Caring for others without neglecting oneself? Grandparent caregivers, gender, and perceived health-related quality of life.

In this study, we explored the impact of caregiving on quality of life and health perceptions and outlined the profile of grandparent caregivers in Andalusia (Spain) in terms of a range of sociodemographic variables related to the care of their grandchildren. A sample of 171 participants (21.6% men) completed the Health-Related Quality of Life (HRQoL) questionnaire and another ad hoc one providing sociodemographic and caregiving data. We studied the relationships between these variables and HRQoL using ANOVA, chi-square and Multiple Linear Regression. We found a mainly female profile for the care of grandchildren and interesting relationships for the physical and mental components of HRQoL. Some relationships were marked by gender: caregiving for pleasure was more often the motive for men while by imposition was more common among women. We discuss the impact of caregiving on health according to the Self-Determination Theory and suggest practical implications derived from the main findings.

Female employees' perception of breastfeeding-friendly support in a public university in Spain.

OBJECTIVE: To explore women's experience with continuing breastfeeding when they returned to work. DESIGN AND SAMPLE: A cross-sectional study was conducted. Participants were female employees at the University of Seville who gave birth in the last 10 years while working at University. MEASURES: A questionnaire in Spanish was used to collect information on sociodemographic variables, employment characteristics, continued breastfeeding behavior after returning to work and the dimensions of the validated scale the Workplace Breastfeeding Support Scale (WBSS). RESULTS: A total of 197 women responded, consisting of 53.8% faculty and 46.2% administrative staff. Almost all the women had breastfed their children (92.9%). The proportion of women who continued to breastfeed after they returned to work was 51.3%. The main reason given for interrupting lactation was the challenge of reconciling family and work (53.1%). Faculty members took more breaks for breastfeeding (p = 0.002) and were able to arrange their breaks more easily (p < 0.001). Since it was easier for them to find a quiet place to pump breast milk (p = 0.025), they were more likely to continue breastfeeding after returning to work than were administrative staff (59.8% vs. 41.1%, p < 0.009). CONCLUSION: A designated lactation space and amenities should be provided in order to extend the duration of breastfeeding.

Influence of Gender and Care Strategy in Family Caregivers´ Strain: A Cross-Sectional Study.

PURPOSE: To analyze the factors that influence the strain on family caregivers of elderly dependent people, relating it to the strategy of care, with a gender perspective. DESIGN: Cross-sectional study. METHODS: We interviewed 328 Spanish family caregivers in 2012. Main variable: Caregiver Strain Index (CSI). INDEPENDENT VARIABLES: relationship, sex, age, marital status, education level, employment status, socioeconomic status, family and/or institutional supports, time they devote to care, and how long they have been giving care. Data were analyzed using bivariate procedures and multiple linear regression. FINDINGS: Caregiver profile: women around 60 years old, housewives, with primary education. CSI average: 6.63 ± 3.36. Female sex, kinship being a son or daughter, housewife employment status, service of home care, and the care recipient being female were significantly associated with the subjective strain. CONCLUSIONS: Caregivers´ strain has a strong gender component: women are more tired, primarily those that practice a partial care strategy. CLINICAL RELEVANCE: Knowing the factors that predict burden, nurses may help caregivers to provide better care. A risk profile for strain and burden: women who practice a partial care strategy; they are adult women and daughters who do not want to give up their professional role and combine it with their duty of caregiving.

[Influencia de las redes de apoyo sociofamiliares en el cuidado de las personas mayores dependientes: un estudio cualitativo.] / Influence of social-family support networks on the care of dependent older people: a qualitative study.

OBJECTIVE: Socio-family support networks (SFSN) are necessary for the care of dependent people. This study aimed to explore the types of support provided in the SFSN for dependent older people in the Aljarafe Health District-Sevilla Norte (Spain) from a gender perspective. METHODS: A qualitative biographical study was carried out, based on semi-structured interviews. The sample size met the theoretical saturation criterion. A total of twenty-four people participated in the study, fifteen women and nine men. For the qualitative analysis of the content and discourse of the people interviewed, Grounded Theory was followed. RESULTS: Four categories emerged corresponding to the types of support provided: cognitive, material, instrumental and emotional support. These categories corresponded to the prototypes that caregivers and patients built through the ideas and concepts they had about caring for dependent people. The different types of support provided reduced the discomfort of all members of the SFSN. Differences were evident in the speeches between men and women. CONCLUSIONS: Caring continues to be an activity that women usually do. The types of support analyzed show that the existence of a network is a guarantee of care and the use of SFSN reduces the overload of the caregiver by being compensated with the other members of the network. Therefore, networks are a health protection factor for family caregivers.

