Reconstrucción inmediata en cáncer de mama. ¿Las mujeres están satisfechas con su decisión? / Immediate breast reconstruction in cancer. are women satisfied with their decision?

Objetivo: Conocer las vivencias, expectativas y satisfacción percibida de un grupo de mujeres diagnosticadas de cáncer de mama con mastectomía con reconstrucción en el mismo acto quirúrgico. Material y Métodos: La metodología utilizada en esta investigación ha sido la cualitativa y las técnicas para la recogida de la información fueron la entrevista en profundidad (cuatro mujeres) y el grupo focal (dos grupos de 8 pacientes cada uno). Resultados: se exploraron cinco áreas 1) El impacto del diagnóstico del cáncer 2) Información recibida ante la intervención 3) Las experiencias en el postoperatorio. 4) Cumplimiento de expectativas y 5) Satisfacción con la decisión tomada. El diagnóstico fue impactante para la mayoría de las mujeres. Inicialmente, la información recibida se consideró buena y suficiente pero hemos comprobado que posteriormente, una vez superada la convalecencia de la intervención, aparecen más quejas sobre todo relacionadas con las complicaciones posteriores y con el dolor. Las expectativas sobre la reconstrucción inmediata estuvieron muy ligadas con los resultados estéticos finales. Algunas mujeres volverían a pasar por lo mismo a pesar de las complicaciones y otras dan mucho valor a los inconvenientes y no se lo volverían a hacer. Conclusiones: No aparece una postura clara y unánime entre las pacientes de si se volverían a reconstruir y si se han cumplido sus expectativas. La paciente necesita una información real, ecuánime y adaptada para poder tomar una decisión compartida. Por eso, creemos necesario elaborar herramientas de toma de decisiones compartidas que faciliten que la información llegue a la paciente

Objective: To know the experiences, expectations and perceived satisfaction in a group of breast cancer women who had undergone immediate breast reconstruction after mastectomy. Material and Methods: 20 women took part in a qualitative study. 4 women were assessed through an in-depth interview and the other 16 women were divided into two focus groups (8 each). The recorded interview and focus group discussions were transcribed and analyzed using "framework analysis". Results: Five areas were explored: 1) Impact of cancer diagnosis, 2) Information received about the surgery, 3) Post-surgery experiences, 4) Fulfilment of expectations and 5) Satisfaction with the decision. Cancer diagnosis was overwhelming for most of the women. For women, information received was considered good and sufficient, but the study shows that after the post-surgical period, more complaints related to pain and other complications appear. The expectations about immediate breast reconstruction were linked with the final aesthetic results. Some women would choose to do the same procedure again despite the complications but some other women would not choose the same option because of the complications and they regret their decision. Conclusion: There is no clear and unanimous position among women about whether they would go through immediate breast reconstruction again and whether the surgery has fulfilled their expectations. The patients need complete, unbiased and appropriate information in order to be able to make an informed and shared decision. It is for that reason that we think it is necessary to devise patient decision aids which could facilitate the information delivering process to patients

Alzheimer: sentidos, significados y cuidados desde una perspectiva transcultural / Alzheimer: Significance, sense and care from a transcultural perspective

Objetivo principal: Explorar las vivencias, las representaciones y las prácticas sociales de los familiares de personas con Alzheimer en distintos contextos culturales. A la luz de tres casuísticas empíricas concretas, nuestro objetivo se centra en analizar cómo los cuidadores familiares identifican, denominan e interpretan el padecimiento y cómo establecen y desarrollan estrategias de cuidados. Con este fin, se comparan las experiencias de cuidadores familiares de la ciudad de Tarragona (España), de la Parroquia Santa Lucía, Municipio Maracaibo del Estado de Zulia (Venezuela) y de Cuernavaca (México).Metodología: En base a una metodología cualitativa, centrada en el punto de vista del actor, los encuentros con los familiares cuidadores han permitido captar el sentido y el significado que adquiere para ellos la enfermedad y el cuidado circunscrito al ámbito doméstico. Como estrategias básicas para la recogida de información se utilizó la observación participante y la entrevista en profundidad. Además, para los casos de Tarragona y Cuernavaca, se realizaron sesiones de grupo focal.Resultados principales: Del análisis comparativo de los resultados se desprende un dominio de la influencia que el discurso biomédico hegemónico ejerce sobre los saberes de los familiares. Se han encontrado variados puntos de encuentro entre las vivencias, las representaciones y las prácticas sociales de los familiares de los tres contextos culturales, con escasos matices que nos permitan hablar de diferencias socioculturales en torno a las manifestaciones y percepciones sobre la demencia.Conclusión principal: Las similitudes encontradas nos hacen pensar en (..) (AU)

