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What factors influence patient participation in an artificial intelligence-based initiative to optimise referrals from primary to specialist haematology care? A multicentre retrospective observational study in four Spanish hospitals

Objectives

Increasing demand for haematological specialist care makes the optimisation of referrals and outpatient workflow a priority. Automated placing of standardised test orders prior to the first appointment may provide haematologists with necessary information to reach diagnoses and initiate treatment at the first patient encounter, reducing low-value follow-up appointments. We aimed to evaluate rates of patient participation in an initiative using artificial intelligence to place standardised test orders as well as reasons for non-participation, differences in the number of participants and non-participants discharged back to primary care with a diagnosis or appropriate treatment plan, and potentially avoidable referrals.

Design

A retrospective, multicentric cohort study.

Setting

Four academic hospitals in Madrid, Spain.

Participants

18 190 patients referred for a first haematologist appointment for 11 included presenting complaints.

Intervention

Referral notes from primary care were classified using natural language processing and automated placement of standardised test order sets was carried out prior to first appointment for participating patients.

Outcome measures

We compared demographic differences between participants and non-participants, the main motives for not participating, and the number of patients discharged back to primary care at first appointment with a diagnosis and treatment plan. Most frequent International Classification of Diseases, tenth revision codes for each of the included presenting complaints were described.

Results

During the study period, 18 190 (41%) patients were referred for a first haematologist appointment for presenting complaints included in the intervention (‘eligible patients’), of which 612 (3.3%) patients agreed to participate in the intervention. Participants were significantly younger than non-participants. Most common motives for not participating were administrative reasons (6268, 76.9%). Only 122 (1.5%) patients expressed explicit unwillingness to participate. A significant increase in the number of patients discharged upon first appointment was observed for participants (146 (23.9%) vs 3375 (19.36%); p=0.041), signifying a 22% relative reduction in avoidable follow-up. The diagnosis ‘haematological disorders ruled out’ was constantly observed as one of the ten most common diagnoses made by the haematology specialist for all but one of the included presenting complaints.

Conclusion

Natural language processing of referrals from primary to specialist haematology care with automated placing of standardised test orders can decrease low-value follow-up appointments. Explicit refusal to participate was low. Participants tended to be younger than non-participants, underlining the importance of designing strategies to target the older population in order to improve participation.

Associations between age, gender and health deterioration in caregivers aged 75 and older in Spain: an observational study

Por: Bernal-Alonso · A. · Ayala · A. · Kirvalidze · M. · Calderon-Larranaga · A. · Forjaz · M. J. · Rodriguez-Blazquez · C.
Objective

This study aims to explore how age and gender are associated with health deterioration related to caregiving among caregivers aged 75 and older in Spain.

Design

Observational, descriptive, cross-sectional study.

Setting

Nationwide survey in Spain: 2020 Survey on Disability, Personal Autonomy and Situations of Dependency.

Participants

All non-professional caregivers identified by the survey (3746): 3166 caregivers younger than 75 (CG75–) and 580 caregivers 75 years old or older (CG75+).

Primary outcome measure

Self-reported caregivers’ health deterioration, as a categorical variable (present or absent).

Results

The majority of caregivers in both groups were women (63.2% of CG75– and 57.0% of CG75+, p=0.011). CG75+ provided care 16 hours/day (vs 14.1 hours/day of CG75–, p=0.032). Over half of CG75+ reported health deterioration (53.0%), compared with 43.5% of CG75– (p

Conclusions

In Spain, older caregivers have a specific socio-demographic profile, provide high-intensity care and report a higher caregiving-related health deterioration. However, the association between older age and health deterioration was found only in women. Public health interventions must prioritise older female caregivers.

Test to assess claims about treatment effects for Spanish primary school children: the development process and cross-sectional validation study of the test

Por: Samso Jofra · L. · Dahlgren · A. · Alonso-Coello · P. · Canovas Martinez · E. · Perez-Gaxiola · G. · Roque i Figuls · M. · Rosenbaum · S. · Sanz-Herranz · H. · Valenzuela Rubio · N. G. · Martinez Garcia · L.
Objectives

The aims of this study were (1) to develop and validate the interactive CLAIM Test (iCLAIM Test) to measure children’s ability to assess claims about treatment effects and make informed health choices and (2) to measure this ability in Spanish primary school children using the developed test.

