Type 1 diabetes mellitus prevalence and care in children under 15 years old in Asturias. / Prevalencia y datos asistenciales de la diabetes mellitus tipo 1 en menores de 15 años en Asturias.

INTRODUCTION: Prevalence of type 1 diabetes mellitus (T1DM) is increasing worldwide. Care provided appears to have an influence on the course of disease. The aim of this study was to ascertain the prevalence of T1DM and to collect data on the resources and care used in Asturias. MATERIAL AND METHODS: A descriptive, cross-sectional study including patients born between 2000 and 2014 with diagnosis of T1DM at 31/12/2014. Patients were identified using two independent data sources. Information was collected from medical records. A descriptive data analysis was performed to provide frequency distributions and measures of position and dispersion. RESULTS: 146 patients were identified, with a total prevalence of 1.25/1.000 children. Prevalence rates by age group were 0.21, 1.15, and 2.40 by 1000 in children aged 0-4, 5-9, and 10-14 years respectively. Autoimmune thyroid disorders and celiac disease were found in 8.2% and 6.8% respectively, while 14.4% had a family history of T1DM and 29.4% of T2DM. Ninety-two children were treated by pediatricians and 34 by endocrinologists. All children were receiving multiple dose insulin treatment and none of them used self-monitoring blood glucose systems. Health education was provided to 37.7% of children. CONCLUSIONS: This study reports the first data on T1DM prevalence in children under 15 years old in Asturias and provides care data that show the disparity in care received depending on healthcare area.

The ethics of nursing care for transgender people / A ética do cuidado de enfermagem às pessoas transgênero / La ética de la atención de enfermería a las personas transgénero

ABSTRACT Objectives: to discuss ethical aspects in nursing care for transgender people. Methods: reflective study based on the dilemmas that emerges in nursing care for transgender people. The report was structured around the four bioethical principles. Results: health care for trans people is complex, transversal to many devices and specialties and longitudinal in time, that is why it requires coordinated action. There is an ethical framework in which the nursing care must be observed in the care of this group. Final Considerations: the nurse as a health worker can assume several general lines in the care of transgender patients. So, complementary training should be provided not only to professionals, but also to students of nursing and other health sciences.

RESUMO Objetivos: discutir aspectos éticos na assistência de enfermagem às pessoas transgênero. Métodos: estudo reflexivo a partir dos dilemas que surgem no cuidado de enfermagem às pessoas transgênero. O relato foi estruturado em torno dos quatro princípios bioéticos. Resultados: a atenção à saúde de pessoas trans é complexa, transversal a muitos dispositivos e especialidades e longitudinal no tempo, por isso requer ação coordenada. Existe um referencial ético no qual se enquadram os cuidados de enfermagem que devem ser observados no atendimento a esse grupo. Considerações Finais: o enfermeiro como agente de saúde pode assumir diversas linhas gerais no atendimento a pacientes transgênero. Para tal, deve ser proporcionada formação complementar não só aos profissionais, mas também aos estudantes de enfermagem e outras ciências da saúde.

RESUMEN Objetivos: debatir sobre aspectos éticos en la atención de enfermería a personas transgénero. Métodos: estudio reflexivo fundamentado sobre los dilemas que se plantean en los cuidados de enfermería a personas transgénero. El relato se ha estructurado en torno a los cuatro principios bioéticos. Resultados: la atención sanitaria a las personas trans es compleja, transversal a muchos dispositivos y especialidades y longitudinal en el tiempo por lo que precisa de la actuación coordinada. Existe un marco ético en el que se encuadran los cuidados de enfermería que se precisan en la atención a este colectivo. Consideraciones Finales: la enfermera como agente de salud puede asumir diversas líneas generales en la atención a pacientes transgénero. Para ello, se debe brindar formación adicional no solo a los profesionales, también a los estudiantes de enfermería y de las demás ciencias de la salud.

[Training in community health: challenges, threats and opportunities. SESPAS Report 2018]. / Formación en salud comunitaria: retos, amenazas y oportunidades. Informe SESPAS 2018.

Incorporating community health teaching in the undergraduate nursing and medicine curriculum and postgraduate training programmes contributes to enhance the quality, rigour and sustainability of health-promoting community interventions. In this article, we discuss the failure of Spanish Medical Universities to include family and community medicine and primary health care as integrated and cross-cutting disciplines on the undergraduate curriculum. During specialized medical and nursing training, community health teaching varies widely depending on the qualification, priorities and motivation of the primary health care workers, teaching units and trainees. Growing job instability and current nurse and medical recruitment systems, are hindering learning being put into practice, as well as the development of health-promoting community activities and the strengthening of training networks and facilities. Amid such adversity, there are initiatives that provide quality training on community health and should, accordingly, be fostered and acknowledged.

[Quality perceived by users of minor surgery according to care level and the professionals that carried it out]. / Calidad percibida por usuarios de cirugía menor según nivel asistencial y profesionales que la realizan.

