Educar i investigar per tenir cura de la gent gran

A la introducció del seu llibre El mono obeso, una teoria de l’evolució de l’espècie humana, José Enrique Campillo (2007) diu que els éssers humans sempre hem intentat evitar el sofriment, la malaltia i la mort. Però en tota la nostra història mai no s’ha disposat de mitjans tan eficaços com els que avui tenim a l’abast per combatre la malaltia, mitigar el dolor i retardar el final inevitable. Ens recorda que si vivim en un país desenvolupat i tenim una mica de sort, probablement superarem els vuitanta anys d’edat; però aquest avantatge és una adquisició molt recent. L’estudi de Realitat Demogràfica de l’Acadèmia de l’Envelliment Saludable, citat per Revelles (2007), diu que a Espanya, l’any 2050, el 40% dels ciutadans tindrà més de 60 anys. Sembla que anem pel camí de convertir-nos en el país amb la població més envellida del planeta

L'Educació sanitària de les cuidadores de gent gran. El cas d'Osona

Descripció del recurs: el 01 setembre 2012Objectiu i context Osona és una de les comarques catalanes, que més ha notat el darrer fenomen migratori de finals del segle XX. Algunes persones immigrants treballen com a cuidadores en residències per a gent gran. És en aquest context que es focalitza aquesta tesi doctoral. La recerca és un diagnòstic educatiu, un estudi de les necessitats formatives d'educació sanitària (i sociosanitària) de les persones immigrants cuidadores de gent gran. Per conèixer aquestes necessitats formatives i la situació d'aquestes persones, ens hem proposat estudiar, d'entrada, les tasques que fan, en profunditat. Al final, hi ha una proposta formativa per millorar la qualitat del servei professional, que hauria de repercutir en la qualitat de vida de les persones cuidades. Metodologia Qualitativa. La mostra de les residències geriàtriques se selecciona de manera intencionada, a partir de la publicació en línia1 dels establiments d'atenció per a les persones grans amb concert o conveni de col·laboració amb la Generalitat de Catalunya (ICASS). La direcció d'aquests establiments, que accepta participar en aquest estudi, és un informant clau. El grup diana inclou aquelles persones que compleixen els requisits de ser immigrants, cuidadores de gent gran, treballadores en residències geriàtriques de la comarca d'Osona i que no tenen responsabilitats directives. S'utilitza un qüestionari semi-estructurat per tal de guiar l'entrevista. També, l'observació directa, amb la finalitat de confirmar, aclarir i valorar tot el que s'ha dit. Finalment, es fa una triangulació per contrastar les informacions recollides a partir de diverses fonts. Resultats La mostra definitiva participant és de nou residències osonenques, quarantaquatre cuidadores immigrants entrevistades i sis d'observades. Les cuidadores són, majoritàriament, dones de 19 a 56 anys, procedents de Llatinoamèrica, Àfrica i Europa, sense nacionalitat espanyola, amb estudis secundaris i poca experiència com a cuidadores abans de treballar al centre residencial. L'educació sanitària i sociosanitària que tenen és poc homogènia i sol ser de tipus no formal. Les mancances formatives que sent el grup diana afecten totes les funcions: higiene personal (32%), habitació (32%), eliminació (86,5%), alimentació (59%), dormir (27%), registres (70,5%), moviment (41%), cures (86,4%), relació (70,5%), medicació (70,5%), neteja, planxa i altres funcions hostaleres (6,8%), reunions (38,6%), formació (93,2%) i altres (59%). L'observació confirma falta de recursos humans per realitzar totes les tasques validades i falta de temps per dedicar-se a algunes d'elles en concret. També, mostra l'existència de rutines, xoc cultural i col·lisions amb infermeria. I, també, afirma la disposició a formar-se. La triangulació ratifica les funcions, però hi ha discrepàncies en les tasques. Suggereix, entre altres coses, la possibilitat de millorar la qualitat del treball del grup diana a través de la formació. Conclusió i perspectives L'anàlisi dels resultats ens aporta evidències qualitatives de les necessitats d'aprenentatge d'aquestes persones cuidadores, que si bé són competents en les atencions proporcionades a les persones grans, podrien millorar la qualitat