Design

We followed a multistep process including (1) definition of the test scope, (2) selection of the questions, (3) translation process, (4) design and development of the online test, (5) external review with experts, (6) user-test with children and (7) cross-sectional validation study with Rasch analysis.

Setting

Spanish primary schools.

Participants

Twelve experts (75% women) participated in the review, 11 children (45% girls) participated in the user-test and 480 Spanish primary school children (46.5% girls) from fourth to sixth grades (9–12 years old) participated in the cross-sectional validation study.

Results

The iCLAIM Test is an online, interactive and user-friendly test in Spanish that measures children’s ability to understand and apply key concepts of the informed health choices (IHC) Project when assessing claims about treatment effects and making IHCs. The test includes 30 questions: six demographic questions and 24 questions from the Claim Evaluation Tools item bank. Less than 40% of the students who participated in the cross-sectional validation study showed basic knowledge of the IHC Key Concepts and how to apply them, and less than 4% showed a clear knowledge. The test showed a good fit to the Rasch model and was acceptable to the target audience.

Conclusions

The iCLAIM Test is the first instrument validated for measuring children’s ability to assess treatment claims in Spain. In the future, we can tailor IHC education interventions and improve critical thinking skills about the health of Spanish children.

Qualitative study of information needs in advanced ovarian cancer: communication among patients, caregivers and healthcare providers regarding the disease, pharmacological treatment and non-pharmacological support

Objectives

Qualitative evidence in ovarian cancer (OC) doctor-patient-caregiver communication is scarce. This study explored the information needs of patients and caregivers, comparing these to healthcare professionals’ (HCPs) perspectives, to uncover why gaps exist.

Design

Qualitative, observational, multicentre and cross-sectional study with OC patients, their caregivers and HCPs. Qualitative data were collected through remote semistructured interviews. Themes were identified using thematic analysis. The EORTC QLQ-C30 and the disease-specific EORTC QLQ-OV28 were collected as quality of life measures and analysed descriptively.

Setting

Patients were recruited during their routine visits in five university hospitals in Spain.

Participants

Patients were ≥18 years of age in stages III or IV according to FIGO classification, were on first line treatment or recurrent and platinum sensitive with the most complex molecular profiles. 19 patients, 7 caregivers and 10 HCPs participated in the study.

Results

Three main themes emerged: (a) patient information needs about the disease and pharmacological treatments, (b) patient information needs about non-pharmacological support and (c) caregiver information needs. The first theme was viewed through three differing attitudes (the Involved, Trusting and Indecisive), with HCPs’ agreeing with the attitudes but without adjusting transmitted information accordingly. For the second theme, patients expressly desired more information on psychosexual issues, psychological support and patient associations (PAs), and HCPs concurred with a need for more non-pharmacological support. Regarding the third theme, caregivers expressed not being engaged by HCPs, despite HCPs recognising their importance, with nurses being more empathetic than oncologists on this matter.

Conclusions

These results highlight the importance of understanding the information needs of OC patients and their caregivers. This understanding enables HCPs to provide better support, helping patients and caregivers make more informed health decisions.

Exploring the Roles and Regulatory Challenges of Advanced Practice Nurses in Acute Pain Management: A Scoping Review

ABSTRACT

Aim

To explore the roles and training of advanced practice nurses specialised in acute pain management, as reported in the current literature.

Design

Scoping review.

Data Sources

We searched PubMed, Scopus and CINAHL in December 2023 to identify relevant studies published from 1996.

Methods

Relevant literature was identified, screened, and analysed using a structured scoping review process. Two reviewers independently selected and extracted data from eligible studies, with a third reviewer resolving any disagreements.

Results

A total of 1682 records were screened, and 36 studies met the inclusion criteria. Four main themes emerged: job titles, roles, training, and barriers. The review revealed substantial variation in job titles and role descriptions across clinical settings and geographic regions, with more comprehensive role definitions found in countries like the United States and the United Kingdom. Training pathways, including postgraduate qualifications and certification, varied significantly and many low- and middle-income countries lacked structured training frameworks. Barriers identified included regulatory limitations, insufficient educational infrastructure and lack of legal authority to practice.

