The reproductive journeys of French women over 40 seeking assisted reproductive technology treatments in Spain.

Fertility decline is a complex phenomenon resulting from converging social and cultural changes that are governed through politics. As it has been discussed in many studies, the European's low fertility rate goes hand in hand with the trend of maternity postponement. Although in many European countries over the last decades reproduction is envisaged as an individual choice that can be made at older ages, having a child after a certain age can be impossible -either "naturally" or using assisted reproductive technology-depending on the medical and legislative possibilities and limits of the country in which people live. In the extremely diverse European reproscape, reproductive legislations have forced but also allowed many people to seek reproductive treatments outside their home countries. Spain is a leading destination in Europe for cross border reproductive travel and, of the foreigners it receives, the French are the largest group. Despite having a history of strong pro-natalist policies, France has been one of the strictest European countries regarding access to medically assisted procreation. Until 2022, only heterosexual couples in which women were under 43 years of age could access treatments. Despite the recent opening of access to "all women", including single women and same-sex female couples, women over 43 years of age were once again excluded from the new legal framework and therefore remain condemned to travel abroad to access reproductive treatments. In this article, we analyze the experience of French women over 40 who cross the Spanish border to access reproductive treatments in order to fulfill their desire to have children. Through ethnographic data emerging from six years of participant observation and in-depth interviews with 15 women, we explore why they remain excluded from the French system of reproductive governance and the obstacles they face during their reproductive journey.

Solidarity exclusions: Problematizing kinship and humanitarianism from the perspective of transnational adoption.

What is, or should be, the role of solidarity within the (transnationally adoptive) family? In Spain, solidaridad is a prized value in family life, political organization, and humanitarian action, yet adoption professionals actively discouraged its use as a motivation for transnational adoption. This article offers a genealogy of the concept of solidaridad, a consideration of its enduring currency in kinship discourse in Spain, and a critical analysis of case studies from our respective research projects. We show that kinship and humanitarianism are considered very differently in terms of their temporalities and entailments-the terms, and specificities, of their engagements. We argue that solidaridad's multivocality within the transnational adoptive family context has broader significance for kinship, both adoptive and nonadoptive, as well as for social and political engagement across inequality. Solidaridad's exclusions from transnational adoption reveal how kinship and humanitarianism both involve the work of identifying, accommodating, and resolving social difference. [adoption, humanitarianism, kinship, law, Spain].

¿Cuál es, o debería ser, el rol de la solidaridad en la familia (adoptiva transnacional)? En España, la solidaridad es un preciado valor familiar, político y humanitario, pero se desaconseja como motivación para adoptar transnacionalmente. Este artículo ofrece una genealogía del concepto de solidaridad, evidencia su permanencia en el lenguaje del parentesco y analiza críticamente casos provenientes de nuestras investigaciones. Así, constatamos que parentesco y humanitarismo son considerados diferentes por sus temporalidades e implicaciones -y por los términos y especificidades de sus compromisos. Una multivocalidad de la solidaridad evidente en la familia adoptiva transnacional que confiere, a través de la desigualdad, un significado más amplio al parentesco, adoptivo y no adoptivo, y a los compromisos sociopolíticos. Asimismo, la exclusión de la solidaridad de la adopción transnacional revela cómo el parentesco y el humanitarismo requieren de un trabajo de identificación, acomodación y resolución de la diferencia social. [adopción, humanitarismo, parentesco, legislación, España].

Quel est, ou devrait être, le rôle de la solidarité dans la famille (adoptive transnationale)? En Espagne, la solidaridad est une importante valeur familiale, politique et humanitaire, mais elle est déconseillée comme motivation pour l'adoption transnationale. Cet article propose une généalogie du concept de solidaridad, une réflexion sur sa pérennité dans le discours de la parenté et une analyse critique des études de cas issus de nos recherches. La parenté et l'humanitarisme sont différenciés dans leurs temporalités et leurs implications­et dans les termes et spécificités de leurs engagements. Nous soutenons qu'une multivocalité de la solidaridad dans le contexte de la famille adoptive transnationale confère une signification plus large à la parenté, adoptive ou non, ainsi qu'à l'engagement politique et social face aux inégalités. L'exclusion de la solidaridad de l'adoption transnationale révèle que la parenté et l'humanitaris'e nécessitent l'identification, 'accommodation et la résolution de la différence sociale. [adoption, humanitarisme, parenté, loi, Espagne].

