Perceived facilitating and hindering factors to exclusive breastfeeding among Latin American immigrant women living in Colmenar Viejo (Community of Madrid, Spain)

The way in which an infant is breastfed by a migrant woman reflects her bio-psycho-social circumstances and her process of cultural transformation and adaptation to the host country. Exploring facilitating and hindering factors to exclusive breastfeeding (EBF) of immigrant mothers in Spain is essential for the development of guidelines that protect EBF. The aim of this qualitative study is to explore the factors perceived as facilitating or hindering EBF during the first six months of the baby's life by Latin American women living in Colmenar Viejo, a city in the Community of Madrid (Spain). We carried out in-depth semi-structured face-to-face interviews between December 2018 and February 2019 with 11 Latin American mothers who were recruited through key informants and snowball sampling. We audio-recorded the interviews, transcribed them, and performed content analysis to examine the data. EBF was facilitated by the mother and her family having information about its benefits, lower economic expenses, family and healthcare system support, certain popular and spiritual beliefs, and the mother's acculturation process in Spanish society. The hindering factors identified were the perception of EBF as a sacrifice, incompatible with working life, with unsightly and painful consequences for the mother, insufficient to nourish the baby and ineffective after some months, poorly supported by the broader social environment and the healthcare system. EBF was restricted by certain popular beliefs, associated with a stigma if abandoned, and linked to less economically favored social classes. Some of these hindering or facilitating factors are similar to those present in the original Latin American society or the receiving Spanish society. EBF is a complex process, with satisfactory and suffering stages, regulated by beliefs and experiences. EBF must be promoted intersectorally by governmental, health and societal actors considering the biological, psychological, social, and cultural characteristics of the mother and her communitySpanish Ministry of Education and Professional Training Collaboration Grant, number 18CO1/003827 (2000 € for the development of a collaboration project endorsed and evaluated by the Nursing Department of the Universidad Autónoma de Madrid

Biomimetic polypyrrole based all three-in-one triple layer sensing actuators exchanging cations†

Simultaneous actuation and sensing properties of a triple layer actuator interchanging cations are presented for the first time. Thick polypyrrole (pPy)/dodecylbenzenesulfonate (DBS) films (36 mm) were electrogenerated on stainless steel electrodes. Sensing characteristics of pPy-DBS/tape/pPy-DBS triple layer artificial muscle were studied as a function of electrolyte concentration, temperature and driving current using lithium perchlorate (LiClO4) aqueous solution as electrolyte. The chronopotentiometric responses were studied by applying consecutive square waves of currents to produce angular movements of 45 by the free end of the triple layer. The evolution of the muscle potential (anode film versus cathode film) during current flow is a function of the studied chemical and physical variables. The electrical energy consumed to describe a constant angle is a linear function of the working temperature or of the driving electrical current, and a double logarithmic function of the electrolyte concentration. Those are the sensing functions. The cation exchanging bending triple layer actuator senses the working conditions. Similar sensing functions were described in the literature for devices interchanging anions. Irrespective of the reaction mechanism, a single electrochemo–mechanical device comprised of two reactive polymer electrodes (oxidation film and reduction film) works simultaneously as both sensor and actuator (self-sensing actuators). These are the general sensing properties of dense and biomimetic reactive gels of conducting polymers. Thus, any reactive device based on the same type of materials and reactions (batteries, smart windows, actuators, electron–ion transducers) is expected to sense surrounding conditions, as biological organs do

Comparison of ALBAYZIN query-by-example spoken term detection 2012 and 2014 evaluations