Conclusion

This review highlights significant international variation in the definition, training and regulation of advanced practice nurses in acute pain management. There is an urgent need to develop global standards, including unified competencies and certification pathways, to ensure consistent and effective care.

Implications for the Profession

Standardising competencies and training will support role recognition, improve consistency in clinical practice and promote high-quality care for individuals experiencing acute pain.

Impact

This review addresses the global inconsistency in role definition and training of advanced practice nurses in acute pain management. Findings may inform educators, health professionals, policymakers and regulators, particularly in resource-limited settings.

Reporting Method

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Patient or Public Contribution

No patient or public contribution.

Determinants of treatment decisions in advanced dementia: a protocol for a cross-cultural mixed-methods study

Por: Lima · J. P. · Mbuagbaw · L. · Prasad · M. · Kumar · A. · Wafeu · G. S. · Bonnet · R. · Agoritsas · T. · Li · S. · Liu · Z. · Alonso-Coello · P. · Akio Nishijuka · F. · Mirza · R. · Matos Silva · C. · Alshanketi · R. · Alsahafi · I. · Alnuaimi · A. · Heen · A. F. · Schwartz · L. · Guyatt
Introduction

Values and preferences are key determinants of optimal care, and variability in patient values and preferences often dictates differences in patient management. Clinicians’ views of patients’ values and preferences may differ across cultural aspects and stage of training, but the extent to which this is the case remains uncertain. One key value and preference issue is the trade-off between quantity and quality of life, and this issue is particularly prominent among patients with dementia. We therefore propose to investigate the extent to which physicians’ perceptions of optimal management for patients living with advanced dementia may differ due to cross-cultural factors and stage of medical training.

Methods and analysis

We will conduct a sequential explanatory mixed-methods study (QUAN -> qual). First, we will administer paper-based or electronic surveys during educational sessions, conferences and rounds to medical students, residents and physicians in ten countries, either in person or online. Following that, a qualitative inquiry, guided by the findings of the quantitative study and the principles of the interpretive description design, will inform an in-depth exploration of the predictive factors identified in the quantitative data analysis.

Ethics and dissemination

The Hamilton Integrated Research Ethics Board at McMaster University has approved this study (approval number 2024-17651). We will disseminate our findings in peer-reviewed publications and present results at conferences as oral and poster presentations.

Study protocol for developing the evaluation instrument of guideline adherence to GRADE approach (GRADE-Check)

Por: Jin · Y. · Yan · S. · Yao · X. · Dahm · P. · Alonso-Coello · P. · Brignardello-Petersen · R. · Keitz · S. · Rylance · J. · Cheung · M. · Agoritsas · T. · Kunkle · R. · Murad · M. H. · Guyatt · G.
Introduction

Many clinical practice guidelines (CPGs) claim to use Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, but its implementation varies. This suggests that CPG developers, methodologists and users would benefit from an instrument to evaluate the extent to which CPGs adhere to GRADE approach. Such a structured instrument is currently unavailable. Accordingly, this study will develop an evaluation instrument for assessing guideline adherence to the GRADE approach, which we have named ‘GRADE-Check’. The goal is to target items to which CPGs fail to adhere and that potentially have serious consequences resulting in inaccuracies in certainty of evidence and inappropriate direction or strength of recommendations, thereby discriminating across CPGs in issues of importance.

Methods and analysis

The panel will include up to 25 individuals with specific knowledge and expertise, including experienced authors, educators and methodologists on CPGs methodology and GRADE approach from relevant organisations. The instrument will focus on the key elements of GRADE, aiming for clarity for GRADE experts and non-GRADE experts to apply. The development process for GRADE-Check will consist of the following five phases: (1) recruitment of a panel of GRADE experts; (2) development of objectives and scope for the development of GRADE-Check and criteria for item selection; (3) generation of candidate items through a literature review and panel consultation; (4) panellist discussion to construct the initial draft and extended explanation manual and (5) user testing.

