Factores asociados con la intensidad del dolor en pacientes mexicanos hospitalizados en periodo postoperatorio

ABSTRACT Objective: To determine the association between the pain intensity (assessment) reported by the hospitalized postoperative mexican patients with some features of patient and nursing staff. Material and methods: The study design was descriptive and correlational. The sample consisted of 231 patients selected through a systematic sampling of one in two with random start, 31 nurses representing the total of nurses who work in the departments of general surgery, orthopedics and gynecology were included. For data collection the patient data certificate, nurse identification card, pain intensity (assessment) questionnaire to postoperative patient and pain awareness survey for nursing were used. Results: A high proportion of patients had moderate to severe pain during the first 24 postoperative hours, 69.6 % of participants had severe pain. No association between pain intensity (assessment) with age and education of the patient, or the knowledge of nurses about pain management were found. Significant difference was found in pain intensity about sex, pain experienced at maximum (U = 3997.50, p = 0.001) and average pain over 24 hours (U = 4852, p = 0.03).The more intensity (assessment) of pain was located in the female. The average of nursing staff knowledge regarding pain management stood at 54.40 (SD = 13.12). The average intensity (assessment) of pain experienced by the patient in the first 24 hours was associated with the number of patients assigned to nurses (rs = 0.167, p = 0.01). Conclusions: Pain management in postoperative period is inappropriate and remains a challenge to national and international trend to have pain-free hospitals. It is recommended as a measure to contribute to pain relief, consider the appropriate pharmacological management to the demands of the patient, the use of non-pharmacological measures, assessment of pain intensity and its effects regularly and education that the patient is provided. Key words: Postoperative pain, pain management, pain assessment, hospitalization, nursing staff. RESUMEN Objetivo: Determinar la asociación entre la intensidad del dolor reportado por pacientes mexicanos hospitalizados en periodo postoperatorio con algunas características del paciente, así como del personal de enfermería. Material y métodos: El diseño del estudio fue de tipo descriptivo correlacional. La muestra fue de 231 pacientes seleccionados a través de un muestreo sistemático de uno en dos con inicio aleatorio. Se incluyeron 31 enfermeras que representan el total del personal de enfermería que trabajan en los departamentos de cirugía general, traumatología y ginecología. Para la recolección de la información se utilizó la cédula de datos del paciente, cédula de identificación de la enfermera, cuestionario de intensidad del dolor en el paciente postoperatorio y la encuesta de conocimiento del dolor por enfermería. Resultados: Una alta proporción de pacientes presentó dolor moderado a severo durante las primeras 24 horas postoperatorias. El 69,6 % de los participantes presentó dolor severo. No se encontró asociación entre la intensidad del dolor con la edad y escolaridad del paciente, ni con el conocimiento del personal de enfermería sobre el manejo del dolor. Se encontró diferencia significativa en la intensidad del dolor respecto al sexo, en el máximo dolor experimentado (U = 3997,50, p = 0,001) y en el dolor promedio en 24 horas (U = 4852, p = 0,03). La mayor intensidad del dolor se ubicó en el sexo femenino. La media de conocimiento del personal de enfermería en relación con el manejo del dolor se ubicó en 54,40 (DE = 13,12). La intensidad del dolor promedio que ha experimentado el paciente en las primeras 24 horas se asoció con el número de pacientes asignados al personal de enfermería (rs = 0,167, p = 0,01). Conclusiones: El manejo del dolor en periodo postoperatorio es inadecuado y sigue siendo un reto a la tendencia nacional e internacional de contar con hospitales libres de dolor. Se recomienda, como medida para contribuir al alivio del dolor, considerar el manejo farmacológico adecuado a las demandas del paciente, el uso de medidas no farmacológicas, la valoración de la intensidad del dolor y sus efectos de manera regular y la educación que se proporciona al paciente. Palabras clave: Dolor postoperatorio, manejo del dolor, intensidad del dolor, hospitalización, personal de enfermerí

