Care for pregnant illegal immigrants by the multidisciplinary out-of-hospital team

In recent years there has been an increase in the immigrant population, especially among pregnant African women who generally arrive on our coastlines on pateras (a Spanish word used to describe a small boat used by immigrants to cross the Mediterranean). This impacts on the professionals who care for women during childbirth, and for this reason we need a wide range of knowledge to improve the care of this vulnerable group. OBJECTIVES: Develop an action protocol for the multidisciplinary out-of-hospital team for the comprehensive care of pregnant woman who arrive illegally on pateras. Comprehensively assess other actions relevant to this emergency through scientific publications in addition to childbirth care in a multicultural environment. METHOD: An exhaustive systematic bibliographical review of the last eight years was carried out, in Pubmed, in physical libraries, by way of recommendations of the WHO and protocols. Compilation of journals by SciELO, where there are references relating to Italy. RESULTS: They found an abundance of these boats in Andalusia. Extensive out-of-hospital medical deployment and expertise is required to offer quality care until their transfer to hospital. After the analysis we verified the need to develop a protocol for childbirth care, due to the fact that there are no basic care protocols in this environment. CONCLUSION: Given their sociocultural differences, there is a need to individualise the care. Therefore, it is very important to make the intervention team aware of the required tools and skills, in addition to expanding future research with relevant examples in Europe

Grupos de edad, menarquia y regularidad de los ciclos menstruales como predictores de eficacia en el tratamiento de sobrepeso

Objective: To evaluate if there is a relation between age groups, menarche, menstrual cycles and previous pregnancies with the success of weight loss in obese patients at a nutrition clinic. Methods: A clinical intervention study was conducted among overweight and obese patients who consulted a nutrition clinic in Barranquilla (Colombia) for the purpose of nutritional assessment. They were subject to a personalized weekly follow-up consultation over the course of 16 weeks in which food consumption patterns, anthropometric measures, body image and self-perception were registered. Results: A total of 135 patients were evaluated. 41 (30,4%) of whom did not complete the study. 69,6% patients did lose weight and 83,7% did lose waist. These losses are lower in older ages (95,5% at 45years group; p=0,009), weight loss percentage (7,3(4,3SD)% vs. 3,8(2,1SD)%, p=0,013), waist loss percentage (8,8(4,1SD)% vs. 5,8(2.5SD)%, p=0,005) and hip loss percentage (5,4(3,8SD)% vs. 3,5(2,6SD)%, p=0,040). Age influence is confirmed by multivariate analysis with no considerable differences observed in relation to menarche, menstrual cycle regularity and previous pregnancy in success distribution. Influence of initial BMI is ≥5% among obese women, with an OR=3,9 (1,2 to 12,8, 95% CI) (p=0,026). Conclusion: Based on these results, age groups and initial BMI are regarded as influential factors in the successful outcome of treatment in overweight and obese patients.Objetivo: Evaluar si existe una relación entre los grupos de edad, la menarquia, ciclos menstruales y embarazos previos con el éxito en la pérdida de peso en pacientes obesos en una clínica de nutrición. Métodos: Se ha llevado a cabo un estudio entre pacientes con sobrepeso y obesidad que acudieron a una clínica de nutrición en la ciudad de Barranquilla (Colombia) con el fin de recibir un tratamiento nutricional. A todos los pacientes se les realizó un tratamiento nutricional semanal personalizado por 16 semanas continuas en los que se registraron los patrones de consumo de alimentos, medidas antropométricas, la imagen corporal y la auto-percepción. Resultados: Se evaluaron un total de 135 pacientes. 41 (30,4%) de los cuales no completaron el estudio. 69,6% perdieron peso y 83,7% perdieron cintura. Estas pérdidas son menores en edades más avanzadas (95,5% 45 años, p=0,009), en el porcentaje de pérdida de peso (7,3%(4,3DS) vs 3,8% (2,1DS), p=0,013), en el porcentaje de pérdida de cintura (8,8%(4,1DS) vs 5,8%(2,5DS), p=0,005) y en el porcentaje de pérdida de cadera (5,4%(3,8DS) vs 3,5%(2,6DS), p=0,040). La Influencia de la edad es confirmada por el análisis multivariante, no apreciándose diferencias considerables en relación con la menarquia, la regularidad del ciclo menstrual y embarazo previos en la distribución de éxito. La influencia del IMC inicial es ≥5% entre las mujeres obesas, con un de OR=3,9 (1,2 a 12,8, IC del 95%) (p=0,026). Conclusión: Basados en los resultados, los grupos de edad y el IMC inicial son considerados como factores influyentes en el éxito del tratamiento en pacientes con sobrepeso y obesidad

