Fecal carriage of extended-spectrum beta-lactamase-producing Enterobacterales in healthy Spanish schoolchildren.

Background: Extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) are a serious threat among emerging antibiotic resistant bacteria. Particularly, the number of cases of ESBL-E infections reported in children has been increasing in recent years, and approved antibiotic treatments for this age group are limited. However, information regarding the prevalence of colonization in European children, risk factors associated with colonization, and the characteristics of the colonizing strains is scarce. The aims of this study were to determine the prevalence of ESBL-E colonization in fecal samples of apparently healthy schoolchildren, to identify lifestyle routines associated with colonization, and to characterize clonal relationships and mechanisms of resistance in ESBL-E isolates. Methods: A cohort of 887 healthy children (3-13 years old) from seven primary and secondary schools in the Madrid metropolitan area was recruited between April-June 2018, and sociodemographic information and daily habits were collected. Fecal samples were screened for ESBL-E carriage in selective medium. ESBL-E isolates were further characterized by assessing molecular epidemiology (PFGE and MLST), ESBL gene carriage, and antibiotic resistance profile. This information was analyzed in conjunction with the metadata of the participants in order to identify external factors associated with ESBL-E carriage. Results: Twenty four ESBL-E, all but one Escherichia coli, were detected in 23 children (prevalence: 2.6%; 95% CI: 1.6-3.6%). Of these, seven contained the blaCTX-M-14 allele, five the blaCTX-M-15, five the blaSHV-12, three the blaCTX-M-27, three the blaCTX-M-32, and one the blaCTX-M-9. Significant clonal diversity was observed among the isolates that grouped into 22 distinct clusters (at <85% similarity of PFGE profile). ESBL-producing E. coli isolates belonged to 12 different STs, with ST10 (25%) and ST131 (17%) being the most frequent. Apart from ß-lactams, resistance to trimethoprim/sulfamethoxazole (46%), ciprofloxacin (33%), levofloxacin (33%), tobramycin (21%), and gentamicin (8%) were the most frequently detected. Conclusion: The prevalence of ESBL-E in the studied cohort of children was lower than the average colonization rate previously detected in Europe for both children and adults. E. coli was the main ESBL-producing species detected and CTX-M were the most frequently identified ESBLs. High ST diversity suggests polyclonal dissemination. Compared to other STs, ST131 isolates were associated with resistance to various antimicrobials.

Prevalence, detection and characterisation of fosfomycin-resistant Escherichia coli strains carrying fosA genes in Community of Madrid, Spain.

OBJECTIVES: The aim of this this study was to describe the presence of different variants of the fosA gene in fosfomycin-resistant Escherichia coli strains in Madrid, Spain. METHODS: fos genes were searched for in 55 E. coli strains collected from seven representative hospitals located in Madrid. A phenotypic screening test was performed following the disk diffusion method with sodium phosphonoformate added as described by Nakamura et al. Additionally, a molecular study based on PCR was used to confirm the screening results. Positive strains for fos genes were further subjected to whole-genome sequencing (WGS). RESULTS: Phenotypic screening was positive in 9/55 strains (16.4%), although genotypic detection was positive in only 3 (fosA3, fosA4 and fosA6). Thus, the prevalence of fos genes in Madrid was 5.5% (3/55). WGS data were not available for the fosA6-positive strain. One isolate with fosA3 (ST69) carried a blaCTX-M-55 gene and seven virulence genes (air, eilA, iha, iss, lpfA, sat and senB). The fosA4-positive isolate (ST4038) carried the virulence genes iss, lpfA, iroN and mchF. Both fos genes were located between two IS26 mobile elements of a plasmid. CONCLUSION: We detected the presence of different variants of plasmid-mediated fosA genes in fosfomycin-resistant E. coli strains in Madrid, Spain. Despite the few reports in Europe, it would be of interest to monitor the spread of these acquired resistance genes.

Palliative care and quality of life in patients with cancer during the terminal phase. A family/patient perspective.

OBJECTIVE: To explore the meaning of palliative care as perceived by the family caregiver and the patient with advanced cancer. METHOD: Information was collected through in-depth interviews and field diaries to conduct this qualitative research study, with an interpretative phenomenological approach. We adopted Heidegger's perspective for the development of hermeneutic interpretation, and therefore followed the stages of intentionality, reduction, and constitution. We used Bardin's constructs of pre-analysis, coding, categorisation, and interpretation for the discourse analysis. RESULTS: Seventeen patient-family caregiver dyads were considered. The perceptions of palliative nursing care focused on transpersonal relationships and the discourses referred to a lack of closeness between nursing staff and the patient. This was mainly expressed as a lack of emotional understanding and unmet needs. Themes were drawn from these findings based on developing a transpersonal relationship as a priority, including meeting needs and providing the empathic accompaniment that is fundamental for emotional well-being. CONCLUSION: From the perspective of the dyads, palliative care covers intangible aspects of care. This requires nursing staff to work collaboratively with colleagues, with other health professionals and interprofessionally, including the institutions involved in care. Further work is required to implement these actions.

Carbapenemase-producing Pseudomonas aeruginosa in Spain: interregional dissemination of the high-risk clones ST175 and ST244 carrying blaVIM-2, blaVIM-1, blaIMP-8, blaVIM-20 and blaKPC-2.