The acquisition of professional skills through service-learning the development of professional skills in the students of the Degree in Early Childhood Education

This experience raises the potential of Service-Learning as a methodology that favors the development of professional skills in the students of the Degree in Early Childhood Education at SAFA University Center (dependent on the University of Jaen). ICT materials and resources have been developed following Universal Design for Learning which promotes an inclusive education making the curriculum accessible to all. The objectives refer to the understanding of inclusive education in real contexts, the search, selection and development of ICT resources and materials following the UDL perspective, as well as promoting reflection on the role of TEPs to promote inclusive education in preschool classrooms. ApS practices have allowed us to get in touch with the real educational context to be able to adjust the materials and resources to students needs. The e-portfolio has allowed us to evaluate the learning of prospect teachers involved. In conclusion, it is shown that the SL methodology favors inclusive education using ICT resources to break down barriers and offer the opportunity to learn to all students.Esta experiencia plantea la potencialidad del Aprendizaje Servicio como metodología que favorece el desarrollo de competencias profesionales en el alumnado del Grado en Educación Infantil del Centro Universitario SAFA (adscrito a la Universidad de Jaén). Se han elaborado materiales y recursos TIC basándose en el planteamiento del Diseño Universal de Aprendizaje que han posibilitado llevar a cabo una educación inclusiva con niños y niñas de infantil haciendo accesible el currículo a todos y todas. Los objetivos que se plantean hacen referencia a la comprensión de la educación inclusiva en contextos reales, la búsqueda, selección y elaboración de recursos y materiales TIC desde la perspectiva del DUA así como potenciar la reflexión sobre el papel de las TEP para potenciar la educación inclusiva en las aulas de infantil. Las prácticas de ApS han permitido conocer el contexto real para poder ajustar los materiales y recursos a las necesidades del alumnado. El e-portafolio nos ha permitido evaluar los aprendizajes de los estudiantes de Magisterio implicados. En conclusión, se pone de manifiesto que la metodología de ApS favorece la educación inclusiva utilizando los recursos TIC para romper las barreras y ofrecer la oportunidad de aprender a todo el alumnado

Descriptive study of stress and satisfaction at work in the Saragossa university services and administration staff

<p>Abstract</p> <p>Background</p> <p>The notion of stress in connection with the work environment became an important topic during the 1970's, when the first studies on the subject were published and the term of work stress was first coined. In 1974, Freudenberger proposed the term <it>burnout </it>to refer to the condition of physical and emotional exhaustion, as well as the associated negative attitudes, resulting from the intense interaction in working with people. The aim of our study is to examine burnout and job satisfaction in Saragossa University Services and Administration Staff (SAS) and detect the main factors which could contribute to too much stress, because job stress has emerged as a major psychosocial influence on mental health, associated with burnout.</p> <p>Methods</p> <p>24 people from the Services and Administration Staff in the University of Saragossa participated in the study. The research was carried out during the implementation of a module on Stress Management organised by the University of Saragossa and commissioned to the Unit for Research in Physical Therapy (University School of Health Sciences) from that University. This research is an exploratory research to improve the stress management program. A personal interview was carried out and additionally, participants were given the Maslach Burnout Inventory and the Scale of Satisfaction at Work of Warr, Cook & Wall.</p> <p>Results</p> <p>However using small sample this is worth to state that participants present most of them low burnout levels in the burnout scale. Only in one person high exhaustion level was reflected, even though other seven showed mean levels; in the professional self-esteem section, most of them showed high self-esteem, with two cases of low self-esteem and five with mean level.</p> <p>With regard to satisfaction people participating in the study show mean levels in intrinsic as much as in extrinsic factors and general satisfaction.</p> <p>Conclusions</p> <p>Services and Administration Staff from the University of Saragossa shows low burnout levels linked with high professional self-esteem and low emotional exhaustion and depersonalization.</p> <p>It has been found also medium levels in work satisfaction probably related with the continuous quality improvement efforts in the academics environment to create protective factors in decreasing levels of job stress.</p> <p>These results show that not only personality or temperament have an influence on burnout and stress, also the job conditions are related with these diseases. These aspects should be taken into account in the design of stress prevention programme at work.</p

