[Psychometric validation of the brief Humanizar Scale on the meaning of suffering]. / Validación psicométrica de la Escala Humanizar breve sobre el sentido del sufrimiento.

OBJECTIVE: To develop the short version of the brief Humanizar Scale, including reducing the dimensionality and the number of items. METHODS: The Humanizar Scale (24 items with Likert scale), consists of five factors that give meaning to suffering; significance, punishment, catalyst for change, masochism, inherent to life. A parallel analysis and exploratory factor analysis (EFA) were carried out on a first sample (n=529) and, using a different sample (n=182) the two-dimensional structure of the scale was confirmed using confirmatory factor analysis (CFA). RESULTS: The parallel analysis procedure obtained two factors. After the EFA, 15 items were retained with greater than 0.4 commonalities. The CFA confirmed the two-dimensional model including the first factor, the sense of suffering as a change (8 items) and the second, the sense of suffering as a burden (6 items). The goodness of fit were suitable: RMSEA=0.07; SRMR=0.08; CFI=0.96, and GFI=0.99. The weight factor of all items was significant and greater than 0.5. Cronbach Alpha was 0.75 for the first factor, and 0.74 for second. The factors showed a correlation of 0.56 (P<.01). Significant differences were found (P<.05) between the factor means according to beliefs (Christian vs. atheists/agnostics) and practice or not of prayer/meditation, the means being higher for both factors among believers (2 points of difference in each factor) and practitioners of prayer/meditation (3 points for Change factor and 1.5 for Burden factor). CONCLUSIONS: The two-dimensionality and the usefulness of the scale on the meaning of suffering have been well-defined.

[Knowledge and preferences on end-of-life resources in a sample of professionals of the Community of Madrid]. / Conocimientos y preferencias sobre los recursos existentes al final de la vida en una muestra de la Comunidad de Madrid.

OBJECTIVE: The Law (4/2017) on rights and guarantees of persons in the process of dying in Community of Madrid regulates the exercise of the rights of the person during this process. The main objective of this study was to determine the knowledge and preferences about palliative sedation (PS), euthanasia, physician-assisted suicide (PAS), and adequacy of the therapeutic effort (ATE). MATERIALS AND METHODS: A questionnaire was designed to collect knowledge about definition and legality of detailed resources, and disposition for themselves or for a relative. The questionnaire was completed by a total of 192 palliative care Conference attendees (October 2017). RESULTS: Of those that completed the questionnaire, 160 (83.3%) were women, and the mean age was of 39 years (SD=15.8). More than two-thirds (131; 68.2%) did not know that the law existed. The definition with the highest rate of knowledge was on PS (89.1%; 171) and the lowest was ATE (50.5%; 97). On legality, the most successful was euthanasia (94.8%; 182) and the lowest was ATE (63.5%; 122). PS was considered the most appropriate resource (93.2%; 179), and the greater willingness of use in both relatives (91.7%; 176) as well as by themselves (90.6%; 174). PAS was the least suitable (34.4%; 66), and that less might resort in case of end-of-life of a relative (29.7%; 57), and themselves (33.3%; 64). CONCLUSIONS: There is a greater awareness of the condition of legality or illegality of each resource than of the definition of the terms. The use of the PAS and euthanasia is disapproved. It is important to clarify the meaning of ATE, and clarify its confusion with other measures such as PS and PAS.

[Ethical attitudes Scale in residences for the elderly. Development of a tool for social and healthcare professionals]. / Escala de actitud ética en residencias. Desarrollo de un instrumento para profesionales asistenciales sociosanitarios.