Carbapenemase-producing (CP) Pseudomonas aeruginosa is rare compared with mutation-driven carbapenem-resistance, but this situation may be changing. A collection of CP P. aeruginosa isolates was characterized in this study. In 2016, 232 unduplicated carbapenem-resistant P. aeruginosa isolates, of which 71 (30.6%) carried carbapenemase genes, were submitted to the Spanish antibiotic reference laboratory and were further analysed by whole-genome sequencing (WGS). Of the 71 CP P. aeruginosa, 39 (54.9%) carried blaVIM-2, 14 (19.7%) blaVIM-1, 8 (11.3%) blaIMP-8, 6 (8.5%) blaVIM-20, 2 (2.8%) blaVIM-2 plus blaKPC-2, one (1.4%) blaIMP-13 and one (1.4%) blaVIM-1 plus blaIMP-18. Four sequence types (ST175, ST244, ST815 and ST155) encompassed 83.1% of the 71 CP P. aeruginosa; ST175 was detected in hospitals from seven provinces. Using core genome multilocus sequence typing (cgMLST), four clusters were detected: Cluster 1 included nine ST815/VIM-2 isolates; Cluster 2 included five ST175/VIM-2 isolates; Cluster 3 included seven ST244 isolates (five VIM-2 and two VIM-2 plus KPC-2); and Cluster 4 included 11 ST175 isolates (seven VIM-2 and four IMP-8). The average number of acquired resistance genes was significantly higher in the blaVIM-1-carying isolates (7.1 ± 0.94) than in the blaVIM-2-carrying isolates (4.5 ± 0.20). CP P. aeruginosa isolates are spreading in Spain, mainly due to the dissemination of high-risk clones such as ST175 and ST244 producing VIM and IMP carbapenemases. Emergence of CP P. aeruginosa is a cause of clinical and epidemiological concern.

Validation of a low-dose contrast 64-slice cardiac computed tomography angiography protocol for aortic valve annulus sizing.

Cardiac computed tomography angiography (CCTA) is the gold standard for accurately sizing the aortic valve annulus prior to aortic valve replacement. A reduction of contrast volume administered for CCTA, without sacrificing image quality, is desirable. Signal-to-noise ratio represents final CCTA image quality. Consecutive patients referred to CCTA for aortic valve annulus sizing were retrospectively analyzed. Patients were grouped into a low-dose contrast (LDCT) group and traditional dose contrast (TDCT) group. In the LDCT group, contrast dose was <50% of the maximal allowable dose (3.7 × estimated glomerular filtration rate). Guided by a time-density curve, the contrast was administered in a two-stage infusion, and retrospectively gated images were acquired with a 64-multidetector computed tomography scanner. Out of 123 patients (age 80 ± 9 years; 46% female), 65 (52.9%) underwent LDCT and 58 (47.2%) underwent TDCT. Contrast volume was significantly lower in the LDCT group (LDCT 41.2 ± 9.8 vs TDCT 76.2 ± 14.2 mL; P < 0.001). The signal-to-noise ratio of the aortic root was 10.4 ± 4.1 for the LDCT group and 8.4 ± 3.3 for the TDCT group (P = 0.004). Aortic root dimensions could be measured in both LDCT and TDCT groups. In conclusion, LDCT with 64-slice CCTA can effectively size the aortic valve annulus to direct aortic valve replacement while offering reduced contrast exposure.

La vivencia de los pacientes con cáncer y el cuidado de enfermería / The experience of cancer patients and nursing care / A experiência de pacientes com câncer e os cuidados de enfermagem

Introducción: En la actualidad, un gran número de personas conviven con cáncer en cualquier etapa de la enfermedad, con todas las repercusiones físicas, emocionales y socio-culturales que esta patología implica. Este estudio explora las experiencias de los pacientes con diagnóstico de cáncer, y la vivencia de los cuidados de enfermería, de tal manera que permita comprender la integralidad del proceso de la enfermedad. Materiales y Métodos: Meta-estudio cualitativo de tipo de análisis principalmente de meta-datos y meta-síntesis, con 12 artículos seleccionados previa revisión exhaustiva de criterios de rigor metodológico en credibilidad, auditabilidad y transferibilidad. Las bases de datos empleadas fueron ISI Web of Knowledge, Pudmed y Scielo. Resultados: Vivir con cáncer significa 1) Capacidad de adaptación, 2) Redescubrir emociones, 3) Ser consecuencia del tratamiento, y 4) Disociar mente y cuerpo. Discusión: La vivencia del cáncer es un fenómeno social y humano complejo, que desafía el derecho individual de salud de las personas en el ámbito sanitario, marcada por la alta mortalidad e incapacidad asociada y establecida por determinantes sociales de la salud. Conclusiones: La vivencia del paciente con cáncer, sin duda es una compleja dinámica que siempre se verá beneficiada con la exploración cualitativa de su existencia, donde los análisis de los hallazgos proporcionados en su conjunto contribuyen sin duda a transcender y comprender mejor el fenómeno del cáncer. Con ello presentando desafíos importantes para la enfermería en materia de perfeccionar sus competencias para entregar un cuidado humano, comprensivo y particular.