Leptin induces cell migration and invasion in a FAK-Src- dependent manner in breast cancer cells

Breast cancer is the most common invasive neoplasia, and the second leading cause of the cancer deaths in women worldwide. Mammary tumorigenesis is severely linked to obesity, one potential connection is leptin. Leptin is a hormone secreted by adipocytes, which contributes to the progression of breast cancer. Cell migration, metalloproteases secretion, and invasion are cellular processes associated with various stages of metastasis. These processes are regulated by the kinases FAK and Src. In this study, we utilized the breast cancer cell lines MCF7 and MDA-MB-231 to determine the effect of leptin on FAK and Src kinases activation, cell migration, metalloprotease secretion, and invasion. We found that leptin activates FAK and Src, and induces the localization of FAK to the focal adhesions. Interestingly, leptin promotes the activation of FAK through a Src and STAT3-dependent canonical pathway. Specific inhibitors of FAK, Src and STAT3 showed that the effect exerted by leptin in cell migration in breast cancer cells is dependent on these proteins. Moreover, we established that leptin promotes the secretion of the extracellular matrix remodelers, MMP-2 and MMP-9 and invasion in a FAK and Src dependent manner. Our findings strongly suggest that leptin promotes the development of a more aggressive invasive phenotype in mammary cancer cells

Factores que influyen en la actitud de los hombres ante la detección precoz del cáncer genital

Objective: describe the factors that contributes men behaviors due to the genital cancer test. Method: Scientific literature systematic review on PubMed, Scincedirect, Ebscohost, Scopus database and web sites, in which English, Portuguese and Spanish documents were included published between October 5th of 2006 and October 25th of 2016. Results: the incidence and prevalence of genital cancer in men is increasing; also, the behavior of men towards health and test of early detection is apathetic, results of the influence of social factors, role norms and masculinity and the attention processes. Conclusions: men actitud regard to early detection of cancer depends on social aspects and specific role norms; it is recommended to investigate, redirect the prevention of behavior associated with masculinity to improve men health.Objetivo: describir los factores que influyen en las conductas de los hombres ante las pruebas de detección precoz del cáncer genital. Método: revisión sistemática de literatura científica, en bases de datos PubMed, ScinceDirect, Ebscohost, Scopus; y sitios web, incluyo documentos en inglés, español y portugués, publicados del 10 de octubre de 2012. Resultados: La incidencia y prevalencia del cáncer genital en los hombres aumenta, además el comportamiento de los hombres hacia la salud y pruebas de detección precoz es de apatía, resultado de la influencia de factores sociales, normas de rol y masculinidad, así como de los procesos de la atención. Conclusiones: Las actitudes de los hombres para la detección precoz del cáncer, depende de aspectos sociales, las normas de rol específicas del contexto; se recomienda investigar y redirigir la prevención, a conductas asociadas a la masculinidad para mejorar la salud de los hombres

Optimal Timing for Cardiac Surgery in Infective Endocarditis with Neurological Complications: A Narrative Review

In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological complication. An English literature search was carried out from June 2018 through July 2022. The resulting selection, comprising observational studies, clinical trials, systematic reviews and society guidelines, was organized into four sections according to the four groups of neurological complications: ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac surgery could be performed without delay in cases of ischemic vascular neurological complication (provided the absence of severe damage, which can be avoided with the performance of mechanical thrombectomy in cases of major stroke), as well as infectious or asymptomatic complications. In the presence of intracranial hemorrhage, a delay of four weeks is recommended for most cases, although recent studies have suggested that performing cardiac surgery within four weeks could be a suitable option for selected cases. The findings of this review are mostly in line with the recommendations of the current European and American infective endocarditis guidelines

Immunological predictors of CD4+ T cell decline in antiretroviral treatment interruptions

