The influence of health care providers’ emotions on clinical judgment regarding diagnosis of the terminally ill

In Spain, the dying process is sometimes described as «bad» or even «awful». There are many reasons for this situation, the most important being the difficulties health care professionals have to face with death and their lack of ability to help and assist patients to go through the dying process. The influence of the current cultural context regarding death and the way people die is paired with other factors. These factors are both clinical and professional in nature such as for example: the moment of diagnosis of a terminally ill patient that entails important emotional implications for the health care professionals, the patient and their family. All these factors have a direct influence on the health care assistance. We conducted Grounded Theory-based, phenomenological, qualitative research using a final sample of 42 indepth interviews with doctors and nurses from different fields in Granada (Spain) in order to understand their point of view, as health care providers, on the assistance given to terminally ill patients. The results were analysed with Atlas-tí software using thematic coding. The results show the effect the emotional factor has on the clinical judgment of health care professionals and support the need for broader and more comprehensive study. En España, el proceso de morir se describe con frecuencia como «malo» o incluso como «muy malo». Entre los motivos, destacan las dificultades de los profesionales de la salud para afrontar la muerte y para asistir y acompañar en el proceso de morir a sus enfermos. A la influencia del contexto cultural actual en cuanto al sentido de la muerte y al modo de morir, se unen situaciones de carácter clínico y profesional como el momento del diagnóstico de una enfermedad terminal, con importantes implicaciones emocionales para el profesional, el enfermo y la familia, y un efecto directo en la respuesta asistencial a la situación. Planteamos un estudio cualitativo de tipo fenomenológico, fundamentado en la Grounded Theory, sobre una muestra final de 42 entrevistas en profundidad a médicos y enfermeros de diferentes ámbitos asistenciales de la provincia de Granada (España), para conocer, en su propio contexto, el punto de vista de los profesionales implicados en la atención al enfermo terminal. Los datos se analizaron con el software ATLAS.tí siguiendo una codificación temática. Los resultados muestran el efecto que el factor emocional tiene en el juicio clínico del profesional y justifican la necesidad de ampliar y profundizar en su estudio

Human papillomavirus detection in women with and without human immunodeficiency virus infection in Colombia

Background: HIV infection leads to a decreasing immune response, thereby facilitating the appearance of other infections, one of the most important ones being HPV. However, studies are needed for determining associations between immunodeficiency caused by HIV and/or the presence of HPV during the course of cervical lesions and their degree of malignancy. This study describes the cytological findings revealed by the Papanicolaou test, laboratory characteristics and HPV molecular profile in women with and without HIV infection. Methods: A total of 216 HIV-positive and 1,159 HIV-negative women were invited to participate in the study; PCR was used for the molecular detection of HPV in cervical samples. Statistical analysis (such as percentages, Chi-square test and Fisher's exact test when applicable) determined human papillomavirus (HPV) infection frequency (single and multiple) and the distribution of six types of high-risk-HPV in women with and without HIV infection. Likewise, a logistic regression model was run to evaluate the relationship between HIV-HPV infection and different risk factors. Results: An association was found between the frequency of HPV infection and infection involving 2 or more HPV types (also known as multiple HPV infection) in HIV-positive women (69.0% and 54.2%, respectively); such frequency was greater than that found in HIV-negative women (44.3% and 22.7%, respectively). Statistically significant differences were observed between both groups (p = 0.001) regarding HPV presence (both in infection and multiple HPV infection). HPV-16 was the most prevalent type in the population being studied (p = 0.001); other viral types had variable distribution in both groups (HIV-positive and HIV-negative). HPV detection was associated with <500 cell/mm(3) CD4-count (p = 0.004) and higher HIV-viral-load (p = 0.001). HPV-DNA detection, <200 cell/mm(3) CD4-count (p = 0.001), and higher HIV-viral-load (p = 0.001) were associated with abnormal cytological findings. Conclusions: The HIV-1 positive population in this study had high multiple HPV infection prevalence. The results for this population group also suggested a greater association between HPV-DNA presence and cytological findings. HPV detection, together with low CD4 count, could represent useful tools for identifying HIV-positive women at risk of developing cervical lesions.This project was supported by the Basque Cooperation Agency Development and by the Spanish Agency for International Development Cooperation (AECID) (Project 10-CAP1-0197)

