Características de la plantilla de enfermería y su repercusión en el control de la HTA y de la Diabetes Mellitus en el contexto de la Atención Primaria

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública y Microbiología. Fecha de lectura: 18-12-201

Impact of primary care nursing workforce characteristics on the control of high-blood pressure: A multilevel analysis

Objective: To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). Design: Cross-sectional analytical study. Setting: Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. Participants: 76 797 hypertensive patients in two health zones within the Community of Madrid, North- West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. Primary outcome measure: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and selfperceived CPE. Results: The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). Conclusions: A CPE, perceived by PHC nurses as more favourable, and more patient–nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are neededThe results presented here form part of a study that has been funded partially with the First Prize for National Research in Nursing (12th edition) from Hospital Universitario Marqués de Valdecilla (Santander) in 2010

Temperature increase prevails over acidification in gene expression modulation of amastigote differentiation in Leishmania infantum

<p>Abstract</p> <p>Background</p> <p>The extracellular promastigote and the intracellular amastigote stages alternate in the digenetic life cycle of the trypanosomatid parasite <it>Leishmania</it>. Amastigotes develop inside parasitophorous vacuoles of mammalian phagocytes, where they tolerate extreme environmental conditions. Temperature increase and pH decrease are crucial factors in the multifactorial differentiation process of promastigotes to amastigotes. Although expression profiling approaches for axenic, cell culture- and lesion-derived amastigotes have already been reported, the specific influence of temperature increase and acidification of the environment on developmental regulation of genes has not been previously studied. For the first time, we have used custom <it>L. infantum </it>genomic DNA microarrays to compare the isolated and the combined effects of both factors on the transcriptome.</p> <p>Results</p> <p>Immunofluorescence analysis of promastigote-specific glycoprotein gp46 and expression modulation analysis of the amastigote-specific A2 gene have revealed that concomitant exposure to temperature increase and acidification leads to amastigote-like forms. The temperature-induced gene expression profile in the absence of pH variation resembles the profile obtained under combined exposure to both factors unlike that obtained for exposure to acidification alone. In fact, the subsequent fold change-based global iterative hierarchical clustering analysis supports these findings.</p> <p>Conclusions</p> <p>The specific influence of temperature and pH on the differential regulation of genes described in this study and the evidence provided by clustering analysis is consistent with the predominant role of temperature increase over extracellular pH decrease in the amastigote differentiation process, which provides new insights into <it>Leishmania </it>physiology.</p

Nursing workforce characteristics and control of diabetes mellitus in primary care: A multilevel analysis. Spain

Fundamentos: La actividad de enfermería está condicionada por las características de la plantilla. El objetivo fue determinar cómo afectan las características de la plantilla de enfermería de atención primaria (AP) al control de la diabetes mellitus (DM) en personas adultas. Método: Estudio analítico transversal. Instrumentos para la recogida de datos: sistemas de información de AP y cuestionario PES-Nursing Work Index. Participantes: 44.214 pacientes diabéticos en dos zonas de salud de la Comunidad de Madrid: Zona Noroeste (ZNO) con mejor situación socioeconómica y Zona Suroeste (ZSO) con peor situación socioeconómica y los 507 profesionales de enfermería de referencia. Se realizaron análisis multivariantes multinivel de regresión logística. La variable dependiente fue la DM estaba mal controlada (cuando los valores de Hb1Ac eran ≥ a 7%) Resultados: La prevalencia DM mal controlada fue de 40,1% (IC95%:38,2-42,1). Existía un riesgo de un 25% más de peor control si el paciente cambiaba de centro de salud y de un 27% si cambiaba de pareja médico de cabaecera y enfermera. En los modelos de regresión logística multivariante multinivel: para la ZSO a mayor ratio de pacientes mayores de 65 años aumentaba el riesgo de mal control (OR=1,00008 [IC95%:1,00006-1,001]); a mayor proporción de pacientes sin seguimiento por centro de salud peor control (OR=5,1 [IC95%:1,6-15,6]). En los dos modelos por zona de salud, la condición de ser inmigrante económico aumentó el riesgo de mal control, ZSO (OR=1,3 [IC95%:1,03-1,7]); y ZNO (OR=1,29 [IC95%:1,03-1,6]). Conclusiones: Son factores de riesgo de tener mal controlada la diabetes mellitus la mayor proporción de pacientes mayores de 65 años por enfermera, ser inmigrante y la proporción de pacientes sin seguimientoBackground: Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. Method: Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. Primary outcome measure: Poor DM control (figures ≥ 7% HbA1c) Results: The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). Conclusions: Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM controlLos resultados presentados en este manuscrito forman parte de un proyecto financiado parcialmente por el Premio Nacional Marqués de Valdecilla (Santander) 2010 (12ª edición

