Síndrome de Lynch en Tenerife. Implicaciones clínicas, genéticas, diagnósticas, profilácticas y terapéuticas

El síndrome de Lynch es una enfermedad hereditaria que se define por la presencia de tumores de diversa localización, siendo los más frecuentes los colorrectales y endometrio. En el origen de este síndrome se encuentra la mutación en uno de los genes implicados en la reparación del ADN o sistema mismatch repair. Este estudio identifica la población de riesgo, describe su espectro tumoral en relación a la Comunidad Autónoma de Canarias y demostra la mutación causante de dicha enfermedad. Los resultados demuestran una predisposición al desarrollo de tumores colorrectales y de endometrio a una edad temprana en la población con criterios diagnósticos para la enfermedad y la descripción, por primera vez en la literatura, de la asociación con un leiomiosarcoma y de una mutación en el exón 13 del gen MSH2

Measuring Explicit Prejudice and Transphobia in Nursing Students and Professionals

Trans* people frequently report attitudes of prejudice/transphobia in health professionals.Conversely, health professionals indicate the lack of adequate training to care for these peopleand its impact on the quality of care provided. Objective: Our objective was to evaluate theexplicit prejudices/transphobia of health students and professionals and compare them with thegeneral population in Tenerife. Methods: A descriptive cross-sectional study was carried out withthe Genderism and Transphobia Scale (GTS) and the Negative Attitude towards Trans* peopleScale (EANT) with a total of 602 participants. Results: We found a low mean level of explicitprejudice/transphobia, with little/no differences between occupation groups. Explicit transphobia wascorrelated with being a man, less educated, and heterosexual, and not personally knowing a trans*person. Men and women were less transphobic about trans* people whose identities coincided withtheir own. Conclusion: All participants showed a low mean level of explicit transphobia. This resultis not incompatible with unconscious prejudice, which may translate to discriminatory behaviors.Interventions to change negative attitudes are still needed, since even a small percentage of transphobichealth professionals could exert a considerable negative impact on health care. In professionalswithout transphobic attitudes, the barriers identified by trans* people might be a problem due to thelack of specific trainin

Gender Identity: The Human Right of Depathologization

Transgender people have a gender identity different from the one allocated to them at birth. In many countries, transsexualism and transgenderism are considered mental illnesses under the diagnosis of gender dysphoria. This pathologization impacts on human rights.Main content: The United Nations (UN) has denounced violations against trans-people, including attacks, forced medical treatments, lack of legal gender recognition, and discrimination in the areas of education, employment, access to healthcare, and justice. The UN has linked these violations directly with discriminatory diagnostic classifications that pathologize gender diversity.Trans-people havebeen pathologized by psycho-medical classification and laws all around the world, with a different impact depending on countries. This paper argues that pathologization infringes infringes upon a wide range of human rights such as; civil, economic, socialcultural and also the access to medical care.Conclusions: The current situation for trans-people with respect to legal healthcare matters,depends on the country. Human rights are universal, not a question for cultural interpretation. They are the minimum that every human being must have assured only by the fact of being human. Countries must protect these rights by regulating trans-pathologization with special attention dedicated to intersex people and their specific needs

Biological, Psychological, Social, and Legal Aspects of Trans Parenthood Based on a Real Case: A Literature Review

Trans men are people who, based on their genitals, were assigned the status of female at birth. However, their identity and their way of living gender do not correspond to the socially established norms. In this paper,we discuss the different perspectives in relation to transgender people and their desire for parenthood. This review, and the basis of this paper, is inspired by the case of a trans man who desiredgestation with his own genetic material. He began the cycle of assisted reproduction when he was a legally recognized woman, but that attempt ended with a miscarriage. From that assisted reproduction cycle, four embryos remainedfrozen. After the failed experience of gestation, the person completed his transition. Now legally a man, he attempted to gestate using his reproductive organs. This literature review aimed to identify relevant studies describing the relationship between transgender person and biological parenthood. This study comprehensively addresses important aspectsone should know when considering a transgender pregnancy. These factors include biological, psychological, social,and legal issues. After reviewing the state-of-the-art information on trans parenthood, the main conclusion is that ‘the desire to have a child is not a male or female desire but a human desire

