Valoración de movimientos generales como herramienta pronóstica de parálisis cerebral infantil en prematuros: revisión sistemática / General movement assessment as a tool for determining the prognosis in infantile cerebral palsy in preterm infants: a systematic review

INTRODUCCIÓN: La parálisis cerebral infantil se considera la principal causa de discapacidad física en la infancia. La valoración de los movimientos generales es una herramienta de evaluación con el fin de pronosticar la afectación neurológica y el desenlace a largo plazo del recién nacido. OBJETIVO: Analizar la evidencia científica sobre la valoración de los movimientos generales en recién nacidos prematuros como medida pronóstica de parálisis cerebral infantil. SUJETOS Y MÉTODOS: Revisión sistemática siguiendo la normativa PRISMA. Se consultaron las bases de datos PubMed/Medline, Lilacs, IBECS, Cochrane, PEDro, Cinhal, Sport Discuss, Phyinfo, Academic Search Complete, Web of Science y SciELO. Se incluyeron estudios donde se valoraban movimientos generales en las primeras 20 semanas de recién nacidos prematuros y se excluyeron aquellos donde la muestra presentaba otras patologías o administraba medicación. Se utilizó la Newcastle-Ottawa Scale para valorar el riesgo de sesgo. RESULTADOS: Se seleccionaron 10 estudios de cohortes para esta revisión y se analizaron un total de 2.243 prematuros, con una media de 30,9 semanas de gestación. Se llevó a cabo la grabación de movimientos generales entre 5 y 30 minutos. Cuando se observan movimientos generales anormales, aumentan las posibilidades de afectación neurológica durante el desarrollo, mientras que cuando se valoran movimientos generales normales, raramente habrá un posterior diagnóstico de parálisis cerebral. CONCLUSIONES: Se confirma la validez predictiva de la valoración de los movimientos generales en prematuros para pronosticar parálisis cerebral de forma precoz. Como los recién nacidos prematuros tienen mayor posibilidad de desencadenar movimientos generales anormales, es interesante promover este tipo de valoración

INTRODUCTION: Cerebral palsy is considered to be the main cause of physical disability in childhood. General movements are an assessment tool in order to predict the neurological and long-term outcome of the newborn. AIM: To analyze the current evidence on the general movements assessment in preterm infants as cerebral palsy prognostic tool. SUBJECTS AND METHODS: Systematic review following PRISMA statements. Databases consulted were: PubMed/Medline, Lilacs, IBECS, Cochrane, PEDro, Cinhal, Sport Discuss, Phyinfo, Academic Search Complete, Web of Science, and SciELO. We included studies that evaluated general movements in the first 20 weeks premature newborns. We excluded studies where the sample submit other pathologies or medication was administered. Newcastle-Ottawa Scale was used to assessment the risk of bias. RESULTS: Ten cohort studies form this review. 2243 premature, with an average of 30.9 weeks of gestation, were analyzed. General movements recording was carried out between 5 and 30 minutes. When there are abnormal general movements, the chances of neurological involvement increase during development, whereas when normal general movements are evaluated, there will rarely be a subsequent cerebral palsy diagnosis. CONCLUSIONS: The predictive validity of the preterm general movements assessment is confirmed as a tool to predict cerebral palsy early. Since preterm infants are more likely to trigger abnormal general movements, it is interesting to promote this type of assessment

Roma Women's Perspectives on End-of-Life Decisions.

Spain's Roma community has its own cultural and moral values. These values influence the way in which end-of-life decision-making is confronted. The objective of this study was to explore the perspective of Roma women on end-of-life decision-making. It was a qualitative study involving thirty-three Roma women belonging to groups for training and social development in two municipalities. We brought together five focus groups between February and December 2012. Six mediators each recruited five to six participants. We considered age and care role to be the variables that can have the most influence on opinion regarding end-of-life decision-making. We considered the discussion saturated when the ideas expressed were repeated. Data analysis was carried out according to five steps: describing, organizing, connecting, corroborating/legitimating, and representing the account. The main ideas gleaned from the data were as follows: (1) the important role of the family in end-of-life care, especially the role of women; (2) the large influence of community opinion over personal or family decisions, typical of closed societies; (3) the different preferences women had for themselves compared to that for others regarding desired end-of-life care; (4) unawareness or rejection of advance directives. Roma women wish for their healthcare preferences to be taken into account, but "not in writing." The study concluded that the success of end-of-life healthcare in Roma families and of their involvement in the making of healthcare decisions depends upon considering and respecting their idiosyncrasy.

Content of Public Health Ethics Postgraduate Courses in the United States.