del conjunt de les tasques que fan. Pensem que és possible superar els dèficits detectats, mitjançant la proposta formativa específica que es fa, pertinent amb el treball que realitzen les cuidadores. L'acreditació oficial de la formació del grup diana, juntament amb la de l'experiència professional, els permetrà formalitzar la seva situació acadèmica d'aquí al 2015, considerada oficialment com a formació professional de grau mitjà, amb el títol de Tècnic en Atenció Sociosanitària (TAS). Aquesta recerca obre més interrogants i fa propostes per respondre'ls en properes investigacions.Objective and background Osona is one of the Catalan regions which has noticed the most the last migratory phenomenon at the end of the twentieth century. Immigrant people use to work as caregivers in retirement homes. This doctoral thesis focuses in this issue. The research is an educational diagnosis, a study of the training needs of health (and long term care) education of caregivers of elderly people who are immigrant. In order to know these training needs and the situation of these people, our aim is to study, for a start, the tasks they do, in depth. Finally, there's a training proposal to improve the professional service quality, which should have an effect in the life quality of the well cared people. Methodology Qualitative. The sample of retirement homes is selected deliberately, from an online publication1 of the retirement homes with accord or cooperation agreement with the Catalan Government (ICASS). The management of these establishments, who accepted to participate in the study, is a key reporter. The Target Group (TG) includes those people who are immigrants, caregivers of elderly people, and workers in retirement homes in Osona and without any executive responsibility. We use a semistructured questionnaire to guide the interview, and the direct observation, in order to confirm, clear up and value everything which has been said. Finally, we present a triangulation to contrast the information collected from different sources. Results The definitive participating sample is formed by nine retirement homes in Osona, forty-four immigrant caregivers interviewed and six observed. Caregivers are, mainly, women from 19 to 56 years old, from Latin America, Africa and Europe, without Spanish citizenship, with secondary studies and without experience as a caregiver before working in the retirement home. The health and long term care education they have isn't very homogeneous and The training lacks the TG feels affect all the tasks: personal cleanliness (32%), room (32%), disposal (86,5%), feed (59%), sleep (27%), registration (70,5%), movement (41%), cares (86,4%), relationship (70,5%), medication (70,5%), cleaning, ironing and other catering tasks (6,8%), meetings (38,6%), training (93,2%) and others (59%). The observation confirms lack of human resources to do all the validated tasks, and lack of time to specially do some of them. It also corroborates the existence of routines, cultural clashes and collisions against sickbay. It also bears out the willingness to be trained. The triangulation ratifies the functions, but there are discrepancies in the tasks. It suggests, among other things, the possibility to improve the quality of the TG work through the training. Conclusions and perspectives The result analysis gives us qualitative evidences of the caregivers training needs, which, even they are competent with the provided attentions to elderly people, they could improve the quality of the tasks they do. We think that exceeding the detected deficits is possible, through the specific training proposal we do, appropriate with the work the caregivers do. The TG training official credentials, together with the professional experience, will allow them to formalize their academic situation in 2015, officially considered as an intermediate level specific vocational training, with the technician in health care degree (known as TAS). This research puts new questions about the issue and suggests answering them in early researches

Genetic Characterization of Non-Lymphogranuloma venereum Chlamydia trachomatis Indicates Distinct Infection Transmission Networks in Spain

Chlamydia trachomatis; OmpA genotyping; Sexual behaviourChlamydia trachomatis; Genotipado ompA; Comportamiento sexualChlamydia trachomatis; Genotipat ompA; Comportament sexualChlamydia trachomatis infection is an important public health problem. Our objective was to assess the dynamics of the transmission of this infection, analysing the distribution of circulating ompA genotypes and multilocus sequence types of C. trachomatis in Spain as a function of clinical and epidemiological variables. During 2018 and 2019, we genetically characterized C. trachomatis in tertiary hospitals in six areas in Spain (Asturias, Barcelona, Gipuzkoa, Mallorca, Seville and Zaragoza), with a catchment population of 3.050 million people. Genotypes and sequence types were obtained using polymerase chain reaction techniques that amplify a fragment of the ompA gene, and five highly variable genes (hctB, CT058, CT144, CT172 and pbpB), respectively. Amplicons were sequenced and phylogenetic analysis was conducted. We obtained genotypes in 636/698 cases (91.1%). Overall and by area, genotype E was the most common (35%). Stratifying by sex, genotypes D and G were more common among men, and genotypes F and I among women (p < 0.05). Genotypes D, G and J were more common in men who have sex with men (MSM) than in men who have sex with women (MSW), in whom the most common genotypes were E and F. The diversity index was higher in sequence typing (0.981) than in genotyping (0.791), and the most common sequence types were ST52 and ST108 in MSM, and ST30, ST148, ST276 and ST327 in MSW. Differences in genotype distribution between geographical areas were attributable to differences in population characteristics. The transmission dynamics varied with sexual behaviour: the predominant genotypes and most frequent sequence types found in MSM were different to those detected in MSW and women.This study was funded by Instituto de Salud Carlos III (ISCIII) through the project “PI17/01886”, and co-funded by the European Union

Phenotypic and Genotypic Antimicrobial Susceptibility Testing of Chlamydia trachomatis Isolates from Patients with Persistent or Clinical Treatment Failure in Spain

Chlamydia trachomatis; Sexually transmitted infection; Treatment failureChlamydia trachomatis; Infecció de transmissió sexual; Fracàs del tractamentChlamydia trachomatis; Infección transmitida sexualmente; Fracaso del tratamientoThe aim of this multicentre project (seven hospitals across the Spanish National Health Service) was to study the phenotypic and genotypic susceptibility of C. trachomatis to the main antimicrobials used (macrolides, doxycycline, and quinolones) in isolates from patients with clinical treatment failure in whom reinfection had been ruled out. During 2018–2019, 73 clinical isolates were selected. Sixty-nine clinical specimens were inoculated onto confluent McCoy cell monolayers for phenotypic susceptibility testing. The minimum inhibitory concentration for azithromycin and doxycycline was defined as the lowest concentration associated with an at least 95% reduction in inclusion-forming units after one passage in the presence of the antibiotic compared to the initial inoculum for each strain (control). Sequencing analysis was performed for the genotypic detection of resistance to macrolides, analysing mutations in the 23S rRNA gene (at positions 2057, 2058, 2059, and 2611), and quinolones, analysing a fragment of the gyrA gene, and searching for the G248T mutation (Ser83->Ile). For tetracyclines, in-house RT-PCR was used to test for the tet(C) gene. The phenotypic susceptibility testing was successful for 10 isolates. All the isolates had minimum inhibitory concentrations for azithromycin ≤ 0.125 mg/L and for doxycycline ≤ 0.064 mg/L and were considered sensitive. Of the 73 strains studied, no mutations were found at positions T2611C or G248T of the gyrA gene. We successfully sequenced 66 isolates. No macrolide resistance-associated mutations were found at positions 2057, 2058, 2059, or T2611C. None of the isolates carried the tet(C) gene. We found no evidence for genomic resistance in this large, clinically relevant dataset.This study was funded by Instituto de Salud Carlos III (ISCIII) via the project “PI17/01886” and co-funded by the European Union

