Strengthening health systems through nursing: Evidence from 14 European countries. Spain.

CAPÍTULO 12 Spain‘Who is a nurse?’ and ‘What is nursing?’ seem to be simple questions yet the answers are strangely elusive. This book explores the variations in structure and organization of the nursing workforce across fourteen different countries in Europe. This diversity, and the reasons for it, are of more than academic interest. The work of nurses has always had a critical impact on patient outcomes. As health systems shift radically in response to rising demand, the role of nurses becomes even more important. The lessons learned from comparative case-study analysis demonstrate wide variation in every dimension of the workforce. It examines what a nurse is; nurse-to-doctor and nurse-to-population ratios; the education, regulation and issuing of credentials to nurses; and the planning of the workforce. While comparative analysis across countries brings these differences into sharp relief, it also reveals how the EU functions as an important ‘binding agent’, drawing these diverse elements together into a more coherent whole. This book is part of a two-volume study on the contributions that nurses make to strengthening health systems. This is the first time that the topic of nursing has been dealt with at length within the Observatory Health Policy Series. The aim is to raise the profile of nursing within health policy and draw the attention of decision-makers. Volume 1 is a series of national case studies drawn from Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland. The countries were chosen as the subject of a large EU-funded study of nursing (RN4Cast). Lithuania and Slovenia were added to provide broader geographical and policy reach. Volume 2 will provide thematic analysis of important policy issues such as quality of care, workforce planning, education and training, regulation and migration

Validación de un instrumento para evaluar el componente comunitario de la estrategia de atención integrada a las enfermedades prevalentes de la infancia (AIEPI)

Objective: Validate an instrument to evaluate the community component of the integrated care strategy for prevalent childhood diseases (IMCI).Method: descriptive cross-sectional study, which sought to find the construct validity of the SIAC survey specified to measure community IMCI, through an exploratory factor analysis, which reduces the number of items that explained the constructs; 120 teenage mothers from the city of Cartagena, Colombia participated. The construction validation was carried out through the Exploratory Factor Analysis, with the Main Factors method, the Bartlett sphericity test and the measurement of the sampling adequacy of Kaiser-Meyer-Olkin (KMO coefficient) were performed using the SPSS statistical package. version 22.0.Results: According to the values obtained in domains 1 (basic sanitation), 3 (breastfeeding and complementary feeding), 4 (immunizations), 5 (warning signs), 11 (care of pregnant women) and 13 (AIDS), the main axis factorization method was applied. In domain 7 (accident prevention) the principal component factorization method was performed.Conclusions: the SIAC survey maintained good levels of validity after the change in the 7 domains, it is necessary to evaluate the cut-off points that allow a more sensitive and specific diagnosis of the degree of appropriation and application of the key practices of the IMCI strategy, for part of the caregivers of children under 5 yearsObjetivo: Validar un instrumento para evaluar el componente comunitario, de la estrategia de atención integrada a las enfermedades prevalentes de la infancia (AIEPI). Método: Estudio transversal descriptivo, el cual buscó hallar la validez de constructo de la encuesta SIAC utilizada para medir AIEPI comunitario, mediante un análisis factorial exploratorio, el cual redujo el número de ítems que explicaban los constructos; participaron 120 madres adolescentes de la ciudad de Cartagena, Colombia. La validación de constructo se realizó a través del Análisis Factorial Exploratorio, con el método de Factores Principales, se utilizó la prueba de esfericidad de Bartlett y la medida de la adecuación muestral de Kaiser-Meyer-Olkin (Coeficiente KMO) mediante el paquete estadístico SPSS versión 22.0. Resultados. De acuerdo a los valores obtenidos en los dominios 1 (saneamiento básico), 3 (lactancia materna y alimentación complementaria), 4 (inmunizaciones), 5 (signos de alarma), 11 (cuidado de la mujer gestante) y 13 (SIDA), se procedió a aplicar el método de factorización por ejes principales. En el dominio 7 (prevención de accidentes) se realizó el método de factorización por componentes principales. Conclusiones: La encuesta SIAC mantuvo en los 7 dominios buenos niveles de validez después del cambio, se hace necesario evaluar los puntos de corte que permitan un diagnóstico más sensible y específico del grado de apropiación y aplicación de las practicas clave de la estrategia AIEPI, por parte de los cuidadores de los niños y niñas menores de 5 años.Objetivo: validar um instrumento para avaliar o componente comunitário da estratégia de atendimento integrado para doenças prevalentes na infância (AIDPI). Método: estudo descritivo transversal, que buscou encontrar a validade de construto da pesquisa SIAC especificada para mensurar o IMCI da comunidade, por meio de uma análise fatorial exploratória, que reduz o número de itens que explicam os construtos; Participaram 120 mães adolescentes da cidade de Cartagena, Colômbia. A validação da construção foi realizada através da Análise Fatorial Exploratória, com o método dos Principais Fatores, o teste de esfericidade de Bartlett e a medição da adequação da amostra de Kaiser-Meyer-Olkin (coeficiente KMO), utilizando o pacote estatístico SPSS. versão 22.0. Resultados: De acordo com os valores obtidos nos domínios 1 (saneamento básico), 3 (aleitamento materno e alimentação complementar), 4 (imunizações), 5 (sinais de alerta), 11 (assistência a gestantes) e 13 (AIDS), o principal eixo método de fatoração foi aplicado. No domínio 7 (prevenção de acidentes), foi realizado o método de fatoração do componente principal. Conclusões: a pesquisa do SIAC manteve bons níveis de validade após a mudança nos 7 domínios, é necessário avaliar os pontos de corte que permitem um diagnóstico mais sensível e específico do grau de apropriação e aplicação das principais práticas da AIDPI. estratégia, para parte dos cuidadores de crianças menores de 5 ano

