Chitosan-based oral hydrogel formulations of ß-galactosidase to improve enzyme supplementation therapy for lactose intolerance.

ß-Galactosidase supplementation plays an important role in the life of people with lactose intolerance. However, these formulations are rendered ineffective by the low pH and pepsin in the stomach and pancreatic proteases in the intestine. Therefore, it is necessary to develop oral transport systems for carrying this enzyme in the active form up to the intestine, where the lactose digestion occurs. In this research, a new hydrogel was developed that could potentially be used for enzyme supplement therapy. In this regard, the chitosan-based ß-Gal formulations described in the manuscript are an alternative long-acting preparation to the so far available preparations that allow for enzyme protection and mucosal targeting. These hydrogels were prepared from chitosan and polyethylene glycol and contained a covalently immobilized ß-galactosidase from Aspergillus oryzae. The ß-galactosidase in the hydrogel was protected from degradation in a gastric medium at a pH of 2.5 and retained 75 % of its original activity under subsequent intestinal conditions. In the case of a simulated gastric fluid with a pH of 1.5, a copolymer containing methacrylic acid functional groups was sufficient to protect the hybrid hydrogel from the extremely acidic pH. In addition, the surface of the hydrogel was chemically modified with thiol and amidine groups, which increased the binding to intestinal mucin by 20 % compared with the unmodified hydrogel. These results represent a promising approach for oral transport as a reservoir for ß-galactosidase in the small intestine to reduce the symptoms of hypolactasia.

Scientific evolution of Corporate Social Responsibility. A bibliometric analysis with mapping analysis tools.

When the term Corporate Social Responsibility (CSR) is heard today, a multitude of concepts such as Corporate Social Responsibility, Social Responsibility, Sustainable Development or Sustainability comes to mind where, without losing the essence of what its implementation entails, it implies not the existence of a consensus that unifies everything into a theory. The objective of this study is to obtain a better understanding of the current situation and trends in this area of research. Thus, in this paper, bibliometrics is used to evaluate performance and productivity in CSR, and scientific maps to extract and classify the most important research topics in this area. The results obtained when analyzing the period 1978-2017 show the conceptual evolution of CSR research, demonstrating the growth potential of CSR, as well as its great development, being the main thematic areas identified: Financial Performance, Corporate Reputation, Ethics, Consumers, Employees and Risk.

Effectiveness of a group educational intervention - prolact - in primary care to promote exclusive breastfeeding: a cluster randomized clinical trial.

BACKGROUND: The rates of exclusive breastfeeding at 6 months in Spain are far from recommended by the World Health Organization, which is 50% by 2025. Evidence of the effectiveness of group interventions in late postpartum is limited. The objective of this study was to evaluate the effectiveness of the PROLACT group educational intervention for increasing the proportion of mother-child dyads with exclusive breastfeeding at 6 months compared to the usual practice in primary care. METHOD: Multicentre cluster randomized clinical trial. A total of 434 mother-child dyads who breastfed exclusively in the first 4 weeks of the children's life and agreed to participate were included. The main outcome was exclusive breastfeeding at 6 months. Secondary variables were type of breastfeeding, reasons for abandonment, degree of adherence and satisfaction with the intervention. To study the effectiveness, the difference in the proportions of dyads with exclusive breastfeeding at 6 months was calculated, and the relative risk (RR) and number needed to treat (NNT) were calculated with their 95% CIs. To study the factors associated with the maintenance of exclusive breastfeeding at 6 months, a multilevel logistic regression model was fitted. All analyses were performed to intention to treat. RESULTS: The percentage of dyads with exclusive breastfeeding at 6 months was 22.4% in the intervention group and 8.8% in the control group. PROLACT intervention obtained an RR =2.53 (95% CI: 1.54-4.15) and an NNT = 7 (95%CI: 5-14). The factors associated with exclusive breastfeeding at 6 months were the PROLACT intervention, OR = 3.51 (95%CI: 1.55-7.93); age > 39 years, OR = 2.79 (95%CI: 1.02-7.6); previous breastfeeding experience, OR = 2.61 (95%CI: 1.29-5.29); income between 500 and 833.33 €, OR = 3.52 (95%CI 1.47-8.47).); planning to start work before the infant was 6 months old, OR = 0.35 (0.19-0.63) . CONCLUSIONS: The PROLACT intervention in primary care is more effective than the usual practice for maintaining exclusive breastfeeding at 6 months, and can therefore be considered evidence-based practice for implementation in standard practice. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (03/06/2013).

Pensamiento, lenguaje y cuidado / Thought, language and care

No disponible

Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study.