Estratègies d'intervenció i avaluació de l'hàbit tabàquic

Objectiu: Donar informació sobre els riscos del tabac, avaluar l’hàbit tabàquic i el compliment de la normativa vigent per part de la comunitat universitària a través d’una campanya de sensibilització. Metodologia: Prèviament a l’inici de les activitats es van dissenyar i passar unes enquestes per avaluar l’hàbit tabàquic als estudiants (a l’aula) i treballadors de l’Escola de Ciències de la Salut. Durant la setmana d’activitats, que coincidia amb el Dia Internacional de LLuita Antitabàquica, es va crear una taula informativa a càrrec dels estudiants de l’assignatura Atencions d’Infermeria a Addiccions i Toxicomanies, per tal d’informar de forma àmplia sobre el tabaquisme, conseqüències i tractaments. Al mateix temps i de forma passiva en uns monitors de TV es donava més informació, amb una material creat per aquesta campanya. Resultats: Els mitjans de comunicació van demostrar, des de l’inici de la campanya, un gran interès. Respecte a la participació per part de la comunitat universitària podem dir que va ser acceptable, al voltant de 1000 persones van passar per la taula informativa. El perfil dels estudiants que van contestar l’enquesta va ser dona (66.4%), alumne de fisioteràpia (49%), fumadors (regulars i ocasionals 52%). Dintre del grup de fumadors regulars per gèneres les dones fumen més 37%, front als homes 27.7%. Consum setmanal de cigarretes (regulars i ocasionals), presenta una mitjana de 59 (D.E=49). La majoria ha fet algun intent de deixar de fumar, 61%. Respecte al temps d’ abstinència un 69.9% no ha passat de 3 mesos i un 96% pensa que fumar en un espai tancat és perjudicial pels altres. Per últim, de tots el entrevistats la gran majoria (97.8%), declaren que fumen davant seu i a un 41.4 % els molesta. Conclusions: La Comissió fa una valoració positiva general, de com es van desenvolupar les diferents activitats. No obstant s’observa poca sensibilització per una part de la comunitat universitària respecte a la llibertat de viure

Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients

Condomless anal sex; HIV; SyphilisSexo anal sin condón; VIH; SífilisSexe anal sense preservatiu; VIH; SífilisBACKGROUND: Since 2000, substantial increases in syphilis in men who have sex with men (MSM) have been reported in many cities. Condomless anal sex (CAS) is one of the factors, along with drugs for sex and sex in group. This study identified factors and clinical manifestations as well as Treponema pallidum (T.pallidum) strains that could be related to early syphilis in Barcelona. METHODS: This prospective study was conducted in a sexually transmitted infections unit in 2015. Epidemiological, behavioral, clinical and microbiological variables were collected in a structured form. Univariate and multivariate statistical analyses were performed focusing on HIV-positive patients. RESULTS: Overall, 274 cases were classified as having early syphilis (27.5% primary, 51.3% secondary, and 21.2% early latent syphilis). In all, 94% of participants were MSM and 36.3% were HIV-positive. The median number of sexual contacts in the last 12 months was 10; 72.5% practiced CAS, 50.6% had sex in group, and 54.7% consumed drugs. HIV-positive cases had more anonymous sex contacts (p = 0.041), CAS (p = 0.002), sex in group (p < 0.001) and drugs for sex (p < 0.001). In the multivariate analysis, previous syphilis (adjusted odds ratio [aOR] 4.81 [2.88-8.15]), previous Neisseria gonorrhoeae infection (aOR 3.8 [2.28-6.43]), and serosorting (aOR 20.4 [7.99-60.96]) were associated with having syphilis. Clinically, multiple chancres were present in 31% of cases with no differences on serostatus, but anal chancre was most common in HIV-positive patients (p = 0.049). Molecular typing did not conclusively explain clinical presentation in relation to specific T.pallidum strains. CONCLUSION: Control of syphilis remains a challenge. Similar to prior studies, HIV-positive patients were found to engage more often in sexual behaviors associated with syphilis than HIV-negative patients. Clinical manifestations were rather similar in both groups, although anal chancre was most common in HIV-positive patients. Various strain types of syphilis were found, but no clinical associations were identified

Yaws recurrence in children at continued risk of infection.

BACKGROUND: In yaws-endemic areas, children with Treponema pallidum subsp. pertenue infection may suffer recurrent episodes due to either reinfection or relapse. However, the possibility of infection with other cutaneous ulcer causative agents and difficulties in interpreting standard laboratory results challenges the estimation of yaws recurrence rates. METHODS: We estimated the rates of yaws recurrences in the Lihir Island (Papua New Guinea) using two approaches: passive surveillance based on a retrospective screening of electronic medical records of cutaneous ulcers diagnosed using serological testing between 2005 and 2016, and active surveillance conducted during a cross-sectional prevalence study which included PCR analyses of ulcers of all suspected cases of yaws. The risk of recurrent infection was assessed based on data from the passive surveillance analysis and using two Cox regression models (crude and multivariate), stratified by year of index episode. Data gathered from the active surveillance was used to characterize the recurrences and no hypothesis testing was performed. RESULTS: The electronic medical records included 6,125 patients (7,889 ulcer episodes) with documented serological results of cutaneous ulcers of which1,486 were diagnosed with yaws. Overall, 1,246/6,125 patients (20.3%) presented more than once with a cutaneous ulcer, and 103/1,486 (6.7%) patients had multiple episodes of yaws. The risk of yaws recurrence significantly increased with age and was higher in patients with ≥3 recurrent episodes. In the active surveillance, we identified 50 individuals with recurrent cutaneous ulcer that had PCR results available for both the index and recurrent episode. Of 12 individuals with T. pallidum in the index ulcer, 8 (66%) had T. pallidum in subsequent assessments, relapse related to macrolide-resistance was identified in two of these cases. CONCLUSIONS: Our results confirm the need for active follow-up of yaws patients after treatment, particularly children and individuals with a history of recurrence

Safety of mass drug coadministration with ivermectin, diethylcarbamazine, albendazole, and azithromycin for the integrated treatment of neglected tropical diseases: a cluster randomized community trial.

INTRODUCTION: Neglected tropical diseases control programmes run separately. For settings with more than one endemic disease, combined mass drug administration (MDA) has potential practical advantages compared with separate programmes but needs confirmation of safety. We assessed the safety of combined MDA for multiple neglected tropical diseases using ivermectin, diethylcarbamazine, albendazole (IDA) and azithromycin (AZI). METHODS: We conducted an open-label, cluster-randomized trial involving individuals living in 34 wards (smaller administrative division) in two study sites, Namatanai District and Lihir Island, Papua New Guinea. We randomly assigned wards to the combined treatment arm (which received a single dose of the triple combination IDA and a single dose of AZI at the same visit) or the control arm (which received IDA separately followed by AZI separately one week after). All participants underwent safety assessments one day after drug administration. Methodology for collecting the adverse events (AEs) was a general question (in Namatanai) and individual questions about specific AEs (in Lihir). The primary endpoint was the prevalence of AEs. Safety of combined treatment was taken to be non-inferior to that of IDA if the upper limit of the two-sided CI for the difference in rates was equal or lower than 5%. FINDINGS: The study enrolled 15,656 participants. Of those enrolled, 7,281 (46.3%) received the combined regimen and 8,375 (53.3%) received standard treatment with IDA for lymphatic filariasis between Nov 1, 2018, and Apr 15, 2019. Of the individuals in the control group, 4,228 (50.5%) attended a second visit one week apart to receive AZI for yaws. In Namatanai, the proportion of AEs was similar in the combined group (0.8%) compared to the IDA group (1.3%, difference 0.5% [95CI -2.5% to 1.4%]) or the AZI group (3.6%, d -2.8% [95CI -8.6% to 2.8%]). In Lihir, the proportion of AEs was higher in the combined group (23.0%) compared to the IDA group (12.2%, d 10.8% [95% CI 1.5% to 20.2%]) or the AZI group (11.1%, d 11.9% [95% CI 2.7% to 21.1%]).We observed 21 (0.3%) grade-2 AEs in the combined treatment group, 33 (0.4%) in the IDA separately group, and 18 (0.2%) in the AZI separately group. No participants required treatment for any AE. We observed no deaths, serious AEs, or AEs of special interest. INTERPRETATION: In the largest trial so far involving coadministration of regimens based on IDA and AZI, the combination was safe and feasible in a population of more than 15,000 people. Combined MDA based on these two regimens opens up new potential for the control of neglected tropical diseases in the Western Pacific region

Typing of Lymphogranuloma Venereum Chlamydia trachomatis Strains

We analyzed by multilocus sequence typing 77 lymphogranuloma venereum Chlamydia trachomatis strains from men who have sex with men in Europe and the United States. Specimens from an outbreak in 2003 in Europe were monoclonal. In contrast, several strains were in the United States in the 1980s, including a variant from Europe