Ethics and dissemination

This study has been approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University (no. (2025047K)). Our research findings will be published in peer-reviewed journal articles and presented at academic conferences. Additionally, the dissemination plan will include considerations for the development of implementation manuals, a dedicated project website and training tools.

Sex-specific sleep profiles in Spanish adults: cross-sectional actigraphy-PSQI study with cluster analysis in Salamanca and Avila

Objective

To identify sex-specific patterns based on determinants related to sleep quality, using a representative sample of the Spanish adult population.

Design

Cross-sectional, age-stratified and sex-stratified study.

Setting

Community-based assessments in two Spanish provinces (Salamanca and Ávila).

Participants

Adults aged 25–65 years (n=500), equally distributed by sex and five age strata, selected from the regional health-card database.

Primary and secondary outcome measures

Objective sleep metrics from wrist actigraphy (time in bed, total sleep time (TST), sleep efficiency, wake after sleep onset, number/duration of awakenings, fragmentation/movement indices) and self-reported sleep quality (Pittsburgh Sleep Quality Index).

Methods

Standardised baseline assessments collected sociodemographic, clinical, mental-health and lifestyle variables using validated instruments. Actigraphy (ActiGraph GT3X+) recorded triaxial acceleration at 30 Hz over 5 days; data were aggregated in 60 s epochs (ActiLife). Sleep/wake was classified with Cole-Kripke and nocturnal episodes identified with Tudor-Locke before deriving sleep indices. Two-step cluster analysis was applied separately by sex.

Results

Three clusters were identified for each sex, with age and educational level being the most influential factors. In men, the 65-year-old cluster with university education and lower anxious–depressive load showed the highest sleep efficiency (91.8±3.8%) and the lowest TST (351.7±74.8 min). In contrast, the 35-year-old cluster with middle or high school presented the lowest efficiency (88.3±10.0%) and higher TST (368.1±83.8 min). In women, the 55-year-old cluster with middle or high school and low emotional load showed the highest efficiency (93.6±2.8%), despite a reduced TST (352.0±79.7 min), while the 35-year-old cluster, with middle or high school and high levels of anxiety and depression, showed the worst efficiency metrics (89.5±3.9%) and a higher TST (394.8±67.3 min).

Conclusion

Sleep quality in Spanish adults is heterogeneous across sex-specific clusters shaped by age, education and mental-health burden. Cluster-based characterisation may support tailored public-health interventions.

Trial registration number

NCT05324267.

Effectiveness of a home-based physical exercise intervention in patients with fragility fractures on functional independence and hospital readmissions: a protocol for a randomised controlled trial

Por: Segura-Ruiz · R. · Ruiz-Canete · M. · Munoz-Alonso · A. · Rivas-Cruces · C. · Serrano-Lazaro · P. · Armenteros-Ortiz · P. J. · Hidalgo-Lopezosa · P. · Lamberti · N. · Manfredini · F. · Lopez-Soto · P. J.
Introduction

Patients with fragility fractures are two times as likely to suffer future fractures as their peers who have not suffered a fracture. In addition, 40% of those who suffer fragility fractures do not recover their level of functioning in terms of activities of daily living after 1 year. The present study aims to verify the hypothesis that a semipersonalised home-based exercise intervention may improve patients’ independence and reduce the number of hospital admissions compared with usual care for a population that suffers fragility fractures.

Methods and analysis

This parallel-arm single-blinded randomised-controlled trial will take place at the University of Cordoba (Spain) between September 2022 and September 2024. Patients aged >50 years old who have undergone surgery for a fragility hip fracture and who were prefracture independent (Barthel index (BI)>60) will be invited to participate. Patients will be excluded if they present a different type of fracture, mild or greater cognitive impairment or contraindication to exercise training. Patients will then be randomised into exercise or usual care group. The former will receive a daily walking appointment (number of steps to be completed inside home, interspersed with sit-to-stand movements) with the total volume increasing weekly. The latter will receive the usual care. The outcomes, collected at baseline, at the end of training (3 months) and at follow-up (6 months) by blinded operators will include the BI and number of readmissions (primary outcomes) and quality of life, exercise capacity, strength, cognitive status, bone mineral density and laboratory biomarkers (secondary outcomes). Variables related to quality of life, cognitive status, laboratory markers and densitometry will also be analysed.

