Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System / Nutritional status and prevalence of dysphagia in cerebral palsy: Usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System

Introducción y objetivos: La enfermedad digestiva es una de las comorbilidades más frecuentes en niños con parálisis cerebral infantil (PCI). Nuestro objetivo es analizar el estado nutricional de los pacientes con PCI, la prevalencia de disfagia según la afectación motriz (GMFCS) y su repercusión en la calidad de vida.Material y métodosEstudio descriptivo transversal y abierto en pacientes con PCI seguidos en un hospital terciario de la Comunidad de Madrid mediante una entrevista estructurada y la clasificación de la disfagia según la escala Eating and Drinking Ability Classification System (EDACS). Recogimos datos demográficos y antropométricos y relacionamos el nivel de disfagia con el nivel funcional según el Gross Motor Function Classification System (GMFCS).ResultadosLa muestra incluyó 44 pacientes (65,9% varones), con una edad media de 9,34 ± 5 años y un IMC de 18,5 ± 4,9. El 43% tenía limitaciones en seguridad y/o eficiencia (EDACS > II). El porcentaje de pacientes afectados fue mayor cuanto más extensa desde el punto de vista topográfico fue la PCI (tetraparesia 60%), más variada la semiología clínica (87% en formas mixtas) y peor el nivel funcional (100% en GMFCS V). La repercusión nutricional aumentó con puntuaciones más altas en EDACS y GMFCS.ConclusionesPresentamos el primer estudio sobre la utilidad de la escala EDACS en una muestra representativa de niños y adolescentes españoles con PCI. Los resultados deben hacernos reflexionar sobre la importancia del cribado de disfagia en estos pacientes, independientemente del grado de afectación motriz y la necesidad de una intervención precoz para evitar sus principales consecuencias: desnutrición (hipocrecimiento, déficit de micronutrientes, osteopenia, etc.), microaspiraciones o infecciones de repetición que empeoran el estado neurológico. (AU)

Introduction and objectives: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life.Material and methodsWe conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS).ResultsOur sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores.ConclusionsThis is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients’ neurological status. (AU)

Nutritional status and prevalence of dysphagia in cerebral palsy: usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System.

INTRODUCTION AND OBJECTIVES: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. MATERIAL AND METHODS: We conducted a descriptive, cross-sectional, open-label study of out-patients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). RESULTS: Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. CONCLUSIONS: This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.

Futuro del cuidado gerontológico de enfermería. Perspectiva de futuros usuarios / The future of gerontologic nursing care. Next users' view

Objetivos: El cuidado institucionalizado de personas mayores es una realidad en España. Muchos hijos acompañan a sus padres en esa experiencia de vida y conforman su propia opinión. El objeto del estudio es conocer esa opinión, proponiendo una mirada hacia el futuro cuidado que ellos podrán recibir, partiendo de la opinión que tienen del cuidado actual que reciben sus padres. Metodología: La metodología utilizada es cualitativa, mediante entrevistas en profundidad y análisis de contenido, en una muestra integrada por hijos/as de residentes de dos centros residenciales de la ciudad de Jaén. Resultados: El resultado es que aceptan el modelo de cuidados actual para sus padres, salvo por algunas cuestiones que podrían mejorar, pero no lo admiten para sí mismos. Conclusiones: Se concluye que es necesaria la evolución de la asistencia, a través de la domiciliación y la especialización del cuidado (AU)

Objectives: The nursing home care of the elderly is a reality in Spain. Many of them are accompanied by their children in this life experience, whom create their own opinion. Knowing the children opinion including a future perspective is the main purpose of the research, on the basis of their current opinion of caring. Methods: A qualitative survey is used, with in-depth interviews and content analysis. The sample was selected from two nursing homes in the city of Jaen. Results: The main outcome was than they are satisfied with this kind of caring but not for themselves. Conclusions: We conclude that elderly care needs moving to home and through care specialization (AU)

Usefulness of chest X-rays for evaluating prognosis in patients with COVID-19.