Detecting Nonvolatile Life- and Nonlife-Derived Organics in a Carbonaceous Chondrite Analogue with a New Multiplex Immunoassay and Its Relevance for Planetary Exploration

Potential martian molecular targets include those supplied by meteoritic carbonaceous chondrites such as amino acids and polycyclic aromatic hydrocarbons and true biomarkers stemming from any hypothetical martian biota (organic architectures that can be directly related to once-living organisms). Heat extraction and pyrolysis-based methods currently used in planetary exploration are highly aggressive and very often modify the target molecules, making their identification a cumbersome task. We have developed and validated a mild, nondestructive, multiplex inhibitory microarray immunoassay and demonstrated its implementation in the SOLID (Signs of Life Detector) instrument for simultaneous detection of several nonvolatile life- and nonlife-derived organic molecules relevant in planetary exploration and environmental monitoring. By utilizing a set of highly specific antibodies that recognize D- or L-aromatic amino acids (Phe, Tyr, Trp), benzo[a]pyrene (B[a]P), pentachlorophenol, and sulfone-containing aromatic compounds, respectively, the assay was validated in the SOLID instrument for the analysis of carbon-rich samples used as analogues of the organic material in carbonaceous chondrites or even Mars samples. Most of the antibodies enabled sensitivities at the 1–10 ppb level and some even at the part-per-trillion level. The multiplex immunoassay allowed the detection of B[a]P as well as aromatic sulfones in a water/methanol extract of an Early Cretaceous lignite sample (ca. 140 Ma) representing type IV kerogen. No L- or D-aromatic amino acids were detected, reflecting the advanced diagenetic stage and the fossil nature of the sample. The results demonstrate the ability of the liquid extraction by ultrasonication and the versatility of the multiplex inhibitory immunoassays in the SOLID instrument to discriminate between organic matter derived from life and nonlife processes, an essential step toward life detection outside EarthThis work was supported by granted projects AYA2011-24803, ESP2014-51989-P, and ESP2015-69540-R, from the Ministry of Economy and Competitiveness (MINECO) of Spain, and by Grant No. ST/N000803/1 (United Kingdom). A. G-C was a fellow of ‘‘Plan de Formación from INTA.Peer reviewe

Detecting Nonvolatile Life- and Nonlife-Derived Organics in a Carbonaceous Chondrite Analogue with a New Multiplex Immunoassay and Its Relevance for Planetary Exploration

[EN] Potential martian molecular targets include those supplied by meteoritic carbonaceous chondrites such as amino acids and polycyclic aromatic hydrocarbons and true biomarkers stemming from any hypothetical martian biota (organic architectures that can be directly related to once living organisms). Heat extraction and pyrolysis-based methods currently used in planetary exploration are highly aggressive and very often modify the target molecules making their identification a cumbersome task. We have developed and validated a mild, nondestructive, multiplex inhibitory microarray immunoassay and demonstrated its implementation in the SOLID (Signs of Life Detector) instrument for simultaneous detection of several nonvolatile life- and nonlife-derived organic molecules relevant in planetary exploration and environmental monitoring. By utilizing a set of highly specific antibodies that recognize D- or L- aromatic amino acids (Phe, Tyr, Trp), benzo[a]pyrene (B[a]P), pentachlorophenol, and sulfone-containing aromatic compounds, respectively, the assay was validated in the SOLID instrument for the analysis of carbon-rich samples used as analogues of the organic material in carbonaceous chondrites or even Mars samples. Most of the antibodies enabled sensitivities at the 1-10ppb level and some even at the ppt level. The multiplex immunoassay allowed the detection of B[a]P as well as aromatic sulfones in a water/methanol extract of an Early Cretaceous lignite sample (c.a., 140 Ma) representing type IV kerogen. No L- or D-aromatic amino acids were detected, reflecting the advanced diagenetic stage and the fossil nature of the sample. The results demonstrate the ability of the liquid extraction by ultrasonication and the versatility of the multiplex inhibitory immunoassays in the SOLID instrument to discriminate between organic matter derived from life and nonlife processes, an essential step toward life detection outside Earth.This work was supported by granted projects AYA2011-24803, ESP2014-51989-P, and ESP2015-69540-R, from the Ministry of Economy and Competitiveness (MINECO) of Spain, and by Grant No. ST/N000803/1 (United Kingdom). A. G-C was a fellow of Plan de Formación from INTA.Moreno-Paz, M.; Gómez-Cifuentes, A.; Ruiz-Bermejo, M.; Hofstetter, O.; Maquieira Catala, A.; Manchado, JM.; Morais, S.... (2018). Detecting Nonvolatile Life- and Nonlife-Derived Organics in a Carbonaceous Chondrite Analogue with a New Multiplex Immunoassay and Its Relevance for Planetary Exploration. Astrobiology. 18(8):1041-1056. https://doi.org/10.1089/ast.2017.1747S1041105618

