ganada con el esfuerzo y la participación de todos aquellos que proporcionaron cuidados a través de los siglos. Por otro lado, la política social en el desempeño de su labor integradora, ha ido adaptando la locura al contexto cultural. En el desarrollo del texto se puede observar cómo "el loco" se ha ido acomodando a las diferentes formas de institucionalización y desinstitucionalización hasta llegar a su situación actual.The present work reflects the evolution of insanity in the Spanish cultural, social and historical context. The sequence of events and the interrelation of social systems have improved "assistance", "care" and "medical attention" towards an understanding of the patient's needs and the application of new medical theories. Nursing role reflects -since the beginning of times- a discipline build by the effort and participation of all those who cared during centuries. On the other hand, social policies in their integrating role have made insanity adapt to cultural contexts. Throughout the article it is shown how the "insane" have adapted to different forms of institutionalization and disinstitutionalization leading to the current situation

A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis

Background: The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. Aim: To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. Method: The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SATSPS), which was comprised of 27 items. The categories assigned to the items were ‘incorrect or not performed’ (0), ‘acceptable’ (1), and ‘correct’ (2). Participants: 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. Results: Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named ‘Nursing process’, ‘Communication skills’, and ‘Safe practice’. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. Conclusions: The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients. This tool has three main components: the nursing process, communication skills, and safety management

Teaching empathy to nursing students: A randomised controlled trial

Background: Empathy has been reported to produce a positive effect on improving patient health outcomes, becoming a fundamental skill in any health personnel-patient relationship. Objective: To evaluate the effectiveness of an intervention designed to improve the nursing students' empathy, the learning perception, the improvement of the perception in the understanding of the content, and in the degree of difficulty as well as the acquisition of skills. Design: Multicentre randomised controlled trial. Setting: This research was conducted at two schools of nursing at a public university in the Southwest of Spain. Participants: 116 nursing students were randomly assigned to an experimental ora control group (delayed intervention group once the post-training analysis was completed) during the second semester of the 2015/ 2016 academic year. Methods: Pre-test, post-test, and follow-up data were obtained for each group using a simulated clinical interview. Empathy was the primary outcome (The Consultation and Relational Empathy Measure, Jefferson Scale of Empathy student version, Reynolds Empathy Scale, and Carkhuff Scale). The students' perceived knowledge, the learning perception, the self-esteem (Rosenberg Self-Esteem Scale) and the understanding of the content and acquisition of skills (ad-hoc questions) were also analysed. Results: The results were improved in ali the measures conducted in the experimental groups at the different centres after the intervention. The mean post-test simulation seores were higher than the pre-test with statistically significan! differences. The results were maintained in the follow-up. The student's perception of learning and the perception of understanding of the content and the acquisition of ski lls were improved as well. Conclusion: The study support that training in empathic competence is effective

Estudio para la mejora de la calidad del Máster en Trabajo Social Comunitario, Gestión y Evaluación de Servicios Sociales en atención a las necesidades del alumnado egresado

Se presenta el informe sobre el desarrollo del proyecto de innovación en calidad llevado a cabo por un equipo interdisciplinar en la Facultad de Trabajo Social. A través de la creación de un cuestionario y un grupo de discusión se analiza la inserción laboral y satisfacción con la titulación de nuestros egresados

DUbbing language-therapy CINEma-based in aphasia post-stroke (DULCINEA): study protocol for a randomized crossover pilot trial

Communication is one of the most important predictors of social reintegration after stroke. Approximately 15–42% of stroke survivors experience post-stroke aphasia. Helping people recover from aphasia is one of the research priorities after a stroke. Our aim is to develop and validate a new therapy integrating dubbing techniques to improve functional communication. Methods: The research project is structured as three work packages (WP). WP1: development of the dubbed language cinema-based therapy: Two research assistants (a speech therapist and a dubbing actor) will select the clips, mute specific words/sentences in progressive speech difficulty, and guide patients to dub them across sessions. Words to be dubbed will be those considered to be functionally meaningful by a representative sample of aphasic patients and relatives through an online survey. WP2: a randomized, crossover, interventional pilot study with the inclusion of 54 patients with post-stroke non-fluent aphasia. Patients will be treated individually in 40-min sessions twice per week for 8 weeks. Primary outcomes will be significant pre/post differences in scores in the Communicative Activity Log (CAL) questionnaire and Boston Diagnostic Aphasia Examination (BDAE) administered by a psychologist blinded to the patients’ clinical characteristics. Secondary outcomes: General Health Questionnaire (GHQ)-12, Stroke Aphasia Quality of Life Scale (SAQOL-39), Western Aphasia Battery Revised (WAB-R), and the Stroke Aphasic Depression Questionnaire (SADQ10). WP3: educational activities and dissemination of results. WP3 includes educational activities to improve public knowledge of aphasia and dissemination of the results, with the participation of the Spanish patients’ association Afasia Activa. Discussion: This pilot clinical trial will explore the efficacy of a new therapeutic tool based on dubbing techniques and computer technology to improve functional communication of patients suffering from post-stroke aphasia with the use of standardized test assessmentThis study is promoted by Blanca Fuentes and the Research Foundation of La Paz University Hospital, which hosts a research consortium joined by the Department of Neurology at La Paz University Hospital, the Department of Psychology at Comillas Pontifical University, and the patients’ association Afasia Activa. This project has received funding from “la Caixa” Banking Foundation under the project code HR18-00026. Funder is not involved in any of the following processes: design of the trial, data collection, analysis, or interpretation of data nor than in writing the manuscrip

