Active listening, shared decision-making and participation in care among older women and primary care nurses: a critical discourse analysis approach from a gender perspective.

BACKGROUND: Nursing care for older women represent a challenge worldwide due to its characteristics. When communication is impaired between primary care nurses and older women living alone, an imbalance in power relations occurs. The main objective of this study is to analyse the power relations between older women and primary care nurses in situations of active listening, shared decision-making and participation in care. METHODS: We developed a qualitative study in southern Spain using a discursive and gender approach. We used purposeful sampling to interview older women who lived alone and received home nursing care. Simultaneously, we conducted focus groups with primary care nurses who provided home care to older women. A linguistic analysis of the transcripts was carried out. RESULTS: Nine semi-structured face-to-face interviews were conducted with older women who lived alone and two face-to-face focus groups with four primary care nurses in each. The discourse of the participants demonstrated an imbalance in power relations. Influenced by work overload, active listening was considered a privilege in primary care nurses´ discourse. Regarding shared decision-making, older women´s discourses revealed "mirages" of real situations where they thought they were deciding. Participation in care was difficult since older women saw themselves as a nuisance in nurses´ presence, and primary care nurses did not facilitate older women's engagement. Older women weren´t considered when organising home visits and had interiorised a subordinated feeling. Similarly, a strict sense of identity made primary care nurses feel powerful in their relationships with older women. CONCLUSIONS: The discourse of older women represented them as victims of a hostile panorama whilst they were sometimes satisfied with the deficient care received. The discourse of primary care nurses used more discursive strategies to represent themselves as professionals committed to caring. However, it also revealed deficiencies in care, discriminatory elements, and feelings of being limited by their working conditions. Active listening to older women and engagement in decision-making readjust empower the older women. Attending to the needs and concerns of primary care nurses could recalibrate the power imbalance between them and healthcare organisations.

Effectiveness of Multicomponent Interventions and Physical Activity in the Workplace to Reduce Obesity: A Systematic Review and Meta-Analysis.

BACKGROUND: Overweight and obesity are public health problems that affects the workplace. This paper aims to analyse the effectiveness of workplace health promotion interventions in reducing Body Mass Index (BMI); Methods: Following PRISMA guidelines, a systematic review was conducted using PubMed, MEDLINE, and SCOPUS databases. The inverse variance statistical method was used for the meta-analysis with a random effects analysis model and standardised means. The results have been represented by Forest Plots and Funnel Plots graphs; Results: The multicomponent approach had the best results for reducing BMI (-0.14 [-0.24, -0.03], 95% CI; p = 0.009) compared to performing physical activity only (-0.09 [-0.39, 0.21], 95% CI; p = 0.56). However, both methods resulted in positive changes in reducing BMI in the general analysis (-0.12 [-0.22, -0.02], 95% CI; p = 0.01). The GRADE evaluation showed low certainty due to the high heterogeneity between interventions (I2 = 59% for overall analysis). CONCLUSIONS: The multicomponent approach could be an effective intervention to reduce obesity in the working population. However, workplace health promotion programs must be standardised to conduct quality analyses and highlight their importance to workers' well-being.

First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

Implementación tecnológica en los servicios de Cirugía General y del Aparato Digestivo en España. Encuesta nacional y resultados / Technological implementation in General Surgery services in Spain. National survey and results

La tecnología constituye uno de los pilares de la cirugía del siglo XXI y resulta un factor clave para la consecución de unos mejores resultados quirúrgicos. El proceso quirúrgico actual lleva implícito no solo la técnica operatoria, sino un grado de especialización muy elevado y el conocimiento y empleo de técnicas y dispositivos propios de otros campos. En España no existen estudios publicados a nivel nacional a este respecto.Desde la Sección de Cirugía Mínimamente Invasiva e Innovación Tecnológica (CMI-IT) de la Asociación Española de Cirujanos hemos diseñado un estudio cuyo objetivo principal es evaluar el grado de implantación tecnológica en la especialidad de cirugía general en España, así como analizar los dispositivos disponibles en los diferentes centros del país. Nos planteamos realizar una descripción pormenorizada de las aplicaciones de dichos dispositivos y técnicas por áreas de interés, señalando las patologías y procedimientos en los que se utiliza dicha tecnología. (AU)

Technology is one of the pillars of surgery in the 21st century and is a key factor in achieving better surgical results. The current surgical process involves not only surgical techniques, but also a very high degree of specialisation and the knowledge and use of techniques and devices from other fields. In Spain, there are no studies published at a national level in this regard.From the Minimally Invasive Surgery and Technological Innovation section of the Spanish Association of Surgeons we have designed a study whose main objective is to evaluate the degree of technological implantation in the specialty of General Surgery in Spain, as well as to analyze the devices available in the different centres of the country. We propose to make a detailed description of the applications of these devices and techniques by areas of interest, pointing out the pathologies and procedures in which this technology is used. (AU)

Technological implementation in General Surgery services in Spain. National survey and results.