Porous Titanium for Biomedical Applications: Evaluation of the Conventional Powder Metallurgy Frontier and Space-Holder Technique

Titanium and its alloys are reference materials in biomedical applications because of their desirable properties. However, one of the most important concerns in long-term prostheses is bone resorption as a result of the stress-shielding phenomena. Development of porous titanium for implants with a low Young’s modulus has accomplished increasing scientific and technological attention. The aim of this study is to evaluate the viability, industrial implementation and potential technology transfer of different powder-metallurgy techniques to obtain porous titanium with stiffness values similar to that exhibited by cortical bone. Porous samples of commercial pure titanium grade-4 were obtained by following both conventional powder metallurgy (PM) and space-holder technique. The conventional PM frontier (Loose-Sintering) was evaluated. Additionally, the technical feasibility of two different space holders (NH4HCO3 and NaCl) was investigated. The microstructural and mechanical properties were assessed. Furthermore, the mechanical properties of titanium porous structures with porosities of 40% were studied by Finite Element Method (FEM) and compared with the experimental results. Some important findings are: (i) the optimal parameters for processing routes used to obtain low Young’s modulus values, retaining suitable mechanical strength; (ii) better mechanical response was obtained by using NH4HCO3 as space holder; and (iii) Ti matrix hardening when the interconnected porosity was 36–45% of total porosity. Finally, the advantages and limitations of the PM techniques employed, towards an industrial implementation, were discussed.Ministry of Economy and Competitiveness of Spain Grant MAT2015-71284-PJunta de Andalucía Grant P12-TEP-1401Comisión Nacional de Investigación, Científica y Tecnológica (CONICYT) of the Chilean government project FONDECYT 1116086

Experiencia de la Evaluación del programa "Atenció a la Gent Gran" en personas mayores de 65 años, frágiles y diagnosticadas de EPOC en el ámbito de la Atención Primaria de Sabadell

España será en el 2050 el país más envejecido del mundo. Este envejecimiento, gradual pero progresivo, de la población comporta a su vez un aumento de las enfermedades crónicas y degenerativas, de comorbilidad, de incapacidad y de dependencia para la realización de las actividades de la vida diaria tanto básicas como instrumentalizadas. De acuerdo con la estructura organizativa de los servicios socio-sanitarios en la mayoría de países, el nivel de atención más cercano al anciano es la Atención Primaria de Salud, por lo que será desde este ámbito desde donde deberán ponerse en marcha las oportunas estrategias que permitan la adecuación de los servicios a las necesidades generadas por el proceso de envejecimiento. Los estudios de evaluación debieran convertirse en la clave para el diseño de diferentes alternativas de prestación y gestión de servicios socio-sanitarios, de manera que sean los propios estudios quienes guíen y antecedan a la evolución de los servicios de manera que éstos puedan hacer frente a los cambios demográficos previstos. El objetivo a conseguir sería pues que el sistema de salud, por otro lado actualmente poco preparado para ello, se adecue a las características de sus clientes, y no a la inversa. Es en esta línea en la que se pretende desarrollar el presente estudio

The Spanish long-term care system in transition: ten years since the 2006 Dependency Act

At the end of 2006, a new System for Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (SAAD) was established in Spain through the approval of the Act 39/2006 of 14th December (the Dependency Act, DA). The DA acknowledged the universal entitlement of Spanish citizens to social services. The recent economic crisis added degrees of uncertainty to several dimensions of the SAAD implementation process. Firstly, the political consensus on which its foundation rested upon has weakened. Secondly, implementation of the SAAD was hampered by several challenges that emerged in the context of the economic crisis. Thirdly, the so-called “dependency limbo” (i.e. the existence of a large number of people eligible for benefits but who do not receive them) has become a structural feature of the system. Finally, contrary to the spirit of the DA, monetary benefits have become the norm rather than a last resort. High heterogeneity across regions regarding the number of beneficiaries covered and services provided reveal the existence of regional inequity in access to long-term care services in the country. Broadly, the current evidence on the state of the SAAD suggests the need to improve the quality of governance, to enhance coordination between health and social systems, to increase the system's transparency, to foster citizens’ participation in decision-making and to implement a systematic monitoring of the system

