Gestational weight gain and its association with perinatal complications: An integrative review

Premio extraordinario de Trabajo Fin de Máster curso 2019/2020. Máster en Nutrición HumanaAntecedentes. La prevalencia de obesidad y la ganancia de peso gestacional (GPG) están aumentando a nivel mundial. La gestación es un periodo de gran vulnerabilidad, por lo que garantizar que las mujeres presenten unas condiciones de salud adecuadas es fundamental para la consecución de un embarazo satisfactorio. En 2009, el Instituto de Medicina (IOM) estableció unas recomendaciones sobre las ganancias óptimas en base al peso pregestacional. Objetivos. Conocer la evidencia disponible de la relación existente entre la ganancia ponderal durante la gestación y los resultados adversos perinatales. Método. Se realizó una Revisión Integrativa en la que se incluyeron artículos e informes sobre las complicaciones perinatales asociadas a la ganancia inadecuada de peso durante la gestación, tanto por déficit como por exceso. La búsqueda se llevó a cabo en el primer semestre de 2020, utilizando las bases de datos PubMed, Scopus y CINAHL. Se incluyeron los artículos publicados en Inglés y Castellano en los últimos 10 años. Los resultados primarios fueron cesárea, parto prematuro, inducción del parto, retención de peso postparto, lactancia materna, desprendimiento prematuro de placenta normoinserta (DPPNI), morbimortalidad materna y complicaciones neonatales. Resultados. Los hallazgos demostraron que un alto porcentaje de mujeres (entre un 55 y un 82,9%) no adaptaron la GPG a las recomendaciones IOM, hallándose una mayor proporción de ganancia por exceso. En ese caso, las mujeres tenían un riesgo aumentado de cesárea, inducción de parto, retención de peso postparto, inicio fallido en la lactancia materna, estancia hospitalaria más prolongada y morbimortalidad materna. Las mujeres con peso por debajo de las recomendaciones tuvieron mayores riesgos de desprendimiento prematuro de placenta normoinserta (DPPNI), parto prematuro y complicaciones neonatales (retraso en el crecimiento intrauterino (RCIU), menores puntuaciones de Apgar y mayores ingresos en UCI). Conclusión. Se encontró una asociación positiva la GPG inadeucada y mayores complicaciones perinatales. Lograr unas ganancias óptimas mejorará los resultados materno-infantiles.Background. The prevalence of obesity and gestational weight gain (GWG) are increasing globally. Pregnancy is a period of great vulnerability, so ensuring that women have adequate health conditions is essential to achieve a successful pregnancy. In 2009, the Institute of Medicine (IOM) established recommendations on optimal gains based on pre-pregnancy weight. Main objective. To know the available evidence of the relationship between weight gain during pregnancy and adverse perinatal outcomes. Methodology. An Integrative Review was performed which included articles and reports on perinatal complications associated with inadequate weight gain during pregnancy, both due to deficit and excess. The search was carried out in the first half of 2020, using the PubMed, Scopus and CINAHL databases. Articles published in English and Spanish in the last 10 years were included. The primary outcomes were caesarean section, preterm delivery, induction of labor, postpartum weight retention, breastfeeding, placental abruption, maternal morbidity and mortality, and neonatal complications. Results. The findings showed that a high percentage of women (between 55 and 82.9%) did not adapt the GWG to the IOM recommendations, finding a higher proportion of excess gain. In that case, the women had an increased risk of caesarean section, induction of labor, postpartum weight retention, failed initiation of breastfeeding, longer hospital stay, and maternal morbidity and mortality. Underweight women had higher risks of placental abruption, preterm delivery, and neonatal complications (Intrauterine Growth Restriction (IUGR), lower Apgar, and higher ICU admissions). Conclusión. Inadequate GWG and greater perinatal complications were found to be positive. Achieving optimal earnings will improve maternal and child outcomes

Reporte del proceso operativo de la empresa Customs Handling Zai S.A. de C.V.

Hoy en día las empresas se enfrentan a competidores cada vez más amplios, lo que hace que todas las actividades relacionadas con la comercialización y distribución de sus productos o servicios adquieran una mayor relevancia. En el presente trabajo abordaré la apertura comercial de país, estadísticas de importaciones y exportaciones del año 2015 a 2017 y tratados internacionales, esto con el fin de ver el papel tan importante que tiene una empresa que brinda servicio de agencia aduanal en el comercio internacional

Engano-te a ti e a mim... : um estudo exploratório sobre o faking good e o MMPI-2 com indicadores de medidas fisiológicas