Motherhood in Spain: From the "Baby Boom" to "Structural Infertility".

We analyze the mechanisms of reproductive governance that influence reproduction in Spain through 66 semi-structured interviews with heterosexual parents. We examine reproductive governance through moral regimes surrounding four arenas: the labor market, gender relations at home, institutional feminist discourses, and the narrative of choice. We show that mothers are considered to be socially responsible for children, a fact that is key to understanding how Spain went from a "baby boom" between the 1950 and 1970s to "structural infertility" since the 1990s.

Spanish nurses' experiences with personal protective equipment and perceptions of risk of contagion from COVID-19: A qualitative rapid appraisal.

AIMS AND OBJETIVES: Explore nurses' experiences and perception of risk regarding the use of personal protective equipment during the first wave of the pandemic in Spain. BACKGROUND: The contribution of our study is to use qualitative methods to understand nurses' experiences and perceptions of the risk of the contagion linked to the shortage of PPE during the first wave of the pandemic, whose explosive start strained health systems around the globe. DESIGN: Qualitative descriptive design according to the Rapid Research Evaluation and Appraisal model. METHODS: Semi-structured videoconference interviews were conducted to explore the experiences of 29 nurses including staff nurses, nursing supervisors and nursing directors from hospital and community services of the Spanish health system. Interviews lasted 30-45 min and were conducted in May 2020. We carried out a thematic analysis using Dedoose. The COREQ checklist was used to report findings. RESULTS: We identified the following themes and subthemes: 1. Experiences with personal protective equipment: scarcity, inequality, reutilization, self-protection, delegation of responsibility, and gap between protocols and reality; 2. Perception of the risk of contagion: lack of credibility, lack of trust, lack of support, and meeting subjective needs. CONCLUSIONS: The scarcity of personal protective equipment and inequality in its distribution led nurses to take initiatives to feel more protected. Mid-ranking supervisors were caught between the responsibility of monitoring and rationing personal protective equipment and providing the necessary protection to nurses. The disjuncture between protocols and the available supply of personal protective equipment caused confusion. Lack of credibility, lack of trust and lack of support from management influenced participants' perception of the risk of contagion. Mid-ranking supervisors were often responsible for trying to alleviate fear among nursing staff. RELEVANCE TO CLINICAL PRACTICE: Understanding the factors involved in risk perception can be helpful to decision-makers who help protect nurses in clinical practice. These results can help administrators and policymakers because they point to the need for nurses to feel that their departments and centers look after their safety at work. Transparent communication and emotional support may contribute to their well-being in the face of risk.

Front-line nurses' responses to organisational changes during the COVID-19 in Spain: A qualitative rapid appraisal.

AIMS: To identify the organisational changes faced by front-line nurses working with COVID-19 patients during the first wave and describe how they responded to these changes. BACKGROUND: The COVID-19 pandemic has altered the provision of care and the management of health care around the world. Evolving information about SARS-CoV-2 meant that health care facilities had to be reorganised continually, causing stress and anxiety for nurses. METHODS: Qualitative study based on Rapid Research Evaluation and Appraisal (RREAL). The research took place in hospital and community health settings of the Spanish national health system with a purposive sampling of 23 front-line nurses. Semi-structured interviews were conducted between May and June 2020. The duration was 30-45 min per interview. We used the Dedoose® data analysis software to perform a thematic analysis. RESULTS: Nurses responded to organisational changes using the following strategies: improvisation, adaptation and learning. CONCLUSION: Our rapid approach allowed us to record how nurses responded to changing organisation, information that is easily lost in a disaster such as the COVID-19. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing about their strategies can help planning for future health disasters, including subsequent waves of the COVID-19.

On Reproductive Work in Spain: Transnational Adoption, Egg Donation, Surrogacy.

Spain's plummeting fertility since the late twentieth century may seem to reflect a waning desire for children. Nevertheless, reproductive disappointments resulting from gender inequalities cause many Spanish women to postpone motherhood and experience age-related fertility problems. For them, creating a family often becomes possible only through the reproductive labor of other women. Our analysis of transnational adoption, egg donation, and surrogacy in Spain shows how anonymity and altruism play out in these three strategies, with implications for the valuation of women's reproductive work and relationships among reproductive providers, intermediaries, recipients, and the resulting children.

Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people.

AIM: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss. BACKGROUND: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective. DESIGN: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman. FINDINGS: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as "obese" and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories. CONCLUSION: Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.

Perceptions of diabetes obtained through drawing in childhood and adolescence.

OBJECTIVE: To examine whether drawing is useful in the detection of problems of psychosocial adaptation in children and adolescents with type 1 diabetes (T1D) and in improving communication with health professionals. METHODS: We performed an exploratory descriptive study in 199 children and adolescents with T1D aged 4-13 years. The participants were asked to render a drawing on a suggested topic. The variables analyzed were related to the drawing and to clinical and sociodemographic data. RESULTS: Most participants showed evidence of having a well-balanced personality, but there were also signs of affective or psychosocial difficulties. CONCLUSION: Drawing is a useful technique by which to identify children's and adolescents' feelings and possible problems in adapting to T1D, as well as to gain information directly from the children themselves. Future studies should delimit the possibilities of this technique in clinical practice in greater detail.

Comparación Directa de Niñas Adoptadas en China y Europa del Este: Ansiedad, Hiperactividad/Impulsividad, Inatención y Conductas Desafiantes / A Direct Comparison of Girls Adopted from China and Eastern Europe: Anxiety, Hyperactivity/Impulsivity, Inattention and Defiant Behaviours

Previous research looking at adopted children has shown that children adopted from Eastern Europe (EE) are more likely to show inattention and hyperactivity/impulsivity whereas girls adopted from China (CH) tend to have normative adjustment scores, although as they grow up, internalising behaviours might increase. We directly compare parental ratings of the SNAP-IV (Hyperactivity/Inattention) and SCARED (Anxiety) of girls adopted from CH (n = 42), EE (n = 34) and other countries (n = 32). EE were more likely to show inattention, hyperactivity/impulsivity and defiant behaviours than CH, independent of age at adoption and number of siblings. The age of the child only had a significant effect on defiant behaviours. No significant differences in anxiety were observed between groups. Overall anxiety levels were related to hyperactivity/impulsivity. Specific factors related to adoption in each region might account for differential levels in inattention, hyperactivity/impulsivity and defiant behaviours and should be taken into account to aid the adjustment of adoptees (AU)

Estudios previos sobre menores adoptados han mostrado que los menores adoptados en Europa del Este (EE) tienen más probabilidades de mostrar inatención e hiperactividad/ impulsividad mientras que las niñas adoptadas en China (CH) suelen obtener puntuaciones normales en adaptación, aunque a medida que crecen, puede que aumenten las conductas internalizantes. Comparamos directamente las puntuaciones obtenidas en el SNAP-IV (Hiperactividad/Inatención) y el SCARED (Ansiedad) por niñas adoptadas en CH (n = 42), EE (n = 34) y en otros países (n = 32). EE muestran más inatención, hiperactividad/ impulsividad y conductas desafiantes que CH, independientemente de la edad de adopción y del número de hermanos. La edad de adopción solo tiene un efecto significativo sobre las conductas desafiantes. No se observan diferencias significativas en ansiedad entre los grupos. En general, los niveles de ansiedad están relacionados con la hiperactividad/impulsividad. Factores específicos relacionados con la adopción en cada una de estas regiones podrían explicar parte de las diferencias en inatención, hiperactividad/inatención y conductas desafiantes y se deberían tener en cuenta para potenciar la adaptación de los adoptados (AU)

ADHD-like symptoms and attachment in internationally adopted children.

Internationally adopted children seem to be more likely to show ADHD-like symptoms than non-adopted children. The aims of this study were to explore the existence of ADHD-like symptoms and/or diagnosis in a sample of internationally adopted children depending on their country of origin and to describe the links that may exist between the display of these symptoms and observed narrative-based attachment patterns. A Catalan sample of 58 adopted children aged 7-8 (24 from Eastern Europe, 23 from China, and 11 from Ethiopia) was assessed with the Behavioral Assessment System for Children to identify ADHD-like symptoms, and the Friends and Family Interview to identify children's' attachment patterns. Results indicated that children adopted from Eastern Europe showed a trend toward more hyperactivity and significantly more attention problems than girls adopted from China. Children with a secure attachment showed significantly less attention problems and a trend toward less hyperactivity. More studies focusing on the etiology and treatment of these symptoms in adopted children are needed.