Introduction: A large number of people now live with cancer at any stage of the disease, in addition to all physical, emotional and socio-cultural effects that this pathology involves. This study explores the experiences of both patients diagnosed with cancer and nursing care to allow the understanding of the completeness of the disease process. Materials and Methods: A qualitative meta-analysis using mainly meta-data and meta-synthesis was conducted on 12 articles selected prior to a comprehensive review of criteria for methodological rigor in credibility, auditability, and transferability. The databases used were ISI Web of Knowledge, PubMed, and SciELO. Results: Living with cancer implies 1) Developing adaptive capacity; 2) Rediscovering emotions; 3) Experience treatment effects; 4) Dissociating mind and body. Discussion: The experience of cancer is a complex social and human phenomenon, which defies the individual right to health of people in the healthcare field, marked by high mortality and disability that have been associated and established by social determinants of health. Conclusions: The experience of cancer patients is undoubtedly a complex dynamic that will always benefit from the qualitative exploration of its existence, in which the analysis of the findings provided as a whole undoubtedly contribute to transcend and better understand the phenomenon of cancer. This represents important challenges for nurses in respect of perfecting their competencies to deliver humane, comprehensive and specific care.

Introdução: Atualmente, um grande número de pessoas convive com câncer em qualquer estágio da doença, com todas as repercussões físicas, emocionais e socioculturais que essa patologia implica. Este estudo explora as experiências dos pacientes diagnosticados com câncer e a experiência do cuidado de enfermagem, de forma que nos permita entender a integralidade do processo da doença. Materiais e Métodos: Meta-estudo qualitativo do tipo de análise, principalmente meta-dados e meta-síntese, com 12 artigos selecionados após uma revisão exaustiva dos critérios de rigor metodológico em credibilidade, auditabilidade e transferibilidade. As bases de dados utilizadas foram ISI Web of Knowledge, PubMed e SciELO. Resultados: Viver com câncer significa 1) Adaptabilidade, 2) Redescobrir emoções, 3) Ser uma consequência do tratamento e 4) Dissociar a mente e o corpo. Discussão: A experiência do câncer é um fenômeno social e humano complexo, que desafia o direito individual à saúde das pessoas no campo da saúde, marcado pela alta mortalidade e incapacidade associada estabelecidas pelos determinantes sociais da saúde. Conclusões: A experiência do paciente com câncer é, sem dúvida, uma dinâmica complexa que sempre se beneficiará da exploração qualitativa de sua existência, onde a análise dos achados fornecidos como um todo certamente contribui para transcender e entender melhor o fenômeno do câncer. Com isso, apresenta desafios importantes para a enfermagem em termos de melhoria de suas competências para prestar um cuidado humano, abrangente e particular.

[The White Paper of the health professions of Catalonia]. / Le livre Blanc des Professions de Santé de Catalogne.

The White Paper of the Health Professions of Catalonia (WPHPC) is a strategic document for the development of the health professions. It deals with the main components of the manpower development (education, management and planning) in relation to the health services development required to attain the objectives defined in the Catalan Health Plan. The WPHPC fosters the coherence between social needs and professional competencies required to respond to them, as well as to the quantitative aspects of service needs under adequate standards of quality, effectiveness and efficiency. The WPHPC has followed a methodological process with maximum stakeholder participation and transparency. Citizens, professionals and health organizations have contributed significantly. The conclusions and recommendations of the WPHPC are organized around four axis: the citizenship, the professionals, the health care organizations and the health care model. Key elements are: the requirement of a new social contract between the different stakeholders, the values of professionalism, the need for a new credentialism of professional competencies, innovation in the education process, innovation of governance and management for organization of knowledge, the redistribution of work inside teams requires deregulation and reregulation of the professions, the need for actualized data on workforce and job positions and the permanent requirement of sociological research.

Intervention of Humanized Nursing Accompaniment and Quality of Life in People with Advanced Cancer / Intervención de acompañamiento humanizado de enfermería y calidad de vida en personas con cáncer avanzado / Intervenção de acompanhamento humanizado de enfermagem e calidad de vida em pessoas con cáncer avançado

ABSTRACT Objective: To assess the effect of an intervention of humanized nursing accompaniment, at home, on the quality of life of people with advanced cancer and of their family caregivers. Method: Pre-experimental study with pre- and post-intervention measurements. The intervention included home visits, internet platform, and telephone contact for three months. The sample was comprised of 17 patient-caregiver dyads. The data analysis was descriptive and correlational. Results: The study obtained a large magnitude of the effect of the intervention, in the global health of the person with cancer, with highly significant differences between the pre- and post-intervention, besides the decrease of symptoms, like fatigue and dyspnea. In the caregivers, there was moderate magnitude of the effect of the intervention on quality of life, in the settings of social relationships and environment, with highly significant differences between the pre- and post-intervention. Conclusion: A humanized nursing care intervention, which reinforces and reaffirms the social, affective, spiritual, and communication areas in the patient-family caregiver dyad, increases the quality of life of people with advanced cancer and that of their caregivers.

RESUMEN Objetivo: evaluar el efecto de una intervención de acompañamiento humanizado de enfermería en domicilio, en la calidad de vida de las personas con cáncer avanzado y su cuidador familiar. Método: estudio pre-experimental con medición pre y post intervención. La intervención incluyó visitas domiciliarias, plataforma de internet y contacto telefónico por tres meses. La muestra fue de diecisiete diadas paciente-cuidador. El análisis de los datos fue descriptivo y correlacional. Resultados: se obtuvo una magnitud grande del efecto de la intervención en la salud global de la persona con cáncer, con diferencias altamente significativas entre la pre y la post intervención, además de la diminución de síntomas como la fatiga y la disnea. En los cuidadores, hubo una magnitud moderada del efecto de la intervención en la calidad de vida, en los ámbitos de relaciones sociales y ambiente, con diferencias altamente significativas entre la pre y la post intervención. Conclusión: una intervención de cuidado humanizado de enfermería, que refuerza y reafirma las áreas sociales, afectivas, espirituales y comunicacionales en la diada paciente-cuidador familiar, aumenta la calidad de vida de las personas con cáncer avanzado y la de sus cuidadores.