OBJECTIVE: Las redes de apoyo sociofamiliares son necesarias para el cuidado de las personas dependientes. El objetivo de este estudio fue explorar los tipos de apoyo que se dan en las Redes de Apoyo Sociofamiliares (RASF) de las personas dependientes mayores del Distrito Sanitario Aljarafe-Sevilla Norte (España) desde una perspectiva de género. METHODS: Se realizó un estudio cualitativo de corte biográfico, basado en la realización de entrevistas semiestructuradas. El tamaño de la muestra atendió al criterio de saturación teórica. Participaron en el estudio un total de veinticuatro personas, quince mujeres y nueve hombres. Para el análisis cualitativo del contenido y del discurso de las personas entrevistadas se siguió la Teoría Fundamentada. RESULTS: Emergieron cuatro categorías correspondientes a los tipos de apoyo prestados: apoyo cognitivo, material, instrumental y emocional. Estas categorías correspondían a los prototipos que las personas cuidadoras y pacientes construían a través de las ideas y conceptos que tenían sobre el cuidado a personas dependientes. Los distintos tipos de apoyo prestados disminuían el malestar de todos los componentes de las RASF. Se evidenciaron diferencias en los discursos entre hombres y mujeres. CONCLUSIONS: Cuidar continúa siendo una actividad que suelen realizar las mujeres. Los tipos de apoyos analizados demuestran que la existencia de una red es una garantía de cuidados y que el empleo de las RASF reduce la sobrecarga de la persona cuidadora al estar compensadas con los otros miembros de la red. Por tanto, las redes son un factor de protección de la salud para las personas cuidadoras familiares.

[Glass ceilings in the scientific societies and professional associations in the field of health in Spain in 2019]. / Techos de cristal en las sociedades científicas y los colegios profesionales del ámbito de la salud en España en 2019.

OBJECTIVE: To analyze the composition of the management structures of Spanish professional associations and scientific societies in the field of health in 2019 and compare them with the data obtained in 2014 and 2015. METHOD: descriptive cross-sectional study. Scientific societies in the health field with state representation as of May 30, 2019 and data from professional associations with provincial, regional or state representation were collected as of June 1, 2019. They are compared to 2014 and 2015. RESULTS: 259 professional associations and 163 scientific societies were analyzed. Both professional associations and scientific societies in the field of Health in 2019 exceed the percentage of 40% of balanced composition. The positions that have increased the most in percentage of women are those of vice-secretary (20,8%) or secretaries (9,3% in companies), vice-presidencies (8,8% and 11%) and members (6,4% and 4%). Presidency (2%) and dean (6%), the least. CONCLUSIONS: It is necessary to continue with the efforts to advance in an equitable representation by sex.

Multiple Gestations and Assisted Reproductive Technologies: Qualitative Study of the Discourse of Health Professionals in Spain.

Multiple gestations have become an increasing phenomenon that has impacted public health globally, largely due to the application of assisted reproductive technologies. The objective of this work was to find out the discourse that the health professionals involved in its follow-up have in our context. For this, a qualitative methodology was chosen, with semi-structured interviews recorded in audio, prior authorisation, and transcribed verbatim. It was based on a script designed for this purpose, with the following analysis categories: the current trend of multiple gestations, impact, and follow-up. The content analysis was based on the experiences, knowledge, and perceptions of the professionals interviewed. Professionals stated that the current socioeconomic and legal context hinders a single embryo transfer policy that decreases multiple gestation rates. They emphasised the importance of the psychic impact of such gestations on the couple, on the mother in particular, as well as the economic effect on families, health, and society in general. They expressed the need to create specific protocols to assist these gestations. Midwives, in particular, demanded that the health administration recognise and support the differentiated care they perform with this type of gestation. Work on specific models is needed to adequately size the impact of multiple gestations, as well as to generate social health policies that lead to co-responsible reconciliation measures that favour women having one pregnancy at a time.

