“You knew you had to be there, it had to be done”: Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain

IntroductionThe COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned.MethodsWe carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi’s 7-step data analysis method.ResultsDuring the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic.ConclusionIn the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic

“You knew you had to be there, it had to be done”: Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain

Introduction: The COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. Methods: We carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi’s 7-step data analysis method. Results: During the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. Conclusion: In the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemi

A abordagem da saúde sexual e reprodutiva em mulheres imigrantes na perspectiva de gênero

En los últimos años se ha producido un importante incremento de la población inmigrante residente en España. Y si en los inicios del fenómeno migratorio emigraban hombres solos, en la actualidad está aumentando el número de mujeres que emigran, bien como consecuencia de la reagrupación familiar o con proyectos migratorios propios. El objetivo de este trabajo es analizar, mediante una revisión de la bibliografía publicada, cuáles son los factores que inciden en la salud sexual y reproductiva de las mujeres inmigrantes y cuáles son las principales barreras que tienen en el acceso normalizado a los servicios sanitarios. Como conclusión podemos destacar que en los estudios realizados se ha puesto de manifiesto que existen una serie de factores que inciden en la salud sexual y reproductiva de las mujeres inmigrantes y que hay un menor uso de los servicios sanitarios por parte de éstas, ya que existen múltiples barreras que impiden una integración normalizada en el sistema sanitario público.In recent years there has occurred a significant increase in the immigrant population resident in Spain. And if at the beginning of phenomenon of migration they emigrated alone men, nowadays a growing number of women are migrating, or as result of family re-unification, or as migration projects of themselves. This work aims to analyze, through a review of published literature, what are the factors that affect the sexual and reproductive health of immigrant women and what are the main barriers that they have on standardized access to the health services. In conclusion we can highlight that previous studies have shown that there are a number of factors that influence the sexual and reproductive health of female immigrants and that there is less use of health services for these, since there are multiple barriers that obstruct a normal integration in the public health system.Nos últimos anos tem-se observado importante implemento da população imigrante residente na Espanha. E se no início este era um fenômeno em que os homens emigravam, na atualidade está aumentando o número de mulheres que emigram, bem como a consequência da reagrupação familiar ou com projetos migratórios próprios. O objetivo do presente estudo é analisar, mediante uma revisão da bibliografia publicada, quais são os fatores que incidem na saúde sexual e reprodutiva das mulheres imigrantes e quais são as principais barreiras que têm no acesso aos serviços de saúde. Como conclusão, podemos destacar que nos estudos realizados destaca-se uma série de fatores que interferem na saúde sexual e reprodutiva das mulheres nesta condição e que têm menor utilização dos serviços de saúde, já que existem múltiplas barreiras que impedem uma integração normalizada no sistema de saúde público

Systematic review of healthcare interventions for reducing gender-based violence impact on the mental health of women with disabilities

Fil: Pastor Moreno, Guadalupe. Escuela Andaluza de Salud Pública, España.Fil: Pastor Moreno, Guadalupe. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Pastor Moreno, Guadalupe. Instituto de Investigación Biosanitaria de Granada, España.Fil: Saletti Cuesta, Lorena. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales, Argentina.Fil: Saletti Cuesta, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Argentina.Fil: Henares Montiel, Jesús. Escuela Andaluza de Salud Pública, España.Fil: Henares Montiel, Jesús. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Henares Montiel, Jesús. Instituto de Investigación Biosanitaria de Granada, España.Fil: Escudero Carretero, María J. Escuela Andaluza de Salud Pública, España.Fil: Escudero Carretero, María J. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Escudero Carretero, María J. Instituto de Investigación Biosanitaria de Granada, España.Fil: Higueras Callejón, Camila. Escuela Andaluza de Salud Pública, España.Fil: Ruiz Pérez Isabel. Escuela Andaluza de Salud Pública, España.Fil: Ruiz Pérez Isabel. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Ruiz Pérez, Isabel. Instituto de Investigación Biosanitaria de Granada, España.Purpose: Women with disabilities are more exposed to violence. The health sector hasa key role in all three levels of prevention of violence against women. The objective ofthis paper was to review the interventions for preventing gender-based violence andreducing its impact on the mental health of women with any form of disability. Method: Relevant studies were identified through conducting searches in PubMed,Scopus, CINAHL, PsyInfo, Social Services Abstracts, and PILOTS. Two reviewers ana-lyzed and selected studies. A qualitative synthesis was made. Results: 3149 references were obtained, among which eight articles describing nineinterventions from the USA and the UK. Most were intended for women with mental/intellectual disability and assessed intimate partner or sexual violence. Only one studyshowed high methodological quality. They were found to be particularly effective asregards improvement of the skills acquired by participants, but the results as regardsimproved mental health are not consistent. Conclusion: Our review shows very little evidence of effective interventions. Furtherstudies are required with higher internal validity and female sample groups with di-verse disabilities.Clinical Relevance: Gender-based violence is a highly prevalent problem for womenwith disabilities, and in addition to being a public health challenge is a violation ofhuman rights. Health care systems and policymakers should take a key role in all threelevels of prevention of violence against women with disabilities. Interventions withlonger follow-up times are required. It is also important for interventions to be de-signed in consultation with people with disabilities.info:eu-repo/semantics/publishedVersionFil: Pastor Moreno, Guadalupe. Escuela Andaluza de Salud Pública, España.Fil: Pastor Moreno, Guadalupe. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Pastor Moreno, Guadalupe. Instituto de Investigación Biosanitaria de Granada, España.Fil: Saletti Cuesta, Lorena. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales, Argentina.Fil: Saletti Cuesta, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Argentina.Fil: Henares Montiel, Jesús. Escuela Andaluza de Salud Pública, España.Fil: Henares Montiel, Jesús. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Henares Montiel, Jesús. Instituto de Investigación Biosanitaria de Granada, España.Fil: Escudero Carretero, María J. Escuela Andaluza de Salud Pública, España.Fil: Escudero Carretero, María J. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Escudero Carretero, María J. Instituto de Investigación Biosanitaria de Granada, España.Fil: Higueras Callejón, Camila. Escuela Andaluza de Salud Pública, España.Fil: Ruiz Pérez Isabel. Escuela Andaluza de Salud Pública, España.Fil: Ruiz Pérez Isabel. Consorcio de Investigación Biomédica yen Red de Epidemiología y Salud Pública, España.Fil: Ruiz Pérez, Isabel. Instituto de Investigación Biosanitaria de Granada, España