<p>Abstract</p> <p>Background</p> <p>The common response to stopping anti-HIV treatment is an increase of HIV-RNA load and decrease in CD4⁺, but not all the patients have similar responses to this therapeutic strategy. The aim was to identify predictive markers of CD4⁺cell count declines to < 350/μL in CD4-guided antiretroviral treatment interruptions.</p> <p>Methods</p> <p>27 HIV-infected patients participated in a prospective multicenter study in with a 24 month follow-up. Patients on stable highly active antiretroviral therapy (HAART), with CD4⁺count > 600/μL, and HIV-RNA < 50 copies/ml for at least 6 months were offered the option to discontinue antiretroviral therapy. The main outcome was a decline in CD4⁺cell count to < 350/μL.</p> <p>Results</p> <p>After 24 months of follow-up, 16 of 27 (59%) patients (who discontinued therapy) experienced declines in CD4⁺cell count to < 350/μL. Patients with a CD4⁺nadir of < 200 cells/μL had a greater risk of restarting therapy during the follow-up (RR (CI95%): 3.37 (1.07; 10.36)). Interestingly, lymphoproliferative responses to <it>Mycobacterium tuberculosis </it>purified protein derivative (PPD) below 10000 c.p.m. at baseline (4.77 (1.07; 21.12)), IL-4 production above 100 pg/mL at baseline (5.95 (1.76; 20.07)) in PBMC cultured with PPD, and increased IL-4 production of PBMC with p24 antigen at baseline (1.25 (1.01; 1.55)) were associated to declines in CD4⁺cell count to < 350/μL.</p> <p>Conclusion</p> <p>Both the number (CD4⁺nadir) and the functional activity of CD4⁺(lymphoproliferative response to PPD) predict the CD4⁺decrease associated with discontinuation of ART in patients with controlled viremia.</p

Introducción : marco conceptual, metodología y guía de lectura

En aquest capítol introductori presentem l'estructura de la recerca que ha donat origen al Llibre Blanc de la Mediació a Catalunya. Es tracta de situar el lector en les coordenades correctes per a la com-prensió dels conceptes i la metodologia utilitzats en el Llibre Blanc, i quin és el sentit dels resultats obtinguts. Aquesta Introducció delimita l'objecte de recerca, distingeix entre sistema de mediació i mediació, deꀀneix els indicadors utilitzats en la investigació empírica, ofereix una guia metodològica de lectura i descriu breument el contingut, disposició i estructura dels capítols

Immune-Complex Mimics as a Molecular Platform for Adjuvant-Free Vaccine Delivery

Protein-based vaccine development faces the difficult challenge of finding robust yet non-toxic adjuvants suitable for humans. Here, using a molecular engineering approach, we have developed a molecular platform for generating self-adjuvanting immunogens that do not depend on exogenous adjuvants for induction of immune responses. These are based on the concept of Immune Complex Mimics (ICM), structures that are formed between an oligomeric antigen and a monoclonal antibody (mAb) to that antigen. In this way, the roles of antigens and antibodies within the structure of immune complexes are reversed, so that a single monoclonal antibody, rather than polyclonal sera or expensive mAb cocktails can be used. We tested this approach in the context of Mycobacterium tuberculosis (MTB) infection by linking the highly immunogenic and potentially protective Ag85B with the oligomeric Acr (alpha crystallin, HspX) antigen. When combined with an anti-Acr monoclonal antibody, the fusion protein formed ICM which bound to C1q component of the complement system and were readily taken up by antigen-presenting cells in vitro. ICM induced a strong Th1/Th2 mixed type antibody response, which was comparable to cholera toxin adjuvanted antigen, but only moderate levels of T cell proliferation and IFN-γ secretion. Unfortunately, the systemic administration of ICM did not confer statistically significant protection against intranasal MTB challenge, although a small BCG-boosting effect was observed. We conclude that ICM are capable of inducing strong humoral responses to incorporated antigens and may be a suitable vaccination approach for pathogens other than MTB, where antibody-based immunity may play a more protective role

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe