Personal assistance in Spain. Perspective of its protagonists: beneficiaries, responsible for the personal assistance of the provider entities and personal assistants

La asistencia personal es un recurso humano que pone en práctica el derecho a una vida independiente de las personas con diversidad funcional, un derecho reconocido internacionalmente. Aunque tiene una larga trayectoria en los Estados Unidos y en algunos países europeos como Suecia, Noruega y Reino Unido, sin embargo, en nuestro país es de reciente implantación. En los últimos años, la asistencia personal ha despertado el interés de algunas administraciones públicas y del mundo asociativo de la discapacidad, pero aún sigue siendo escaso su desarrollo académico en nuestro país. El objetivo de esta investigación es conocer y analizar la situación actual de este recurso en España. Para ello, se han estudiado las características y opiniones de las personas beneficiarias, los/as asistentes personales y los/as responsables de la asistencia personal de las entidades proveedoras. Se ha utilizado una metodología mixta para una mejor comprensión del problema investigado. Los resultados muestran la escasa información existente sobre la asistencia personal, el limitado acceso a este recurso y la precariedad laboral en la profesión de asistente personal.The personal assistance is a human resource that puts into practice the right to an independent life of people with disabilities, an internationally recognized right. Although it has a long history in the United States and in some countries of Europe such as Sweden, Norway and the United Kingdom, in our country it has been recently established. In recent years, personal assistance has aroused the interest of some public administrations and the associative world of disability, implementing different projects, but in our country, there is still weak academic development. The aim of this research is to know and analyse the current situation of this resource in Spain. To this end, the characteristics and opinions of the beneficiaries, the personal assistants and the responsibles for the personal assistance of the provider entities have been studied. A mixed methodology has been used for a better understanding of the researched issue. The main results obtained show the insufficient information on personal assistance, the limited access to this resource and the labour precariousness in the personal assistant profession.Departamento de Trabajo Social y Servicios Sociales; Facultad de Trabajo Socia

Pattern of expression of the jun family of transcription factors during the early development of the inner ear: implications in apoptosis

8 pages, 6 figures, 1 table.Jun transcription factors have been implicated in the regulation of cell proliferation, differentiation and apoptosis. We have investigated the relationship between Jun expression and cell death in the developing chicken inner ear. c-jun and junD transcripts were expressed in the epithelium of the otic placode and otic vesicle. c-jun expression was restricted to the dorsal area of the otic pit (stages 14-17), dorsal otic vesicle and cochleo-vestibular ganglion (stages 18-20). junD expression was transient and occurred in the dorsal and upper medial aspects of the otic pit and otic cup, but it was down-regulated in the otic vesicle. A parallel TUNEL analysis revealed that expression of c-jun co-located within areas of intense apoptosis. Furthermore, phosphorylation of c-Jun at serine-63 by Jun amino-terminal-kinases was detected in the dorsal otic pit, otic vesicle and cochleo-vestibular ganglion. c-Jun protein exhibited DNA binding activity, as assessed by gel mobility shift assays. The association between c-Jun and apoptosis was further demonstrated by studying nerve growth factor-induced apoptosis in cultured otic vesicles. Nerve growth factor-induced cell death and c-Jun phosphorylation that were suppressed by insulin-like growth factor-I and by viral-mediated overexpression of Raf, which had survival effects. In conclusion, the precise regulation of the expression and activity of Jun proteins in the otic primordium suggests that it may operate as a fundamental mechanism during organogenesis.L.A. and Y.L. held a CSIC research contract, C.S. was supported by Ministerio de Educación y Cultura and S.C. by the Comunidad de Madrid. This work was supported by grants from Dirección General de Investigación, Ciencia y Tecnología (PM96-0075 and PB95-0086), Europharma (Boehringer Ingelheim Inc.) and Junta de Castilla y León to F.G and I. V.-N.Peer reviewe

Currículum enfermero y estrategias pedagógicas en materia de sostenibilidad medioambiental en los procesos de salud y cuidado