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020

[EN] Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3,4,5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes.S

CD14+ macrophages that accumulate in the colon of African AIDS patients express pro-inflammatory cytokines and are responsive to lipopolysaccharide

BACKGROUND : Intestinal macrophages are key regulators of inflammatory responses to the gut microbiome and play a central role in maintaining tissue homeostasis and epithelial integrity. However, little is known about the role of these cells in HIV infection, a disease fuelled by intestinal inflammation, a loss of epithelial barrier function and increased microbial translocation (MT). METHODS : Phenotypic and functional characterization of intestinal macrophages was performed for 23 African AIDS patients with chronic diarrhea and/or weight loss and 11 HIV-negative Africans with and without inflammatory bowel disease (IBD). AIDS patients were treated with cotrimoxazole for the prevention of opportunistic infections (OIs). Macrophage phenotype was assessed by flow cytometry and immuno-histochemistry (IHC); production of proinflammatory mediators by IHC and Qiagen PCR Arrays; in vitro secretion of cytokines by the Bio-Plex Suspension Array System. Statistical analyses were performed using Spearman’s correlation and Wilcoxon matched-pair tests. Results between groups were analyzed using the Kruskal-Wallis with Dunn’s post-test and the Mann–Whitney U tests. RESULTS : None of the study participants had evidence of enteric co-infections as assessed by stool analysis and histology. Compared to healthy HIV-negative controls, the colon of AIDS patients was highly inflamed with increased infiltration of inflammatory cells and increased mRNA expression of proinflammatory cytokine (tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IFN-γ, and IL-18), chemokines (chemokine (C-C motif) ligand (CCL)2 and chemokine (C-X-C) motif ligand (CXCL)10) and transcription factors (TNF receptor-associated factor (TRAF)6 and T-box (TXB)21). IHC revealed significant co-localization of TNF-α and IL-1β with CD68+ cells. As in IBD, HIV was associated with a marked increase in macrophages expressing innate response receptors including CD14, the co-receptor for lipopolysaccharide (LPS). The frequency of CD14+ macrophages correlated positively with plasma LPS, a marker of MT. Total unfractionated mucosal mononuclear cells (MMC) isolated from the colon of AIDS patients, but not MMC depleted of CD14+ cells, secreted increased levels of proinflammatory cytokines ex vivo in response to LPS CONCLUSIONS : Intestinal macrophages, in the absence of overt OIs, play an important role in driving persistentinflammation in HIV patients with late-stage disease and diarrhea. These results suggest intensified treatmentstrategies that target inflammatory processes in intestinal macrophages may be highly beneficial in restoringthe epithelial barrier and limiting MT in HIV-infected patients.This research and selected researchers (EC, TR, PM, SM and CS) were funded in part by a grant from the Delegation of the European Union to South Africa: “Drug Resistance Surveillance and Treatment Monitoring Network for the Public Sector HIV Antiretroviral Treatment Programme in the Free State – Sante 2007/147-790” and by a grant from the National Research Council of South Africa, Unlocking the Future 61509.http://www.biomedcentral.com/bmcinfectdisam201