Influencia de las redes de apoyo sociofamiliares en el cuidado de las personas mayores dependientes: un estudio cualitativo / Influence of social-family support networks on the care of dependent older people: a qualitative study

Fundamentos: Las redes de apoyo sociofamiliares son necesarias para el cuidado de las personas dependientes. El objetivo de este estudio fue explorar los tipos de apoyo que se dan en las Redes de Apoyo Sociofamiliares (RASF) de las personas dependientes mayores del Distrito Sanitario Aljarafe-Sevilla Norte (España) desde una perspectiva de género. Métodos: Se realizó un estudio cualitativo de corte biográfico, basado en la realización de entrevistas semiestructuradas. El tamaño de la muestra atendió al criterio de saturación teórica. Participaron en el estudio un total de veinticuatro personas, quince mujeres y nueve hombres. Para el análisis cualitativo del contenido y del discurso de las personas entrevistadas se siguió la Teoría Fundamentada. Resultados: Emergieron cuatro categorías correspondientes a los tipos de apoyo prestados: apoyo cognitivo, material, instrumental y emocional. Estas categorías correspondían a los prototipos que las personas cuidadoras y pacientes construían a través de las ideas y conceptos que tenían sobre el cuidado a personas dependientes. Los distintos tipos de apoyo prestados disminuían el malestar de todos los componentes de las RASF. Se evidenciaron diferencias en los discursos entre hombres y mujeres. Conclusiones: Cuidar continúa siendo una actividad que suelen realizar las mujeres. Los tipos de apoyos analizados demuestran que la existencia de una red es una garantía de cuidados y que el empleo de las RASF reduce la sobrecarga de la persona cuidadora al estar compensadas con los otros miembros de la red. Por tanto, las redes son un factor de protección de la salud para las personas cuidadoras familiares.(AU)

Background: Socio-family support networks (SFSN) are necessary for the care of dependent people. This study aimed to explore the types of support provided in the SFSN for dependent older people in the Aljarafe Health District-Sevilla Norte (Spain) from a gender perspective. Methods: A qualitative biographical study was carried out, based on semi-structured interviews. The sample size met the theoretical saturation criterion. A total of twenty-four people participated in the study, fifteen women and nine men. For the qualitative analysis of the content and discourse of the people interviewed, Grounded Theory was followed. Results: Four categories emerged corresponding to thnal support. These categories corresponded to the prototypes that caregivers and patients built through the ideas and concepts they had about caring for dependent people. The different types of support provided reduced the discomfort of all members of the SFSN. Differences were evident in the speeches between men and women. Conclusions: Caring continues to be an activity that women usually do. The types of support analyzed show that the existence of a network is a guarantee of care and the use of SFSN reduces the overload of the caregiver by being compensated with the other members of the network. Therefore, networks are a health protection factor for family caregivers.(AU)

Techos de cristal en las sociedades científicas y los colegios profesionales del ámbito de la salud en España en 2019 / Glass ceilings in the scientific societies and professional associations in the field of health in Spain in 2019

Objetivo: Analizar la composición de las estructuras directivas de los colegios profesionales y las sociedades científicas españolas del ámbito de la salud en 2019 y compararlas con los datos de 2014 y 2015. Método: Estudio descriptivo transversal. Se recopilaron los datos de las sociedades científicas del ámbito sanitario con representación estatal a fecha 30 de mayo de 2019 y de los colegios profesionales con representación provincial, autonómica o estatal a fecha 1 de junio de 2019. Se compararon con los datos de 2014 y 2015. Resultados: Se analizaron 259 colegios profesionales y 163 sociedades científicas. Tanto los colegios profesionales como las sociedades científicas del ámbito de la salud en 2019 superan el porcentaje del 40% de composición equilibrada. Los cargos que más han aumentado en porcentaje de mujeres son los de vicesecretaria (20,8%) o secretaria (9,3% en sociedades), vicepresidenta (8,8% y 11%) y vocal (6,4% y 4%). Lo cargos de presidenta (2%) y decana (6%) los que menos han aumentado. Conclusiones: Es necesario continuar con los esfuerzos para avanzar en una representación equitativa por sexo. (AU)