Technology is one of the pillars of surgery in the 21st century and is a key factor in achieving better surgical results. The current surgical process involves not only surgical techniques, but also a very high degree of specialisation and the knowledge and use of techniques and devices from other fields. In Spain, there are no studies published at a national level in this regard. From the Minimally Invasive Surgery and Technological Innovation section of the Spanish Association of Surgeons we have designed a study whose main objective is to evaluate the degree of technological implantation in the specialty of General Surgery in Spain, as well as to analyze the devices available in the different centres of the country. We propose to make a detailed description of the applications of these devices and techniques by areas of interest, pointing out the pathologies and procedures in which this technology is used.

Technological implementation in General Surgery services in Spain. National survey and results. / Implementación tecnológica en los servicios de Cirugía General y del Aparato Digestivo en España. Encuesta nacional y resultados.

Technology is one of the pillars of surgery in the 21st century and is a key factor in achieving better surgical results. The current surgical process involves not only surgical techniques, but also a very high degree of specialisation and the knowledge and use of techniques and devices from other fields. In Spain, there are no studies published at a national level in this regard. From the Minimally Invasive Surgery and Technological Innovation section of the Spanish Association of Surgeons we have designed a study whose main objective is to evaluate the degree of technological implantation in the specialty of General Surgery in Spain, as well as to analyze the devices available in the different centres of the country. We propose to make a detailed description of the applications of these devices and techniques by areas of interest, pointing out the pathologies and procedures in which this technology is used.

First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery. / Valor del Ratio Neutrófilo-Linfocito, Ratio Plaqueta-Linfocito y Proteína C Reactiva del primer día como predictores de complicaciones postoperatorias tras cirugía oncológica gástrica.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was 266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

Women-centred workplace health promotion interventions: a systematic review.

AIM: To analyse workplace health promotion interventions implemented exclusively for the female population. BACKGROUND: The differences in biological, psychological and social characteristics, as well as the type of work carried out by men and women, make it necessary for workplace health promotion to be specific for each group. This study focussed on working women. INTRODUCTION: Workplace health promotion interventions are centred on increasing the well-being and health of the employees. Occupational health nurses play an essential role in the implementation of these interventions. METHODS: A systematic review was carried out using the MEDLINE and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. RESULTS: Twelve articles met the inclusion criteria. Two lines of interventions were found: (1) promotion of breastfeeding (16.6%) and (2) promotion of physical activity and other healthy lifestyles (83.4%). The interventions studied underlined promoting breastfeeding, preventing a sedentary lifestyle, improving body composition, reducing cardiovascular risk, relieving premenstrual symptoms, time of breastfeeding after returning to work, and showing favourable results. DISCUSSION: The lack of studies on the subject and the medium-to-low quality of the articles included in the review have made it difficult to analyse workplace health promotion interventions, making it necessary to continue research in this area. CONCLUSION: There are very few occupational health promotion interventions targeting women (1.9%), and the majority of them focus on promoting physical activity. It is worrying that specific aspects of women's health are poorly addressed. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY: The work of the occupational nurse essentially is to guarantee the health of women in the workplace, being the key figure in the research and development of gender-related policies in the field of public health.

Perforación esofágica tras dilatación por estenosis péptica que oculta cáncer de esófago / No disponible

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Esophageal perforation after dilation due to a peptic stricture that concealed esophageal cancer.

The management and prognosis of benign esophageal strictures differ from those of malignant strictures. Distinguishing between the two entities may occasionally be challenging, despite endoscopy and biopsies. The consequences of erroneous treatment may be fatal. We review this topic in a patient who required an emergency esophagectomy following a perforation after dilation due to a peptic stricture, which concealed an esophageal cancer.

Determining the optimal clinical cutoff on the CES-D for depression in a community corrections sample.