BACKGROUND AND AIMS: The pandemia caused by SARS-CoV-2 (COVID-19) has been a diagnostic challenge in which chest X-rays have had a key role. This study aimed to determine whether the Radiological Scale for Evaluating Hospital Admission (RSEHA) applied to chest X-rays of patients with COVID-19 when they present at the emergency department is related with the severity of COVID-19 in terms of the need for admission to the hospital, the need for admission to the intensive care unit (ICU), and/or mortality. MATERIAL AND METHODS: This retrospective study included 292 patients with COVID-19 who presented at the emergency department between March 16, 2020 and April 30, 2020. To standardize the radiologic patterns, we used the RSEHA, categorizing the radiologic pattern as mild, moderate, or severe. We analyzed the relationship between radiologic severity according to the RSEHA with the need for admission to the hospital, admission to the ICU, and mortality. RESULTS: Hospital admission was necessary in 91.4% of the patients. The RSEHA was significantly associated with the need for hospital admission (p = 0.03) and with the need for ICU admission (p < 0.001). A total of 51 (17.5%) patients died; of these, 57% had the severe pattern on the RSEHA. When we analyzed mortality by grouping patients according to their results on the RSEHA and their age range, the percentage of patients who died increased after age 70 years in patients classified as moderate or severe on the RSEHA. CONCLUSIONS: Chest X-rays in patients with COVID-19 obtained in the emergency department are useful for determining the prognosis in terms of admission to the hospital, admission to the ICU, and mortality; radiologic patterns categorized as severe on the RSEHA are associated with greater mortality and admission to the ICU.

Usefulness of chest X-rays for evaluating prognosis in patients with COVID-19. / Utilidad de la radiografía de tórax para evaluar el pronóstico de pacientes con COVID-19.

BACKGROUND AND AIMS: The pandemia caused by SARS-CoV-2 (COVID-19) has been a diagnostic challenge in which chest X-rays have had a key role. This study aimed to determine whether the Radiological Scale for Evaluating Hospital Admission (RSEHA) applied to chest X-rays of patients with COVID-19 when they present at the emergency department is related with the severity of COVID-19 in terms of the need for admission to the hospital, the need for admission to the intensive care unit (ICU), and/or mortality. MATERIAL AND METHODS: This retrospective study included 292 patients with COVID-19 who presented at the emergency department between March 16, 2020 and April 30, 2020. To standardize the radiologic patterns, we used the RSEHA, categorizing the radiologic pattern as mild, moderate, or severe. We analyzed the relationship between radiologic severity according to the RSEHA with the need for admission to the hospital, admission to the ICU, and mortality. RESULTS: Hospital admission was necessary in 91.4% of the patients. The RSEHA was significantly associated with the need for hospital admission (p=0.03) and with the need for ICU admission (p<0.001). A total of 51 (17.5%) patients died; of these, 57% had the severe pattern on the RSEHA. When we analyzed mortality by grouping patients according to their results on the RSEHA and their age range, the percentage of patients who died increased after age 70 years in patients classified as moderate or severe on the RSEHA. CONCLUSIONS: Chest X-rays in patients with COVID-19 obtained in the emergency department are useful for determining the prognosis in terms of admission to the hospital, admission to the ICU, and mortality; radiologic patterns categorized as severe on the RSEHA are associated with greater mortality and admission to the ICU.

Outcomes of basicervical femoral neck fracture treated with percutaneous compression plate (PCCP).

INTRODUCTION: Basicervical femoral neck fracture is associated with high rates of failure due instability patterns, mainly collapse and rotational instability. The purpose of this study was to evaluate the clinical-radiological results of a group of patients with a bascervical proximal femoral fractures treated with Percutaneous Compression Plate (PCCP). MATERIAL AND METHODS: Among 5817 patients with a hip fracture who were admitted in our hospital from January 2005 to December 2017, 234 factures (4%) were diagnosed of basicervical femoral fracture. 30 of them were treated with a PCCP, 22 women and 8 men, mean age was 81.2 years (63-94). Demographic and perioperative variables were collected. The patients were followed up at 1, 3 and 6 months clinically and radiologically. RESULTS: There were no intra-operative complications and no conversions to open surgery. There was no early implant failure. No surgical wound infection was diagnosed. Crude mortality was 13% the first year and 87% were able to walk at the 6 months. The last follow-up x-rays revealed 97% fracture healing and the collapse at fracture site occurred in 4 hips. No instances of cut-out were observed. In one case, a fatigue failure of the lag screws of a PCCP plate was observed at 3 months from osteosynthesis. CONCLUSION: PCCP is an appropriated implant for basicervical femoral neck fractures.

Prenatal Exposure to Endocrine-Disrupting Chemicals and Asthma and Allergic Diseases.