Tese de mestrado, Psicologia (Secção de Psicologia Clínica e da Saúde, Núcleo de Psicoterapia Cognitiva-Comportamental e Integrativa), Universidade de Lisboa, Faculdade de Psicologia, 2012A literatura tem-se debruçado sobre o faking good nos instrumentos de avaliação da personalidade, nomeadamente sobre a sensibilidade das escalas de validade do MMPI-2 na detecção do faking good. No entanto, a maioria dos estudos têm privilegiado as situações de simulação O presente estudo visou a caracterização do faking good na avaliação da personalidade e da psicopatologia através da resposta ao MMPI-2 em contexto natural, i.e., no âmbito de processos reais de avaliação onde os indivíduos possam estar motivados para fazer faking good. Esta caracterização contou com evidências de medidas fisiológicas, nomeadamente a actividade electrodermal (EDA). Utilizou-se para tal uma metodologia diferencial, quantitativa e qualitativa, em que se procurou encontrar relações entre variáveis específicas dos indivíduos (análise intra-participante) e semelhanças e diferenças no comportamento dos diferentes indivíduos (inter-participantes). Para o efeito, foi estudada uma amostra de participantes provenientes de diferentes contextos, normal e clínico/forense (N = 24). A análise exploratória sugeriu a ocorrência de faking good em ambos os contextos. Especificamente, foi possível distinguir dois estilos de faking good, com características particulares, sendo que um dos estilos se destaca por ter particularidades que não vão no sentido do descrito na literatura para indicadores comportamentais de faking good. As características de personalidade deste grupo vão ao encontro da conceptualização de Paulhus (1984; 1997; Paulhus & John, 1998), onde identifica duas características: self-deception e impression management. As implicações e limitações do estudo, bem como direcções de investigação futuras foram discutidas.Literature has tackled faking good in personality assessment instruments, namely the sensitivity of the validity scales of the MMPI-2 to the detection of faking good. However, most studies have privileged the simulation designs. The present study aimed at the characterisation of faking good in personality and psychopathology assessment through response to the MMPI-2 in a natural context, which is to say in the context of a real evaluation process where the individuals may be motivated to faking good. This characterisation included marks of physiological measures, namely the electrodermal activity (EDA). For such, a differential methodology was used, quantitative and qualitative, in which we tried to find relations between specific variables from the individuals (intra-participant analysis) and similarities and differences between the behaviour of the different participants (inter-participants). For this purpose, we studied a sample of participants from different contexts, normal and clinical/forensic (N = 24). The exploratory analysis suggested the occurrence of faking good in both contexts. Specifically, it was possible to distinguish two styles of faking good, with particular characteristics, considering that one of the styles stands out for having particularities which differ from what is described as behavioural indicators of faking good. The personality characteristics of this group are in accordance with Paulhus conceptualization (1984; 1997; Paulhus & John, 1998), where he identifies two characteristics: self-deception e impression management. The implications and limitations of this study, as well as future investigation directions, were discussed

Implementação do sistema de gestão de desempenho na carreira de enfermagem no Centro Hospitalar Barreiro Montijo: caso pedagógico

O contexto socioeconómico atual leva a que as organizações de saúde procurem novas formas de responder aos desafios, nomeadamente os constrangimentos orçamentais e a simultânea necessidade de atrair, desenvolver e reter os recursos humanos, fundamentais no contexto da saúde. Os recursos humanos constituem um ativo intangível nas organizações de saúde e a principal fonte de vantagem competitiva. O desempenho das pessoas é um dos principais fatores que contribuem para a "performance" organizacional. Os sistemas de gestão do desempenho configuram-se como meio de excelência na promoção do desempenho e consequente "performance" da organização. Neste sentido, um sistema de gestão do desempenho deverá guiar-se pelo conjunto de boas práticas na área da Gestão de Pessoas, de modo a potenciar os seus efeitos positivos na organização. O presente caso pedagógico descreve o processo de implementação do sistema de gestão de desempenho no Centro Hospitalar Barreiro Montijo para a carreira de enfermagem, num contexto onde a profissão de enfermagem assume especial destaque, já que o número de profissionais representa um volume significativo da força de trabalho, e as suas áreas de atuação são transversais. Este modelo de gestão do desempenho assume um caráter único no setor da saúde pública pelo seu nível de alinhamento estratégico, adaptabilidade às características da profissão, flexibilidade e concordância com as boas práticas descritas na literatura. Na medida em que as organizações no geral, e as organizações da saúde em particular se têm vindo a deparar com dificuldades estratégicas na implementação de sistemas de gestão de desempenho que respondam às normas do SIADAP e que, simultaneamente, se adaptem às especificidades do contexto e da profissão, optou-se pela elaboração de um caso pedagógico, com o intuito de fornecer ferramentas pedagógicas a atuais e futuros profissionais de Gestão de Pessoas, para a implementação de um sistema de gestão de desempenho.The present social and economic situation has lead health organisations to search for new ways to deal with the challenges they face, particularly the issues related to budget restraints and the simultaneous need to attract, develop and maintain professionals who are a part of the health sector. Human Resources are an unmeasurable asset to health organisations and the main source of competitive advantage as its performance is one of the main factors contributing to organisational performance of the industry. Performance management systems are the best mean to promote individual productivity and consequently the organisational performance. In this sense, a performance management system should be devised from best practices as pointed out by literature in order to maximise its positive effects on organisations. This pedagogical case describes the process of implementing the performance management system in Centro Hospitalar Barreiro Montijo in regards to nursing careers. In this setting, the role of a performance management system plays a special part due to the fact that the number of professionals represents a significant part of the workforce and their acting fields are transversal. This model for a performance management system is unique in the public health sector due to the level of strategic alignment, adaptability to the specifics of the role, its flexibility and the fact that it was done according to the best practices as described in the literature. Considering the fact that organisations in general, and the ones from the health sector in particular, have been struggling with strategic issues in implementing performance management systems that are both corresponding to SIADAP´s rules and simultaneously adjusted to the specifics of the setting and roles, we chose to build a pedagogical case in order to provide pedagogical tools for current and future people management managers implementing a performance management system