Attendance and response to treatment for overweight and obesity in a Barranquilla (Colombia) population

Objetivo: Evaluar la respuesta al tratamiento según sexo en una consulta de nutrición por sobrepeso y obesidad. Métodos: Se realiza un estudio clínico entre pacientes de un centro médico nutricional en tratamiento estético de sobrepeso y obesidad, realizado mediante valoración y tratamiento médico nutricional por seguimiento continuo semanal y personalizado durante 16 semanas, basado en su consumo habitual de alimentos, adecuación de la cantidad de alimentos y percepción de su estado de salud y bajada de peso. Resultados: De la muestra inicial de 271 pacientes que acudieron a consulta para bajar de peso y mejorar su imagen corporal (233♀/ 38♂) se excluyeron a 100 pacientes (98♀ y 2♂) por encontrase en normopeso (IMC<25) (test Chi2 p<0.001, OR=0,08; IC 95% 0,01-0,32 de únicamente razones de estética de los hombres frente a las mujeres). De los 171 pacientes con sobrepeso u obesidad, siguieron el tratamiento 155 (122♀ y 33♂), con un 68,4% de éxito en la pérdida de peso y cintura, no encontrándose diferencias estadísticas entre sexos. La pérdida de peso en los pacientes que han seguido el tratamiento es mayor en hombres que en mujeres (6,2% (4,2DE) frente a 4,6% (3,8DE), p=0,026); observándose un mayor descenso de IMC en hombres que en mujeres (2,0 kg/m2(1,5DE) frente a 1,4kg/m2(1,1DE) p=0,009); y mayor porcentaje en pérdida cintura (8,1%(4,6DE) frente a 6,2%(3,8DE), p=0,018); no siendo significativa la diferencia de porcentaje de pérdida cadera. En el análisis de correlación logística multinomial se ha encontrado que el único factor condicionante significativamente (p<0,001) en el éxito de pérdida de peso es de forma inversa la edad; es decir, que hay más fracasos a mayor edad, no teniendo influencia ni el grupo de IMC ni el sexo. Conclusión: La asistencia por razones de estética corporal a la consulta de tratamiento de sobrepeso u obesidad es mayor en mujeres que en hombres, siendo la adherencia al tratamiento igual en ambos sexos. Sin embargo, los hombres obtienen mayores pérdidas que las mujeres. La edad condiciona de forma inversa el éxito en el tratamiento.Objective: To evaluate the genre treatment results at a nutrition clinic for overweight and obesity. Methods: A clinical study was conducted among overweight and obese patients who consulted a nutrition clinic for the purpose of nutritional assessment, subject to a personalized weekly follow-up consultation over the course of 16 weeks in which food consumption patterns, body image and weight decreasing. Results: Women attend more than men (233 versus 38); a total of 271 patients were evaluated, discarding 98 women and 2 men because normal weight (Chi2 test p<0.001, OR=0.08, 95%CI 0.01 to 0.32 for aesthetic reasons by gender). 171 patients followed the treatment, 155 (122 women and 33 men), with a 68.4 % success in weight and waist loss and with no statistical difference between genders. Weight loss in patients who have followed the treatment is higher in men than in women (6.2% (4.2SD) versus 4.6% (3.8SD), p=0.026); greater BMI decrease in men than in women (2.0kg/m2 (1.4SD) versus 1.0kg/m2 (1.1SD) p=0.009); and higher waist loss percentage (8.1% (4.6SD) versus 6.2% (3.8SD), p=0.018); being no significant difference in hip loss percentage. By multinomial logistic analysis correlation the only determining significantly factor (p<0.001) in weight loss success is inversely age; so there are more older age failures with no BMI group or gender influence. Conclusion: Based on these results, women attend more for aesthetic reasons than men, with equal treatment adherence in both sexes. However, men get higher losses than women. Age conditions inversely treatment success