Endocrine-disrupting chemicals (EDCs) interfere with endogenous hormones and are present in many consumer products. In addition, they affect the development and functions of the immune system. The prenatal period is critical, because exposure to EDCs can induce irreversible changes in the immune system and increase susceptibility to asthma and allergies later in life. Nonpersistent EDCs are of most concern owing to their high annual production and potential toxicity. In this review, we summarize the literature on the effects of prenatal exposure to nonpersistent EDCs-phthalates and phenols-on asthma and allergic diseases, describe the underlying biological mechanisms, and make recommendations. Between 2011 and 2020, a total of 19 prospective studies were published. Most of these were focused on phthalates and bisphenol A and few on other bisphenols, parabens, triclosan, and benzophenone-3. Evidence remains insufficient owing to differences in chemical use between countries, sociodemographic characteristics of the study populations, misclassification of exposure due to the high within-subject variability, and heterogeneity in the definition of health outcomes. EDCs can alter airway cell differentiation and gut microbiota, shift the immune response towards TH2, alter expression of T regulatory cells and TH17, and weaken innate immunity. In order to better understand the burden of EDCs on the respiratory and immune systems, we require thoughtfully designed studies to assess exposure, appropriately characterize asthma and allergic phenotypes, and evaluate biological mechanisms and EDC mixtures.

Nutritional status and prevalence of dysphagia in cerebral palsy: Usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System. / Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System.

INTRODUCTION AND OBJECTIVES: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. MATERIAL AND METHODS: We conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). RESULTS: Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level>II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. CONCLUSIONS: This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.

Effects of radiotherapy on plasma energy metabolites in patients with breast cancer who received neoadjuvant chemotherapy.

PURPOSE: Neoadjuvant chemotherapy (NACT) is employed in patients with breast cancer (BC) with the aim of reducing tumor burden and improving surgical outcomes. We evaluated the levels of energy metabolites pre- and post-radiotherapy (RT) in breast cancer (BC) patients who previously received NACT and investigated the alterations of these metabolites in relation to the patient achieving a pathologic complete response to NACT. MATERIALS AND METHODS: We included 37 BC patients who were treated with NACT following surgery and analyzed the concentrations of energy balance-related metabolites using targeted metabolomics before and one month after the end of RT. The control group was composed of 44 healthy women. RESULTS: Pre-radiotherapy, patients had significant decreases in the plasma levels of 12 metabolites. RT corrected these alterations and the improvement was superior in patients with a pathologic complete response. CONCLUSION: Our results highlight the importance of metabolism in the outcomes of patients with BC.

Prenatal exposure to endocrine-disrupting chemicals and asthma and allergic diseases

Endocrine-disrupting chemicals (EDCs) interfere with endogenous hormones and are present in many consumer products. In addition, they affect the development and functions of the immune system. The prenatal period is critical, because exposure to EDCs can induce irreversible changes in the immune system and increase susceptibility to asthma and allergies later in life. Nonpersistent EDCs are of most concern owing to their high annual production and potential toxicity. In this review, we summarize the literature on the effects of prenatal exposure to nonpersistent EDCs-phthalates and phenols-on asthma and allergic diseases, describe the underlying biological mechanisms, and make recommendations. Between 2011 and 2020, a total of 19 prospective studies were published. Most of these were focused on phthalates and bisphenol A and few on other bisphenols, parabens, triclosan, and benzophenone-3. Evidence remains insufficient owing to differences in chemical use between countries, sociodemographic characteristics of the study populations, misclassification of exposure due to the high within-subject variability, and heterogeneity in the definition of health outcomes. EDCs can alter airway cell differentiation and gut microbiota, shift the immune response towards TH2, alter expression of T regulatory cells and TH17, and weaken innate immunity. In order to better understand the burden of EDCs on the respiratory and immune systems, we require thoughtfully designed studies to assess exposure, appropriately characterize asthma and allergic phenotypes, and evaluate biological mechanisms and EDC mixtures