Objective: To analyze the composition of the management structures of Spanish professional associations and scientific societies in the field of health in 2019 and compare them with the data obtained in 2014 and 2015. Method: descriptive cross-sectional study. Scientific societies in the health field with state representation as of May 30, 2019 and data from professional associations with provincial, regional or state representation were collected as of June 1, 2019. They are compared to 2014 and 2015. Results: 259 professional associations and 163 scientific societies were analyzed. Both professional associations and scientific societies in the field of Health in 2019 exceed the percentage of 40% of balanced composition. The positions that have increased the most in percentage of women are those of vice-secretary (20,8%) or secretaries (9,3% in companies), vice-presidencies (8,8% and 11%) and members (6,4% and 4%). Presidency (2%) and dean (6%), the least. Conclusions: It is necessary to continue with the efforts to advance in an equitable representation by sex. (AU)

Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial.

BACKGROUND: perineal injury is common after birth and may be caused by tears or episiotomy or both. Perineal massage has been shown to prevent episiotomies in primiparous women. On the other hand, pelvic floor exercises might have an influence by shortening the first and second stages of labour in the primigravida. AIM: the aim of this study was to investigate the effects of a pelvic floor training following a birth programme on perineal trauma. DESIGN: a single-blind quasi-randomized controlled trial with two groups: standard care and intervention. SETTING: a tertiary, metropolitan hospital in Seville, Spain. PARTICIPANTS: women (n=466) who were 32 weeks pregnant, having a singleton pregnancy and anticipating a normal birth were randomised. Women in the experimental groups were asked to perform a pelvic floor training programme that included: daily perineal massage and pelvic floor exercises from 32 weeks of pregnancy until birth. They were allocated to an intervention group by clusters (antenatal education groups) randomized 1:1. The control group had standard care that did not involve a perineal/pelvic floor intervention. These women were collected in a labour ward at admission 1:3 by midwives. RESULTS: outcomes were analysed by intention-to-treat. Women assigned to the perineal/pelvic floor intervention showed a 31.63% reduction in episiotomy (50.56% versus 82.19%, p<0.001) and a higher likelihood of having an intact perineum (17.61% versus 6.85%, p<0.003). There were also fewer third (5.18% versus 13.12%, p<0.001) and fourth degree-tears (0.52% versus 2.5%, p<0.001). Women allocated to the intervention group also had less postpartum perineal pain (24.57% versus 36.30%, p<0.001) and required less analgesia in the postnatal period (21.14% versus 30.82%, p<0.001). CONCLUSIONS: a training programme composed of pelvic floor exercises and perineal massage may prevent episiotomies and tears in primiparous women. This programme can be recommended to primiparous women in order to prevent perineal trauma. KEY CONCLUSION: the pelvic floor programme was associated with significantly lower rates of episiotomies and severe perineal trauma; and higher intact perineum when compared with women who received standard care only. IMPLICATIONS FOR PRACTICE: the programme is an effective intervention that we recommend to all women at 32nd week of pregnancy to prevent perineal trauma.

[Developing a predictive model for the caregiver strain index]. / Desarrollo de un modelo predictivo para el índice de esfuerzo del cuidador.

BACKGROUND: Patient homecare with multiple morbidities is an increasingly common occurrence. The caregiver strain index is tool in the form of questionnaire that is designed to measure the perceived burden of those who care for their families. The aim of this study is to construct a diagnostic nomogram of informal caregiver burden using data from a predictive model. METHODS: The model was drawn up using binary logistic regression and the questionnaire items as dichotomous factors. The dependent variable was the final score obtained with the questionnaire but categorised in accordance with that in the literature. Scores between 0 and 6 were labelled as "no" (no caregiver stress) and at or greater than 7 as "yes". The version 3.1.1R statistical software was used. To construct confidence intervals for the ROC curve 2000 boot strap replicates were used. RESULTS: A sample of 67 caregivers was obtained. A diagnosing nomogram was made up with its calibration graph (Brier scaled = 0.686, Nagelkerke R2=0.791), and the corresponding ROC curve (area under the curve=0.962). FINDINGS: The predictive model generated using binary logistic regression and the nomogram contain four items (1, 4, 5 and 9) of the questionnaire. R plotting functions allow a very good solution for validating a model like this. The area under the ROC curve (0.96; 95% CI: 0.994-0.941) achieves a high discriminative value. Calibration also shows high goodness of fit values, suggesting that it may be clinically useful in community nursing and geriatric establishments.