Influencia de las emociones en el juicio clínico de los profesionales de la salud a propósito del diagnóstico de enfermedad terminal

En España, el proceso de morir se describe con frecuencia como «malo» o incluso como «muy malo». Entre los motivos, destacan las dificultades de los profesionales de la salud para afrontar la muerte y para asistir y acompañar en el proceso de morir a sus enfermos. A la influencia del contexto cultural actual en cuanto al sentido de la muerte y al modo de morir, se unen situaciones de carácter clínico y profesional como el momento del diagnóstico de una enfermedad terminal, con importantes implicaciones emocionales para el profesional, el enfermo y la familia, y un efecto directo en la respuesta asistencial a la situación. Planteamos un estudio cualitativo de tipo fenomenológico, fundamentado en la Grounded Theory, sobre una muestra final de 42 entrevistas en profundidad a médicos y enfermeros de diferentes ámbitos asistenciales de la provincia de Granada (España), para conocer, en su propio contexto, el punto de vista de los profesionales implicados en la atención al enfermo terminal. Los datos se analizaron con el software ATLAS.tí siguiendo una codificación temática. Los resultados muestran el efecto que el factor emocional tiene en el juicio clínico del profesional y justifican la necesidad de ampliar y profundizar en su estudio.In Spain, the dying process is sometimes described as «bad» or even «awful». There are many reasons for this situation, the most important being the difficulties health care professionals have to face with death and their lack of ability to help and assist patients to go through the dying process. The influence of the current cultural context regarding death and the way people die is paired with other factors. These factors are both clinical and professional in nature such as for example: the moment of diagnosis of a terminally ill patient that entails important emotional implications for the health care professionals, the patient and their family. All these factors have a direct influence on the health care assistance. We conducted Grounded Theory-based, phenomenological, qualitative research using a final sample of 42 indepth interviews with doctors and nurses from different fields in Granada (Spain) in order to understand their point of view, as health care providers, on the assistance given to terminally ill patients. The results were analysed with Atlas-tí software using thematic coding. The results show the effect the emotional factor has on the clinical judgment of health care professionals and support the need for broader and more comprehensive study.Este trabajo se ha financiado con ayudas del Fondo de Investigación Sanitaria (PI030495) y del Departamento de Enfermería de la Universidad de Granada

The commensal bacterium Lactiplantibacillus plantarum imprints innate memory-like responses in mononuclear phagocytes

Gut microbiota is a constant source of antigens and stimuli to which the resident immune system has developed tolerance. However, the mechanisms by which mononuclear phagocytes, specifically monocytes/macrophages, cope with these usually pro-inflammatory signals are poorly understood. Here, we show that innate immune memory promotes anti-inflammatory homeostasis, using as model strains of the commensal bacterium Lactiplantibacillus plantarum. Priming of monocytes/macrophages with bacteria, especially in its live form, enhances bacterial intracellular survival and decreases the release of pro-inflammatory signals to the environment, with lower production of TNF and higher levels of IL-10. Analysis of the transcriptomic landscape of these cells shows downregulation of pathways associated with the production of reactive oxygen species (ROS) and the release of cytokines, chemokines and antimicrobial peptides. Indeed, the induction of ROS prevents memory-induced bacterial survival. In addition, there is a dysregulation in gene expression of several metabolic pathways leading to decreased glycolytic and respiratory rates in memory cells. These data support commensal microbe-specific metabolic changes in innate immune memory cells that might contribute to homeostasis in the gut.Supported by grants from the Spanish Ministry of Science, Innovation and Universities (MCIU) co-financed with FEDER funds (RTI2018-096494-B-100 to JA; BFU2016-76872-R to EB; AGL2017-86757-R to LA; SAF2015-73549-JIN to HR; SAF2016–77433-R and PID2019-110240RB-I00 to RPR). AP is supported by a Postdoctoral Fellowship from the Basque Government. DB and TMM are recipients of MCIU FPI fellowships. APC is a recipient of a fellowship from the University of the Basque Country. LA and RPR are supported by the Ramon y Cajal program from the Spanish Ministry of Economy and Competitiveness. We thank the MCIU for the Severo Ochoa Excellence accreditation (SEV-2016-0644), the Basque Department of Industry, Tourism and Trade (Etortek and Elkartek programs) and the Innovation Technology Department of the Bizkaia Province. This work was further supported by grants from the Jesús de Gangoiti Barrera Foundation.Peer reviewe