BACKGROUND: Screening instruments are urgently needed to rapidly and efficiently identify those in need of mental health treatment, particularly among underserved populations. Although designed initially for use in research, the CES-D has become a widely used clinical screening tool for the presence of major depression. Despite four decades and three major revisions to the DSM since the CES-D was first introduced, the cutoff score of 16 remains the marker by which individuals are assessed. The present study aims to examine an optimal cutoff score in a low-income, high-risk sample of ethnically diverse adults involved in some phase of the criminal justice system. The utility of the CES-D to detect depression in this population is unknown as these individuals are unlikely to be included in community studies of mental health. METHODS: A diverse sample of participants under criminal justice supervision (n = 500, ages 19-72) completed the CES-D at up to six time points and the MINI-D at two time-points over a year. RESULTS: Using receiver operating characteristic (ROC) curves, a cut point of 21 on the CES-D was determined to produce the best overall screening characteristics (sens = 0.82, spec = 0.76) using an efficiency calculation when compared with the gold standard MINI-D, though these results varied by race and gender. The optimal cutoff for women in this sample was determined to be 23 as opposed to 15 for men, and 20 for nonwhites versus 23 for whites. LIMITATIONS: This study is limited in its generalizability to low-income individuals without criminal justice involvement or those without substance use. CONCLUSION: Results suggest that the CES-D is a useful screening measure for depressive symptoms among high-risk individuals under criminal justice supervision. However, the current cutoff score of 16 is inadequate for optimizing true positives and false negatives. Possible gender and racial/ethnic bias may limit the utility of this instrument in this population. The current study contributes to the understanding of mental health needs in underserved populations.

Utilidad de la miotomía quirúrgica en la disfagia por distrofia oculofaríngea / Utility of surgical myotomy in the dysphagia due to oculopharyngeal dystrophy

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Utility of surgical myotomy in the dysphagia due to oculopharyngeal dystrophy.

Oculopharyngeal muscular dystrophy (OPMD), is a rare hereditary myopathy that affects mainly the levator palpebrae and the constrictor pharyngeal muscles, being able to cause severe dysphagia. It can be treated effectively by surgical cricopharyngeal myotomy, as in the case presented below.

Disfagia tras artrodesis cervical por migración del material protésico / Dysphagia after cervical spine fusion caused by migration of the prosthetic material

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Influence of early life stress on intra- and extra-amygdaloid causal connectivity.

Animal models of early life stress (ELS) are characterized by augmented amygdala response to threat and altered amygdala-dependent behaviors. These models indicate the amygdala is a heterogeneous structure with well-differentiated subnuclei. The most well characterized of these being basolateral (BLA) and central nucleus (CeA). Parallel human imaging findings relative to ELS also reveal enhanced amygdala reactivity and disrupted connectivity but the influence of ELS on amygdala subregion connectivity and modulation of emotion is unclear. Here we employed cytoarchitectonic probability maps of amygdala subregions and Granger causality methods to evaluate task-based intra-amygdaloid and extra-amygdaloid connectivity with the network underlying implicit regulation of emotion in response to unconditioned auditory threat in healthy controls with ELS (N=20) and without a history of ELS (N=14). Groups were determined by response to the Childhood Trauma Questionnaire and threat response determined by unpleasantness ratings. Non-ELS demonstrated narrowly defined BLA-driven intra-amygdaloid paths and concise orbitofrontal cortex (OFC)-CeA-driven extra-amygdaloid connectivity. In contrast, ELS was associated with extensive and robust CeA-facilitated intra- and extra-amygdaloid paths. Non-ELS findings paralleled the known anatomical organization and functional relationships for both intra- and extra-amygdaloid connectivity, while ELS demonstrated atypical intra- and extra-amygdaloid CeA-dominant paths with compensatory modulation of emotion. Specifically, negative causal paths from OFC/BA32 to BLA predicted decreased threat response among non-ELS, while a unique within-amygdala path predicted modulation of threat among ELS. These findings are consistent with compensatory mechanisms of emotion regulation following ELS among resilient persons originating both within the amygdala complex as well as subsequent extra-amygdaloid communication.

Early life trauma and directional brain connectivity within major depression.

OBJECTIVE: Early life trauma (ELT) is a significant risk factor for the onset of depression. Emerging findings indicate ELT is associated with enhanced amygdala reactivity to aversive stimuli in never-depressed healthy controls as well as those with acute depression but may be absent in non-ELT exposed depressed. The precise mechanism mediating these differences in amygdala reactivity remains unclear. METHOD: The authors used Granger causality methods to evaluate task-based directional connectivity between medial or lateral prefrontal cortex (PFC) and amygdala in 20 unmedicated patients with current major depressive disorder (MDD) and 19 healthy matched controls while participants engaged in an affective variant of the flanker task comparing response to sad and neutral faces. These data were correlated with childhood trauma history. RESULTS: Exposure to ELT was associated with failure of inhibition within the MDD group based on medial PFC-amygdala connectivity. In contrast, non-ELT exposed MDD was associated with a negative causal pathway from medial prefrontal cortex to amygdala, despite reduced dorsolateral PFC input in comparison to healthy controls. Neither MDD group demonstrated significant lateral PFC-amygdala connectivity in comparison to healthy controls. CONCLUSIONS: Failure of the circuit implicated in emotion regulation was associated with a significant history of ELT but not with MDD more broadly. Non-ELT related depression was associated with intact regulation of emotion despite the absence of difference in severity of illness. These findings indicate opposing system-level differences within depression relative to ELT are expressed as differential amygdala reactivity.