Telessimulação sobre visita domiciliar e cuidado infantil: facilidades, barreiras e percepções de estudantes de enfermagem

Objetivo:&nbsp;evaluar las facilidades, barreras y percepciones de estudiantes de enfermería en el aprendizaje sobre visita domiciliaria y cuidado infantil por telesimulación en la pandemia de COVID-19.&nbsp;Método:&nbsp;estudio cualitativo que evalúa la telesimulación por computadora, basado en el modelo teórico de Kolb. Se aplicó un cuestionario semiestructurado y la Escala de Satisfacción de los Estudiantes y Autoconfianza en el Aprendizaje, con análisis descriptivo y análisis temático cualitativo sobre las percepciones de 41 estudiantes de enfermería.&nbsp;Resultados:&nbsp;la telesimulación contextualizada brindó oportunidades de aprendizaje en los aspectos estrategia pedagógica, escenario telesimulado, comunicación y especificidades del cuidado infantil en visitas domiciliarias. Es una actividad segura y dinámica, que contribuyó a consolidar conocimientos y actitudes reflexivas, permitió un acercamiento a la realidad, el desarrollo de la interacción, observación y tipos de acercamientos. Hubo restricciones por fallas en la conexión. La mayoría de los estudiantes indicaron buenos niveles de satisfacción y confianza en sí mismos con el aprendizaje en la escala aplicada.&nbsp;Conclusión:&nbsp;la situación clínica real con participación a distancia permitió la observación, toma de decisiones, reflexión y elaboración de conclusiones inherentes al ciclo de aprendizaje experiencial. El conjunto de elementos de esta telesimulación creó un ambiente que estimuló el interés de los estudiantes de enfermería por otras etapas de aprendizaje, por lo que se considera un espacio que fortalece el conocimiento y dialoga con las prácticas presenciales.Objective:&nbsp;to evaluate the facilitators, barriers and perceptions of Nursing students in learning about home visiting and child care through Telesimulation during the COVID-19 pandemic.&nbsp;Method:&nbsp;a qualitative study to evaluate Telesimulation via computers, grounded on Kolb’s theoretical model. A semi-structured questionnaire and the Student Satisfaction and Self-Confidence in Learning Scale were applied, with descriptive analysis and qualitative thematic analysis on the perceptions of 41 Nursing students. Results:&nbsp;the contextualized Telesimulation provided learning opportunities in dimensions of the pedagogical strategy, telesimulated scenario, communication and specificities of child care in home visits. It was considered a safe and dynamic activity that helped knowledge consolidation and reflective attitudes, proximity to reality, and develop interaction, observation and types of approaches. There were restrictions due to Internet connection failures. A large percentage of the students indicated good satisfaction and self-confidence level with learning in the scale applied. Conclusion:&nbsp;the real clinical situation with remote immersion allowed observation, decision-making, reflection and elaboration of conclusions, inherent to the experiential learning cycle. The set of elements of this Telesimulation created an environment that stimulated the interest of Nursing students for other learning stages, suggesting a space that strengthens knowledge and maintains dialogue with face-to-face practices.Objetivo:&nbsp;avaliar as facilidades, barreiras e percepções de estudantes de enfermagem na aprendizagem sobre visita domiciliar e cuidado infantil por telessimulação na pandemia da COVID-19.&nbsp;Método:&nbsp;estudo qualitativo avaliativo de telessimulação por computador, fundamentado no modelo teórico de Kolb. Foram aplicados um questionário semiestruturado e a Escala de Satisfação de Estudantes e Autoconfiança na Aprendizagem, com análise descritiva e análise qualitativa temática sobre percepções de 41 graduandos de enfermagem.&nbsp;Resultados:&nbsp;a telessimulação contextualizada proporcionou oportunidades de aprendizagem em dimensões da estratégia pedagógica, cenário telessimulado, comunicação e especificidades do cuidado infantil em visita domiciliar. Atividade segura e dinâmica, auxiliou a solidificar conhecimentos e atitudes reflexivas, aproximação à realidade, desenvolvimento da interação, observação e tipos de abordagens. Houve restrições por falhas de conexão. Grande parte dos estudantes indicou níveis bons de satisfação e autoconfiança com a aprendizagem na escala aplicada.&nbsp;Conclusão:&nbsp;a situação clínica real com imersão remota permitiu observação, tomada de decisão, reflexão e elaboração de conclusões inerentes ao ciclo de aprendizagem experiencial. O conjunto de elementos desta telessimulação criou um ambiente que estimulou o interesse dos estudantes de enfermagem para outras etapas de aprendizagem, sugerindo um espaço que fortalece conhecimentos e que guarda interlocução com as práticas presenciais