INTRODUCTION: In Spain, there is very little institutional training in bioethics for healthcare professionals, and even less tools for measuring ethical attitudes. The objective of this study was the design and validation of a brief measure of ethical attitudes, collecting general attitudes of healthcare professionals in their daily practice with the dependent elderly. MATERIAL AND METHODS: After drawing up a list of 42 items around the principles of bioethical autonomy, beneficence, confidentiality, justice, and non-maleficence, a committee of experts selected 31 items. A total of 191 health care professionals with a mean age of 43.8 years (SD=11.3), including 150 (78.5%) women and 41 (21.5%) men, and with experience in the field of dependence. responded to the online questionnaire. Model fit was studied using confirmatory factor analysis. Cronbach's alpha was used for the analysis of internal consistency. RESULTS: A model of 2independent scales with adjusted goodness-of-fit index was observed. Autonomy scale (4 items related to this principle) explained 83% of the variance (P=.005), with χ2/gl=1.782; RMSEA=0.064; GFI=0.991; CFI=0.958. The beneficence, confidentiality and non-maleficence scale (9 items including these 3principles), explained 82% (P<.001) with goodness-of-fit index: χ2/gl=2.194; RMSEA=0.079; GFI=0.931; CFI=0.627. The Cronbach Alphas were 0.525 and 0.748, respectively. CONCLUSIONS: An ethical attitudes scale (EAS) is presented for professionals in the field of caring for dependent adults, including 13 items related to the observance, in daily practice, of the 4 principles of bioethics, autonomy, beneficence, confidentiality and non-maleficence.

[Validation of the Scale of Hope in Terminal Illness for relatives brief version (SHTI-b). Validity and reliability analysis.] / Validación de la Escala de Esperanza en Enfermedad Terminal (EEET-fb). Análisis de validez y fiabilidad.

BACKGROUND: Bermejo and Villacieros' Scale of Hope in Terminal Disease (SHTD) specifically collects meanings of hope facing terminal disease, including considerations relating to psycho-emotional support and that have a transcendental sense. The objective of this paper is to validate the SHTD abbreviated and rephrased to adapt all the items to a single domain. METHODS: Starting from the published SHTD, an exploratory factor analysis (EFA) was carried out with a sample of 177 valid questionnaires. In a second study, with another sample of 180 valid questionnaires, a confirmatory factor analysis (CFA) and a correlation analysis with other measurements of spiritual wellbeing (Functional Assessment of Chronic Illness Therapy-Sp) and hope (Herth Hope Index) were done. RESULTS: A bidimensional model with satisfactory goodness of fit index values was obtained (GFI = 0.991; CFI = 0.984; SRMR = 0.08; RMSEA = 0.057); the Relations of Transcendence factor obtained a Cronbach's alpha of 0.872 and Personal Relations an alpha of 0.762. The correlations of the SHTI-rb with external measures were: r = 0.527with FACIT; r = 0.266 with HHI; r = 0.667 with the Spirituality subscale of FACIT; and r = 0.348 with the Interrelation factor of HHI. The Relations of Transcendence subscale correlated with both Layout and Expectation and Interrelation of HHI (r = 0.162 and r = 0.329 respectively), while the scale of Personal Relations only correlated with Interrelation of HHI (r = 0.244). CONCLUSIONS: The Scale of Hope in Terminal Illness for relatives (brief version) is a valid and reliable specific instrument for terminal patients.

Diseño y validación de una escala de actitudes de los profesionales asistenciales hacia la liberación del uso de sujeciones en personas dependientes / Development and validation of a scale of healthcare professional attitudes to the liberation from restraint use with dependent people

Fundamento. En nuestro entorno ya existen estudios sobre prevalencia y uso de sujeciones pero no un instrumento de medida que elimine la subjetividad del evaluador para su uso en clínica y en investigación. Objetivo: diseño y validación de una escala de medida de la actitud del profesional asistencial hacia el uso de las sujeciones físicas y farmacológicas. Método. Estudio descriptivo y correlacional de validación de escala. Tras revisión bibliográfica, se elaboró un listado de ítems que se sometieron a análisis de validez; de contenido mediante jueces, de criterio mediante contraste con variable externa y de constructo mediante análisis factorial exploratorio. La fiabilidad mediante coeficiente alfa de Cronbach. Resultados. Contestaron al cuestionario 276 personas, 224 mujeres (82,4%) y 48 hombres (17,6%), media de edad de 38,65 años. La escala con 40 ítems ofreció un alfa de Cronbach 0,90. Se obtuvieron 4 dimensiones que explicaban un 46,76% de la varianza total. Se nombraron los factores Autonomía (15,08% de la varianza), Seguridad (12,23%), Entorno (8,46%) y Evitación (6,06%). Salvo la última, todas las subescalas obtuvieron un alfa superior a 0,72. Se obtuvieron diferencias debido a la experiencia en el cuidado del Alzheimer. El personal con experiencia puntúa significativamente más bajo en Factor 1 y Factor 3 y más alto en Factor 2, pero sin diferencias en el cómputo global. También por género, las mujeres puntuaron en Factor 1 más alto. Conclusión. Esta escala constituye un paso significativo en el estudio de las actitudes de los profesionales asistenciales profundizando en las causas subyacentes (AU)