Query-by-example spoken term detection (QbE STD) aims at retrieving data from a speech repository given an acoustic query containing the term of interest as input. Nowadays, it is receiving much interest due to the large volume of multimedia information. This paper presents the systems submitted to the ALBAYZIN QbE STD 2014 evaluation held as a part of the ALBAYZIN 2014 Evaluation campaign within the context of the IberSPEECH 2014 conference. This is the second QbE STD evaluation in Spanish, which allows us to evaluate the progress in this technology for this language. The evaluation consists in retrieving the speech files that contain the input queries, indicating the start and end times where the input queries were found, along with a score value that reflects the confidence given to the detection of the query. Evaluation is conducted on a Spanish spontaneous speech database containing a set of talks from workshops, which amount to about 7 h of speech. We present the database, the evaluation metric, the systems submitted to the evaluation, the results, and compare this second evaluation with the first ALBAYZIN QbE STD evaluation held in 2012. Four different research groups took part in the evaluations held in 2012 and 2014. In 2014, new multi-word and foreign queries were added to the single-word and in-language queries used in 2012. Systems submitted to the second evaluation are hybrid systems which integrate letter transcription- and template matching-based systems. Despite the significant improvement obtained by the systems submitted to this second evaluation compared to those of the first evaluation, results still show the difficulty of this task and indicate that there is still room for improvement.This research was funded by the Spanish Government ('SpeechTech4All Project' TEC2012 38939 C03 01 and 'CMC-V2 Project' TEC2012 37585 C02 01), the Galician Government through the research contract GRC2014/024 (Modalidade: Grupos de Referencia Competitiva 2014) and 'AtlantTIC Project' CN2012/160, and also by the Spanish Government and the European Regional Development Fund (ERDF) under project TACTICA

Atributos de atención primaria y respuestas a la violencia de compañero íntimo en España

Objective: This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV). Methods: A qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis. Results: Four categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach. Conclusion: There is a gap between the theoretical attributes of PHC and the “reality” of how these attributes are managed in everyday work, and how this influences IPV care.Objetivo: Este estudio presenta las percepciones de profesionales de atención primaria sobre cómo los atributos de la atención primaria en España pueden influenciar las respuestas sanitarias a la violencia del compañero íntimo (VCI). Métodos: Estudio cualitativo con entrevistas semiestructuradas con 160 profesionales sanitarios de 16 centros de atención primaria en España. Los datos se analizaron con el enfoque de análisis de contenido. Resultados: Del análisis de las entrevistas emergieron cuatro categorías: Implicados/as con el enfoque de primaria, pero enfrentando dificultades para implementarlo; El trabajo comunitario depende del voluntarismo; ¿Trabajo multidisciplinario o profesionales que trabajan juntos?; y Continuidad amenazada por la sobrecarga de trabajo. Los participantes consideraron que la atención centrada en la persona y otros atributos del enfoque de atención primaria facilitaban la detección de VCI y una mejor respuesta a este problema. Sin embargo, también reconocieron que la forma en que se gestionan los servicios sanitarios (sobrecarga de trabajo, débil supervisión y escaso feed-back, distribución de los recursos humanos y materiales, etc.) no facilita la sostenibilidad de este enfoque. Conclusión: Existe una brecha entre los atributos teóricos de la atención primaria y la «realidad» de cómo estos atributos se gestionan en la actividad profesional del día a día y de qué manera esta influye en la atención a la VCI.This study has been funded through a COFAS grant (supported by COFUND action within the Marie Curie Action People, in the Seventh Framework programme and the Swedish Council for Working Life and Social Research/FAS-Forskningsradet för arbetsliv och socialvetenskap) through a competitive call. This work was partly supported by the Umeå Center for Global Health Research, funded by FAS, the Swedish Council for Working Life and Social Research (Grant no. 2006-1512)

Barriers and facilitators for exclusive breastfeeding in women’s biopsychosocial spheres according to primary care midwives in Tenerife (Canary Islands, Spain)

The objective of our study is to determine, from a primary care midwife’s perspective, which biopsychosocial factors can favour or be detrimental to exclusive breast feeding. (2) The study was carried out in Tenerife (Canary Islands, Spain) and is based on qualitative methodology. Twenty in-depth interviews were carried out with midwives working in primary care centres in Tenerife, using a content analysis approach. The transcript data was then encoded following an inductive approach. (3) According to the perceptions of the primary care midwives who were interviewed, the barriers and facilitators that influence exclusive breastfeeding related to the biopsychosocial spheres of women are, at an individual level, the physical and emotional aspects during the postnatal period; at the relationship level, the presence or not of support from the close family and partner; at the community level, the environment and social networks the new mothers may have; and at the work level, characteristics of jobs and early return to work. (4) The findings of our research can help healthcare professionals to approach the promotion and encouragement of exclusive breast feeding at each of the levels studied, with the aim of increasing rates following recommendations issued by The World Health OrganizationThis research was funded by the Spanish Health Research Fund (PI 080306). Canary Islands Foundation Health Research Institute of the Canary Islands (FIISC). CIF: G76208396