BACKGROUND: The World Health Organization leads a global strategy to promote the initiation and maintenance of breast-feeding. Existing literature shows that education and supportive interventions, both for breast-feeding mothers as well as for healthcare professionals, can increase the proportion of women that use exclusive breast-feeding, however, more evidence is needed on the effectiveness of group interventions. METHODS: This study involves a community-based cluster randomised trial conducted at Primary Healthcare Centres in the Community of Madrid (Spain). The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice. The number of patients required will be 432 (216 in each arm). All mother-infant pairs using exclusive breastfeeding that seek care or information at healthcare centres will be included, as long as the infant is not older than four weeks, and the mother has used exclusive breastfeeding in the last 24 h and who gives consent to participate. The main response variable is mother-infant pairs using exclusive breast-feeding at six months. Main effectiveness will be analysed by comparing the proportion of mother-infant pairs using exclusive breast-feeding at six months between the intervention group and the control group. All statistical tests will be performed with intention-to-treat. The estimation will be adjusted using an explanatory logistic regression model. A survival analysis will be used to compare the two groups using the log-rank test to assess the effect of the intervention on the duration of breastfeeding. The control of potential confounding variables will be performed through the construction of Cox regression models. DISCUSSION: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO. Group education is an instrument used by professionals in Primary Care that favours the acquisition of skills and modification of already-acquired behaviour, all making it a potential method of choice to improve rates of exclusive breast-feeding in this period. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (Date of registration: June 3, 2013).

Nursing Taxonomies in Spain: Research Themes Presented at the AENTDE Conferences Over a 16-Year Period.

OBJECTIVE: To identify the types of studies of nursing taxonomies and priority research themes presented at AENTDE conferences between 1996 and 2012. METHOD: Four hundred oral communications and posters and 27 lectures presented at the AENTDE meetings were reviewed by means of a descriptive analysis of the types of studies conducted and a content analysis of priority research themes. RESULTS: The most commonly presented studies were descriptions of the implementation of nursing taxonomies, which accounted for 27.4% of the total over the 16-year period. However, their prevalence fell from 31.8% in 1996 to 9.1% in 2012. Basic research studies accounted for 17.4% of studies overall but were the most frequent in 2012, when their proportion had risen to 37.5%. CONCLUSION: The prevalence of basic research studies increased notably over the 16-year period. Content validity studies rose in number, while face validity studies fell. Studies of the practical implementation of taxonomies also declined. OBJETIVO: Identificar los tipos de estudios de taxonomías enfermeras y los temas de investigación prioritarios presentados en las convenciones de AENTDE desde 1996 a 2012. MÉTODO: Se revisaron 400 comunicaciones y 27 ponencias presentadas a 9 simposiums de AENTDE realizando un análisis del tipo de estudio y un análisis de contenido de los temas. RESULTADOS: Los estudios más frecuentes son las experiencias de implantación de las taxonomías enfermeras con un porcentaje medio de un 27.4% que partiendo de un 31.8% en 1996 disminuyó a un 9,1% en 2012. La investigación básica tienen un porcentaje medio del 17.4% obteniéndose el mayor porcentaje en 2012 con un 37,5%. CONCLUSIÓN: La prevalencia de los estudios de investigación básica se incrementó notablemente durante el período de 16 años. Los estudios de validez de contenido aumentaron en número, mientras que los estudios de validez aparente cayeron. Los estudios sobre la aplicación práctica de las taxonomías también disminuyeron.

Riesgos psicosociales en el profesorado de enseñanza universitaria: diagnóstico y prevención / Psychosocial risks in university education teachers: diagnosis and prevention

El objetivo de este estudio es evaluar los riesgos psicosociales de los docentes universitarios e identificar áreas de mejora para una organización saludable en una muestra de 621 docentes de la Universidad de A Coruña. Para ello se aplicó el cuestionario Copenhagen Psychosocial Questionnaire (CoPsoQ) adaptado a población española (Método ISTAS21). Los resultados mostraron una situación desfavorable para la salud en cinco dimensiones psicosociales: altas exigencias psicológicas, baja estima, doble presencia elevada, bajo apoyo social y inseguridad elevada en el empleo. Por el contrario, se constató una situación favorable en la dimensión trabajo activo y posibilidades de desarrollo. También se comprobó que no existe un único perfil de profesor universitario en riesgo psicosocial. En conclusión, se presenta un diagnóstico de los riesgos psicosociales de los docentes universitarios y a partir de ese panorama de riesgos se avanzan estrategias para su prevención dentro del ámbito docente universitario (AU)

The aim of this study is to assess the psychosocial risks of university teachers and identify enhancement areas for a healthy organization in a sample of 621 teachers from the University of A Coruña, Spain. To achieve this aim, the Copenhagen Psychosocial Questionnaire (CoPsoQ) adapted to the Spanish population (ISTAS21 Method) was applied. The results showed an unfavorable situation for psychosocial health in five dimensions: high psychological demands, low esteem, high double presence, low social support, and high job insecurity. In contrast, a favorable situation for health is the dimension active work and development opportunities. It was also found that there is not a single profile of university teacher in psychosocial risk. To conclude, a diagnosis of psychosocial risks of university teachers is made and, in that scenario, some risk prevention strategies at university level are proposed (AU)

Effectiveness of Nursing Process Use in Primary Care.