Enuresis. Diagnóstico diferencial y tratamiento específico / Enuresis. Differential diagnosis and specific treatment

Introducción. A pesar de su gran prevalencia y antigüedad, esta patología tiene importantes interrogantes etiológicos, diagnósticos y terapéuticos. Hay que partir de dos grupos completamente diferentes: la enuresis (E) monosintomática o no complicada y el síndrome (S) enurético o E complicada con sus respectivos subgrupos, cada uno con etiología diferente que además es multifactorial. Diagnóstico diferencial. Se estructura en 3 niveles: 1º ¿E. monosintomática o S. enurético?; 2º ¿Patalogía o malos hábitos?; 3º ¿Disfunción de llenado o vaciado? Historia. Se describen tratamientos utilizados en diferentes culturas y épocas, demostrando la diversidad y a veces antagonismo que persiste hasta hoy, como demostración de la necesidad de un diagnóstico diferencial y un tratamiento etiológico. Tratamiento actual. Tras estudio de metaanálisis y revisiones sistemáticas se han ordenado por nivel de evidencia (NE) y grado de recomendación (GR) los estudios más válidos de tratamientos de E. monosintomática. La desmopresina, la alarma y la asociación de ambas tienen el máximo NE y GR, mientras que los antidepresivos tienen el mismo NE pero el menor GR por riesgo de efectos adversos. Los anticolinérgicos asociados a desmopresina están en el 2º nivel de NE y GR. Tratamiento personalizado. Se expone un tratamiento integral personalizado multidisciplinar. Se expone un tratamiento integral personalizado y multidisciplinar. Se inicia con diagnóstico diferencial y valoración psicológica. En E. monosintomática se inicia 1º un tratamiento básico conductal, seguido de un 2º paso con desmopresina y/o alarma según características personales. Si el resultado con uno de ellos es insuficiente se aconseja un 3º paso asociando el otro o añadiendo anticolinérgicos. Si es necesario un 4º paso se proponer biofeedback. El soporte psicológico de la familia y del niño es importante para la motivación, adhesión al tratamiento y mantenimiento de éxito. Conclusiones. Cada enurético es distinto y precisa un diagnóstico diferencial adecuado, además de una investigación personalizada, identificando sus factores influyentes. En la E. monosintomática el mejor NE y GR actualmente corresponden a la desmopresina, a la alarma y a ambas juntas. Hay que conocer todos los recursos terapéuticos disponibles, para diseñar un tratamiento lo más individualizado posible. Con frecuencia la combinación de tratamiento es efectiva. En la experiencia de los autores, el tratamiento multidisciplinar en equipo puede ser la mejor opción (AU)

Introduction. In spite of its great prevalence and antiquity, this condition has significant etiological, diagnostic and therapeutic questions. Two completely different groups must be considered: monosymptomatic or uncomplicated enuresis (E) and enuretic or complicated E syndrome (S) with their respective subgroups, each one with different etiology that is also multifactorial. Differential diagnosis. This diagnosis is structured into 3 levels: 1) Monosymptomatic E or enuretic syndrome?; 2) Disease or poor habits?; 3) Filling or emptying dysfunction? History. Treatments used in different cultures and periods that demonstrate the diversity and sometimes antagonisms that persists up to the current date are described as a demonstration of the need for a differential diagnosis and etiological treatment. Current treatment. After the meta-analysis study and systematic reviews, the most valid studies of treatments of monosymptomatic E. were ordered by level of evidence (LE) and recommendation grade (RG). Desmopressin, the alarm and the association of both have a maximum LE and while antidepressants have the same LE, but a lower RG, due to the risk of adverse events. The anticholinergics associated to desmopressin are on the second level of the LE and RG. Personalized treatment. A personalized comprehensive and multidisciplinary treatment is explained. It is begun with the differential diagnosis and psychological evaluation. In monosymptomatic E, a first basic behavioural treatment is initiated followed by a second step with desmopressin and/or o alarm according to personal characteristics. If the result with one of them is insufficient, a third step is recommended by means of associating the other or adding anticholinergics. If a four step is necessary, biofeedback is proposed. The psychological support of the family and of the child is important for motivation, treatment adherence, and maintenance of success. Conclusions. Each enuretic is differential diagnoses in addition to a personalized study, identifying their influencing factors. In Monosymptomatic E, the best LE and RG currently correspond to desmopressin, to the alarm and to both of them. It is necessary to know all the therapeutic resources available to design the most individualized treatment possible. The combination of treatments is frequently effective. In the experience of the authors, team multidisciplinary treatment may be the best option (AU)