Subinhibitory Concentrations of Clinically-Relevant Antimicrobials Affect Resistance-Nodulation-Division Family Promoter Activity in Acinetobacter baumannii

Efflux pumps contribute to multidrug resistance in Acinetobacter baumannii due to their ability to expel a wide variety of structurally unrelated compounds. This study aimed to characterize the effect of subinhibitory concentrations of clinically-relevant antibiotics and disinfectants on the promoter activity of members of the Resistance-Nodulation-Division (RND) family in A. baumannii. The promoter regions from three RND efflux pumps (AdeABC, AdeFGH and AdeIJK) and the AdeRS regulatory system from three different A. baumannii strains (ATCC 17961, ATCC 17978, and ATCC 19606) were cloned into a luciferase reporter system (pLPV1Z). Promoter activity was quantitatively assessed in both exponential and stationary phase cultures after exposure to subinhibitory concentrations of four antibiotics from different classes (rifampicin, meropenem, tigecycline and colistin) and two disinfectants (ethanol and chlorhexidine). Subinhibitory concentrations of the compounds tested had variable effects on promoter activity that were highly dependent on the A. baumannii strain, the compound tested and the growth phase. Fold changes in AdeABC promoter activity ranged from 1.97 to 113.7, in AdeFGH from -5.6 to 1.13, in AdeIJK from -2.5 to 2, and in AdeRS from -36.2 to -1.32. Taken together, these results indicate that subinhibitory concentrations of clinically-relevant antibiotics and disinfectants affect the promoter activity of RND family members in A. baumannii in a strain and growth phase dependent manner. These results may have important implications for the treatment of infections caused by A. baumannii.AT is supported by the Garantía Juvenil Program of the Comunidad Autonoma de Madrid and ML-S is supported by the Sara Borrell Program of the Instituto de Salud Carlos III. MJM is supported by grants from the Instituto de Salud Carlos III (MP 516/19 and MPY 380/18).S

Role of peptidoglycan recycling enzymes AmpD and AnmK in Acinetobacter baumannii virulence features

Acinetobacter baumannii is an important causative agent of hospital acquired infections. In addition to acquired resistance to many currently-available antibiotics, it is intrinsically resistant to fosfomycin. It has previously been shown that AmpD and AnmK contribute to intrinsic fosfomycin resistance in A. baumannii due to their involvement in the peptidoglycan recycling pathway. However, the role that these two enzymes play in the fitness and virulence of A. baumannii has not been studied. The aim of this study was to characterize several virulence-related phenotypic traits in A. baumannii mutants lacking AmpD and AnmK. Specifically, cell morphology, peptidoglycan thickness, membrane permeability, growth under iron-limiting conditions, fitness, resistance to disinfectants and antimicrobial agents, twitching motility and biofilm formation of the mutant strains A. baumannii ATCC 17978 ΔampD::Kan and ΔanmK::Kan were compared to the wild type strain. Our results demonstrate that bacterial growth and fitness of both mutants were compromised, especially in the ΔampD::Kan mutant. In addition, biofilm formation was decreased by up to 69%, whereas twitching movement was reduced by about 80% in both mutants. These results demonstrate that, in addition to increased susceptibility to fosfomycin, alteration of the peptidoglycan recycling pathway affects multiple aspects related to virulence. Inhibition of these enzymes could be explored as a strategy to develop novel treatments for A. baumannii in the future. Furthermore, this study establishes a link between intrinsic fosfomycin resistance mechanisms and bacterial fitness and virulence traits.ML-S was supported by the Sara Borrell Program of the Instituto de Salud Carlos III (CD17CIII/00017), and AT was supported by the Garantıa Juvenil Program of the Comunidad ́Autónoma de Madrid (PEJ2018-004820-A -MPY 387/19), is currently supported by a FPU grant (FPU20/03261) and PhD student in Biomedical Sciences and Public Health, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain ([email protected]). MM is supported by grants from the Instituto de Salud Carlos III (MP 516/19 and MPY 380/18).S