Effectiveness of telenutrition in a women’s weight loss program

Objective. The objective of this study is to evaluate the effectiveness of telenutrition versus traditional nutritional consultations for female obese patients in need of nutritional treatment. Methods. A comparative clinical study was conducted among 233 obese or overweight women (including 20 who dropped out and 60 who failed) who consulted a nutrition clinic in Barranquilla (Colombia) for nutritional assessment and chose either telenutrition or a traditional consultation that included a weekly follow-up consultation over 16 weeks, food consumption patterns, Body Mass Index (BMI, kg/m2) registeration and waist and hip circumference registeration. Treatment responses and differences between telenutrition and the traditional consultations were made according to BMI, waist, hip and initial-waist/height ratio (iWaist), calculating for the relative risk. Results. In 68 (29.2%) women who chose traditional attention, 9 (37.5%) dropped out, 24 (40%) failed and 35 (23.5%) were successful, showing 1.4% (1.0 SD) BMI loss, 5.8% (3.4 SD) in waist circumference, 4.5% (2.8 SD) in hip circumference and 0.04% (0.02 SD) in iWaist/height ratio. In 165 (70.8%) women who chose telenutrition, 15 (62.5%) dropped out, 36 (60%) failed and 114 (76.5%) were successful, showing 1.1% (1.0 SD) BMI loss, 5.0% (3.2 SD) in waist circumference, 3.5% (3.1 SD) in hip circumference and 0.03% (0.02 SD) in iWaist/height ratio. A significance level of p < 0.05 is considered. Conclusion. Telenutrition has a failure or dropout risk factor of about half of the value of traditional consultation, and showed slight, statistically significant differences. This study concludes that telenutrition can support or sometimes replace traditional consultations when developing weight loss programs for obese women

Adherence to an overweight and obesity treatment: how to motivate a patient?

Objective. To explore anthropometric changes in normal-weight, overweight and obese subjects who did not dropout or fail a weight loss program over the 16 treatment weeks to improve patient motivation and treatment adherence. Methods. A clinical intervention study was conducted among 271 (including 100 dropouts and/or failures) obese and overweight patients who consulted a nutrition clinic in Barranquilla (Colombia) for the purpose of nutritional assessment. They were subject to a personalized weekly follow-up consultation over the course of 16 weeks in which initial and the final Body Mass Index (BMI, kg/m2), photographs, food consumption patterns, percentage weight loss, waist and hip circumference were registered and grouped according to BMI, measuring treatment response. Data’s nonparametric statistical comparison was made. Results. In 62 patients from the BMI 30 group, there is weight loss of 4.8% (3.7 SD), 7.0% (3.6 SD) in waist circumference loss and 3.9% (2.4 SD) in hip circumference loss. Monitoring is done every 4 weeks by the Friedman test, with significant differences between the three groups (p < 0.001). Patients do not drop out of treatment because they start to see physical results in waist decrease. When comparing final values of initial waist/hip circumference ratios and waist/height ratios, a clear decrease in the three BMI groups was observed (p < 0.001). Conclusion. After three weeks of continuous treatment patients improved in all overweight and obesity parameter indicators; there were not statistically significant differences in hip circumference (HC) and waist loss (WC) (%) among the three BMI groups (normal-weight, overweight, and obesity). In contrast, there were statistically significant differences in weight loss (%) and waist-to-hip ratios. Based on anthropometric outcomes and patient perception of their body image it can be concluded that the waist circumference loss is the parameter that retains obese patients in the weight loss program

Social Classes, Level of Education, Marital Status, Alcohol and Tobacco Consumption as Predictors in a Successful Treatment of Obesity

Objective: To evaluate if there is a relation between social classes, level of education, marital status, alcohol and tobacco consumption with the success of weight loss in obese patients at a nutrition clinic. Methods: A clinical intervention study was conducted among overweight and obese patients who consulted a nutrition clinic in Barranquilla (Colombia) for the purpose of nutritional assessment. They were subject to a personalized weekly follow-up consultation over the course of 16 weeks in which food consumption patterns, body image and self-perception were registered. Results: A total of 271 patients were evaluated. 27 (10%) of whom did not complete the study. 244 (90%) patients followed the treatment, 70 (28,7%) didn't lose weight, considering them failures and 174 (71,3%) did lose weight. No considerable differences were observed in relation to social classes, level of education, marital status, alcohol and tobacco consumption in failure-success distribution. Conclusion: Based on these results, social classes, level of education, marital status, alcohol and tobacco consumption are not regarded as influential factors in the successful outcome of treatment in overweight and obese patients

Predictors of weight loss and fat in the dietary management: sex, age, BMI and consulting assistance