Los disruptores endocrinos (DEs), sustancias químicas que pueden interferir con las hormonas endógenas y que están presentes en muchos productos de consumo, pueden afectar el desarrollo y función del sistema inmune. El período prenatal es crítico porque su exposición puede inducir cambios irreversibles en el sistema inmunitario y aumentar la susceptibilidad al asma y alergias. Los DEs de mayor preocupación son los no persistentes por su alta producción y potencial toxicidad. En esta revisión, resumimos la literatura sobre los efectos de la exposición prenatal a DEs no persistentes (ftalatos y fenoles) sobre el asma y las alergias, describimos los mecanismos biológicos y desarrollamos recomendaciones. Entre 2011 y 2020, se publicaron un total de 19 estudios prospectivos. La mayoría se centraron en ftalatos y bisfenol A y pocos en otros bisfenoles, parabenos, triclosán y benzofenona-3. En general, la evidencia aún es insuficiente, probablemente debido a diferencias en el uso de químicos y las características sociodemográficas entre países, la clasificación errónea de la exposición y la heterogeneidad en la definición de los fenotipos. Los DEs pueden alterar la diferenciación celular de las vías respiratorias, cambiar la respuesta inmune hacia Th2, alterar la expresión de las células T reguladoras y Th17 y alterar la microbiota intestinal. Se necesitan estudios con buena medida de exposición y caracterización de los fenotipos y que consideren mecanismos biológicos y mezclas de DEs. Esta investigación contribuirá a la implementación de políticas de salud pública para reducir la exposición a los DEs en la comunidad, particularmente en mujeres embarazadas

Nature-Based Social Prescribing in Urban Settings to Improve Social Connectedness and Mental Well-being: a Review.

PURPOSE OF REVIEW: Recent reports of a "loneliness epidemic" in the USA are growing along with a robust evidence base that suggests that loneliness and social isolation can compromise physical and psychological health. Screening for social isolation among at-risk populations and referring them to nature-based community services, resources, and activities through a social prescribing (SP) program may provide a way to connect vulnerable populations with the broader community and increase their sense of connectedness and belonging. In this review, we explore opportunities for social prescribing to be used as a tool to address connectedness through nature-based interventions. RECENT FINDINGS: Social prescribing can include a variety of activities linked with voluntary and community sector organizations (e.g., walking and park prescriptions, community gardening, farmers' market vouchers). These activities can promote nature contact, strengthen social structures, and improve longer term mental and physical health by activating intrapersonal, interpersonal, and environmental processes. The prescriptions are appropriate for reaching a range of high-risk populations including moms who are minors who are minors, recent immigrants, older adults, economically and linguistically isolated populations, and unlikely users of nature and outdoor spaces. More research is needed to understand the impact of SPs on high-risk populations and the supports needed to allow them to feel at ease in the outdoors. Additionally, opportunities exist to develop technologically and socially innovative strategies to track patient participation in social prescriptions, monitor impact over time, and integrate prescribing into standard health care practice.

Distribución de enfermeras por Unidades de pacientes agudos y Unidades de Cuidados Intensivos en España / Allocation of nurses by acute or Intensive Care Units in Spain

En el contexto sociodemográfico y económico en el que nos encontramos, es necesario que los sistemas sanitarios, potencien la promoción y prevención de la salud e implementen nuevas estrategias para atender a la población. En España se aprecia un importante déficit de enfermeras, con respecto a los países de nuestro entorno. Este déficit implica un aumento de la ratio enfermera-paciente, lo que conlleva un incremento de la morbi-mortalidad de la población y un aumento de costes. Los objetivos de este estudio son conocer la distribución de enfermeras en España en entornos de pacientes agudos y analizar las necesidades por provincias, así como compararlo con las ratios de seguridad recomendadas por organismos oficiales. Para ello se realizó un estudio descriptivo transversal multicéntrico durante 2016. Del análisis de los datos se desprende que la media de pacientes por enfermera y turno es elevada en unidades de agudos polivalentes, situación que se agrava en los turnos de noche, fines de semana y festivos. Y por lo tanto ninguna Comunidad Autónoma cumple en todos los turnos de trabajo las ratios recomendadas. En las Unidades de Cuidados Intensivos, en todas las Comunidades Autónomas, en todos los turnos, están por encima de dos pacientes por enfermera por lo que tampoco se sitúan en estándares recomendados. Es necesario, junto con un cambio de modelo sanitario, incorporar enfermeras al sistema nacional de salud, ya que esto aportara retornos económicos, sociales y de salud