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

Searching for a cross-cultural definition of suffering; a bibliographic review

INTRODUCCIÓN; ¿Podríamos ofrecer una definición de sufrimiento que no esté sujeta a nuestra propia subjetividad? La intención de la presente revisión bibliográfica es ofrecer una definición lo más completa de sufrimiento, siendo secundaria la cuestión de su medición. MÉTODOS; Se revisaron las bases de datos de lengua inglesa Medline, Proquest y Scopus. y se seleccionaron 30 artículos. RESULTADOS; La mayoría los autores que abogan por la complementariedad de dolor/síntoma y sufrimiento. La definición de mayor calado en la literatura científica es la de E. Cassell; Estado de severo estrés asociado con eventos amenazantes para la integridad de la persona. El sufrimiento de una persona está condicionado por la sociedad y la cultura. Existen tres tipos de estrategias para detectar y/o medir el sufrimiento; práctica clínica, investigación cualitativa y cuantitativa. DISCUSIÓN; Es necesario profundizar en el concepto de sufrimiento con el fin de hallar una definición transcultural que contemple aspectos individuales y socio-culturales. No se han encontrado instrumentos que midan la de forma objetiva la intensidad del sufrimiento. La experiencia del sufrimiento es totalmente subjetiva.Introduction: Could we offer a definition of suffering free from our own subjectivity? The aim of the current bibliographic review is to offer a definition of suffering, leaving its measurement aside as a secondary matter. Methods: Medline, Proquest and Scopus databases in English were reviewed and 30 articles were selected. Results: Most authors support the complementarity of pain/symptom and suffering. The definition offered by E. Cassell is the most broadly cited in the literature: “Severe stress state associated with threatening events for personal integrity. The suffering of a person is conditioned by society and culture. There are three types of strategies in order to detect and/or measure suffering: Clinical practice, qualitative and quantitative research. Discussion: It is necessary to go deeper in the concept of suffering in order to find a cross – cultural definition which takes into account individual and socio – cultural aspects. Instruments for the objective measure of the intensity of suffering have not been found. Suffering is a subjective experience

Bad news for the patient and the family? The worst thing for the health care professional

In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenological, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news

Terminal illness, death... in the words of professionals. A qualitative study based on in-depth interviews with health professionals (Second study).

This article is the second part of an interesting qualitative research project which presents and interprets opinions made by diverse medical and nursing professionals regarding care provided to terminal patients and relationships with patients' relatives

Human papillomavirus detection in women with and without human immunodeficiency virus infection in Colombia