RESUMO Objetivo: avaliar o efeito de uma intervenção de acompanhamento humanizado de enfermagem em domicílio, na qualidade de vida das pessoas com câncer avançado e cuidador familiar. Metodo: Estudo pré-experimental com medição pré e pós intervenção. A entrevista inclui visitas domiciliares, plataforma de internet e telefone por 3 meses. La muestra fue de 17 diadas paciente-cuidador. A análise dos dados foi descritiva e correlacional. Resultados: Uma grande magnitude do efeito da Intervenção Global de Saúde da pessoa com câncer foi obtida, com diferenças altamente significativas entre o pré e o pós-intervenção, além da diminuição de sintomas como fadiga e dispneia. Nos cuidadores, houve moderada magnitude do efeito da Intervenção na Qualidade de Vida, nas áreas de Relações Sociais e Meio Ambiente, com diferenças altamente significativas entre o pré e pós-intervenção. Conclusão: uma Intervenção Humanizada de Cuidados de Enfermagem, que reforça e reafirma as áreas social, afetiva, espiritual e de comunicação na família cuidador-paciente, aumenta a qualidade de vida das pessoas com câncer avançado e de seus cuidadores.

Effect of lipopolysaccharide on inflammation and insulin action in human muscle.

Accumulating evidence from animal studies suggest that chronic elevation of circulating intestinal-generated lipopolysaccharide (LPS) (i.e., metabolic endotoxemia) could play a role in the pathogenesis of insulin resistance. However, the effect of LPS in human muscle is unclear. Moreover, it is unknown whether blockade/down regulation of toll-like receptor (TLR)4 can prevent the effect of LPS on insulin action and glucose metabolism in human muscle cells. In the present study we compared plasma LPS concentration in insulin resistant [obese non-diabetic and obese type 2 diabetic (T2DM)] subjects versus lean individuals. In addition, we employed a primary human skeletal muscle cell culture system to investigate the effect of LPS on glucose metabolism and whether these effects are mediated via TLR4. Obese non-diabetic and T2DM subjects had significantly elevated plasma LPS and LPS binding protein (LBP) concentrations. Plasma LPS (r = -0.46, P = 0.005) and LBP (r = -0.49, P = 0.005) concentrations negatively correlated with muscle insulin sensitivity (M). In human myotubes, LPS increased JNK phosphorylation and MCP-1 and IL-6 gene expression. This inflammatory response led to reduced insulin-stimulated IRS-1, Akt and AS160 phosphorylation and impaired glucose transport. Both pharmacologic blockade of TLR4 with TAK-242, and TLR4 gene silencing, suppressed the inflammatory response and insulin resistance caused by LPS in human muscle cells. Taken together, these findings suggest that elevations in plasma LPS concentration found in obese and T2DM subjects could play a role in the pathogenesis of insulin resistance and that antagonists of TLR4 may improve insulin action in these individuals.

Una mirada a la calidad de vida y salud de las educadoras de párvulos / A look to the life and health quality of kindergarten teachers

INTRODUCCIÓN: La medición de la calidad de vida desde la perspectiva de la salud y su relación en el ámbito laboral de las Educadoras de Párvulos como agentes fundamentales en el desarrollo cognitivo y socioemocional en la primera infancia es de relevancia, pues existen aspectos claves para conseguir una buena calidad pedagógica en concordancia con los anhelos de las nuevas políticas en educación implementadas en Chile. OBJETIVO: determinar con qué factores se asocian la calidad de vida relacionada con la salud de las Educadoras de Párvulos, desde los elementos sociodemográficos y laborales concernientes en sus actividades profesionales. MÉTODO: Diseño metodológico descriptivo, correlacional, de corte transversal en 156 Educadoras de Párvulos de una comuna de Chillán, Chile. Resultados: las Educadoras de Párvulos, que se desempeñan casi en su totalidad en el aula, refieren un rol físico, función física y rol emocional óptimo, con una regular vitalidad y función social, una buena salud mental y mal dolor corporal, con relaciones altamente significativas en la función física con el ausentismo y dependencia laboral, y significativa con el número de niños a cargo y años laborales. También altamente relacionados en forma significativa el dolor corporal y los días de ausentismo, significativamente la vitalidad y el número de niños a cargo, y el rol emocional con los días de ausentismo laboral, entre otros. DISCUSIÓN: Estos antecedentes podrían ser determinantes en la orientación de las prácticas educativas y ponen en manifiesto que las nuevas disposiciones y políticas gubernamentales no aseguran condiciones que propicien una buena calidad de vida docente.