Economic mapping and assessment of Cymodocea nodosa meadows as nursery grounds for commercially important fish species. A case study in the Canary Islands

Cymodocea nodosa seagrass meadows provide several socio-economically ecosystem services, including nurseries for numerous species of commercial interest. These seagrasses are experiencing a worldwide decline, with global loss rates approaching 5% per year, mainly related to coastal human activities. Cymodocea nodosa, the predominant seagrass in the Canary Archipelago (Spain), is also exposed to these threats, which could lead to habitat loss or even local disappearance. In this case study, we estimated the potential economic value of Cymodocea nodosa seagrass meadows for local fisheries at an archipelago scale. Habitat suitability maps were constructed using MAXENT 3.4.1, a software for modelling species distributions by applying a maximum entropy machine-learning method, from a set of environmental variables and presence and background records extracted from historical cartographies. This model allows characterising and assessing the C. nodosa habitat suitability, overcoming the implicit complexity derived from seasonal changes in this species highly dynamic meadows and using it as a first step for the mapping and assessment of ecosystem services. In a second step, value transfer methodologies were used, along with published economic valuations of commercially-interesting fish species related to C. nodosa meadows. We estimate that the potential monetary value of these species can add up to more than 3 million euros per year for the entire Archipelago. The simplicity of the proposed methodology facilitates its repeatability in other similar regions, using freely available data and hence, being suitable for data-scarce scenarios.En prens

Conflicts between nursing ethics and health care legislation in Spain

Objetivo: Evidenciar los conflictos éticos que pueden surgir entre los discursos legal y ético, a través deexplorar el contenido del Real Decreto-Ley 16/2012 que modifica la ley sanitaria en Espa˜na y los códigoséticos.Método: Revisión y análisis crítico del discurso de cinco códigos éticos de Enfermería de Barcelona,Catalu˜na, Espa˜na, Europa e Internacional, y del discurso de la legislación sanitaria vigente en Espa˜naen 2013, en los que se identificaron y compararon estructuras lingüísticas referentes a cinco principiosy valores éticos del marco teórico de la ética de los cuidados: equidad, derechos humanos, derecho a lasalud, accesibilidad y continuidad de los cuidados.Resultados: Mientras que el discurso ético define la función enfermera en función de la equidad, el recono-cimiento de los derechos humanos, el derecho a la salud, la accesibilidad y la continuidad de los cuidadosde la persona, el discurso legal se vertebra sobre el concepto de beneficiario o asegurado.Conclusiones: La divergencia entre el discurso ético y legal puede producir conflictos éticos que afectennegativamente a la práctica de la profesión enfermera. La aplicación del RDL 16/2012 promueve un marcode acción que impide que los profesionales enfermeros presten sus cuidados a colectivos no asegurados,lo que atenta contra los derechos humanos y los principios de la ética de los cuidados

Cardiopatía congénita y situs inverso como expresión prenatal del síndrome Ivemark