%WL: porcentaje de pérdida de peso; %FL: porcentaje de pérdida de grasa; PNLWF: pacientes que pierden peso o grasa; PLWF: pacientes que pierden peso y grasa. Objetivo: evaluar si el %WL y el %FL en el tratamiento dietético, se vieron afectados por el género, la edad, el IMC y la asistencia a la consulta. Método: 4.700 consultas, 670 pacientes (IMC ≥ 25), en el sur-este de España (2006-12). Se utilizó la dieta equilibrada e hipocalórica. Dos tipos de pacientes: PNLWF y PLWF (91,9%). Resultados: en los PLWF, los hombres y los que asisten en mayor número de ocasiones a la consulta han mostrado una mayor pérdida, frente a las mujeres (%FL: 23,0 vs 14,3%, p = 0,000; %WL: 7,7 vs 6,6%, p = 0,020), y los que asisten con menor frecuencia (%FL: 19,1 vs 7,3%, p = 0,000; %WL: 7,8 vs 2,9%, p = 0,000). El análisis de regresión multinomial (PNLWF/ PLWF) indica que solo el asistir a más de mes y medio a la consulta es un factor que influye en la pérdida, OR 8,3 (IC 95% 4,5-15,1; p = 0,000). Conclusión: la medición de la grasa corporal proporciona una información adicional al peso perdido; la mayoría de los pacientes que asisten más de mes y medio obtienen un elevado %FL; la asistencia es un factor predictor de la pérdida; el %FL indica que el tratamiento dietético juega un papel principal en la resolución de esta patología; se recomienda diseñar esquemas prácticos del proceso de actuación de los nutricionistas en función del IMCi y el variable.WL%: percentage of weight loss; % FL: percentage fat loss; PNLWF: patients who lose weight or fat; PLWF: patients who lose weight and fat. Objective: assess whether the% WL and FL% in the dietary treatment was affected by gender, age, BMI and assistance to the query. Method: 4,700 consultations, 670 patients (BMI ≥ 25), in the south-east of Spain (2006-12). Balanced and hypo-caloric diet was used. Two types of patients: PNLWF and PLWF (91.9%). Results: in PLWF, men and those attending a greater number of occasions to the consultation have shown a greater loss against women (%FL: 23.0 vs 14.3%, p = 0.000; %WL: 7.7 vs 6.6%, p = 0.020), and those who attend less frequently (%FL: 19.1 vs 7.3%, p = 0.000; %WL: 7.8 vs 2.9%, p = 0.000). Multinomial regression analysis (PNLWF / PLWF) indicates that only attend more than one and a half to the consultation is a factor in the loss, OR 8.3 (IC 95% 4.5-15.1; p = 0.000). Conclusion: the body fat measurement provides additional information lost weight; Most patients attend more than six weeks, obtained a high %FL; attendance is a predictor of loss; the %FL indicates that the dietary management plays a major role in the resolution of this pathology; It is recommended to design practical schemes of action process nutritionists according to the IMCI and variable

Indicadores de éxito en el tratamiento dietético del sobrepeso y la obesidad: pérdida de peso, grasa corporal y calidad de pérdida

Concepts: %WL: Percentage of weight loss; %FL: Percentage of fat loss. Objective: evaluate which unit of measurement for weight loss could determine the success or failure of dietary treatment for overweight and obesity. Method: 4,625 consultations carried out on 616 patients in the southeast of Spain from 2006 to 2012. All of the patients were over 25 years of age and suffered from overweight or obesity. The consultations were carried out every fortnight, using the Mediterranean or low-calorie diet. The patients were divided into four groups according to their %WL and %FL. Results: most of the sample consisted of: women; participants between 25-45 years of age; attended consultations for over a month and a half; obese. 80% of the patients obtained a %FL ≥ 5% (15.5 ± 12.8). The groups with a higher %FL obtained significant differences in weight loss (22.6 vs 11.2%, p = 0.000). The multinomial analysis shows significant differences between the groups with the highest %FL and the lowest %WL and %FL: sex (p = 0.006 vs p = 0.005), BMI (p = 0.010 vs p = 0.003) and attendance (p = 0.000 vs p = 0.000). Conclusion: the patients who lost < 5% of fat had higher initial parameters (percentage of weight and fat); most of the sample lost ≥ 5% of fat. This means that the method of personalised dietary treatment results in a high fat loss; fat is an indicator of the quality loss obtained. Recommendations: use the measurement of fat as a complementary unit of measurement to weight loss; establish a limit of 5% to evaluate such loss; and increase this type of research in any method of weight loss.Conceptos: %WL: Porcentaje de pérdida de peso; %FL: Percentage of fat loss. Objetivo: evaluar qué unidad de medida en la pérdida podría determinar el éxito o fracaso del tratamiento dietético en el sobrepeso y obesidad. Método: 4.625 consultas se llevaron a cabo con 616 pacientes mayores de 25 años con sobrepeso y obesidad, en el sur-este de España, durante los años 2006-12. Las consultas se realizaban quincenalmente, se utilizó la dieta mediterránea e hipo-calórica. Se formaron cuatro grupos en función del menor o mayor %WL y %FL. Resultados: la mayoría de la muestra está formada por: mujeres; participantes entre 25-45 años; asistentes a más de mes y medio; obesos. El 80% de los pacientes obtienen un %FL ≥ 5% (15,5±12,8). Los grupos con mayor %FL obtiene diferencias significativas en la pérdida (22,6 vs 11,2%, p=0,000). El análisis multinomial, destaca diferencias significativas cuando se compara los grupos de mayor %FL con el menor %WL y %FL: en el sexo (p=0.006 vs p=0.005), IMC (p=0.010 vs p=0.003) y asistencia (p=0.000 vs p=0.000). Conclusión: los pacientes que pierden < 5% de grasa, muestran parámetros iniciales mayores (Porcentaje de peso y grasa); la mayoría de la muestra pierde ≥ 5% de grasa, por lo que el tratamiento dietético individualizado es un método que obtiene una elevada pérdida de grasa; la grasa es un indicador de la calidad de la pérdida obtenida. Se recomienda: la medición de la grasa como unidad de medida complementaria al peso; establecer el límite del 5% para evaluar dicha pérdida; y aumentar la investigación en esta línea en cualquier método de pérdida