Las metáforas del cuidado en las vivencias y sentimientos de las personas cuidadoras / The metaphors of care in the experien-ces and feelings of caregivers

Objetivo principal: explorar las vivencias y sentimientos sobre el cuidado que manifiestan las personas cuidadoras a través de las metáforas, profundizando en las diferencias de género. Metodología: Estudio cualitativo a través de entrevistas semi-estructuradas. Participaron 24 informantes, 7 pacientes y 17 personas cuidadoras vinculadas a una red de apoyo socio familiar. Se llevó a cabo un análisis del contenido con el software Atlas-ti versión 7®. Resultados principales: Las metáforas expresadas a través de los sentimientos muestran sentimientos comunes en hombres y mujeres: el amor y la satisfacción. Se identificaron sentimientos exclusivos de mujeres, que beben de mandatos de género. Se observó que los hombres se están incorporando al cuidado. Conclusión principal: Las metáforas encontradas desvelan los significados que se atribuyen al cuidado. Las mujeres son conscientes del valor de cuidar, pero lo normalizan. Los hombres esperan reconocimiento social.(AU)

Objective: to explore the experiences and feelings about care that caregiver’s manifest through experiential and emotional metaphors, with special focus on gender differences. Methods: Qualitative study through semi-structured interviews. 24 informants, 7 patients and 17 caregivers participated, linked to a social and family support network. A content analysis was carried out with Atlas-ti version 7® software. Results: The metaphors expressed through feelings show common feelings in men and women: love and satisfaction. Feelings exclusive to women were identified, that come from gender mandates. It was observed that men are joining care more and more. Conclusions: The metaphors found reveal the meanings attributed to care. Women are aware of the value of caring, but they normalize it. Men expect social recognition.(AU)

Factors influencing family care by immigrant women in Spain: a qualitative study.

OBJECTIVES: To identify and understand factors that influence the relationships in the environment of family care provided by live-in immigrant caregivers. METHODS: Interpretive qualitative study from a phenomenological perspective, using in-depth interviews, discussion groups and participant observation. The observation unit was the Sevillian families (Spain) with elderly dependents and a live-in female immigrant caregiver. Analysis units considered were health, care, dependence, gender, ethnicity and social class. Categories were analysed using QSR-NUD*ISTVivo9. After saturation, we triangulated between researchers, disciplines, sources and techniques to validate the results. RESULTS: Factors of cultural discovery or clash were: language, religion, food, concept of space and time, caregiver's name and the attitudes held by both the hiring family, related to its social class, and by caregivers. CONCLUSIONS: Interpersonal relationships are the most important factor: an egalitarian relationship based on good treatment is beneficial to all involved. Knowing these codes will improve the quality of professional care in the family.

Gendering Guilt among Dependent Family Members' Caregivers.

This study analyzes guilt among family caregivers of dependent patients, from a gender perspective. A qualitative design was used, conducting in-depth interviews and focus groups. Using purposive sampling, we selected 73 family caregivers and 23 health professionals (family medicine, community nursing, and social work) from the Primary Care District of Seville. The content of the information collected was analyzed in terms of the following categories: a) guilt for abandoning family and friends; b) guilt for the relationship with the dependent person; and c) guilt for placing the relative in a nursing home. To validate the findings, data sources, methodological techniques, and researchers' disciplines were all triangulated. Results indicated that women report more guilt than men for abandoning family and friends, and because of their relationship with the dependent person. However, with respect to nursing home placement, no difference was observed as a function of gender. The high incidence of caregiver guilt needs to be addressed by health professionals to avoid the emergence of other mental health issues.