Introduction: Ivemark Syndrome is a rare congenital condition that affects multiple organs of the body; it is classified as a disorder of heterotaxiaor laterally disorder. It is characterized by anomalies of the spleen and other abdominal organs as well as malformations of the heart. Case report: a 15-month-old boy who underwent fetal echocardiography in the 28th week of his fetal development, in the left heart cavity an axis of more than 650 with increase of right cavities, at the aortic valve level a slight decrease in its caliber was observed. Diagnostic impressions are presented as inverse situs, interruption of inferior vena cava and continuation with azygos vein, aortic valvular stenosis and left isomerism. Cesarean delivery was performed at 39 weeks of pregnancy, weight 5080 gr, apgar scoring 9-9. In the abdominal ultrasound the spleen was not defined, the right kidney was malrotated observing also intestinal malrotation. Ivemark Syndrome was the definitive diagnosis. The infant is periodically monitored by a multidisciplinary medical team. Conclusions: at present, it is possible to formulate an early diagnosis of the cardinal signs that involve internal organs such as cardiovascular system, liver, and spleen during prenatal stage to confirm the Ivemark Syndrome, which contributes to the genetic counseling and the multidisciplinary approach in the neonatal stage, avoiding fatal complications and therefore to increase in quality and life expectancy.Introducción: El Síndrome Ivemark es una rara condición congénita que afecta múltiples órganos del cuerpo, es clasificada como un desorden de heterotaxia o desorden de lateralidad. Se caracteriza por anomalías del bazo y de otros órganos abdominales así como malformaciones cardiacas.Presentación del caso: Niño de 15 meses que en la semana 28 de su desarrollo fetal se le realizó la ecocardiografía fetal, observándose corazón a la izquierda con un eje de más de 650 con aumento de cavidades derechas, a nivel valvular aórtico una ligera disminución de su calibre. Se plantea como impresiones diagnóstica situs inverso, Interrupción de vena cava inferior y continuación con vena ácigos, estenosis valvular aórtica e Isomerismo izquierdo. Se realizó parto por cesárea, con un tiempo gestacional de 39 semanas, peso  5080 gr, apgar 9-9. Se realiza ultrasonido abdominal donde no se define bazo, el riñón derecho se encuentra malrotado, se diagnosticó malrotación intestinal. Se concluyó como diagnóstico definitivo el Síndrome Ivemark. Se mantiene en seguimiento periódico por varias especialidades médicas.Conclusiones: En la actualidad es posible realizar el diagnóstico precoz de los signos cardinales que involucran órganos internos como sistema cardiovascular, hígado, bazo, en la etapa prenatal y por tanto pensar en el Síndrome Ivemark, lo cual contribuye al asesoramiento genético y al abordaje multidisciplinario en la etapa neonatal, con lo cual se evitan complicaciones fatales y por tanto se revierte en el aumento de la calidad y esperanza de vida

Sospecha prenatal y diagnóstico postnatal de un paciente con fibrosis quística

Introduction: Cystic fibrosis is a genetic disease of autosomal recessive inheritance, characterized by dysfunction of the exocrine secretion glands.Case report: Male patient 2 years of age, at term (39 weeks). In the third trimester of pregnancy, polyhydramnios, dilated bowel loops and a possible low bowel atresia is not ruled out at that time. Rest of normal genetic tests. At the month of birth he enters due to malnutrition and liquid diarrhea. After 2 months, she re-entered due to respiratory manifestations, in the nutritional evaluation her height and weight was below the third percentile, she had skin-pale pallor, demonstrating anemia due to iron deficiency and light hair color. Given the prenatal history and the predominance of digestive and respiratory manifestations, it is decided to perform sweat electrolyte examination in 2 moments, which are negative. It is decided to conduct a molecular study for the detection of mutations that results: ΔF508del / R1162X (Heterozygous compound for cystic fibrosis). Dietary and vitamin therapy treatment is applied. He continues his attention in multidisciplinary consultations, Nutrition, Gastroenterology, Genetics and Pediatrics.Conclusions: The early diagnosis of cystic fibrosis is made by detecting the cardinal signs that involve the respiratory and digestive system; as well as family history. In the prenatal stage, the findings related to the increased amniotic fluid, the alteration of the fetal vesicle should be taken into account, which allows the definitive diagnosis to be made by studying the mutations.Introducción: La fibrosis quística es una enfermedad genética de herencia autosómica recesiva, caracterizada por disfunción de las glándulas de secreción exocrina.Presentación del caso: Paciente masculino de 2 años de edad, a término (39 semanas). En el tercer trimestre del embarazo, se reporta por ultrasonido polihidramnios, asas intestinales dilatadas, ecorrefrigencia abdominal grado III, no descartándose en esos momentos una posible atresia intestinal baja. Resto de exámenes genéticos normales. Al mes de nacido ingresa por desnutrición y diarreas liquidas. A los 2 meses reingresa por manifestaciones respiratorias, en la evaluación nutricional su peso para la talla se encontraba por debajo del tercer percentil, tenía palidez cutáneomucosa, demostrándose anemia por déficit de hierro y coloración clara del pelo. Ante los antecedentes prenatales y el predominio de manifestaciones digestivas y respiratorias, se decide realizar examen de electrolitos en sudor en 2 momentos, los que resultan negativos. Se decide realizar estudio molecular para detección de mutaciones que resulta: ΔF508del/R1162X (Heterocigoto compuesto para la fibrosis quística). Se pone tratamiento dietético y con vitaminoterapia. Continúa su atención en consultas multidisciplinarias, de Nutrición, Gastroenterología, Genética y Pediatría.Conclusiones: El diagnóstico precoz de la fibrosis quística se realiza mediante la detección de los signos cardinales que involucran al sistema respiratorio y al digestivo; así como los antecedentes familiares. En la etapa prenatal se deben tener en cuenta los hallazgos relacionados con el líquido amniótico aumentado, la ecorrefrigencia abdominal, la alteración de la vesícula fetal lo cual permite realizar el diagnóstico definitivo mediante el estudio de las mutaciones