OBJECTIVE: Nowadays minor surgery is performed by di- fferent professionals at primary as well as specialized care. Being a healthcare technology, minor surgery must be assessed in order to achieve an organizational efficiency. User's satisfaction must be one of the quality criteria. That is why an analysis of the quality perceived by users according to where minor surgery takes place and who carries it out is made. METHODS: This study explores, conducting telephone surveys, the satisfaction of a sample of 275 minor surgery patients of two hospitals and three primary healthcare areas of Asturias. The survey is based on the SERVQUAL model adapting the one used by the Spanish Ministry of Health in 1977. A behavior pattern of satisfaction was established in terms of the variables that increase or diminish it. RESULTS: In every item, satisfaction was perceived as good or very good at least in 84% of the survey users and in the majority was over 95%. There was a significant difference in favour of primary care with respect to waiting time (p less than 0,001), explanations received (p=0,002) and security perceived (p=0,015). The more explanatory variables of excellent satisfaction were the sense of security and the staff attention. The kind of professional did not represent a conditioning factor and the level of healthcare only appeared to be so among those who did not feel safe showing to be less satisfied those treated in primary care. CONCLUSIONS: Good quality perceived by users does not seem to be penalized by the fact that minor surgery can be carried out at different healthcare levels or which specialist performs it.

OBJETIVO: La cirugía menor es realizada actualmente por diversos profesionales en atención primaria y especializada. Como tecnología sanitaria debe ser evaluada para conseguir una eficiencia organizacional. La satisfacción del usuario es uno de los criterios de calidad. Por ello se plantea un análisis de la calidad percibida por el usuario según dónde y quién realice cirugía menor. METODOS: Se estudió por encuesta telefónica la satisfacción de una muestra de 275 pacientes de cirugía menor pertenecientes a dos hospitales y tres áreas de atención primaria de Asturias. El cuestionario sigue el modelo SERVQUAL adaptando el utilizado por el Ministerio de Sanidad en 1977. Se establece un modelo de comportamiento de la satisfacción en función de las variables que la incrementan o disminuyen. RESULTADOS: En todos los ítems la satisfacción fue buena o muy buena como mínimo en el 84% de los encuestados y en la mayoría estaba por encima del 95%. Había una diferencia significativa, a favor de atención primaria en tiempo de espera (p menor que 0,001), explicaciones recibidas (p=0,002) y seguridad percibida (p=0,015). Las variables más explicativas de una satisfacción excelente fueron la sensación de seguridad y la atención del personal. El tipo de profesional no apareció como condicionante y el nivel asistencial solo apareció entre los que no se sentían muy seguros, en cuyo caso estaban menos satisfechos los atendidos en atención primaria. CONCLUSIONES: La buena calidad percibida por los usuarios no penaliza el que la cirugía menor sea realizada en ninguno de los niveles asistenciales ni por ninguno de los profesionales que la realizan actualmente.

The training of specialists in Family and Community Health Nursing according to the supervisors of the teaching units. / La formación de especialistas en Enfermería Familiar y Comunitaria según las responsables de las unidades docentes.

OBJECTIVE: To analyze the current situation of the training of specialists in family and community nursing from the perspective of nurses responsible for teaching units. METHODS: Exploratory analysis using nominal group technique of the contributions made by representatives of 19 multidisciplinary teaching units in family and community care from 11 Spanish autonomous communities. They categorized and weighted those contributions. RESULTS: The emerging categories on the strengths and difficulties encountered related to the tutors, the environment where the training took place, the structure of the teaching unit, the organization of the teaching and the official programme of the speciality, the external supports and the theoretical training. CONCLUSIONS: Training in Family and Community Nursing is an opportunity to improve primary health care to train in news and necessary but complex skills. Support is required for training to be effective and the specialty and training should be made known. Tutors are a key part of this process.

[Research competencies in nursing specialties]. / Competencias de investigación en las especialidades de Enfermería.

Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses.

[Difficulties and opportunities for research as perceived by nurses in Asturias (Spain)]. / Dificultades y oportunidades para investigar percibidas por las enfermeras en Asturias.

OBJECTIVE: To identify, through communicative consensus, the difficulties and opportunities for research perceived by nurses in Asturias (Spain). METHOD: The Regional Ministry of Health and the Health Service of Asturias made an open call and 80 nurses from all fields (clinical, teaching, and management) were assigned to 10 groups. Using a nominal group technique, these nurses identified and prioritized the difficulties and opportunities they perceived for research. Through independent pairs, the research group analyzed the content of the contributions made. RESULTS: In order of priority, the difficulties perceived were related to training deficit, lack of resources, lack of available time, little acknowledgement and support, and professional idiosyncrasy and sociology. The opportunities perceived were grouped into training opportunities, material resources -when known to exist-, support from experts, access to information resources, the existence of financial support, and time available when working in primary care. CONCLUSIONS: The nurses identified the difficulties and opportunities that should be taken into account if strategies to stimulate nursing research are to be established. The situation should continue to be analyzed in order to provide possible solutions to the difficulties encountered, especially those related to professional idiosyncrasy and sociology.