Ethics and dissemination

The research ethics committee of the province of Cordoba approved the project (number 326; date 28 July 2021). Patients who meet the eligibility criteria will receive a patient information document and the consent form and will be encouraged to ask any questions. The proposed research respects the fundamental principles of the Declaration of Helsinki, the Council of Europe Declaration on Human Rights and Biomedicine, the UNESCO Universal Declaration on the Human Genome and Human Rights, and the Oviedo Council on Human Rights and Biomedicine. The data obtained in this study will be confidential. They will be treated by the Organic Law 3/2018, of 5 December, on the Protection of Personal Data and Guarantee of Digital Rights, keeping it strictly confidential and not accessible to unauthorised third parties, and the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on Data Protection (RGPD). Written informed consent will be obtained from all the participants. The study’s results will be published in peer-reviewed journals and presented at scientific congresses worldwide. The results will also be disseminated through patient advocacy group newsletters and social media platforms. Patient partners will help select the appropriate channels and develop plain-language summaries tailored to their communities’ needs.

Trial registration number

ClinicalTrials.gov ID: NCT04934358 (registration date: 14 June 2021).

Changes in prescription patterns of antidiabetic medication in patients newly diagnosed with type 2 diabetes in Spain: an observational study

Por: Cea-Soriano · L. · Moreno · A. · Calonge · M. · Rivas · A. · Pulido-Manzanero · J. · Colchero · M. C. · Artola · S. · Serrano · R. · Franch-Nadal · J. · Regidor · E. · the PRECOZIN Study Group · Adan · Almanzar · Alonso · Alonso · Alonso · Alvarez · Alvarez · Amoros · Araujo · Arbide
Objective

To estimate the frequency of antidiabetic prescriptions in type 2 diabetes mellitus (T2DM) in Spain and describe changes in prescription patterns between 2018–2022 and 2023-2024.

Design

Observational study.

Participants

Patients from primary care centres newly diagnosed with T2DM in 2018–2022 and 2023–2024.

Primary and secondary outcomes

In each period, the prescription frequency of an antidiabetic medication at the diagnosis of T2DM was calculated and subsequently subdivided into monotherapy and combination therapy. The prescription frequency of the most common antidiabetic drugs was also calculated. Calculations were made for the entire group of subjects and stratified by sex and age (under 60 years and 60 years or older). Comparison of the frequencies between the two periods was performed using the chi-square test.

Results

In 2018–2022 and 2023–2024, 78.4% and 88.9% of patients, respectively, were prescribed an antidiabetic medication. The prescription frequencies for monotherapy and combination therapy were 66.1% and 33.9% in the first period and 57.4% and 42.6% in the second. The prescription frequencies for metformin as monotherapy and combination therapy were 57.4% and 27.8% in the first period and 46.6% and 39.8% in the second. Prescribing metformin with sodium-glucose cotransporter-2 inhibitors (SGLT2i) and/or glucagon-like peptide receptor 1 agonists (GLP1a) was the most frequent combination therapy: 12.8% in 2018–2022 and 29.5% in 2023–2024. With a few exceptions, the prescribing pattern was similar by sex and age. The difference between the prescribing distributions in the two periods is significant.

Conclusion

Antidiabetic medication prescribing at the diagnosis of T2DM was high. Most prescriptions contained metformin. Monotherapy decreased in 2023–2024 compared with 2018–2022, while combination therapy increased due to increased prescriptions of metformin with SGLT2i and/or GLP1a.

Association of nociceptive, neurocognitive, psychological and genetic profile on conditioned pain modulation in women with migraine: protocol for a case-control study

Introduction

Migraine is a primary headache showing a multifactorial component that includes altered pain processing, psychological/emotional problems, neurocognitive and executive function deficits, all with a possible genetic association. The aim of the current study will be to evaluate the association between sensitisation, psychological/emotional, neurocognitive and genetic profile on conditioned pain modulation (CPM) in women with migraine from a multidisciplinary perspective.