[Motivations and emotional experiences of the first hospital multidisciplinary team trained to care for people with Ebola in Andalusia, Spain (2014-2016)]. / Motivaciones y experiencias emocionales del primer equipo multidisciplinario hospitalario entrenado para atender casos de Ébola en Andalucía (2014-2016).

OBJECTIVE: The Hospital Universitario Virgen del Rocío (HUVR) of Seville was chosen as the reference Andalusian site to treat possible cases of Ebola. After the health alert (WHO, 2014), a voluntary group of healthcare and non-healthcare professionals was set up, which, after being trained, treated a possible case. In this light, the aim is to understand the motivations and emotional experiences of this group and to identify the facilitators of and obstacles to its operation. METHOD: Qualitative, interpretative and phenomenological study. Observation unit: professional team of the HUVR trained to treat Ebola cases. Analysis units: teamwork, motivations and emotions. Three interviews with key informants were conducted, as well as three discussion groups involving 23 of the 60 team members (2014-2016). A content analysis of the motivations, emotions and elements affecting the team's operation was conducted with QSRNUDISTVivo10. VALIDITY: data sources, techniques and disciplinary perspectives were triangulated. The results were presented to the team, which duly agreed with the findings. RESULTS: Training, professional responsibility, professional self-esteem, risk appetite or loyalty to the leader stood out as motivations to voluntarily join the team. Emotional experiences evolved from fear and stress to self-pressure control, while essential elements for the team's operation were found to be calmness and confidence based on training and teamwork. Family, source department, resources, communication media and emotional management were facilitators of or obstacles to the team's success. CONCLUSION: An understanding of the key motivational and influential factors may be important in the management of effective and successful multidisciplinary teams during health alerts.

[Representation of women in health-related scientific societies in Spain in 2014]. / Representatividad de las mujeres en las sociedades científicas españolas del ámbito de la salud en 2014.

OBJECTIVE: To describe the presence of women in the governance of health-related scientific societies in Spain today. METHODS: Spanish scientific societies were identified by vising the websites of the Ministry of Health, Social Services and Equality, and Fisterra. The sex of the president, executive officers and the board of directors was identified. Data were analyzed according to the overall percentage of women and by profession and setting. RESULTS: Of 173 scientific societies in July 2014, 41 had a female president (22.53%). Women held 35.45% of executive positions and accounted for 36.32% of the boards of directors. Only 16.07% of medical societies had a female president compared with 76.92% of nursing societies. Primary care societies had more women in executive positions (54.55%) than societies in which the professional activity of members involved both primary and secondary care (35.74%) and societies related to hospital care (27.93%). CONCLUSION: There is a lack of parity, which is greater in nursing and primary care societies than in medical and hospital-related societies. Parity decreases as the level of responsibility rises.

[Presence of women in management bodies of the professional associations of the field of health in 2015]. / Presencia de las mujeres en los órganos de dirección de los colegios profesionales del ámbito de la salud en 2015.

BACKGROUND: The gradual increase of women in the health professions does not correspond with her presence in positions of power. Given that professional colleges have an essential role in the representation and professional regulation, arises as an aim to describe the presence of women in the managerial structures of the professional colleges of health in Spain now to verify the degree of compliance with the criteria of parity. METHODS: The Spanish official professionals' colleges were compiled by visiting the websites of the General Council of the Psychology of Spain, General Council of Medical Associations of Spain, General Council of Colleges of Nursing of Spain, General Council of Physiotherapists Schools of Spain, General Dental Council, Organization collegiate Pharmaceutical General and Council of Associations of Podiatrists. All their webs were visited. The sex of the presidency, the executive and the entire board was identified. Data were analyzed according to the overall percentage of women and profession. We compared this to the INE-2014 collegiate professionals. RESULTS: Out of 251 professionals' colleges in July-2015, 21, 91% had a female president. Women hold 34,69% of the executive positions and 42,80% of total boards. 11, 32% of Medical colleges had a female president and 43,48% of Nursing ones. The Psychology are those with more women in the presidency, 45, 83%. CONCLUSION: There is no parity, being higher in Psychology and Nursing and, much lower in Dentistry, Physiotherapy, Podiatry and Medicine. It decreases with the responsibility level. Health Inequality.