In the socio-demographic and economic context in which we are, it is necessary that the health systems empower health promotion and prevention and implement new strategies to assist the population. In Spain there is a significant deficit in nurses with respect to other countries of our surroundings. This deficit implies an increase in the ratio patient-nurse, which leads to an increase in the morbi-mortality of the population and an increase of the costs. The objectives of this study are to know the distribution of nurses in Spain in acute patient settings and to analyze the needs provinces, as well as to compare it with the safety ratios recommended by official bodies. To this end, a multicentric cross-sectional descriptive study was carried out during 2016. From the analysis of the data it is discovered that both at the level of the province and Autonomous Community, the average number of patients per nurse and shift is high in acute polyvalent care units, a situation that gets worse in night shifts, weekends and holidays. Therefore, no Autonomous Community fulfills the recommended ratios in all shifts. In Intensive Care Units, in all Autonomous Communities, in all shifts, they are above two patients per nurse, so they are not placed within the recommended standards either. It is necessary, together with a change of the health model, to incorporate nurses into the national health system, since this will provide economic, social and health returns

Detection of clinical and neurological signs in apparently asymptomatic HTLV-1 infected carriers: Association with high proviral load.

Several studies suggest that HTLV-1 infection may be associated with a wider spectrum of neurologic manifestations that do not meet diagnostic criteria for HAM/TSP. These conditions may later progress to HAM/TSP or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. Our aim was to determine the prevalence of HTLV-1-associated disease in subjects without HAM/TSP, and the relationship between these findings with HTLV-1 proviral load (PVL). METHODS: 175 HTLV-1-infected subjects were submitted to a careful neurological evaluation, during their regular follow up at the HTLV outpatient clinic of the Institute of Infectious Diseases "Emilio Ribas", São Paulo city, Brazil. Clinical evaluation and blinded standardized neurological screening were performed for all the subjects by the same neurologist (MH). RESULTS: After the neurological evaluation, 133 patients were classified as asymptomatic and 42 fulfilled the criteria for intermediate syndrome (IS). The mean age of the enrolled subjects was 46.3 years and 130 (74.3%) were females. Clinical classification shows that neurological symptoms (p<0.001), visual disorders (p = 0.001), oral conditions (p = 0.001), skin lesions (p<0.001), bladder disorders (p<0.001), and rheumatological symptoms (p = 0.001), were strongly associated to IS, except for disautonomy (p = 0.21). A multivariate analysis revealed that HTLV-1 proviral load, oral conditions, bladder disorders and rheumatological symptoms were independently associated with the IS. CONCLUSIONS: We found some early alterations in 42 patients (24%), particularly the presence of previously not acknowledged clinical and neurological symptoms, among subjects previously classified as "asymptomatic", who we reclassified as having an intermediate syndrome.

Detection of clinical and neurological signs in apparently asymptomatic HTLV-1 infected carriers: Association with high proviral load

Several studies suggest that HTLV-1 infection may be associated with a wider spectrum of neurologic manifestations that do not meet diagnostic criteria for HAM/TSP. These conditions may later progress to HAM/TSP or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. Our aim was to determine the prevalence of HTLV-1-associated disease in subjects without HAM/TSP, and the relationship between these findings with HTLV-1 proviral load (PVL). METHODS: 175 HTLV-1-infected subjects were submitted to a careful neurological evaluation, during their regular follow up at the HTLV outpatient clinic of the Institute of Infectious Diseases "Emilio Ribas", São Paulo city, Brazil. Clinical evaluation and blinded standardized neurological screening were performed for all the subjects by the same neurologist (MH). RESULTS: After the neurological evaluation, 133 patients were classified as asymptomatic and 42 fulfilled the criteria for intermediate syndrome (IS). The mean age of the enrolled subjects was 46.3 years and 130 (74.3%) were females. Clinical classification shows that neurological symptoms (p<0.001), visual disorders (p = 0.001), oral conditions (p = 0.001), skin lesions (p<0.001), bladder disorders (p<0.001), and rheumatological symptoms (p = 0.001), were strongly associated to IS, except for disautonomy (p = 0.21). A multivariate analysis revealed that HTLV-1 proviral load, oral conditions, bladder disorders and rheumatological symptoms were independently associated with the IS. CONCLUSIONS: We found some early alterations in 42 patients (24%), particularly the presence of previously not acknowledged clinical and neurological symptoms, among subjects previously classified as "asymptomatic", who we reclassified as having an intermediate syndrome

Developing digital educational materials for nursing and sustainability: The results of an observational study.