INTRODUCTION: the measurement of life quality from a health perspective and its relationship on the labor field of Kindergarten Teachers as main agents on the cognitive and socio emotional development in early childhood, is relevant, since there are key aspects in order to get a good pedagogical quality according to the desires of the new educational politics implemented in Chile. OBJECTIVE: to determinate which factors are associated to the quality of life related to the health of Kindergarten Teachers, from sociodemographic and labor elements concerning their professional activities. Method: descrip tive methodological design, correlational, cross sectional in 156 Kindergarten Teachers from a commune in Chillán, Chile. RESULTS: the Kindergarten Teachers, who mostly perform in the classroom, relate a physical role, physical function and an optimal emotional role, with a regular vitality and social function, a good mental health and body ache, with highly meaningful relations in the physical function with absenteeism and labor dependency. Also, body ache and days of absenteeism are highly related in a meaningful way, as well as vitality and the amount of kids they are in charge of, and the emotional role with the days of labor absenteeism, among others. DISCUSSION: these antecedents may be determinant on the guidance of the teaching practices and show that the new regulations and governmental politics do not ensure conditions that promote good quality in docent life.

Salud Global: Ébola y Enfermería / Global health: nursing and ebola

El artículo reflexiona sobre los grandes desafíos y problemas enmarcados en la diseminación de enfermedades infecciosas que enfrenta la Salud Global, por efectos de esta sociedad móvil y coexistente. Se analiza el brote de la enfermedad por virus de ébola, que demostró lo importante que es el buen funcionamiento y eficacia de los sistemas internacionales, y la disponibilidad de profesionales competentes, como la mejor garantía de seguridad contra epidemias. Analizando los mayores retos de la Enfermería establecidos por el alto contacto y relación con el cuidado de los pacientes, en la toma de decisiones clínicas fundamentales en la recuperación, promoción y prevención de las personas y las comunidades en riesgo, requiriendo una mejor formación y difusión de las contingencias mundiales en materias de salud, salud pública y seguridad clínica

Article that reflects on the major challenges and issues framed in the spread of infectious diseases faced by Global Health, for purposes of this mobile society and coexisting. The disease outbreak of Ebola virus, which demonstrated the importance of the proper operation and effectiveness of the international system, and the availability of competent professionals as the best guarantee of security against epidemics. Analyzed the biggest challenges of Nursing established by the high contact and relationship with the care of patients, in making fundamental clinical decisions in recovery, promotion and prevention of individuals and communities at risk, and requiring better training dissemination of global contingencies in areas of health, public health and clinical safety

TAK-242, a small-molecule inhibitor of Toll-like receptor 4 signalling, unveils similarities and differences in lipopolysaccharide- and lipid-induced inflammation and insulin resistance in muscle cells.

Emerging evidence suggests that TLR (Toll-like receptor) 4 and downstream pathways [MAPKs (mitogen-activated protein kinases) and NF-κB (nuclear factor κB)] play an important role in the pathogenesis of insulin resistance. LPS (lipopolysaccharide) and saturated NEFA (non-esterified fatty acids) activate TLR4, and plasma concentrations of these TLR4 ligands are elevated in obesity and Type 2 diabetes. Our goals were to define the role of TLR4 on the insulin resistance caused by LPS and saturated NEFA, and to dissect the independent contribution of LPS and NEFA to the activation of TLR4-driven pathways by employing TAK-242, a specific inhibitor of TLR4. LPS caused robust activation of the MAPK and NF-κB pathways in L6 myotubes, along with impaired insulin signalling and glucose transport. TAK-242 completely prevented the inflammatory response (MAPK and NF-κB activation) caused by LPS, and, in turn, improved LPS-induced insulin resistance. Similar to LPS, stearate strongly activated MAPKs, although stimulation of the NF-κB axis was modest. As seen with LPS, the inflammatory response caused by stearate was accompanied by impaired insulin action. TAK-242 also blunted stearate-induced inflammation; yet, the protective effect conferred by TAK-242 was partial and observed only on MAPKs. Consequently, the insulin resistance caused by stearate was only partially improved by TAK-242. In summary, TAK-242 provides complete and partial protection against LPS- and NEFA-induced inflammation and insulin resistance, respectively. Thus, LPS-induced insulin resistance depends entirely on TLR4, whereas NEFA works through TLR4-dependent and -independent mechanisms to impair insulin action.

Instrumento para valoración del cuidado humanizado brindado por profesionales de enfermería a personas hospitalizadas / Assessment instrument to humanized care provided by nurses to hospital patients

Objetivo: Diseñar y determinar la validez de contenido y confiabilidad de un instrumento que evalúe la percepción del paciente en relación al cuidado humanizado recibido por el profesional de enfermería. Metodología: Estudio cuantitativo y transversal desarrollado en tres fases: elaboración del instrumento, validez de contenido, y evaluación de validez y confiabilidad. Resultados y discusión: Se creó un instrumento de 36 ítems, con 7 dimensiones fácticas y una consistencia interna adecuada. El principal enfoque del cuidado humanizado es la vivencia personal de la enfermedad y cómo el profesional de enfermería ayuda a entender y vivir este proceso, a través de la expresión de sentimientos. Los procedimientos y entrega de cuidados personalizados, profundizan la relación enfermero-paciente a través del equilibrio entre habilidades y competencias técnicas. Conclusiones: El instrumento permite identificar la percepción de los usuarios respecto al carácter humanizado del cuidado brindado por el profesional de enfermería en pacientes hospitalizados

Objective: To design and determine the content validity and reliability of an instrument to assess the patient's perception regarding the humane care received by the nurse. Methodology: This quantitative and transversal study for the validation of an instrument was conducted through three phases: preparation of the instrument, content validity, and other evidence of validity and reliability. Results and discussion: The instrument was composed of 36 items, 7 factual dimensions, with adequate internal consistency. The results establish that the main focus of humanized care is the personal experience of the disease and how the nurse helps to understand and live this process, through the expression of feelings. The procedures and delivery of personalized care, deepen the nurse - patient relationship through the balance of skills and expertise. Conclusions: The instrument allows to identify the perception of users regarding the humanized nature of care provided by the nurse in hospitalized patients