[Family care provided by immigrant women and its impact on the quality of care and health]. / El cuidado familiar prestado por mujeres inmigrantes y su repercusión en la calidad del cuidado y en la salud.

OBJECTIVE: To understand the effects of care within the family provided by live-in female immigrants on elderly dependents and their families and the carers themselves in Seville (Spain). METHODS: We designed a qualitative study using in-depth interviews of key informants, immigrant care workers, elderly dependents and their families, and discussion groups composed of health professionals. The study was carried out in Seville between 2006 and 2008. The observation unit consisted of the families of elderly dependents with a live-in female immigrant care worker. The analysis units were health, care, dependence, gender, ethnicity and social class. Category analysis was carried out using QSR-NUD*ISTVivo1.3. After saturation, we triangulated among disciplines, researchers, sources and techniques to validate the results. RESULTS: The most important factors for carers' health were the migration process and care tasks. Interpersonal relationships constituted the principal factor affecting the health of all involved. CONCLUSIONS: The care tasks provided by immigrant women, together with the migration process, have an important impact on their health. Good and egalitarian interpersonal relationships are a protective factor for health.

[Overload in the informal caregivers of patients with multiple comorbidities in an urban area]. / Sobrecarga sentida en personas cuidadoras informales de pacientes pluripatológicos en una zona urbana.

OBJECTIVES: The aim of the study was, to determine the profile of the family caregiver of patients with multiple pathologies, identify factors associated with overload, and construct predictive models using items from the Caregiver Strain Index (CSI). METHOD: A cross-sectional study of caregivers of patients with multiple comorbidities who attended an urban health centre. Data were collected from health records and questionnaires (Barthel index, Pfeiffer index, and CSI). Statistical analysis was performed using measures of central tendency and dispersion, and by building multivariate models with binary logistic regression with the CSI items as predictors (program R version 2.14.0). RESULTS: The sample included 67 caregivers, with a mean age of 64.69 years (standard deviation=12.71, median 62 years), of whom 74.6% were women, 35.8% were wives, and 32.8% were daughters. The level of dependence of the patients cared for was total/severe in 77.6%, and moderate in 12% (Barthel), and 47.8% had some level of cognitive impairment (Pfeiffer). A CSI equal or greater than 7 was seen in 47.8% of caregivers, identifying life problems in more than 40% of them such as, restriction of social life, physical exertion, discomfort with change, bad behaviour, personal and family emotional changes, and sleep disturbances. Item 4 of the CSI, analysing the social restriction, was the one that showed a greater significance in the predictive multivariate model. Item 12 (economic burden) was the most significant with age in patients with cognitive impairment. CONCLUSIONS: Women tend to take the role of caregiver at an earlier age than men in the urban environment studied, and items from CSI showed that items 4 (social restrictions) and 12 (economic burden) have more significance in the predictive models constructed with Binary Logistic Regression.

Desarrollo de un modelo predictivo para el índice de esfuerzo del cuidador / Developing a predictive model for the caregiver strain index

Fundamentos. La atención al paciente pluripatológico en el hogar es un hecho cada vez más frecuente. El índice de esfuerzo del cuidador es un instrumento en forma de cuestionario que está diseñado para medir la carga percibida en aquellas personas que cuidan a sus familiares. El objetivo fue la construcción de un nomograma diagnóstico de sobrecarga en el cuidador informal mediante el cuestionario del índice de esfuerzo del cuidador con los datos de un modelo predictivo. Métodos. El modelo se confeccionó mediante regresión logística binaria, siendo incluidos los ítems del cuestionario del índice de esfuerzo del cuidador como variables predictoras dicotómicas. La variable dependiente fue la puntuación final obtenida mediante el cuestionario realizándose la categorización referenciada por la bibliografía: valores entre 0 y 6 fueron considerados como no existencia de estrés del cuidador y los iguales o superiores a 7 como existencia de estrés del cuidador. Se utilizó el programa estadístico R versión 3.1.1. Para construir los intervalos de confianza de la curva ROC se utilizaron 2.000 repeticiones bootstrap. Resultados. Sobre una muestra de 67 cuidadores se confeccionó un nomograma diagnóstico, con su gráfica de calibración (índice de Brier escalado = 0,686; R2 de Nagelkerke=0,791) y con la correspondiente curva ROC (área bajo la curva de 0,962). Conclusiones. El modelo predictivo generado mediante regresión logística binaria y su nomograma contienen cuatro variables predictoras (los ítems 1, 4, 5 y 9 del cuestionario). El área bajo la curva ROC (0,96; IC al 95%: 0,994-0,941) muestra un valor alto y discriminativo. La calibración del nomograma también presenta valores altos de bondad de ajuste por lo que estimamos que puede tener utilidad clínica en la consultas de enfermería comunitaria, de gestión de casos, de medicina de familia y de geriatría (AU)