Prokaryotic and viral community of the sulfate‐rich crust from Peñahueca ephemeral lake, an astrobiology analogue

Peñahueca is an athalassohaline hypersaline inland ephemeral lake originated under semiarid conditions in the central Iberian Peninsula (Spain). Its chemical composition makes it extreme for microbial life as well as a terrestrial analogue of other planetary environments. To investigate the persistence of microbial life associated with sulfate‐rich crusts, we applied cultivation‐independent methods (optical and electron microscopy, 16S rRNA gene profiling and metagenomics) to describe the prokaryotic community and its associated viruses. The diversity for Bacteria was very low and was vastly dominated by endospore formers related to Pontibacillus marinus of the Firmicutes phylum. The archaeal assemblage was more diverse and included taxa related to those normally found in hypersaline environments. Several ‘metagenome assembled genomes’ were recovered, corresponding to new species of Pontibacillus, several species from the Halobacteria and one new member of the Nanohaloarchaeota. The viral assemblage, although composed of the morphotypes typical of high salt systems, showed little similarity to previously isolated/reconstructed halophages. Several putative prophages of Pontibacillus and haloarchaeal hosts were identified. Remarkably, the Peñahueca sulfate‐rich metagenome contained CRISPR‐associated proteins and repetitions which were over 10‐fold higher than in most hypersaline systems analysed so far.This research was supported by the Spanish Ministry of Economy projects CLG2015_66686-C3-1 (to RRM) CLG2015_66686-C3-3 (to JA), CGL2015-66455-R (to MAGC, MESM, JPRA), AYA2011-24803 and ESP2015-69540-R (to VP) which were also supported by the European Regional Development Fund and the MDM-2017-0737 Unidad de Excelencia “María de Maeztu”- Centro de Astrobiología (INTA-CSIC)

Efficacy of prompted voiding for reversing urinary incontinence in older adults hospitalized in a functional recovery unit: Study protocol

Aims: To assess the efficacy of a prompted voiding programme for restoring urinary continence at discharge in hospitalized older adults who presented with reversible urinary incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors associated with the success of the prompted voiding programme. Design: Quasi-experimental, pre-/post-intervention study without a control group. Methods: Participants were aged 65 and over with a history of reversible UI in the previous year who had been admitted to a FRU and were on a prompted voiding programme throughout their hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling method, in order of recruitment after signing the informed consent form, was used. The primary outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge. Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of Health). The proposal was approved by the Spanish Research Ethics Committee. Discussion: The prompted voiding programme described can reverse UI or decrease the frequency and amount of urine loss in hospitalized older adults. Impact: Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided by the nursing team during hospitalization and can also be provided by family caregivers at home after receiving proper training by the nursing team. Prompted voiding will enhance the health, functional ability and quality of life of older adults with UI, resulting in the reduction of associated healthcare costs and the risk of developing complicationsThis study has been funded by Instituto de Salud Carlos III through the project “PI19/00168” (Co-funded by European Regional Development Fund/ European Social Fund “A way to make Europe”/“Investing in your future”

Evaluación de una intervención educativa (edworkcases) que involucra casos clínicos y estudiantes de enfermería: estudio transversal y observacional

To evaluate the impact of the (edworkcases) educational intervention on students’ evaluation outcomes in their clinical practices, their attitudes towards Nursing diagnoses, and their satisfaction. This study used a cross-sectional observational design. The participants were 69 third-year Nursing students from a public university in Madrid, Spain. The data analysed in the study were the grades obtained by students for their clinical practices, as well as pre-post intervention scores on the Positions on Nursing Diagnosis Scale and a satisfaction survey. A means comparison by participation in the project (yes/no) was carried out using Student’s t-test. A means comparison by professor was conducted using Kruskal-Wallis tests. Participation rate: 72.4%; 92% of the participants were women; median age = 21 years old. Statistically significant differences were found between participants and non-participants in terms of mean score in the Overall Evaluation and in the Case Study Evaluation, with higher scores found among the group of participants. The mean score for attitudes towards Nursing diagnoses was 99.9 (SD=2.8) before the intervention and 111.1 (SD=2.9) after the intervention [95% CI: 3.3 19.2]. The use of (edworkcases) as part of the practical training was considered satisfactory, enabling theory and practice to be combined and improving students’ attitudes towards Nursing diagnose