Background. There are studies on the prevalence and use of restraints but not a measuring instrument to eliminate subjectivity in evaluation of their use in clinical practice and research in our environment. Objective. Design and validation of a scale of measurement of attitudes of health care professionals towards the use of physical and pharmacological restraints. Methods. Descriptive and correlational study for scale validation. Following a literature review, we developed a list of items that were subjected to a validity analysis: validity of content through judges, validity of criterion through external variable contrast, and validity of construct using exploratory factor analysis. Reliability was analysed using the Cronbach alpha coefficient. Results. Two hundred and seventy-six people answered the questionnaire, 82.4% (224) women and 17.6% (48) men, average age 38.65 years. The 40 item scale provided a Cronbach alpha of 0.897. Four dimensions were obtained explaining 46.758% of the total variance. The factors were named: Autonomy (15.084% of the variance), safety (12.228%), environment (8.463%) and avoidance (6.062%). Except for the last one, all the subscales obtained an alpha superior to 0.717. There were differences due to the experience in Alzheimer care. Staff with experience score significantly lower in Factor 1 and Factor 3, and higher in Factor 2, but there is no difference in the overall computation. Moreover, by gender, women scored higher in Factor 1.Conclusions. This scale is a significant step forward in the study of the attitudes of health care professionals as it enquires into underlying causes (AU)

[Development and validation of a scale on sense of suffering: the "Humanizar" Scale]. / Desarrollo y validación de una escala sobre el sentido del sufrimiento: Escala Humanizar.

BACKGROUND: There are studies on the causes and sense of suffering, but not a measuring instrument for clinical and research use that eliminates the subjectivity of the evaluator. The aim of this article is to analyse the meaning that people give to suffering and its underlying factors by developing a measuring scale. METHODS: Descriptive and correlational study for scale validation. Following a review of the literature, a list of items was developed that were subjected to a validity analysis: content through judges, criterion through external variable contrast, and construct using exploratory factor analysis. Reliability using Cronbach alpha coefficient. RESULTS: The questionnaire was answered by 253 people, 83% (207) women and 17% (42) men, average age 41.37 years. The 24 item scale offered a Cronbach alpha of 0.871. Seven dimensions were obtained that explained 62.42% of total variance. Five factors were named Transcendence (26.367% of the variance), Punishment (9.929%), Catalyst of change (6.498%), Masochism (5.691%) and Inherent to life (5.254%). Except the last one, all the subscales obtained an alpha superior to 0.67. No gender differences were found, although they were found depending on the existence or absence of religious beliefs. CONCLUSIONS: The "Humanizar" Scale is a valid and reliable scale with a coherent structure of five factors. It collects the meaning that a person gives to suffering, leaving open the possibility of exploration depending on populations and on whether or not there are religious beliefs.

Desarrollo y validación de una escala sobre el sentido del sufrimiento: Escala Humanizar / Development and validation of a scale on sense of suffering: The “Humanizar” Scale

Fundamento. Existen estudios sobre causas y sentido del sufrimiento, pero no un instrumento de medida que elimine la subjetividad del evaluador para su uso en clínica y en investigación. El objetivo del presente trabajo es analizar el sentido que las personas damos al sufrimiento y los factores que subyacen desarrollando una escala de medida. Material y método. Estudio descriptivo y correlacional de validación de escala. Tras revisión bibliográfica, se elaboró un listado de ítems que se sometieron a análisis de validez; de contenido mediante jueces, de criterio mediante contraste con variable externa y de constructo mediante análisis factorial exploratorio. La fiabilidad mediante coeficiente alfa de Cronbach. Resultados. Contestaron al cuestionario 253 personas, 83% (207) mujeres y 17% (42) hombres, con una media de edad de 41,37 años. La escala con 24 ítems ofreció un alfa de Cronbach 0,871. Se obtuvieron 7 dimensiones que explicaban un 62,42% de la varianza total. Se nombraron los factores Trascendencia (26,367% de la varianza), Castigo (9,929%), Catalizador de cambio (6,498%), Masoquismo (5,691%) e Inherente a la vida (5,254%). Salvo la última, todas las subescalas obtuvieron un alfa superior a 0,67. No existieron diferencias de género, pero sí en función de la existencia o no de creencias religiosas. Conclusiones. La Escala Humanizar se plantea fiable y en principio válida con una estructura coherente de cinco factores, que recoge el sentido que la persona da al sufrimiento, dejando abierta la posibilidad de la exploración según poblaciones y en función de que existan o no creencias religiosas (AU)