PURPOSE: To determine whether patients assigned to primary care nurses who use the nursing process (use of NANDA-I, NIC, and NOC) achieve better intermediate health outcomes than the population assigned to nurses who do not use the nursing process. METHODS: This is a retrospective cross-sectional study conducted in 34 primary healthcare centers of Area 11 of the Community of Madrid (Spain) based on electronic health records. FINDINGS: The extension of health care provided was greater in nurses who used the nursing process. Patients assigned to these nurses have better control of their chronic diseases and incur lower drug costs. CONCLUSIONS: The use of the nursing process can lead to improved health of populations. IMPLICATIONS: The development of strategies is necessary to ensure greater use of the nursing process among nurses in primary care.

Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy.

PURPOSE: The purpose of this paper is to show nursing procedures and standardized languages in care provided by community nurses to a patient affected by urinary incontinence after a prostatectomy. DATA SOURCES: Data were extracted from patient interviews during various consultations with the community nurse, and from electronic health records. The care plan was based on available scientific evidence. DATA SYNTHESIS: Clinical reasoning was used to select NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification. CONCLUSIONS: Urinary incontinence problems have a physical, psychological, and social development impact on people who suffer from this condition.

[Ineffective sexuality pattern in an adolescent: nursing approach in primary health care]. / Patrón sexual ineficaz en un adolescente: abordaje enfermero en atención primaria.

Adolescent is a phase of continual physiological, psychological and social adaptation. It is during this time that young people tend to have their first sexual experiences. Sexual dysfunctions are characterized by important clinical changes in sexual desire and/or by psycho-physiological changes in the sexual response cycle. Premature ejaculation is one of the most frequent sexual dysfunction amongst men, with a higher prevalence in the younger population compared to other populations. The clinical case is presented of a 17 year-old male who experienced difficulties during his sexual relations. It is discussed whether his condition was a sexual dysfunction or ineffective sexual pattern. The care plan which was developed in nursing consultation was described for ineffective sexual pattern; the pending nursing treatment incorporated activities recommended by scientific evidence. Finally, the role of primary health care nursing professionals is pointed out in the detection and approach of sexual problems in adolescents.

Patrón sexual ineficaz en un adolescente: abordaje enfermero en atención primaria / Ineffective sexuality pattern in an adolescent: Nursing approach in primary health care

La adolescencia es una etapa de continua adaptación fisiológica, psicológica y social. Es durante este tiempo cuando los jóvenes suelen tener sus primeras experiencias sexuales. Los trastornos sexuales se caracterizan por alteraciones clínicas importantes del deseo sexual y/o por cambios psicofisiológicos en su ciclo de respuesta. La eyaculación precoz es una de las alteraciones sexuales más frecuentes en hombres, presentando una prevalencia mayor en jóvenes que en otros grupos etarios. Se presenta el caso clínico de un varón de 17 años que manifiesta dificultades durante sus relaciones sexuales. Se discute sobre el diagnóstico diferencial entre las etiquetas diagnósticas disfunción sexual y patrón sexual ineficaz Se describe el plan de cuidados desarrollado en consulta de enfermería ante el problema patrón sexual ineficaz, incorporándose, en el tratamiento enfermero a realizar, las actividades recomendadas por la evidencia científica. Finalmente se señala el papel de los profesionales enfermeros de atención primaria en la detección y abordaje de los problemas sexuales en adolescentes (AU)

Adolescent is a phase of continual physiological, psychological and social adaptation. It is during this time that young people tend to have their first sexual experiences. Sexual dysfunctions are characterized by important clinical changes in sexual desire and/or by psycho-physiological changes in the sexual response cycle. Premature ejaculation is one of the most frequent sexual dysfunction amongst men, with a higher prevalence in the younger population compared to other populations. The clinical case is presented of a 17 year-old male who experienced difficulties during his sexual relations. It is discussed whether his condition was a sexual dysfunction or ineffective sexual pattern. The care plan which was developed in nursing consultation was described for ineffective sexual pattern; the pending nursing treatment incorporated activities recommended by scientific evidence. Finally, the role of primary health care nursing professionals is pointed out in the detection and approach of sexual problems in adolescents (AU)

Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12).

BACKGROUND: The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency. METHODS/DESIGN: The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3-8,and 1 mg/month in weeks 9-52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1-8 and 1 mg/week in weeks 9-52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses. DISCUSSION: The results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment. TRIAL REGISTRATION: This trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial.