UNLABELLED: This paper evaluates the content of the syllabi of postgraduate courses on public health ethics (PHE) within accredited schools and programs of public health (PH) in the United States in order to gain an awareness of the topics addressed within these courses. METHODS: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health for 2012. The "Epidemiology and PHE Syllabi" project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. RESULTS: Data was obtained from 25 schools (52%) and 36 accredited programs (42%); 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. CONCLUSIONS: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi.

Efectividad de un plan de apoyo a cuidadores en dos hospitales públicos de Granada (España) / Effectiveness of a Plan to Support Caregivers at Two Public Hospitals in Granada (Spain) / Efetividade de um plano de apoio a cuidadores em dois hospitais públicos de Granada (Espanha)

Objetivo: dos hospitales granadinos realizan una experiencia pionera implementando medidas de apoyo innovadoras para personas cuidadoras. Transcurridos dos años desde su implantación se plantea: ¿Las medidas implementadas han logrado los beneficios esperados en personas cuidadoras en hospitalización? Para responder se realiza un estudio con el objetivo de evaluar la efectividad de las medidas de apoyo a personas cuidadoras incluyendo propuestas de mejora. Materiales y métodos: estudio cualitativo, interpretativo, basado en la Teoría Fundamentada. Se realizaron 45 entrevistas en profundidad a personas cuidadoras con distintos perfiles, en los hospitales Virgen de las Nieves y Baza. Se ha seguido como estrategia de análisis la comparación constante y la codificación abierta y axial. Se contó con el apoyo del software Atlas.ti®. Resultados: las personas cuidadoras valoran positivamente la mayoría de las medidas, destacando personalización, educación, hostelería y accesos prioritarios. La identificación de enfermera y auxiliar referentes no siempre ha funcionado bien. La utilización de zonas de descanso habilitadas ha sido escasa, debido principalmente a su ubicación. Conclusiones: las medidas implementadas han mejorado el bienestar y la autoestima de las personas cuidadoras durante la hospitalización. Aportan una evidencia que anima a extenderlas a otros hospitales y mejorar el trato y el apoyo a este colectivo.

Purpose: Two hospitals in Granada are involved in a pioneering experience to implement innovative measures to support caregivers. Two years after the onset of that initiative, the question is: Are the measures implemented achieving the expected benefits for caregivers during hospitalization? A study was conducted to answer that question by evaluating the effectiveness of those measures, including suggestions for improvement. Study Materials and Methods: This is a qualitative, interpretive study based on grounded theory. Forty-five (45) in-depth interviews were conducted at the Virgen de las Nieves and Baza hospitals with caregivers who have different profiles. The strategy for analysis involved constant comparison and open and axial coding, supported by Atlas.ti® software. Results: The caregivers reacted positively to most of the measures, highlighting personalization, education, accommodation and priority access. Use of the term nurse and auxiliary nurse as a form of identification has not always worked well. Only limited use has been made of the areas outfitted for rest and relaxation, mainly due to their location. Conclusions: The measures implemented have improved the well-being and self-esteem of caregivers during hospitalization. Moreover, they provide evidence that encourages their extension to other hospitals to improve the way this group is treated and the support it receives.

Objetivo: dois hospitais granadinos realizam uma experiência pioneira implementando medidas de apoio inovadoras para pessoas cuidadoras. Transcorridos dois anos de sua implantação, propõe-se: as medidas implantadas têm atingido os benefícios esperados em pessoas cuidadoras em hospitalização? Para responder a essa pergunta, realiza-se um estudo com o objetivo de avaliar a efetividade das medidas de apoio a pessoas cuidadoras em que são incluídas propostas de melhoria. Materiais e métodos: estudo qualitativo, interpretativo, baseado na Teoria Fundamentada. Realizaram-se 45 entrevistas em profundidade a pessoas cuidadoras com diferentes perfis, nos hospitais Virgen de las Nieves e Baza. Como estratégia de análise, foi seguida a comparação constante e a codificação aberta e axial. Contou-se com o apoio do software Atlas.ti®. Resultados: as pessoas cuidadoras valorizam positivamente a maioria das medidas e destacam: personalização, educação, hotelaria e acessos prioritários. A identificação de enfermeira e auxiliar referentes nem sempre tem funcionado bem. A utilização de áreas de descanso habilitadas é escassa, devido, principalmente, a sua localização. Conclusões: as medidas implantadas têm melhorado o bem-estar e a autoestima das pessoas cuidadoras durante a hospitalização. Além disso, estimulam sua extensão a outros hospitais e melhoram o tratamento e o apoio a esse coletivo.