Genética y ambiente en la embriogénesis de la secuencia sirenomelia, reporte de un caso

Introduction: the sirenomelia sequence is a primary defect that occurs in the mesoderm of the posterior middle axis of the embryo and turns out the fusion of the primordium of limbs in its fibular margins, with absence or complete development of the intercurrent caudal structures.Case report: a 36-year-old pregnant woman with a reproductive history of three previous pregnancies and two deliveries without abortions, who in the genetic risk assessment consultation, classified as increased genetic risk (risk of chromosomal alterations). A history of possible exposure to teratogens was collected. Multiple congenital defects were observed in the study of the fetus by means of ultrasound. Genetic counseling and reproductive options are provided in multidisciplinary team office to both members of the couple. Both gave their consent for the interruption of pregnancy. The pathological study confirmed multiple congenital anomalies.Conclusions: major congenital anomalies, that are part of the sirenomelia sequence, can be diagnosed in the prenatal stage by means of Ultrasonography Studies during the first and second trimesters of pregnancy. The definitive and classified diagnosis can be completed after the pathological study of the fetus.  Genetic counseling is improved and based on the consideration of the alterations in embryogenesis with its genetic and environmental aspects; where the concluding aspects are personalized considering the pregnant woman, her family, as well as her social and personal situation.Introducción: la secuencia sirenomelia es un defecto primario que ocurre en mesodermo del eje medio posterior del embrión y produce la fusión de los primordios de miembros en sus márgenes fibulares, con ausencia o desarrollo completo de las estructuras caudales intercurrentes.Presentación de caso: gestante de 36 años, con una historia reproductiva de tres gestaciones, dos partos y ningún aborto. En la consulta de evaluación de riesgo genético se clasificó como riesgo genético incrementado (riesgo de alteraciones cromosómicas). Se recoge el antecedente de posible exposición a teratógenos. Por el estudio del feto mediante el uso del ultrasonido se observan defectos congénitos múltiples. Se brinda asesoramiento genético y opciones reproductivas en consulta multidisciplinaria a ambos miembros de la pareja. Ambos ofrecen sus consentimientos para la interrupción de la gestación. Se realiza el estudio anatomopatológico en el cual se reportan múltiples defectos congénitos.Conclusiones: Los defectos congénitos mayores que forman parte de la secuencia sirenomelia, son posibles diagnosticarlos, en la etapa prenatal, mediante la ultrasonografía del primer y segundo trimestre de la gestación. El diagnóstico definitivo, clasificado, puede ser concluido después del estudio anatomopatológico fetal.  El asesoramiento genético se enriquece y se fundamenta si se tiene en cuenta las alteraciones en la embriogénesis con sus aspectos genéticos y ambientales, estos últimos personalizados según la gestante y su entorno familiar, social y personal