Background: Nurses should be knowledgeable about how it affects climate change to health. To acquire this knowledge it is necessary to define competences and educational strategies that tackle environmental sustainability in nursing training. The objective of this paper is to describe the dimensions that should be included in nurse education in the field of environmental sustainability, climate change and health care and determine the most appropriate pedagogical strategies.Methods: A narrative review of publications on environmental sustainability in relation to nursing and health care has been carried out over the last 10 years. Search strategies have been designed for fifteen databases of Nursing and Health Sciences. The results were systematized in various data arrays.Results: Nurse training in environmental sustainability should include contents such as globalization, environmental impact, promotion of health, use of resources and proper management of waste, food and influences of production processes, the effects of smoking and environmental effects on the health of children. Educational approaches, such as the participatory action research and problem-based learning, are more appropriate to include in the nurse training while covering environmental sustainability.Conclusions: Nurse training in environmental sustainability should include competences at different levels: individual, understanding the rationale and scope of the problem as well as acting accordingly in the professional field and with personnel. Finally, at the social level, nursing has a key role in the promotion of environmental health.Fundamentos: Las enfermeras deben ser conocedoras de cómo afecta el cambio climático a la salud. Para la obtención de estos conocimientos es necesario definir las competencias a adquirir y las estrategias pedagógicas que afronten la sostenibilidad medioambiental en la formación de Enfermería. Objetivo: Describir las dimensiones que debe incluir la formación enfermera en materia de sostenibilidad medioambiental, cambio climático y cuidados de salud y determinar las estrategias pedagógicas más adecuadas. Métodos: Se realizó una revisión narrativa de publicaciones sobre sostenibilidad medioambiental en relación a enfermería y cuidados de salud de los últimos 10 años. Se diseñaron estrategias de búsqueda para quince bases de datos de enfermería y ciencias de la salud. Los resultados se sistematizaron en matrices de datos. Resultados: La formación enfermera en sostenibilidad medioambiental debe incluir contenidos sobre globalización, impacto ambiental, promoción de salud, uso de recursos y gestión adecuada de residuos, alimentos e influencias de los procesos de producción, los efectos del tabaquismo y los efectos ambientales en la salud de la infancia. Los enfoques educativos más adecuados para incluir la sostenibilidad medioambiental en la formación enfermera son la Investigación-Acción Participativa y el aprendizaje basado en problemas. Conclusiones: La formación enfermera en materia de sostenibilidad medioambiental debe incluir competencias en diferentes niveles: en lo individual, comprendiendo los fundamentos y el alcance del problema y actuando consecuentemente en el ámbito profesional y en el personal, y en el plano social, Enfermería tiene un papel clave en la promoción de  la salud medioambiental

A abordagem da saúde sexual e reprodutiva em mulheres imigrantes na perspectiva de gênero

En los últimos años se ha producido un importante incremento de la población inmigrante residente en España. Y si en los inicios del fenómeno migratorio emigraban hombres solos, en la actualidad está aumentando el número de mujeres que emigran, bien como consecuencia de la reagrupación familiar o con proyectos migratorios propios. El objetivo de este trabajo es analizar, mediante una revisión de la bibliografía publicada, cuáles son los factores que inciden en la salud sexual y reproductiva de las mujeres inmigrantes y cuáles son las principales barreras que tienen en el acceso normalizado a los servicios sanitarios. Como conclusión podemos destacar que en los estudios realizados se ha puesto de manifiesto que existen una serie de factores que inciden en la salud sexual y reproductiva de las mujeres inmigrantes y que hay un menor uso de los servicios sanitarios por parte de éstas, ya que existen múltiples barreras que impiden una integración normalizada en el sistema sanitario público.In recent years there has occurred a significant increase in the immigrant population resident in Spain. And if at the beginning of phenomenon of migration they emigrated alone men, nowadays a growing number of women are migrating, or as result of family re-unification, or as migration projects of themselves. This work aims to analyze, through a review of published literature, what are the factors that affect the sexual and reproductive health of immigrant women and what are the main barriers that they have on standardized access to the health services. In conclusion we can highlight that previous studies have shown that there are a number of factors that influence the sexual and reproductive health of female immigrants and that there is less use of health services for these, since there are multiple barriers that obstruct a normal integration in the public health system.Nos últimos anos tem-se observado importante implemento da população imigrante residente na Espanha. E se no início este era um fenômeno em que os homens emigravam, na atualidade está aumentando o número de mulheres que emigram, bem como a consequência da reagrupação familiar ou com projetos migratórios próprios. O objetivo do presente estudo é analisar, mediante uma revisão da bibliografia publicada, quais são os fatores que incidem na saúde sexual e reprodutiva das mulheres imigrantes e quais são as principais barreiras que têm no acesso aos serviços de saúde. Como conclusão, podemos destacar que nos estudos realizados destaca-se uma série de fatores que interferem na saúde sexual e reprodutiva das mulheres nesta condição e que têm menor utilização dos serviços de saúde, já que existem múltiplas barreiras que impedem uma integração normalizada no sistema de saúde público