Cuidado humanizado en pacientes con cáncer avanzado. Una perspectiva desde la diada paciente-familia / Palliative care and quality of life in patients with cancer during the terminal phase. A family/patient perspective

Objetivo: Explorar el significado del cuidado humanizado percibido por el cuidador familiar y la persona con cáncer avanzado. Método: Para realizar este estudio cualitativo, con enfoque fenomenológico interpretativo, se recopiló la información a través de entrevistas en profundidad y diarios de campo. Para el desarrollo de la interpretación hermenéutica se asumió la perspectiva de Heidegger, por lo que se siguieron las etapas de intencionalidad, reducción y constitución. En cuanto al análisis del discurso se utilizaron los constructos de Bardin: preanálisis, codificación, categorización e interpretación. Resultados: Se consideraron 17 diadas (paciente-familiar). Las percepciones del cuidado humanizado de enfermería se centraron en la relación transpersonal y los discursos recopilados refirieron una ausencia de cercanía entre enfermería y el paciente, cuyas principales expresiones eran la falta de comprensión emocional y la insatisfacción de necesidades. De dichos hallazgos se derivaron temas basados en la generación de una relación transpersonal de forma prioritaria, pasando por la satisfacción de las necesidades y el acompañamiento empático fundamental para el bienestar emocional. Conclusión: El cuidado humanizado desde las diadas abordadas contempla aspectos intangibles del cuidado, para lo cual enfermería requiere trabajar de manera colaborativa con sus colegas, con otros profesionales de la salud y también de forma interprofesional, incluyendo a las instituciones involucradas en la atención. Se requiere profundizar en la materialización de estas acciones.

Objective: To explore the meaning of palliative care as perceived by the family caregiver and the patient with advanced cancer. Method: Information was collected through in-depth interviews and field diaries to conduct this qualitative research study, with an interpretative phenomenological approach. We adopted Heidegger's perspective for the development of hermeneutic interpretation, and therefore followed the stages of intentionality, reduction, and constitution. We used Bardin's constructs of pre-analysis, coding, categorisation, and interpretation for the discourse analysis. Results: Seventeen patient-family caregiver dyads were considered. The perceptions of palliative nursing care focused on transpersonal relationships and the discourses referred to a lack of closeness between nursing staff and the patient. This was mainly expressed as a lack of emotional understanding and unmet needs. Themes were drawn from these findings based on developing a transpersonal relationship as a priority, including meeting needs and providing the empathic accompaniment that is fundamental for emotional well-being. Conclusion: From the perspective of the dyads, palliative care covers intangible aspects of care. This requires nursing staff to work collaboratively with colleagues, with other health professionals and interprofessionally, including the institutions involved in care. Further work is required to implement these actions.(AU)

Control emocional, felicidad subjetiva y satisfacción vital relacionados al afrontamiento y adaptación en personas con cáncer avanzado / Emotional control, subjective happiness and personal satisfaction related to coping and adaptation in people with advanced cancer

La teoría del Proceso de Afrontamiento y Adaptación de Roy identifica las estrategias que utiliza la persona para responder a las influencias y cambios ambientales que percibe, de manera de crear una integración humana y ambiental. El objetivo de esta investigación fue conocer la relación entre las variables individuales -control emocional, satisfacción vital y felicidad subjetiva- con el proceso de afrontamiento y adaptación al cáncer, en usuarios con diagnóstico de cáncer avanzado del Policlínico del Dolor y Cuidados Paliativos de Chillán. Material y método: estudio descriptivo, transversal y correlacional en una muestra de 49 sujetos inscritos a julio de 2013 en ese centro. Resultados: el 61,2% de la muestra mostró alta capacidad de afrontamiento y adaptación. Respecto a la dimensión espiritual, el 75,5% de los participantes presentó alto control emocional, específicamente para la tristeza, siendo mediana para la represión, el enojo y la preocupación. Un 96% evidenció mayor felicidad subjetiva y alta satisfacción con la vida, existiendo significancia estadística entre la felicidad subjetiva y entre el conocimiento de la patología con el grado de capacidad general de afrontamiento y adaptación. Por su parte la tristeza, como emoción controlada, reveló asociación significativa con el factor 1 recursivo y centrado del proceso de afrontamiento. Asimismo, presentó una relación significativa la variable sexo y el factor 3 de procesos de alerta. Conclusión: algunas de las características de las variables individuales mostraron relación con el grado de afrontamiento y adaptación al cáncer terminal, tales como la felicidad subjetiva y el control emocional de la tristeza.