Perception of care from the perspective of nursing students: A study using photovoice, storytelling and poetry

Background: The Higher Education in Nursing requires providing students with skills such as critical and reflective thinking about the actions to be carried out so that they are capable of providing humanised and quality care in an increasingly complex and technified society. Participatory teaching methodologies promote the development of these skills. Objectives: to explore the potential of photovoice, storytelling and poetry as instruments capable of encouraging reflection. To identify through images (photovoice) and poetic narratives (storytelling and poetry) the perception that students of the nursing degree express about nursing care. Design: qualitative study in the framework of the socio-critical paradigm, using photovoice, storytelling and poetry in the field of care. Participants: first-year undergraduate nursing students at two Spanish universities in the academic year 2021-2022. Methodology: 48 images were shown and students were asked to select one, write a narrative and generate a short poem connected to the image. Subsequently, a content analysis was conducted of those poems evoked by the five photographs most chosen by the students. The analysis was supported by qualitative data analysis software. A total of 67 contributions from 67 students were analysed. Results: the concepts addressed in the poems and the compositions generated reveal how critical humanist thinking and reflection on the subject of care developed. The topics identified were care, accompaniment throughout the life cycle, working on the basis of values and caring for small details as subcategories of nursing care. Conclusion: The combination of different tools in university education has encouraged reflection and enabled students to identify for themselves the importance of humanised care. Working on the theoretical foundation in an active way can reduce the gap between theory and practice and foster the empowerment of the nursing identity

The Art of Childbirth of the Midwives of Al-Andalus: Social Assessment and Legal Implication of Health Assistance in the Cultural Diversity of the 10th–14th Centuries

(1) Background: The role of Al-Andalus’s women were the result of Arabization and Islamization in Spain. The 10th to the 14th centuries were a time of significant cultural diversity in the region. Female physicians and midwives were important for providing care to women. Despite existing studies, there is still a lack of focused research on the professionalization of these trades, including their requirements, intervention areas, and treatments. (2) Methods: To address this gap, we conducted a scoping review using the dialectical structural model of care (DSMC). Primary medical and legislative sources were used. (3) Results: two kinds of midwife, or qābila, were discovered, along with a woman physician, or ṭabība, who also acted as a midwife. These professions underwent diverse training and fulfilled duties as obstetricians and pediatricians. Midwives were esteemed members of society and were the sole female professionals who needed qualified training. Their performance in the courts was exemplary. Tools for facilitating childbirth and interventions related to female health were discovered in the study. (4) Conclusions: The patriarchal societies suffer from significant inequality in terms of academic training, knowledge transmission, and healthcare provision. Midwives functioned in segregated domestic and legal spaces and were responsible for providing public care to communities from the 10th to 14th centuries.This work is financed by ENDOCU research group, through resolution 31 March 2023 UCLM aid for research projects co-financed by FEDER, reference 2023-GRIN-34481

Emotional intelligence during clinical practices of nursing students. An approach from educational anthropology applied to clinical practices

Las emociones y sentimientos durante las prácticas clínicas de los estudiantes de enfermería están integrados en el currículum oculto. Objetivos: contribuir a la concienciación de las emociones y sentimientos que convergen en el proceso de construcción del conocimiento durante las prácticas clínicas. Método: Se utilizó la escala TMMS - 24 para valorar la inteligencia emocional y una entrevista abierta. Se han implementado con 40 alumnos. Se muestran resultados positivos respecto a la percepción, regulación y comprensión emocional. Conclusiones: La escala TMMS - 24 resulta pertinente para valorar la Inteligencia Emocional, pero es aconsejable emplear estudios cualitativos para profundizar en un fenómeno tan complejo.Emotions and feelings during the clinical practices of nursing students are integrated into the hidden curriculum. Objectives: to contribute to the awareness of the emotions and feelings that converge in the process of knowledge construction during clinical practices. Method: The TMMS - 24 scale was used to assess emotional intelligence and an open interview. They have been implemented with 40 students. Positive results are shown regarding perception, regulation and emotional understanding. Conclusions: The TMMS - 24 scale is relevant to assess Emotional Intelligence, but it is advisable to use qualitative studies to delve into such a complex phenomenon.Este trabajo se enmarca en el seno del Programa Redes-I3CE de investigación en docencia universitaria del Vicerrectorado de Calidad e Innovación Educativa-Instituto de Ciencias de la Educación de la Universidad de Alicante (convocatoria 2016 - 17), Ref.:3826/ Proyecto Antropología educativa aplicada a las prácticas clínicas