Objective: In this paper, the interest for exploring the living experiences, representations and social practices of family members of persons who have Alzheimer disease within different cultural contexts is outlined. Seen from three concrete empiric polls, our objective is to analyze how family-member care takers identify, designate and interpret the disease and how they establish and develop care strategies. With this in mind, the care taking family member experience in the city of Tarragona (Spain), in the Parish of Santa Lucia, Municipality of Maracaibo of the State Zulia (Venezuela) and in Cuernavaca (Mexico) are compared.Methods: Based on a qualitative methodology, focused on the actor's point of view, the meetings with the care taking family, have allowed us grasp the sense and the significance that the disease and the care involved in the domestic field have upon them. The participating observation and in depth interviews were used as a basic strategy for gathering information. Also, in the Tarragona and Cuernavaca cases, focal group sessions were carried out.Results: The comparative analysis shows the influence that the hegemonic biomedical discourse has upon the family member's knowledge. In the three cultural contexts, we found several common grounds in the living experiences, representations and social practices of the family members, with few changes allowing us to speak of social-cultural differences with respect to the manifestations and (..) (AU)

Representaciones del cuerpo en el embarazo. Experiencias de las mujeres / The representations of the body during pregnancy. Women´s experiences

Objetivo: Este artículo tiene como objetivo analizar las representacionesque una serie de mujeres embarazadas expusieron sobre el cuerpo,revisando las influencias externas sobre sus experiencias.Diseño: Metodología cualitativa con un enfoque antropológico.Resultados: Las interpretaciones y experiencias del cuerpo fueron diversasy evolucionaron a lo largo del embarazo. Entre ellas destacamossu percepción positiva, al responder de forma natural y automática,aunque conllevara a su transformación-deformación. La previsión delaumento de peso fue una imagen preocupante para la mayoría y, aunqueaceptada, se tradujo en prácticas de autocontrol. Otras experienciasfueron de ocupación e interpretación del cuerpo a partir de los discursosprofesionales.Conclusiones: Conocer las representaciones que las mujeres hacen desus cuerpos en gestación y revisar las propias puede mejorar la efectividadde los cuidados (AU)

Objetive: The purpose of this paper is to analyze the representations ofthe body presented by pregnant women, through the review of their influenceon their experiences.Design: Qualitative methodology with a anthropologic design.Results: Their corporal perceptions and experiences were very diverseand developed throughout the pregnancy. Among them, we highlighttheir positive perception, due to the natural and automatic response,although it leads to its transformation-deformation. The predictableweight gain was a worrying image for most of them. The prediction ofweight gain was an image of concern for most of them, and, althoughthey accepted it, it leads to self-control practices. Other experienceswere of feelings of invasion and interpretation of their body followinginteractions with professionals.Conclusions: Knowing women’s representations of their pregnant bodiesand revising our own may improve the effectiveness of prenatal care (AU)

Plasma vitellogenin levels and gonadal morphology of wild carp (Cyprinus carpio L.) in a receiving rivers downstream of sewage treatment plants.

A field study was carried out in order to assess, in a wild cyprinid fish, the biological effects related to the exposure to estrogenic compounds. The gonadosomic index (GSI), plasma vitellogenin (VTG) level and histological observations of gonads were performed to evaluate the reproductive health in common carp (Cyprinus carpio) from three rivers receiving sewage treatment plant (STP) effluents (Guadarrama, Henares and Jarama rivers, Spain) and from a reference site (Lozoya river). No significative differences in male GSI between sites were described. Only in the 18% of fish from Guadarrama river were elevated plasma VTG levels detected. The presence of oocytes in the testis was not found in any of males examined. The results suggest that the released estrogenic compounds by STPs effluents are not enough capable to adversely affect the gonadal development of the fish studied. Additional studies will be required to assess the risk of estrogenic compounds on fish from other sites of this area.

Identification of organic compounds and ecotoxicological assessment of sewage treatment plants (STP) effluents.

An integrated approach combining chemistry and biological methods was conducted to assess the toxicity of seven sewage treatment plant effluents. Solid phase concentration procedures were applied to facilitate the study of organic micro pollutants. A chemical analysis was performed by GC/MS. Organic fraction toxicity was determined by using bioassays such as Daphnia magna and Chlorella vulgaris tests and sub-lethal effects were also evaluated by using Salmonella typhimurium Test (mutagenicity), recombinant yeast screen (estrogenicity), and Oryzias latipes embryo-larval test. More than 49 compounds were detected in the organic fraction due to the various inputs of each effluents. The most frequently detected compounds in the effluents were bisphenol A (BPA), octylphenol (OP), 1,2-benzenedicarboxylic acid, bis(2-ethylhexyl) ester (DEHP) and 1,2-benzenedicarboxylic acid, bis(methylpropyl) ester (DBP). Biological assays showed toxicity effects on D. magna tests in all samples, whereas toxicity on C. vulgaris or S. typhimurium tests were not observed. Estrogenicity and teratogenicity were observed in several samples. The cause-effect relationship could not be established given the high chemical complexity of the effluents and the lack of information available on 70% of the detected compounds subsequent to reviewing various data bases. Nevertheless, due to the high chemical variability revealed by STP effluents, bioassay sets may provide a very useful amount of information for detecting potential toxicity risks.