Background. There are studies on the causes and sense of suffering, but not a measuring instrument for clinical and research use that eliminates the subjectivity of the evaluator. The aim of this article is to analyse the meaning that people give to suffering and its underlying factors by developing a measuring scale. Methods. Descriptive and correlational study for scale validation. Following a review of the literature, a list of items was developed that were subjected to a validity analysis: content through judges, criterion through external variable contrast, and construct using exploratory factor analysis. Reliability using Cronbach alpha coefficient. Results. The questionnaire was answered by 253 people, 83% (207) women and 17% (42) men, average age 41.37 years. The 24 item scale offered a Cronbach alpha of 0.871. Seven dimensions were obtained that explained 62.42% of total variance. Five factors were named Transcendence (26.367% of the variance), Punishment (9.929%), Catalyst of change (6.498%), Masochism (5.691%) and Inherent to life (5.254%). Except the last one, all the subscales obtained an alpha superior to 0.67. No gender differences were found, although they were found depending on the existence or absence of religious beliefs. Conclusions. The “Humanizar” Scale is a valid and reliable scale with a coherent structure of five factors. It collects the meaning that a person gives to suffering, leaving open the possibility of exploration depending on populations and on whether or not there are religious beliefs (AU)

[Development and validation of a scale of healthcare professional attitudes to the liberation from restraint use with dependent people]. / Diseño y validación de una escala de actitudes de los profesionales asistenciales hacia la liberación del uso de sujeciones en personas dependientes.

BACKGROUND: There are studies on the prevalence and use of restraints but not a measuring instrument to eliminate subjectivity in evaluation of their use in clinical practice and research in our environment. OBJECTIVE: Design and validation of a scale of measurement of attitudes of health care professionals towards the use of physical and pharmacological restraints. METHODS: Descriptive and correlational study for scale validation. Following a literature review, we developed a list of items that were subjected to a validity analysis: validity of content through judges, validity of criterion through external variable contrast, and validity of construct using exploratory factor analysis. Reliability was analysed using the Cronbach alpha coefficient. RESULTS: Two hundred and seventy-six people answered the questionnaire, 82.4% (224) women and 17.6% (48) men, average age 38.65 years. The 40 item scale provided a Cronbach alpha of 0.897. Four dimensions were obtained explaining 46.758% of the total variance. The factors were named: Autonomy (15.084% of the variance), safety (12.228%), environment (8.463%) and avoidance (6.062%). Except for the last one, all the subscales obtained an alpha superior to 0.717. There were differences due to the experience in Alzheimer care. Staff with experience score significantly lower in Factor 1 and Factor 3, and higher in Factor 2, but there is no difference in the overall computation. Moreover, by gender, women scored higher in Factor 1. CONCLUSIONS: This scale is a significant step forward in the study of the attitudes of health care professionals as it enquires into underlying causes.

Spatial variations of heavy metals contamination in sediments from Odiel river (Southwest Spain).

The presence of heavy metal concentrations was examined in surface sediments from 27 sites within the Odiel river in the southwest Spain suffering inputs from industrial and mining activities. The interest is specially focused on the final delta located in the Odiel Natural Park, which constitutes a feeding ground of international importance for migrating birds. The behavior of 10 heavy metals (Zn, Cd, Pb, Cu, Cr, Mn, Ni, Fe, Hg) is conditioned by chemical properties of sediments such as acidity and carbonate or the presence of sulfate Very acidic sediments in the medium course of river contribute to the lower presence of metal as a consequence of leaching process. However, tidal action raises the pH in the marshes of the delta with correlative metal accumulation. In accordance with the Müller [Umschan 79 (1979) 133-149] scale for geoaccumulation index, the entire watercourse could be considered polluted by Zn and Pb, while Cu exhibits a high presence in the delta marshes of the river.