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Chloride nutrition at macronutrient levels regulates plant development, water balance and drought resistance of tobacco plants

Chloride (Cl-) is considered to be a strange micronutrient since actual Cl- concentrations in plants is 10-100 times higher than the content required as essential micronutrient, (Marschner, 1995; Brumós et al, 2010), whereas all the other mineral micronutrients (B, Cu, Fe, Mn, Mo, Ni, Zn) are present at much lower concentrations in plant tissues (1-5 orders of magnitude below). Since Cl- uptake and transport is an energetically expensive process (White and Broadley 2001; Brumós et al, 2010), we propose that Cl-, when accumulated to concentrations typical of the content of a macronutrient, plays a poorly understood biological role, not critical under normal growth conditions. Since Cl- appears to be particularly well suited to accomplish osmoregulatory functions, the proposed biological role could be related to the regulation of water balance at both the cell and the whole plant level. There is little experimental evidence in this regard since: i) it is unclear in which extent Cl- is specifically required to fulfil osmoregulatory roles or whether other anions, like nitrate, phosphate, sulphate, and organic acids can replace chloride in such functions; ii) usually the role of Cl- is not adequately differentiated from that of their accompanying cations; iii) the concepts linking Cl- homeostasis with osmotic/turgor regulation have been frequently discussed in the context of halophyte species and in glycophytes under salt stress conditions (Flowers et al, 1988), what have led to some confusion in the context of Cl- nutrition. We intend to establish the role of Cl- in glycophyte plants when accumulated to macronutrient levels, and we will present results showing that under non-saline conditions (1-5 mM external Cl- concentrations) and no water limitation, Cl- specifically promotes the growth of tobacco plants through mechanisms regulating leaf cell elongation and water relations. Furthermore, under water deficit conditions, Cl--treated plants exhibit drought resistance due to the sum of stress avoidance (reduced estomatal water loss) and tolerance (probably due to higher solute accumulation) mechanisms. - Brumós J., Talón M., Bouhlal R.Y.M. & Colmenero-Flores J.M. (2010) Cl- homeostasis in includer and excluder citrus rootstocks: transport mechanisms and identification of candidate genes. Plant Cell Env, 33, 2012-2027. - Marschner H. (1995) Mineral Nutrition of Higher Plants, 2nd ed. (Second Edition ed.). Academic Press, London. - Flowers T.J. (1988) Chloride as a nutrient and as an osmoticum. In: Advances in plant nutrition (ed L.A. Tinker B), pp. 55-78. Praeger, New York.ENVIRONMENT WORKSHOPS 2013 “GENOMIC, PHYSIOLOGICAL AND BREEDING APPROAHES FOR ENHANCING DROUGHT RESISTANCE IN CROPS ” Baeza, Spain, 23–25 September 2013Peer Reviewe

Chloride Nutrition: Novel Functions in Water Relations

4 páginas.-- 3 figuras.-- 11 referencias.-- Póster presentado en el XI Simposio Hispano-Portugués de Relaciones Hídricas en las Plantas, Sevilla 17-20 Sep. (2012)Although Cl- has been characterized as a micronutrient, we have observed that when available in the millimolar range (e.g. 1-5 mM), higher plants accumulate Cl- to levels that are typical of the content of a macronutrient (Plant Cell Env. 2010, 33: 2012-27). Since this requires a considerable cost of energy, we speculate whether Cl- might play a poorly understood function in plants when accumulated to macronutrient levels. Given that Cl- is a major osmotically active solute in the plant vacuole, we propose that this element alter plant water relation mechanisms. Besides promoting plant growth and dry weight, we observed that chloride nutrition in the millimolar range improved water parameters like the relative water content, leaf succulence and water use efficiency. Under conditions of water deficit chloride-treated plants exhibited an improved regulation of the water balance and drought-tolerance. According to the data obtained, we propose that critical factors behind these phenomena are an improved osmotic regulation, a reduced transpiration and developmental alterations.This work was financed by ‘MICINN’ (AGL2009-08339; Spain)Peer Reviewe