Atención sanitaria trans* competente, situación actual y retos futuros. Revisión de la literatura

Introducción: Conocemos como una persona trans* a aquella que no se identifica con el sexo de nacimiento, este hecho aún recogido como patología por el actual manual diagnóstico y estadístico de enfermedades mentales (DSM-V) va a provocar que existan desigualdades y barreras significativas a la hora de la atención sanitaria.Objetivo: Explorar las dificultades parala asistencia sanitaria percibidas por las personas trans* y por los profesionales que los atienden en centros sanitarios.Material y método: Revisión de la literatura.Resultados: Tanto los profesionales como las personas trans* perciben barreras significativas. Se podrían agrupar en diversos temas: desigualdades en la atención sanitaria percibidas por los pacientes trans*, prejuicios y discriminación sentida, riesgos específicos de salud, déficit de conocimientos de los profesionales y déficit de formación en los planes de estudio actuales. Por otro lado, enfermería ante los pacientes trans* puede resultar un facilitador.Conclusiones:Existen numerosos factores que pueden ser modificables y que provocan que las personas trans* no perciban una asistencia adecuada. La adecuada formación de los profesionales sanitarios es uno de los que adquiere mayor relevanciaLos resultados encontrados aportan una información clave para el futuro diseño de intervenciones dirigidas a mejorar la calidad de la asistencia en este colectivoIntroduction: We know as a transgender person who is not identified with the sex of birth, this fact still collected as pathology by the current Diagnostic and Statistical Manual of Mental Illness (DSM-V) will cause inequalities and barriers At the time of health care.Objective:To explore the difficulties for health care perceived by trans* people and by the professionals who assist them in health centres.Material and method:Literature review.Results:Both professionals and trans* people perceive significant barriers. They could be grouped by diverse topics: healthcare inequalities noticed by trans* patients, prejudices and felt discrimination, specific health risks, lack of professional knowledge and deficit of training in current curricula. On the other hand, nursing with trans* patients may result in a facilitator. Conclusions: There are multiple factors which can be modified and which produce that trans* people do not notice appropriate care. Appropriate training of health professionals is the one which acquires more relevance. The results found provide key information for the future design of interventions aimed at improving the quality of the assistance in this grou

Impact of a Formative Program on Transgender Healthcare for Nursing Students and Health Professionals. Quasi-Experimental Intervention Study

The field of specific healthcare for transgender people has not been includedin the official curriculum of professionals. This causes a lack of knowledge that can be presumedto become a barrier to healthcare. Currently, different methodologies are emerging to achievemeaningful learning for students and professionals. The objective of this study was to evaluatethe increase in the level of knowledge of final-year nursing students, applying methodologicalstrategies such as problem-based learning (PBL) and film-forum. Methods: 59 nursing studentswere randomly assigned to two intervention groups (G1=31 and G2=28), and another 57 wereassigned to the control group (without specific classes or workshops on the subject of the study).The intervention consisted of a specific training course on transgender issues (TGSC&W, TransGenderSpecific Course and Workshop), where the type of meaningful learning strategy used depended on thegroup (G1=film-forum and G2=PBL). The study was carried out at the Faculty of Nursing NuestraSeñora de Candelaria of the Canary Islands Health Service. The randomization was done by blindlychoosing a computer-generated code. Results: The main outcome was based on 116 participants,comparing their level of knowledge before and after the workshop. The comparison by pairsshows that there were statistically significant differences (p=0.000) between those undergoing themethodological interventions and the control group. Statistical significance between film-forum andPBL was not obtained (p=1.000): Both methodologies increased the level of knowledge, but there wasno significant difference between them. The means for satisfaction with the learning methodologyused did not show statistically significant differences. Conclusion: The workshop carried out washighly effective and significant in terms of increasing knowledge. No significant differences wereobserved in the level of knowledge, or in the degree of satisfaction, between the two methodologiesused (PBL and film-forum