BACKGROUND: Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low. METHOD/DESIGN: This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive. TRIAL REGISTRATION: ISRCTN: ISRCTN83365316.

Factores perinatales que influyen en el descenso de hemoglobina materna tras el parto y en el pH neonatal / Perinatal factors influencing the decline in both maternal hemoglobin level after the birth and in the neonatal pH

Objetivo: Conocer cómo influyen ciertos factores perinatales presentes en la mayoría de los partos hospitalarios en el descenso de hemoglobina materna tras el parto y en el pH de cordón umbilical recogido tras el nacimiento. Personas y método: Estudio observacional, descriptivo y retrospectivo, realizado en 2009 en el Hospital do Salnés, hospital comarcal situado en Vilagarcía de Arousa (Pontevedra). Inicialmente se incluyeron en el estudio todas las mujeres (928) que tuvieron un parto eutócico entre marzo de 2004 y diciembre de 2006. Tras la aplicación de los criterios de inclusión y exclusión, se obtuvo una muestra final de 806 casos. Resultados: En el descenso de la hemoglobina materna posparto influyeron el uso de anestesia regional (p= 0,006), la práctica de episiotomía (p= 0,0001) y la paridad (p= 0,0001). En el pH del cordón umbilical influyeron el uso de anestesia regional (p= 0,0001) y la paridad (p= 0,003). Conclusiones: Puesto que la utilización de anestesia regional durante el trabajo de parto influye a la vez en el descenso de hemoglobina materna y en el pH neonatal, la matrona debería proporcionar a la embarazada información basada en la evidencia científica sobre las ventajas e inconvenientes de los distintos métodos de alivio del dolor disponibles, para que pueda tomar una decisión informada al respecto (AU)

Objective: To know how certain perinatal factors present in most of the hospital births influence the decline in maternal postpartum hemoglobin (Hb) and in umbilical cord pH collected after birth. Subjects and methods: An observational, descriptive and retrospective study was conducted during 2009 at Hospital del Salnes, Regional Hospital located in Vilagarcia (Pontevedra, Spain). All women (928) with an eutocic delivery between March 2004 and December 2006 were included in the study. Taking into account the inclusion and exclusion criteria a final sample of 806 cases was obtained. Results: The level of maternal postpartum Hb is influenced by the use of Local Anesthesia (p= 0.006), the practice of episiotomy (p= 0.0001), and parity (p= 0.0001). The umbilical cord pH is influenced by the use of Local Anesthesia (p= 0.0001) and parity (p= 0.003). Conclusions: Since the use of Local Anesthesia during labor influences in the decline of both maternal Hb and neonatal pH, the midwife should provide the pregnant patient with information based on scientific evidence on the advantages and disadvantages of the different methods of pain relief available, so she could take an informed decision (AU)

Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial.

BACKGROUND: The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age. METHOD/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age..Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide's recommendations, clinical variability can be reduced and the care received by patients can be improved. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01474096.

The autoscopic phenomena in neurological clinic: a study of two cases.

Autoscopic phenomena are part of the reduplicative misidentification syndromes. These disorders may be a manifestation of both neurological and psychiatric conditions and consist of a double perception of the own body. These phenomena have been attributed to a dysfunction of the nondominant gyrus angularis. Two cases with this symptom are described. Case 1: A female with previous history of multiple sclerosis presented with episodes in which she saw herself in her extrapersonal space. Holter EEG was normal. An MRI scan showed multiple T2 hyperintensities. She was treated with carbamazepine and the symptom subsided. Case 2: A man presented with visual loss in the left field and episodic visualization of his own image. Examination confirmed left homonymous hemianopia. Serum glucose was 417 mg/dL. MRI was normal. Glycemia correction made the autoscopia disappear. In case 1, ephaptic transmission is proposed as the pathogenic mechanism and in the case 2, transient glucose toxicity is likely to explain the autoscopic phenomena.

Prevalencia de parasitos intestinales en perros de la clinica veterinaria de municipio Ciego de Avila, Cuba

Se efectuó un estudio descriptivo del parasitismo intestinal en perros que acuden a la clínica veterinaria de la capital provincial de Ciego de Avila, Cuba. La investigación abarcó el período de 1991 a 1996 donde se estudiaron 1196 perros mediante las técnicas parasitológicas de tinción directa y flotación de Sheater. El 60 porciento de los perros estaban parasitados detectándose 5 tipos diferentes de parásitos ellos son: Ancylostoma caninum, Toxoscara canis, Trichuris vulpis, Dipilidiun caninun e isospora, las mayoes frecuencias lo presentaron Ancylostona caninum 41 porciento y Toxocara canis 13 porciento. (AU)