Theoretical approach to the satisfaction of international adoption children needs from the nurse's point of view

Los niños de adopción internacional presentan problemas de salud consecuencia de la exposición a factores de riesgo e institucionalización, que no ofrece las condiciones necesarias para satisfacer sus necesidades. El objetivo del trabajo es sustentar teóricamente la satisfacción de las necesidades de los niños adoptados desde la perspectiva enfermera, tomando como referencia teorías de diferentes disciplinas. Desde el metaparadigma enfermero, la persona es el niño adoptado y su familia, la salud se analiza desde la Teoría de las Necesidades Infantiles de Ochaita y Espinosa, el entorno desde la Teoría Ecológica del Desarrollo Humano de Bronfenbrenner y el cuidado desde la Teoría de la Necesidades de Henderson.The Internationally Adoption children have health problems due to the exposure to risk factors and institutionalization, which does not provide the necessary conditions to satisfy their needs. This work aims to theoretically sustain the satisfaction of adopted children's needs from the nurse's perspective, reffering to theories of different disciplines. From the nursing metaparadigm, the adopted child and his family are the persons, health is analyzed from the Ochaita and Espinosa's Theory of Needs Children's point of view, the environment from the Ecological Theory of Human Development from Bronfenbrenner, and the care is analyzed Theory of Needs Henderson

Impact of paid work on the academic performance of nursing students

Background. Little research exists on the impact of paid work on academic performance of students of health sciences. No research exists on this subject for students in Colombia. Objectives. This paper seeks to analyze the impact of paid work on academic performance among nursing students. Design, settings and participants: cross-sectional research, involving 430 of nursing students from the National University of Colombia (N = 566). Methods. Variables analyzed: sex, age, work activity, attendance, current semester, degree subjects studied and unavailable, lost credits, grades during the second semester of 2013, and delayed semesters. Subgroups analyzed: (i) according to labor activity: do not work, work up to 20 h and work more than 20 h per week; (ii) Grade point average: failing is considered as less than 3.0 and passing 3.0 or above out of 5.0. Percentage of delayed semesters were calculated. Qualitative and quantitative variables were analyzed for groups by work activity. The percentage and probability of students getting a grade point average less than 3.0 and delaying semesters were calculated by multivariate logistic regression. Results. A total of 219 of the students work (50.9%), the main reason is socioeconomic, of which 99 (45.2%) work more than 20 h per week and have an increased risk of failing, which is higher in the first semester. They also get lower grades, lose more credits and take longer to finish the degree. The logistic bivariate regressions of success (grade point average, credits gained, courses gained and not having delayed semesters) reduce with work, above all in those who work more than 20 h per week and increase as the number of semesters completed increases, independent of sex. Conclusion. A high percentage of nursing students work more than 20 h per week. The compatibility of paid work with studies in university nursing students has a negative impact on academic performance, more so when they work more than 20 h per week. This negative impact diminishes as the student completes semesters, irrespective of the sex of the students