Coping Process theory and Roy Adaptation identifies strategies used by the person to respond to environmental influences and perceived changes so creating a human and environmental integration. The objective of this study was to identify the relationship between the individual variables -emotional control, vital satisfaction and subjective happiness- with the coping and adaptation of cancer in users with a diagnosed advanced cancer, which results contribute with the quality and integrated humanized care in Nursing. Method: A descriptive, transverse and correlate study was developed in 49 samples, enrolled until July 2013. Results: It showed that a 61,2% of the samples presented a great capacity of coping and adaptation. According to the spiritual dimension, a high percent of participants presented a high emotional control, specifically in sadness, with a medium control in the repression, anger and concern. A great percent demonstrated a higher subjective happiness and high satisfaction with their lives, existing a statistics significance between subjective happiness and between knowledge of the pathology with the degree of general capacity with the coping and adaptation. On the other hand, the sadness as a controlled emotion, showed a significance association with the factor 1 recursive and centred. As well, it presented a significance relation the sex and the factor 3 from the warning processes. As a conclusion, most participants in this study reflected a high and very high capacity to face the difficulties and problems, in this case, the advanced cancer. In general, the strategies used in the passive and active management adopted a favorable and positive attitude at the moment of taking decisions and solving problems, even in the changes of lifestyle. This shows the relevance in the incorporation of the spiritual dimension aspects of the users in order to get on provision of health quality with proper tools adapted to the social reality. Conclusion: some of the characteristics of individual variables demonstrated relationship with the degree of coping and adaptation of cancer as subjective happiness and emotional control of sadness.

Fuerza laboral que envejece, ¿qué hacer ante esta tendencia? / Ageing workforce: What do to this trend?

OBJETIVO: Conocer las diversas implicancias del envejecimiento en la fuerza laboral activa, sus consecuencias y las posibles estrategias ante esta tendencia desde el punto de vista de la salud y la enfermería del trabajo. MÉTODO: Se realizó una revisión narrativa consultando diversas bases de datos y textos relacionadas con la temática. DESARROLLO: Se exponen diferentes enfoques del envejecimiento de las personas trabajadoras, considerando su desarrollo humano como un fenómeno multidimensional, que involucra una serie de consecuencias que afectan directamente al desempeño laboral actual. De este modo, se analizan los desafíos enmarcados en las necesidades de salud convocadas por los muchos problemas del adulto trabajador envejecido y se proyecta una serie de estrategias ante esta tendencia. CONCLUSIONES: El envejecimiento de la fuerza laboral y los años de vida socialmente productivos se ven influenciados por varios factores, en donde la condición de salud delimita la calidad y prolongación del período de trabajo activo, por lo cual, el rol de enfermería es preponderante en la protección de la salud y la prevención de accidentes y enfermedades profesionales, guiando por medio de su rol promotor a diversas entidades, fomentando la intersectorialidad con involucramiento de la familia, la comunidad, las empresas y entes afines al trabajador, con el objetivo de propiciar lineamientos y oportunidades para un envejecimiento activo y saludable.

OBJECTIVE: To know the various implications of aging on the active labor force, its consequences and possible strategies to this trend from the point of view of health and nursing work. METHOD: Narrative review made by consulting various databases and texts related to the topic. DEVELOPMENT: In the study are exposed different approaches the aging of working people, given its human development as a multidimensional phenomenon that involves a series of consequences that directly affect the actual job performance. Thus, are analyzed the challenges framed in health needs convened by the many problems of the aged adult worker and a number of strategies projected with this trend. CONCLUSIONS: The aging of the workforce and socially productive years of life are influenced by several factors, where the health condition defines the quality and extension of the period of active work, so the nursing role is predominant in the health protection and prevention of occupational accidents and diseases, through its leading role in promoting in various entities, promoting intersectoral involvement with the family, the community, companies and entities related to the worker, with the aim of promoting guidelines and opportunities for an active and healthy aging.

El nivel del síndrome de burnout en el personal de enfermería que labora en el hospital psiquiátrico la salud Tlazolteotl en el estado de México / The level of burnout syndrome in the nursing staff that works in the Tlazolteotl health psychiatric hospital in the state of Mexico / O nível de síndrome de burnout na equipe de enfermagem que atua no hospital psiquiátrico Tlazolteotl no estado do México

Antecedentes: El Síndrome de Burnout se define como una respuesta al estrés laboral crónico, que puede tener repercusiones fisiológicas, conductuales, laborales, familiares, sociales dando lugar al bajo rendimiento laboral demeritando la calidad de atención que el individuo ofrece, ocurre con frecuencia en profesionales de organizaciones de servicios humanos, maestros, policías, trabajadores sociales, médicos y enfermeras, su estudio inicia en 1974, ha cruzado fronteras dado a la problemática mundial por la falta de enfermeras. Objetivo. Analizar el Nivel de Síndrome de Burnout en el personal de enfermería que labora en el Hospital Psiquiátrico La Salud Tlazolteotl en el Estado de México. Metodología. Se llevó a cabo un estudio descriptivo, analítico y transversal, en una población de 76 sujetos, de los cuales 31 pertenecen al sexo masculino y 45 al femenino, en relación con las variables sociodemográficas y laborales, se identificó los principales estresores para desarrollarlo y se elaboró un programa de intervención. El instrumento fue un cuestionario de 47 ítems tipo Likert, con 2 preguntas abiertas. Se realizó un cálculo de riesgo (razón de momios) a través de un análisis de relación logística. Resultados. La frecuencia del Síndrome de Burnout fue un Nivel III en la dimensión Fisiológica, Nivel II en las Dimensiones Psicológicas Conductual y Laboral. En este tenor, las áreas alteradas en la primera son: la fatiga, insuficiencia venosa (várices), exceso de trabajo, dolor físico, agotamiento, infecciones respiratorias frecuentes, gastrointestinal, cefaleas o migrañas, problema de tipo cardiovascular. En la psicológica: estrés, angustia, sentimiento de culpa, depresión, alteración del buen humor, insensibles. En la conductual, rigidez y dureza, conducta agresiva, alteración del apetito, facilidad para llorar, toma de medicamento. Para la laboral: críticas frecuentes, disminución de la capacidad laboral, conflictos, perturbación del ritmo biológico, ausentismo laboral. (p<0.05) Se encontró un porcentaje mayor en personal del turno matutino (p<0.05). Dentro de las variables sociodemográficas y laborales afectadas, se encuentra el sexo p=.612, edad p=.828, el estado civil p=.914, número de hijos p=.423, Turno p=.907, tiempo de recorrido casa-trabajo p=.999, número de empleos p=.135. Discusión. Los resultados requieren realizar un estudio longitudinal, posterior a aplicar el programa de intervención que permita reducir la problemática que vive el personal de salud, con el objetivo de mejorar la calidad de atención.