Background. Patient homecare with multiple morbidities is an increasingly common occurrence. The caregiver strain index is tool in the form of questionnaire that is designed to measure the perceived burden of those who care for their families. The aim of this study is to construct a diagnostic nomogram of informal caregiver burden using data from a predictive model. Methods. The model was drawn up using binary logistic regression and the questionnaire items as dichotomous factors. The dependent variable was the final score obtained with the questionnaire but categorised in accordance with that in the literature. Scores between 0 and 6 were labelled as 'no' (no caregiver stress) and at or greater than 7 as 'yes'. The version 3.1.1R statistical software was used. To construct confidence intervals for the ROC curve 2000 boot strap replicates were used. Results. A sample of 67 caregivers was obtained. A diagnosing nomogram was made up with its calibration graph (Brier scaled = 0.686, Nagelkerke R2=0.791), and the corresponding ROC curve (area under the curve=0.962). Findings. The predictive model generated using binary logistic regression and the nomogram contain four items (1, 4, 5 and 9) of the questionnaire. R plotting functions allow a very good solution for validating a model like this. The area under the ROC curve (0.96; 95% CI: 0.994-0.941) achieves a high discriminative value. Calibration also shows high goodness of fit values, suggesting that it may be clinically useful in community nursing and geriatric establishments (AU)

Significado cultural de la menstruación en mujeres españolas / Cultural meaning of menstruation among spanish women

RESUMEN Objetivo: Conocer qué significados culturales existen en nuestra sociedad respecto de la menstruación, desde la perspectiva de la enfermería transcultural y analizar si se han superado creencias falsas del pasado. Material y método: Estudio cualitativo con diseño basado en la Teoría Fundamentada y cuyas técnicas de investigación fueron la entrevista semiestructurada y los grupos de discusión. Participaron 47 mujeres de diferentes regiones de España. Como criterios de segmentación se establecieron la edad y el lugar de residencia. Como criterios de variabilidad el nivel educativo, madres o mujeres sin hijos/as y la profesión. Las categorías de análisis fueron la menarquia, menstruación, conocimientos sobre sus propios cuerpos y el género. Resultados: La menarquia es vivida de diferente forma según el grado de conocimiento previo; existencia de tabú en diferentes grados según la edad de la mujer, asociado a desconocimiento e ideas falsas; el traspaso de creencias populares erróneas, por transmisión oral, sigue presente. Conclusión: Los cuidados de enfermería transcultural deben ir encaminados a desterrar creencias falsas, utilizando talleres grupales que permitan erradicar creencias erróneas y ayuden a las mujeres a aclarar dudas que al respecto puedan tener.

ABSTRACT The objective of the research was to know what cultural meanings exist in our society regarding menstruation, from the perspective of transcultural nursing, and to analyze whether past false beliefs have been overcome. Method : Qualitative study with a design based on Grounded Theory and whose research techniques were semi-structured interviews and discussion groups. 47 women from different regions of Spain participated. Age and place of residence were established as segmentation criteria and educational level, mothers or women without children and the profession were established as the variability criteria. The categories of analysis were menarche, menstruation, knowledge about their own bodies and gender. Results: The menarche is lived in a different way depending on the degree of prior knowledge; presence of taboo in different degrees depending on the age of the woman, associated to ignorance and false ideas; the transfer of erroneous popular beliefs, by oral transmission, is still present. Conclusion: Transcultural nursing care should be aimed at banishing false beliefs, using group workshops to eradicate erroneous beliefs and help women to clarify any doubts they may have.