¿Diversidad cultural o desigualdad social? Una aproximación crítica a la competencia cultural en la salud a partir de las necesidades sentidas por mujeres en contextos de diversidad, injusticia social y austeridad

En el presente trabajo, se realiza un análisis crítico de la competencia cultural como estrategia para reducir las desigualdades en salud en contextos de diversidad asociada a la inmigración. Tras un breve recorrido histórico sobre el surgimiento y evolución de este concepto, se plantea una severa crítica a las políticas y prácticas de promoción de la competencia cultural dada su incapacidad para transformar las condiciones generadoras de desigualdad en el acceso a la salud y los servicios sanitarios en contextos de diversidad, particularmente en tiempos de crisis y austeridad.Neste trabalho, apresenta-se uma análise crítica da competência cultural como estratégia para reduzir as desigualdades em saúde em contextos de diversidade associada à imigração. Após um breve percurso histórico pelo surgimento e evolução deste conceito, faz-se uma severa crítica das políticas e práticas de promoção da competência cultural, dada a sua incapacidade para transformar as condições que levam à desigualdade na saúde e no acesso aos serviços de saúde em contextos de diversidade, particularmente nos atuais tempos de crise e austeridade.The main aim of this paper is to critically examine the adequacy of cultural competence as a strategy to reduce health inequalities in contexts of migration-driven diversity. After a brief historical overview of the emergence and evolution of this concept, cultural competence policies and practices are severely criticized due to their inability to transform the conditions leading to inequalities in health and healthcare in contexts of diversity, particularly in current times of crisis and austerity

La aproximación multimétodo en evaluación de necesidades

La evaluación de necesidades es una modalidad de investigación social aplicada, de carácter evaluativo, que consiste en identificar y priorizar los problemas existentes en un contexto determinado, como base para la planificación de intervenciones que incidan sobre las principales carencias detectadas. A pesar de la amplia variedad de métodos de investigación disponibles para el desarrollo de este tipo de estudios, la práctica de la evaluación de necesidades suele caracterizarse por cierta pobreza metodológica, con un claro predominio de la encuesta como principal o único método de recogida de información. En el presente trabajo, tras realizar una breve revisión de las aproximaciones metodológicas alternativas que es posible adoptar en el ámbito general de la investigación social y la evaluación de programas, se propone un modelo multimétodo de evaluación de necesidades que plantea el uso combinado de técnicas de investigación tanto cuantitativas como cualitativas.Needs assessment is a type of applied social evaluative research, focused on the identification and prioritization of problems in a specific context, as a base for intervention planning oriented to solve the main identified needs. In spite of the huge availability of research methods for the development of this kind of studies, needs assessment practice is too often charaterized by certain methodological poverty, with a clear dominance of the survey as the main or only research method. In the present paper, after a brief revision of the methodological approaches that may be adopted in the general field of social research and programme evaluation, a multimethod needs assessment model is proposed, suggesting the combined use of both qualitative and quantitative research techniques

Good practices in the recovery of ambulation in octogenarian women with hip fractures

p. 1417-1422OBJECTIVE: Determine good recovery practices for ambulation of octogenarian women after hospital discharge after being operated on for hip fracture. METHODS: Prospective study during the second half of 2019, with 192 women (85.95 ± 5.1 years) with hip fracture. A medical history, fracture types, complications, surgical treatment, and assessment of the level of ambulation were recorded before and after six months of hospital discharge. RESULTS: 100 patients lived in the family home and 92 in an institutional center, 68.2% provided pertrochanteric fracture and a total of 3.7 comorbidities, all of them received spinal anesthesia and were admitted an average of 11.4 days. After six months, the patients showed a significant loss of functional independence with respect to the situation prior to the fracture, both for the ability to wander and for activities of daily living. It is noteworthy that the worst prognosis in the recovery of ambulation has to do with intermediate levels of ambulation and that the functional level of departure influences to a lesser extent than the place where they perform the recovery. CONCLUSIONS: Age is a factor that influences the recovery of hip fracture, but there are other influential factors since patients who remain in the family home have a better functional prognosis than those who recover in institutionalized centers, after six months of hospital discharge.S

Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture

p. 7467Introduction: Since delirium is a major complication that can arise after a patient with a hip fracture has been hospitalized, it is considered to be one of the most common geriatric conditions. Therefore, its prevention and early detection are essential for reducing both the length of the patient’s stay in the hospital and complications during the hospitalization process. Objective: To identify and analyze the predictors for developing delirium in octogenarians who were admitted to hospital for a hip fracture. Methodology: A prospective study conducted with a sample of 287 patients aged 80 years and older (mean age 87.2 ± 3.2 years; 215 women, 72 men), recruited from the Trauma Unit of the University Hospital of León (Spain). Further, 71.1% of the patients lived in a family member’s home, while the other 28.9% lived in a nursing home. After observing each patient’s interactions with their doctor in a clinical setting, the data for this study were obtained by reviewing the selected patients’ charts. The variables analyzed were sociodemographic information (age, sex, and place of residence), medical information (type of hip break and surgical intervention), cognitive impairment (MMSE score), functional level (Barthel Index score), and clinical information (pharmacological, comorbidities, complications, and the diagnosis and assessment of the severity of delirium in a patient). The univariate and multivariate logistic regression analysis showed a significant relationship between acute confusional state and the following variables: anemia, American Society of Anesthesiologists (ASA) III and IV patients, state of cognitive frailty and functional level, a urinary tract infection, changes in the visual field, renal arterial occlusion, and the type and dosage of drugs administered (this variable was identified in the multivariate model). The inverse relationship between anemia and acute confusional state is surprising. Conclusion: This research shows that clinical observation of acute confusional state is necessary but not sufficient for addressing this condition early and adequately in older adults who have been hospitalized for a hip fracture.S

Factores predictores del delirium en pacientes octogenarios hospitalizados por fractura de cadera

p. 19-23l delirium es considerado como uno de los grandes síndromes geriátricos por el impacto sobre el comportamiento de los pacientes y el desconcierto y frustración que origina en los profesionales y familiares. Objetivo: identificar y describir los factores predictores del riesgo de desarrollar delirium en pacientes octogenarios hospitalizados con fractura de cadera. Método: estudio de cohorte, prospectivo realizado con una muestra de 287 pacientes (87.2 ± 3.2 años) ortogeriá- tricos reclutados de la Unidad de Traumatología del Hospital Universitario de León (España). Se incluyeron factores predisponentes, precipitantes y de riesgo que incluyen variables sociodemográficas, basales, quirúrgicas, farmacológicas, comorbilidades y complicaciones. Resultados: la presencia de anemia, ASA (en categoría 3-4) deterioro cognitivo, ITU, alteraciones visuales y RAO, por este orden, pueden ser consideradas como variables predictivas del delirium en pacientes octogenarios hospitalizados con fractura de cadera. Conclusión: el tipo de factores predictivos que más impactan en el desarrollo del delirium podrían ser controlados desde el mismo momento de la hospitalización del paciente. Por consiguiente, es posible minimizar el efecto de desconcierto que ocasiona habitualmente el cuadro en pacientes, familiares y sanitarios.S

Cuidados enfermeros en el síndrome confusional agudo en pacientes con fractura de cadera

p. 27-32El síndrome confusional agudo (SCA) o delirium es uno de los trastornos cognitivos más importantes en el anciano, tanto por su prevalencia como por su pronóstico. Objetivo: Identificar variables diagnósticas y de intervención (farmacológicas/ no farmacológicas) en enfermería, implicadas en el SCA en ancianos hospitalizados con diagnóstico de fractura de cadera (FC). Método: se aplicó una búsqueda en inglés, español y portugués de los descriptores clave de la investigación en Medline/Pubmed, Web of Science, Wiley Online Library, COCHRANE, y sciencedirect. También se realizó una búsqueda manual en las referencias de revisiones. Resultados: se identificaron 22 publicaciones en los últimos diez años, en todas ellas se hace referencia a variables clínicas y únicamente en 6 se mencionan variables relacionadas con las buenas prácticas de enfermería. La práctica más común de enfermería está orientada a la administración de fármacos prescritos por el médico, desatendiendo otras medidas relacionadas con el control de variables ambientales y sociales que precipitan a este síndrome en personas mayores. Conclusiones: se hace necesario establecer protocolos de diagnóstico y actuación para el SCA que implementen un papel más activo a la enfermería. Además, en estos protocolos deben incluirse no solo variables clínicas sino también no farmacológicas.S