Different frequency of cilia with transposition in human nasal and bronchial mucosa. A case of acquired ciliary dyskinesia.

Nasal and bronchial cilia and spermatozoa of a patient with a high clinical suspicion of a ciliary dyskinesia syndrome were ultrastructurally studied and quantified. Defective cilia showed two types of axonemal patterns: 9d+0s and 8d+1d. Of these, 9d+0s cilia prevailed in the proximal region, whereas 8d+1d prevailed in the distal region. Translocation of a peripheral doublet to the central position occurred at the middle region of cilia lacking the central pair, probably to compensate for its absence. Quantitative analysis showed that the percentages of anomalous cilia were 5.32+/-0.93 in nasal samples and 43.17+/-2.34 in bronchial samples. Spermatozoa without the central pair or with a translocated microtubular doublet were rarely observed, but a variety of nonspecific defects were seen. Even though transposition is generally considered to be an inherited ciliary defect and one of the causes of primary ciliary dyskinesia, in this case quantitative ultrastructural analysis and clinical data indicate that this is an acquired ciliary defect.

Seizure-refractory period after a single stimulation and inhibition of seizures after repetitive stimulation in the gerbil: effects on blood cortisol levels.

PURPOSE: To determine the epileptic response of gerbils to external shock stimulus, assessing blood cortisol levels as a parameter to determine stress conditions. METHODS: Five sets of two-month-old Mongolian gerbils were stimulated to elicit seizures by the clapping of a sheaf of papers. Stimulation was done once a week over a 10-week period to obtain a stable situation and a similar response in all the animals. Four of the sets were killed to collect blood samples: those not manipulated; those stimulated twice a day for 5 days; those stimulated once to obtain samples immediately after seizure recovery; and those stimulated once to obtain samples 30 min after seizure recovery. Blood samples from the fifth set of animals were taken in vivo from the retro-orbital plexus. RESULTS: Eliciting seizures with this stimulus, twice a day in a repetitive way, prevented further induced seizures from the second day of stimulation on. Changes in the gerbils' behavior--from exploratory to escape mode--were also observed. The blood cortisol levels found in the sets of animals killed without induced seizures were similar to the others, regardless of whether the animals had been subjected to repetitive stimulation. Additionally, significant decreases in blood cortisol levels were detected in the animals killed immediately and 30 min after recovering from an induced epileptic episode. CONCLUSIONS: The normal refractory period in gerbils can be estimated at 1 h. The lack of correlation between cortisol levels and the inhibition of seizure-elicitation through repetitive stimulation supports the environmental and exploratory hypothesis of seizure generation rather than a stress hypothesis.

Diagnosis of pleural tuberculosis by detection of specific IgG anti-antigen 60 in serum and pleural fluid.

The objective of this study was the prospective evaluation of the IgG antibody levels to mycobacterial antigen 60 (A60) in serum and pleural fluid and their role in the diagnosis of tuberculous pleuritis. The level of IgG was measured by Elisa in 30 patients with tuberculous pleuritis and 48 control subjects with pleural effusion (24 with carcinoma, 10 with transudative pleural effusion, 11 with empyema or parapneumonic effusion, 1 with pulmonary embolism and 2 due to systemic lupus erythematosus). The median titers of IgG against A60 of both serum and pleural fluid from tuberculous patients [445.6 +/- 133.56 and 263 +/- 72.58 Elisa units (EU) respectively] were significantly higher than those of corresponding median values (97.3 +/- 8.35 and 41.3 +/- 4.93 EU) of the control group (p < 0.01 and p < 0.01, respectively). Considering 240 units as cutoff point for a positive test in serum, the sensitivity was 53.3% and the specificity 100%. In the pleural fluid the cutoff point value was established at 150 units, with a sensitivity of 50% and specificity of 100%. We concluded that Elisa using A60 is a reliable and rapid test with an acceptable sensitivity and magnificent specificity.