Cross-cultural adaptation of children´s environmental health questionnaires for English nursing students

Objectives: Children are among the most vulnerable population groups with regard to environmental risks. Nursing students must be fully educated on children’s environmental health as they are in a key position to prevent and reduce the effects of environmental hazards. The main objective of this study was to adapt and validate an English language version of two questionnaires about children’s health and the environment, to assess the knowledge and skills of student nurses in England. Design: Observational cross-sectional study. Setting: A university in Southern England. Method: The study involves translating, adapting and validating the Children’s Environmental Health Knowledge Questionnaire (ChEHK-Q) and the Children’s Environmental Health Skills Questionnaire (ChEHS-Q) with nursing students in England (N = 232). Results: The psychometric characteristics of both questionnaires were strong. Infit and outfit values were close to 1. The reliability values for the items and people were 0.96 and 0.79 for ChEHK-Q and 0.98 and 0.89 for ChEHS-Q, respectively. Only 52 (22.41%) and 77 (33.62%) participants had at least good knowledge and skills, respectively. Higher knowledge and skills were found with respect to the vulnerability of children and identification of environmental risks in the home. Lower levels of knowledge and skills were found with respect to the effects of pesticides and the assessment of neoplastic pollutants. Conclusion: Findings demonstrate deficiencies in nursing competencies related to children’s environmental health. The use of these questionnaires will facilitate improvement in both knowledge and skills related to children’s environmental health among future nurses

Women's Pain

Women's Pai

O papel da família na normalização da gravidez em idade precoce /

En esta investigación la familia tiene un lugar central para analizar el embarazo a temprana edad. Se realizó una investigación de corte cualitativo y hermenéutico a través de entrevistas semi-estructuradas a 16 adolescentes embarazadas de la ciudad de Bucaramanga, Colombia. Los hallazgos sugieren que las familias de las adolescentes tienen un origen muy disperso y una tipología en continua recomposición cuestionando la capacidad familiar como contenedor del embarazo a temprana edad. Se destaca que las familias y las adolescentes priorizan más las situaciones para la normalización social cuando se presenta el embarazo que las posibilidades de contención a través de la educación, la prevención, el auto cuidado y el disfrute pleno de la etapa del ciclo vital.Universidad Autónoma del Caribe

Attitude and maternal adaptation during pregnancy

El objetivo de nuestro estudio es evaluar la influencia de diversos factores como la edad, planificación del embarazo, nivel de estudios, etc. sobre la actitud y percepción del embarazo que tiene la mujer gestante en la recta final del mismo. Se ha realizado un estudio descriptivo transversal, en mujeres embarazadas más de 36 semanas que se sometían a revisiones rutinarias de cardiotocografía en la consulta de bienestar fetal del hospital Materno-Infantil perteneciente al Complejo Hospitalario Ciudad de Jaén. El instrumento usado ha sido el cuestionario de actitud y adaptación maternal de Kumar y cols. (1984). Los resultados obtenidos en el estudio nos muestran que el hecho de que el embarazo sea deseado esta íntimamente ligado a un alto grado de satisfacción de la gestante en todo el proceso del embarazo, el estado civil influye de manera determinante en el deseo del embarazo, y el afecto mostrado por la pareja de la gestante aumente proporcionalmente con el número de embarazos.The aim of our study is to evaluate the influence of several factors such as age, wanted pregnancy, education level, etc, on final stages pregnant women’s attitude and perception of pregnancy. A cross-sectional descriptive study was carried out with over 36 weeks pregnant women undergoing routine cardiotocographic check-ups in the Foetal Welfare outpatients unit at the Maternity-Children’s hospital (Ciudad de Jaén Hospital). Kumar et al’s attitude and maternal adaptation questionnaire (1984) was used. The results obtained suggest that a wanted pregnancy is closely linked to a high degree of satisfaction throughout pregnancy, that marital status has a determinant influence on wanted pregnancies, and that affection showed by pregnant women’s partners increases proportionally to the number of pregnancies