Trans* Pregnancy and Lactation: A Literature Review from a Nursing Perspective

Pregnancy and lactationinvolve two aspects that are socially and culturally associated with women. However, there are a few biological differences between male and female breast tissue. Lactation and pregnancy are viable processes that do not depend on sex. Even for the latter,it is only necessary to have an organ capable of gestation. Ways to favor mammogenesis and lactogenesis in trans* women have been established. There are protocols to promote lactation in trans* women, usually used for adoptive mothers or those whose children have been born through gestational surrogacy. Chestfeeding a baby could be the cause of feelings as diverse as gender dysphoria in the case of trans* men, and euphoria and affirmation of femininity in trans* women. This study involves a review of the available scientific literature addressing medical aspects related to pregnancy and lactation in trans* individuals, giving special attention to nursing care during perinatal care. There are scarce studies addressing care and specificallynursing care in trans* pregnancy and lactation. Our study indicates the factors that can be modified and the recommendations for optimizing the care provided to these individuals in order to promote and maintain the lactation period in search of improvement and satisfaction with the whole proces

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Competent trans* health care, current situation and future challenges. A Review

Introducción: Conocemos como una persona trans* a aquella que no se identifica con el sexo de nacimiento, este hecho aún recogido como patología por el actual manual diagnóstico y estadístico de enfermedades mentales (DSM-V) va a provocar que existan desigualdades y barreras significativas a la hora de la atención sanitaria.Objetivo: Explorar las dificultades parala asistencia sanitaria percibidas por las personas trans* y por los profesionales que los atienden en centros sanitarios.Material y método: Revisión de la literatura.Resultados: Tanto los profesionales como las personas trans* perciben barreras significativas. Se podrían agrupar en diversos temas: desigualdades en la atención sanitaria percibidas por los pacientes trans*, prejuicios y discriminación sentida, riesgos específicos de salud, déficit de conocimientos de los profesionales y déficit de formación en los planes de estudio actuales. Por otro lado, enfermería ante los pacientes trans* puede resultar un facilitador.Conclusiones:Existen numerosos factores que pueden ser modificables y que provocan que las personas trans* no perciban una asistencia adecuada. La adecuada formación de los profesionales sanitarios es uno de los que adquiere mayor relevanciaLos resultados encontrados aportan una información clave para el futuro diseño de intervenciones dirigidas a mejorar la calidad de la asistencia en este colectivo.ABSTRACT:Introduction: We know as a transgender person who is not identified with the sex of birth, this fact still collected as pathology by the current Diagnostic and Statistical Manual of Mental Illness (DSM-V) will cause inequalities and barriers At the time of health care.Objective:To explore the difficulties for health care perceived by trans* people and by the professionals who assist them in health centres.Material and method:Literature review.Results:Both professionals and trans* people perceive significant barriers. They could be grouped by diverse topics: healthcare inequalities noticed by trans* patients, prejudices and felt discrimination, specific health risks, lack of professional knowledge and deficit of training in current curricula. On the other hand, nursing with trans* patients may result in a facilitator. Conclusions: There are multiple factors which can be modified and which produce that trans* people do not notice appropriate care. Appropriate training of health professionals is the one which acquires more relevance. The results found provide key information for the future design of interventions aimed at improving the quality of the assistance in this group

Use of PBL as a teaching innovation methodology in University Nursing Studies in Spain

[eng] Health Sciences have undergone a great transformation. University degrees such as Nursing, in its adaptation to the Bologna Plan, have seen how their studies went from a purely mechanistic conception (Haidar Torres, 2015), as surgeon assistants, to the establishment of a university superior Degree where the students must develop and acquire a series of competencies and knowledge that are considered necessary for their future development as professionals