The Drosophila nuclear factor DREF positively regulates the expression of the mitochondrial transcription termination factor DmTTF

et al.The DREF [DRE (DNA replication-related element)-binding factor], which regulates the transcription of a group of cell proliferation-related genes in Drosophila, also controls the expression of three genes involved in mtDNA (mitochondrial DNA) replication and maintenance. In the present study, by in silico analysis, we have identified DREs in the promoter region of a gene participating in mtDNA transcription, the DmTTF (Drosophila mitochondrial transcription termination factor). Transient transfection assays in Drosophila S2 cells, with mutated versions of DmTTF promoter region, showed that DREs control DmTTF transcription; moreover, gel-shift and Chip (chromatin immunoprecipitation) assays demonstrated that the analysed DRE sites interact with DREF in vitro and in vivo. Accordingly, DREF knock-down in S2 cells by RNAi (RNA interference) induced it considerable decrease in DmTTF mRNA level. These results clearly demonstrate that DREF positively controls DmTTF expression. On the other hand, mtRNApol (mitochondrial RNA polymerase) lacks DREs in its promoter and is not regulated in vivo by DREF. In situ RNA hybridization Studies showed that DmTTF was transcribed almost ubiquitously throughout all stages of Drosophila embryogenesis, whereas mRNApol was efficiently transcribed from stages 11-12. Territories where transcription occurred mostly were the gut and Malpighi tubes for DmTTF, and the gut, mesoderm, pharyngeal muscle and Malpighi tubes for mtRNApol. The partial overlapping in the temporal and spatial mRNA expression patterns confirms that transcription of the two genes is differentially regulated during embryogenesis and suggests that DmTTF might play multiple roles in the mtDNA transcription process, for which different levels of the protein with respect to mtRNApol are required.Peer reviewe

Prebiotic properties of non-fructosylated α-galactooligosaccharides from PEA (Pisum sativum L.) using infant fecal slurries

The interest for naturally-occurring oligosaccharides from plant origin having prebiotic properties is growing, with special focus being paid to supplemented products for infants. Currently, non-fructosylated α-galactooligosaccharides (α-GOS) from peas have peaked interest as a result of their prebiotic activity in adults and their mitigated side-effects on gas production from colonic bacterial fermentation. In this study, commercially available non-fructosylated α-GOS from peas and β-galactooligosaccharides (β-GOS) derived from lactose were fermented using fecal slurries from children aged 11 to 24 months old during 6 and 24 h. The modulatory effect of both GOS on different bacterial groups and bifidobacteria species was assessed; non-fructosylated α-GOS consumption was monitored throughout the fermentation process and the amounts of lactic acid and short-chain fatty acids (SCFA) generated were analyzed. Non-fructosylated α-GOS, composed mainly of manninotriose and verbascotetraose and small amounts of melibiose, were fully metabolized and presented remarkable bifidogenic activity, similar to that obtained with β-GOS. Furthermore, non-fructosylated α-GOS selectively caused an increase on the population of Bifidobacterium longum subsp. longum and Bifidobacterium catenulatum/pseudo-catenulatum. In conclusion, non-fructosylated α-GOS could be used as potential ingredient in infant formula supplemented with prebiotic oligosaccharides.This research was funded by the Spanish Ministry of Economy, Industry and Competitiveness, grant numbers AGL2017-83772-R and AGL2017-84614-C2-1-R (AEI/FEDER,UE); the Spanish Ministry of Science, Innovation and Universities grant number RTI2018-101273-J-I00 (JIN Program) and AGR2011-7626 from Junta de Andalucía

Ferroelectric, Dielectric and Electromechanical Performance of Ba0.92Ca0.08Ti0.95Zr0.05O3 Ceramics with an Enhanced Curie Temperature

Ba0.92Ca0.08Ti0.95Zr0.05O3 (BCZT8-5) ceramic materials have been scarcely studied as lead-free piezo/ferroelectrics despite their enhanced Curie temperature (&gt;100 °C) with respect to most studied BCZT compositions. In this work, homogeneous dense BCZT8-5 ceramics with grain size in the range of 20 μm, and optimum ferroelectric, dielectric, and electromechanical performance, were prepared by the mixed oxides route using moderate synthesis (1250 °C-2 h) and sintering (1400 °C-2 h) conditions. Thickness-poled thin disks and monomodal shear plate resonators were used for the determination of piezoelectric coefficients, coupling factors, elastic, and dielectric permittivity coefficients, including all losses, by iterative analysis of impedance curves at resonance. Furthermore, the thermal evolution of the piezoelectric characteristics at resonance was determined to assess the enhanced working range of the ceramics (≈100 °C). Ferroelectric hysteresis loops and strains vs. electric-field butterfly loops were also measured and showed soft behavior with Ec = 2 kV/cm, Pr = 12 μC/cm2 after a maximum applied field of 3 kV was used. The ceramics showed a high endurance of P-E cycles to electrical fatigue up to 107 cycles. Moreover, dielectric properties as a function of temperature were also accomplished and showed nearly normal ferroelectric behavior, characteristic of samples with low crystallographic disorder. Overall, these ceramics showed high sensitivity and higher stability than other currently studied BCZT compositions.<br/