BACKGROUND: There is limited European literature on nursing and sustainability; nursing students are poorly prepared on the connections between resources, climate change, sustainability, and health, so they must acquire knowledge and develop skills and competencies in this field. The use of digital technologies and teaching via E-learning has grown, and has been widely adopted as a learning method for nursing. OBJECTIVES: The aim of the current study was to test and evaluate digital educational materials on environmental sustainability and health, in the context of university nursing education in different European countries. DESIGN: An observational cross-sectional design. SETTINGS: University of Plymouth, University of Jaén, and University of Esslingen for Nursing Degree Studies. PARTICIPANTS: 299 nursing students: 161 students from University of Jaén; 106 from Plymouth; and 32 from Esslingen. 22 professional evaluators with different profiles were recruited: Teachers, Clinical professionals, Delphi Experts, and Technical Experts. METHODS: We conducted a piloting and validation process. The materials were designed and adapted to the NurSusTOOLKIT Sustainability Literacy and Competency framework. Evaluation was developed by professionals and students. We used the Spanish Standard for the assessment of Digital Educational Material Quality at University level questionnaire. All students provided informed consent prior to taking part in the learning and evaluation. RESULTS: The overall evaluations of materials by students and professionals were 7.98±1.28 and 8.50±1.17, respectively. The Ability to generate learning was scored higher among students (mean difference: 0.84; 0.22-1.47; p=0.008). In the overall assessment by students, statistically significant differences were found between the three universities (Welch: 11.69, p<0.001). CONCLUSIONS: Students, professionals, and technical experts considered the materials to be very good quality, especially regarding the quality of contents, format, and design. For students, these materials can generate reflection and learning regarding environmental and health issues during nursing training.

La importancia de la primera vez / No disponible

No disponible

Currículum enfermero y estrategias pedagógicas en materia de sostenibilidad medioambiental en los procesos de salud y cuidado / Curriculum nurse and strategies training on environmental sustainability and climate change

Fundamentos: Las enfermeras deben ser conocedoras de cómo afecta el cambio climático a la salud. Para la obtención de estos conocimientos es necesario definir las competencias a adquirir y las estrategias pedagógicas que afronten la sostenibilidad medioambiental en la formación de Enfermería. Objetivo: Describir las dimensiones que debe incluir la formación enfermera en materia de sostenibilidad medioambiental, cambio climático y cuidados de salud y determinar las estrategias pedagógicas más adecuadas. Métodos: Se realizó una revisión narrativa de publicaciones sobre sostenibilidad medioambiental en relación a enfermería y cuidados de salud de los últimos 10 años. Se diseñaron estrategias de búsqueda para quince bases de datos de enfermería y ciencias de la salud. Los resultados se sistematizaron en matrices de datos. Resultados: La formación enfermera en sostenibilidad medioambiental debe incluir contenidos sobre globalización, impacto ambiental, promoción de salud, uso de recursos y gestión adecuada de residuos, alimentos e influencias de los procesos de producción, los efectos del tabaquismo y los efectos ambientales en la salud de la infancia. Los enfoques educativos más adecuados para incluir la sostenibilidad medioambiental en la formación enfermera son la Investigación-Acción Participativa y el aprendizaje basado en problemas. Conclusiones: La formación enfermera en materia de sostenibilidad medioambiental debe incluir competencias en diferentes niveles: en lo individual, comprendiendo los fundamentos y el alcance del problema y actuando consecuentemente en el ámbito profesional y en el personal, y en el plano social, Enfermería tiene un papel clave en la promoción de la salud medioambiental (AU)

Background: Nurses should be knowledgeable about how it affects climate change to health. To acquire this knowledge it is necessary to define competencies and educational strategies that tackle environmental sustainability in nursing training. Objective: To describe the dimensions that should be included in nurse education in the field of environmental sustainability, climate change and health care and determine the most appropriate pedagogical strategies. Methods: A narrative review of publications on environmental sustainability in relation to nursing and health care in the last 10 years has been carried out. Search strategies have been designed for fifteen databases of Nursing and Health Sciences. The results were systematized in a data arrays. Results: Training nurse in environmental sustainability should include contents about globalization, environmental impact, promotion of health, use of resources and proper management of waste, food and influences of production processes, the effects of smoking and environmental effects on the health of children. Educational approaches more appropriate to include environmental sustainability in the nurse training are the Participatory Action Research and problem-based learning. Conclusion: The training nurse on environmental sustainability should include competencies at different levels: individual, understanding the rationale and scope of the problem and acting accordingly in the professional field and in the personnel; and at the social level, nursing has a key role in the promotion of environmental health (AU)