PENSAMIENTO CRÍTICO EN LA INVESTIGACIÓN CIENTÍFICA Y ACADÉMICA COLECCIÓN CIENTÍFICA EDUCACIÓN, EMPRESA Y SOCIEDAD

PENSAMIENTO CRÍTICO EN LA INVESTIGACIÓN CIENTÍFICA Y ACADÉMICA COLECCIÓN CIENTÍFICA EDUCACIÓN, EMPRESA Y SOCIEDAD Primera Edición 2023 Vol. 21 Editorial EIDEC Sello Editorial EIDEC (978-958-53018) NIT 900583173-1 ISBN: 978-628-95884-1-5 Formato: Digital PDF (Portable Document Format) DOI: https://doi.org/10.34893/e1150-3660-8721-s Publicación: Colombia Fecha Publicación: 13/09/2023 Coordinación Editorial Escuela Internacional de Negocios y Desarrollo Empresarial de Colombia – EIDEC Centro de Investigación Científica, Empresarial y Tecnológica de Colombia – CEINCET Red de Investigación en Educación, Empresa y Sociedad – REDIEES Revisión y pares evaluadores Centro de Investigación Científica, Empresarial y Tecnológica de Colombia – CEINCET Red de Investigación en Educación, Empresa y Sociedad – REDIEE

Violencia de género en mujeres embarazadas y resultados en la salud de la madre y del recién nacido

INTRODUCCIÓN: La violencia contra las mujeres es un problema público de primer nivel, en cuanto atenta contra los derechos humanos y los valores de cualquier sociedad. Por su magnitud y la gran carga que conlleva para la salud de las mujeres, es además en una cuestión de salud pública. El principal objetivo de esta tesis ha sido estudiar la frecuencia y formas de violencia en mujeres embarazadas en Andalucía, así como analizar la literatura científica internacional sobre la asociación entre VCI y los resultados en la salud perinatal de la madre y del recién nacido. MÉTODOS: Se han realizado tres estudios. En primer lugar un estudio observacional de frecuencia de Historia de Violencia y resultados en salud en mujeres embarazadas que realizaron el seguimiento de su embarazo en el Sistema Sanitario Público de Andalucía. En segundo lugar, una Revisión Sistemática de la Literatura sobre la asociación entre VCI y resultados de salud perinatal en la mujer y en el feto o recién nacido. Y en tercer lugar una Revisión Sistemática de la Literatura y meta-análisis sobre la asociación entre VCI durante el embarazo y muerte perinatal. RESULTADOS: En el primer estudio participaron 754 mujeres, de las cuales el 9% refirieron haber sido maltratadas por alguna persona a lo largo de su vida, el 4,8% indicó VCI por su actual pareja y el 1,9% VCI durante su embarazo. Una mayor prevalencia de Historia de Violencia se asoció significativamente con una mala percepción del estado de salud durante el embarazo, tener morbilidad psíquica y consumo de medicación en el embarazo. En el segundo estudio se identificaron 655 referencias y se incluyeron 50 artículos. El 82% de los mismos obtuvo una evaluación de calidad metodólogica elevada, y aportaron una mediana de prevalencia de VCI de 24,6% para VCI no diferenciada (decir, no se especificaba el tipo de violencia o era violencia de cualquier tipo), 26,6% para VCI psicológica, 10% para VCI física y 5,1% para VCI sexual. Se identificaron 39 resultados de salud perinatal diferentes analizados en relación a la VCI. Los resultados informados con más frecuencia fueron parto prematuro (50%), bajo peso al nacer (46%), aborto espontáneo (30%), muerte perinatal (20%) y rotura prematura de membranas (20%). Doce de los estudios que analizaron VCI no diferenciada, 18 de los que analizaron VCI física, seis de VCI psicológica y dos de VCI sexual observaron una asociación estadísticamente significativa con diferentes resultados de salud perinatal. El tercer estudio identificó 480 referencias, de las cuales 17 artículos fueron incluidos. Diez artículos obtuvieron una puntuación elevada en la evaluación de la calidad metodológica. Los modelos de efectos aleatorios mostraron un aumento estadísticamente significativo en las probabilidades de muerte perinatal entre las mujeres embarazadas expuestas a VCI no diferenciada, VCI física y cualquier tipo de VCI. El análisis de meta regresión mostró asociaciones más fuertes en países con un PIB más alto y un mayor porcentaje de gasto en salud. La proporción de muertes atribuibles a la exposición a VCI en los estudios de cohortes fue del 60% (IC95% 15-81%). CONCLUSIONES: Estos resultados muestran el peso que la desigualdad estructural de género, y por tanto la violencia contra las mujeres, tiene sobre la salud perinatal, reforzando la necesidad de que los servicios de salud tengan un papel activo en la prevención de la violencia. La gravedad del problema requiere un posicionamiento por parte de los y las profesionales sanitarios, por lo que la recomendación más consensuada es que tengan una postura activa, es decir, estén alerta y actúen sobre las mujeres que presentan factores de riesgo o señales de alarma de maltrato