De la opresión al bienestar. Explorando poder, opresión y bienestar entre inmigrantes marroquíes en España

Durante las últimas décadas, millones de personas han llegado a países de la Unión Europea para mejorar su calidad de vida y la de sus familiares. Las diferentes culturas, mercados y servicios que encuentran en Europa, fomentan en estos nuevos ciudadanos de la Unión Europea expectativas de satisfacción de sus necesidades, reconocimiento justo de sus aportaciones. Sin embargo, frecuentemente los inmigrantes se incorporan a un mercado laboral precario, que les obliga a asentarse en barrios sin acceso a servicios y recursos sociales, fomentando actitudes de rechazo en los vecinos nativos. La incorporación de los inmigrantes se realiza, por tanto, en condiciones asimétricas, que dificultan sus posibilidades para desarrollar su proyecto migratorio. En este contexto, la adaptación de la comunidad inmigrante se configura como uno de los principales desafíos para el presente y futuro de la Unión Europea

Barreiras Socioeconómicas no Acesso à Saúde Materno-Infantil das Mulheres Imigrantes na Área Metropolitana de Lisboa

Este artigo analisa o impacto da crise económica e as reformas no sistema de saúdePortuguês no acesso à saúde materno-infantil e recurso à saúde reprodutiva dasmulheres imigrantes, bem como as estratégias para enfrentar ou minimizar essasdificuldades. Os resultados do estudo mostram um agravamento das barreirassocioeconómicas no acesso e recurso a estes cuidados de saúde das mulheresimigrantes e outros grupos vulneráveis. Face às crescentes limitações que osprofissionais de saúde e outros membros da sociedade civil enfrentam naprestação de cuidados de saúde de qualidade, identifica-se um conjunto deestratégias específicas que tentam superar ou minimizar essas barreiras.Abstract:This paper analyses the impact of the economic crisis and the reforms in thePortuguese health system in the access to maternal and child health and use ofreproductive health of immigrant women, as well as the strategies to cope with orminimise those difficulties. The results of this study show a worsening of the socialand economic barriers in the access to and use of these health care services inimmigrant women and other vulnerable groups. Due to the growing limitationsthat the health care professionals and other members of the society face in theprovision of quality health care services, a set of specific strategies is identified,which can help to overcome and minimise those barriers

Spanish cohort of VEXAS syndrome : clinical manifestations, outcome of treatments and novel evidences about UBA1 mosaicism

The vacuoles, E1-enzyme, X linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease (AID) due to postzygotic UBA1 variants. To investigate the presence of VEXAS syndrome among patients with adult-onset undiagnosed AID. Additional studies evaluated the mosaicism distribution and the circulating cytokines. Gene analyses were performed by both Sanger and amplicon-based deep sequencing. Patients' data were collected from their medical charts. Cytokines were quantified by Luminex. Genetic analyses of enrolled patients (n=42) identified 30 patients carrying UBA1 pathogenic variants, with frequencies compatible for postzygotic variants. All patients were male individuals who presented with a late-onset disease (mean 67.5 years; median 67.0 years) characterised by cutaneous lesions (90%), fever (66.7%), pulmonary manifestations (66.7%) and arthritis (53.3%). Macrocytic anaemia and increased erythrocyte sedimentation rate and ferritin were the most relevant analytical abnormalities. Glucocorticoids ameliorated the inflammatory manifestations, but most patients became glucocorticoid-dependent. Positive responses were obtained when targeting the haematopoietic component of the disease with either decitabine or allogeneic haematopoietic stem cell transplantation. Additional analyses detected the UBA1 variants in both haematopoietic and non-haematopoietic tissues. Finally, analysis of circulating cytokines did not identify inflammatory mediators of the disease. Thirty patients with adult-onset AID were definitively diagnosed with VEXAS syndrome through genetic analyses. Despite minor interindividual differences, their main characteristics were in concordance with previous reports. We detected for the first time the UBA1 mosaicism in non-haematopoietic tissue, which questions the previous concept of myeloid-restricted mosaicism and may have conceptual consequences for the disease mechanisms