Seguridad y eficiacia de una nueva pauta de suplementación en pacientes con fibrosis quística e insuficiencia de vitamina D

Cystic fibrosis; Vitamin D; Multicentre studyFibrosis quística; Vitamina D; Estudio multicéntricoFibrosi quística; Vitamina D; Estudi multicèntricObjectives Based on the European and American Cystic Fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or defficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. Material and methods Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30 ng/mL) received increasing doses of VD (between 800 and 10 000 IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. Statistical analysis: t test for paired data and multivariate logistic regression analysis. Results Thirty patients aged 1–39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100 ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6 ng/mL (95% CI, 4.6−10 ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30 ng/mL or greater, 50% levels between 20 and 30 ng/mL and 13% remained with levels of less than 20 ng/mL. We found no association between improved VD levels and pulmonary function. Conclusions The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity.Objetivos Basándonos en los documentos de consenso europeo y americano de Fibrosis Quística (FQ) se propone un incremento de la suplementación de vitamina D (VD) en pacientes con FQ y niveles insuficientes. El objetivo de nuestro estudio fue conocer la seguridad y la eficacia de este nuevo protocolo. Material y métodos Estudio multicéntrico, experimental no aleatorizado ni controlado. A los pacientes con niveles insuficientes (<30 ng/mL) se les administró dosis crecientes de VD (entre 800 y 10000 UI/día). Se realizó seguimiento durante 12 meses analizando estatus vitamínico, nutricional, función pulmonar y metabolismo fosfo-cálcico. Análisis estadístico: pruebas t para datos apareados y regresión logística con análisis multivariable. Resultados 30 pacientes entre 1 y 39 años (mediana 9,1) completaron el estudio. Se retiraron 2 por niveles de 25 OH VD > 100 ng/mL a los 3 meses sin encontrarse signos clínicos ni analíticos de hipercalcemia. Tras 12 meses se observó un incremento de 7,6 ng/mL (IC 95% 4,6−10 ng/mL) de los niveles medios de 25 OH VD. El 37% alcanzaron niveles ≥30 ng/mL, un 13% <20 ng/mL y un 50% entre 20 y 30 ng/mL. No se observó asociación de la mejoría de los niveles de VD con la función pulmonar. Conclusiones Con el protocolo propuesto se consigue un incremento de los niveles séricos de VD y una disminución del porcentaje de pacientes con insuficiencia de la misma, aunque todavía muy lejos de alcanzar los porcentajes de suficiencia recomendados para esta entidad.This study received funding from the Fundación Ernesto Sánchez Villares (05/2015) and the Fundación Nutrición y Crecimiento

Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective?

Cystic fibrosis; Multicenter study; Vitamin DFibrosis quística; Estudio multicéntrico; Vitamina DFibrosi quística; Estudi multicèntric; Vitamina DIntroduction: In recent years, guidelines for vitamin D supplementation have been updated and prophylactic recommended doses have been increased in patients with cystic fibrosis (CF). Objective: To evaluate safety and efficacy of these new recommendations. Results: Two cohorts of pancreatic insufficient CF patients were compared before (cohort 1: 179 patients) and after (cohort 2: 71 patients) American CF Foundation and European CF Society recommendations were published. Cohort 2 patients received higher Vitamin D doses: 1509 (1306-1711 95% CI) vs 1084 (983-1184 95% CI) IU/Day (p < 0.001), had higher 25 OH vitamin D levels: 30.6 (27.9-33.26 95% CI) vs. 27.4 (25.9-28.8 95% CI) ng/mL (p = 0.028), and had a lower prevalence of insufficient vitamin D levels (<30 ng/mL): 48% vs 65% (p = 0.011). Adjusted by confounding factors, patients in cohort 1 had a higher risk of vitamin D insufficiency: OR 2.23 (1.09-4.57 95% CI) (p = 0.028). Conclusion: After the implementation of new guidelines, CF patients received higher doses of vitamin D and a risk of vitamin D insufficiency decreased. Despite this, almost a third of CF patients still do not reach sufficient serum calcidiol levels.This research was partially funded by Fundación Ernesto Sánchez Villares and Fundación Nutrición y Crecimiento