Background: HIV infection leads to a decreasing immune response, thereby facilitating the appearance of other infections, one of the most important ones being HPV. However, studies are needed for determining associations between immunodeficiency caused by HIV and/or the presence of HPV during the course of cervical lesions and their degree of malignancy. This study describes the cytological findings revealed by the Papanicolaou test, laboratory characteristics and HPV molecular profile in women with and without HIV infection.Methods: A total of 216 HIV-positive and 1,159 HIV-negative women were invited to participate in the study; PCR was used for the molecular detection of HPV in cervical samples. Statistical analysis (such as percentages, Chi-square test and Fisher's exact test when applicable) determined human papillomavirus (HPV) infection frequency (single and multiple) and the distribution of six types of high-risk-HPV in women with and without HIV infection. Likewise, a logistic regression model was run to evaluate the relationship between HIV-HPV infection and different risk factors.Results: An association was found between the frequency of HPV infection and infection involving 2 or more HPV types (also known as multiple HPV infection) in HIV-positive women (69.0% and 54.2%, respectively); such frequency was greater than that found in HIV-negative women (44.3% and 22.7%, respectively). Statistically significant differences were observed between both groups (p = 0.001) regarding HPV presence (both in infection and multiple HPV infection). HPV-16 was the most prevalent type in the population being studied (p = 0.001); other viral types had variable distribution in both groups (HIV-positive and HIV-negative). HPV detection was associated with &lt;500 cell/mm3 CD4-count (p = 0.004) and higher HIV-viral-load (p = 0.001). HPV-DNA detection, &lt;200 cell/mm3 CD4-count (p = 0.001), and higher HIV-viral-load (p = 0.001) were associated with abnormal cytological findings.Conclusions: The HIV-1 positive population in this study had high multiple HPV infection prevalence. The results for this population group also suggested a greater association between HPV-DNA presence and cytological findings. HPV detection, together with low CD4 count, could represent useful tools for identifying HIV-positive women at risk of developing cervical lesions. © 2014 Camargo et al.; licensee BioMed Central Ltd

The mitochondrial negative regulator MCJ modulates the interplay between microbiota and the host during ulcerative colitis

Recent evidences indicate that mitochondrial genes and function are decreased in active ulcerative colitis (UC) patients, in particular, the activity of Complex I of the electron transport chain is heavily compromised. MCJ is a mitochondrial inner membrane protein identified as a natural inhibitor of respiratory chain Complex I. The induction of experimental colitis in MCJ-deficient mice leads to the upregulation of Timp3 expression resulting in the inhibition of TACE activity that likely inhibits Tnf and Tnfr1 shedding from the cell membrane in the colon. MCJ-deficient mice also show higher expression of Myd88 and Tlr9, proinflammatory genes and disease severity. Interestingly, the absence of MCJ resulted in distinct microbiota metabolism and composition, including a member of the gut community in UC patients, Ruminococcus gnavus. These changes provoked an effect on IgA levels. Gene expression analyses in UC patients showed decreased levels of MCJ and higher expression of TIMP3, suggesting a relevant role of mitochondrial genes and function among active UC. The MCJ deficiency disturbs the regulatory relationship between the host mitochondria and microbiota affecting disease severity. Our results indicate that mitochondria function may be an important factor in the pathogenesis. All together support the importance of MCJ regulation during UC.This work was supported by grants [AGL2017-86757-R to LA, SAF2015-65327-R to JA, AGL2017-89055-R to CS and VGC, SAF2016-77433-R to RPR] from the Spanish Ministry of Economy and Competitiveness co financed with FEDER funds, the XIII Grant from GETECCU-Otsuka (Grupo Español de Trabajo en Enfermedad de Crohn y Colitis ulcerosa to LA) and Basque Government project for health [number 2015111117 to LA]. LA and RP-R are Ramón y Cajal fellows [RYC-2013-13666] from the Spanish Ministry of Economy and Competitiveness. RP-R is supported in part by National Institute of Health [grant AI115091]. APC is a fellow of the University of the Basque Country (UPV/EHU), DB from FPI program of the Spanish Ministry of Economy and Competitiveness, and AC and AP from the Basque Government. CIC bioGUNE support was provided by the Basque Department of Industry, Tourism and Trade (Etortek and Elkartek Programs), the Innovation Technology Department of Bizkaia County, and Spanish MINECO the Severo Ochoa Excellence Accreditation [SEV-2016-0644].Peer reviewe