Background: The syndrome of Burout is defined as a respnse to chronic stress at work, which can impact physiological, behavioral, occupational, familiar, and social, leading to low job performance preclude the quality of care that offers the indiviudal, int usually has been founded in professional human service organizations, teachers, policem, social workers, doctors and nurses. This study began in 1974, and since then, it has been develop through many parts of the world because many countries have been exposed to the lack of nurses. Aim: Analyze how many workers at the Psychiatric Hospital Health Tlazolteotl in State of Mexico have the syndrome of burnout. Methodology: To realize that study we carried out a descriptive, analytical and cross study in a population of 76 subjects, of whom 31 are males and 45 females, in relation to socio-demographic variables and working conditions; identify the main factors that produce stress an also we developed an intervention program. The instrument to reach our goal was a questionnaire of 47 items "Liker type", with 2 open-ended questions. We performed a calculation of risk (odds ratios) through an analysis of relationship logistics. Results. The frequency of the Burnout syndrome was a Level III in the Physiological dimension, Level II in the behavioral, workin, and psychological dimension. In this vein, the areas that are affected in the first are: fatigue, venous insufficiency (varicose veins), overwork, and physical pain; frequent respiratory and gastrointestinal infections, headaches or migraines, and cardiovascular types of problems. In the psychological area: stress, anxiety, guilt, depression, mood disturbance, insensitive. In the behavioral area: rigidity and toughness, aggressive behavior, abnormal appetite, ease too mourn, and the excessive use of medicines. For the workin area: frequent criticism, reduced working capacity, conflict, distubance of the biological rhythm, absenteeism, (p<0,05). We found a higher percentage of staff in morning shift (p<0,05). Among the socio-demographic and labor affected sector arre: the sex is p=,612, p= ,828 age, marital status p=,914, numember of children p=,838, p=type of contract 423, which benefit provided by the intitution that p=,423, p=,625 Turn, P=,000, p=,105 Joined total of patients treated, p=,907, time distance home-work p=,999, number of jobs p=135, Discussion: The results requered that we perform a longitudinal study, after implementing the intervention program to reduce the problems experienced by health staff, with the aim of improving the quality of care.

Antecedentes: Síndrome de Burnout é definida como uma resposta ao estresse laboral crônico, que pode ter fisiológicos, comportamentais, trabalho, família, impactos sociais que levam ao desempenho de trabalho pobre deméritos qualidade dos cuidados que as ofertas individuais, ocorre freqüentemente em profissional de organizações de serviço humano, professores, policiais, assistentes sociais, médicos e enfermeiros, seu estudo começou em 1974, cruzou fronteiras devido ao problema global devido à falta de enfermeiros. Objetivo Analisar o nível de Síndrome de Burnout na equipe de enfermagem que atua no Hospital Psiquiátrico de Saúde Tlazolteotl no Estado do México. Metodologia Foi realizado um estudo descritivo, analítico e transversal em uma população de 76 sujeitos, dos quais 31 pertencem ao sexo masculino e 45 ao feminino, em relação às variáveis ​​sociodemográficas e laborais, os principais estressores para desenvolvê-lo foram identificados e desenvolveu um programa de intervenção. O instrumento foi um questionário de 47 itens do tipo Likert, com duas questões abertas. Um cálculo de risco (odds ratio) foi realizado através de uma análise de relacionamento logístico. Resultados A frequência da Síndrome de Burnout foi um Nível III na dimensão Fisiológica, Nível II nas Dimensões Psicológica e Comportamental. Neste sentido, as áreas afectadas no primeiro são: fadiga, insuficiência venosa (varizes), excesso de trabalho, dor física, fadiga, infecções respiratórias frequentes, gastrointestinal, ou dores de cabeça de enxaqueca, tipo cardiovascular problema. No psicológico: estresse, angústia, culpa, depressão, alteração de bom humor, insensível. No comportamento, rigidez e dureza, comportamento agressivo, alteração do apetite, facilidade de chorar, tomar medicação. Para o trabalho: frequentes críticas, diminuição da capacidade de trabalho, conflitos, perturbação do ritmo biológico, absenteísmo no trabalho. (p <0,05) Um percentual maior foi encontrado no pessoal do turno da manhã (p <0,05). Dentro das variáveis ​​sócio-demográficas e laborais afetadas, encontramos sexo p = 0,612, idade p = 0,828, estado civil p = 0,914, número de filhos p = 0,423, turno p = 0,907, tempo de viagem em casa trabalho p = 0,999, número de empregos p = 0,135. Discussão Os resultados exigem um estudo longitudinal, após a aplicação do programa de intervenção para reduzir os problemas vivenciados pelo pessoal de saúde, com o objetivo de melhorar a qualidade do atendimento.