Methods and analysis

A cross-sectional observational case–control study including 90 women with chronic migraine, 90 women with episodic migraine and 90 women without migraine (as controls) will be conducted. Clinical variables (disability, pain), processing (sensitisation-associated, neuropathic-like symptoms), psychological/emotional (anxiety, depression, sleep quality, catastrophising), neurocognitive (attention), executive functions (memory, mental inhibition, speed processing) and genetics (Val158Met polymorphism rs4680 gene) will be assessed in all subjects by healthcare professionals. Subsequently, CPM will be evaluated with the cold-pressor test paradigm by assessing changes obtained in mechanical and thermal stimuli. The association of each group of variables on CPM will be analysed with multivariate analyses (OMNIBUS analysis of variance). A network model will also be created to identify those variables showing the greatest key measure of centrality with the rest of the severity indicators (strength, intermediation and closeness) to establish the potentially therapeutic targets in patients with migraine from a multidisciplinary point of view.

Ethics and dissemination

The protocol of the current study has been approved by the Ethics Committee of all involved institutions (Hospital Universitario Fundación Alcorcón 24–117, Universidad Rey Juan Carlos 010220240912024). All procedures will be conducted following the Declaration of Helsinki. Participants will be informed of the aims and procedures of the study and will receive the informed written consent which should be signed before their inclusion. Study results will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Parental grief following infant death in the NICU: a longitudinal mixed-methods exploration of parental experiences and influencing factors

Por: Alonso-Prieto · E. · Chung · R. · Allison · K. · Nightbird · M. · Kieran · E. · Albersheim · S.
Objectives

To characterise neonatal intensive care unit (NICU) parents’ grieving process across time and to identify their perspectives on the healthcare providers’ actions that acted as facilitators or barriers to the grieving process in the short (3–9 months) and longer term (18–24 months).

Design

Longitudinal mixed-methods study combining standardised grief and care satisfaction scales with qualitative data collected through semistructured interviews. The qualitative component was guided by an interpretive description approach, which is well-suited for generating clinically relevant insights into complex human experiences such as parental grief. Triangulating quantitative and qualitative data enhanced insight into how parental grief and perceptions of care evolved between 3–9 months and 18–24 months post loss.

Setting

Tertiary-level NICU hospital in British Columbia, Canada.

Participants

13 parents participated in the study, including 10 mothers and three fathers. Among them were two couples who participated as individuals. Their median age was 35 years (IQR: 32–38).

Primary and secondary outcome measures

Quantitative data obtained through the application of the Perinatal Grief Scale (PGS) and care satisfaction scale and qualitative data collected through semistructured interviews. Data were collected at two points (3–9 months and 18–24 months post loss) to track parents’ grief over time.

Results

The PGS scores indicated active grieving without complicated grief, while the Care Satisfaction Scale reflected high overall satisfaction with care. Thematic analysis identified two primary grieving stages: the initial traumatic event during NICU hospitalisation and the complex adjustment to life post loss. Key factors influencing parents’ coping mechanisms included respecting the infant’s dignity, enhancing communication and decision-making, preserving the bond between parents and the NICU team, nurturing enduring connections with the infant and aiding in finding meaning from the experience.

Conclusion

The study outlined the stages parents experience during and after infant loss, offering practical steps for NICU professionals to aid families in their healing process.

Desafíos en la formación de la Enfermera Gestora de Recursos Materiales

La formación de la enfermera gestora de recursos materiales (EGRM) se enfrenta a una carencia de especialización reconocida y de programas académicos oficiales que fundamenten su rol crucial en la optimización de recursos y consiguiente mejora de la calidad asistencial. Como se anticipó en el 16º congreso de ANECORM, en esta editorial se reflexiona sobre la actual situación de su formación y de su cuerpo de conocimientos, así como sobre estrategias para su impulso.

Autotrascendencia y su efecto en el bienestar físico, psicológico y social en adultos mayores

Objetivos: Conocer el efecto de la autotrascendencia sobre el bienestar, por lo cual se planteó la hipótesis que indica que a mayor autotrascendencia (intrapersonal, interpersonal y transpersonal [espiritualidad]) mayor bienestar (físico, psicológico y social) en los adultos mayores. Metodología: estudio descriptivo correlacional. La población fueron adultos mayores de ambos sexos. El muestreo fue probabilístico aleatorio estratificado, la muestra total fueron 251 adultos mayores. Resultados: El efecto de la autotrascendencia y la espiritualidad fue significativo (F(1,249) = 4.24, p=.015) sobre el bienestar físico (consumo de alcohol sensato) explicando el 25% de la varianza total. Respecto al efecto de estas mismas variables sobre el bienestar psicológico se puede observar que el modelo fue significativo (F(1,249) = 51.52,p=.001) explicando el 28.8% de la varianza total. Por último se identificó que el efecto de la autotrascendencia y la espiritualidad sobre el bienestar social fue significativo (F(1,249) = 31.00, p=.001), este modelo explicó el 20.0% de la varianza total. Conclusiones: La autotrascendencia (intra e interpersonal y transpersonal [espiritualidad]) tiene efecto sobre el bienestar físico (consumo de alcohol sensato), bienestar psicológico y social. Debido a los resultados se considera que la enfermería debe de abordar estas problemáticas de estudio bajo marcos teóricos que promuevan el desarrollo integrar en el adulto mayor y facilitar el bienestar de la persona en todas las etapas de la vida.

ABSTRACT

Objectives: To know the effect of self-transcendence on well-being, for which the hypothesis was raised that indicates that the greater the self-transcendence (intrapersonal, interpersonal and transpersonal [spirituality]), the greater the well-being (physical, psychological and social) in elderly. Methodology: predictive descriptive study. The population was older adults of both sexes. The sampling was stratified random probabilistic, the total sample was 251 older adults. Results: The effect of self-transcendence and spirituality was significant (F(1,249) = 4.24, p=.015) on physical well-being (sensible alcohol consumption) explaining 25% of the total variance. Regarding the effect of these same variables on psychological well-being, it can be seen that the model was significant (F(1,249) = 51.52, p=.001) explaining 28.8% of the total variance. Finally, it was identified that the effect of self-transcendence and spirituality on social well-being was significant (F(1,249) = 31.00, p=.001), this model explained 20.0% of the total variance. Conclusions: Self-transcendence (intra- and interpersonal and transpersonal [spirituality]) has an effect on physical well-being (sensible alcohol consumption), psychological and social well-being. Therefore, it is considered that nursing should address these study problems under theoretical frameworks that promote the comprehensive development of the elderly and facilitate the well-being of the person at all stages of life.

Patrones y representaciones sociales del consumo de alcohol en jóvenes universitarios

Introducción. El consumo de alcohol es un fenómeno complejo y multifactorial que puede surgir a partir de múltiples características del individuo y el entorno, así como de creencias e ideologías sobre esta conducta. Objetivo. Identificar los patrones del consumo de alcohol y explorar las representaciones sociales del consumo de alcohol que construyen los jóvenes universitarios. Metodología. Se realizó un estudio descriptivo con enfoque cualitativo. En la recolección cuantitativa se obtuvieron 59 participantes, a quienes se aplicó una cédula de datos personales y consumo de alcohol y el cuestionario AUDIT, en la recolección cualitativa se realizaron siete entrevistas semiestructuradas en línea. Resultados. En los 59 participantes, se identificó que el 93.2% consumió alcohol alguna vez en la vida, el 83.1% en el último año, el 55.9% en el último mes y el 28.8% en los últimos siete días. El 36.7% presentó consumo de bajo riesgo, el 34.7% dependiente o de riesgo y el 28.6% perjudicial. A partir de las siete entrevistas surgieron siete categorías: conducta previa relacionada, percepción de beneficios del consumo de alcohol, percepción de barreras para el consumo de alcohol, autoeficacia de resistencia al consumo de alcohol, afectos positivos relacionados al consumo de alcohol, influencias interpersonales e influencia situacional de las redes sociales. Discusión. Los resultados evidencian el papel que pueden tener las creencias, percepciones e ideologías sobre la conducta del consumo de alcohol en los jóvenes universitarios; hallazgos que se convierten en un importante aporte para el desarrollo de futuros estudios y de estrategias de prevención enfocada a jóvenes universitarios.

ABSTRACT

Introduction. Alcohol consumption is a complex phenomenon to study that can arise from multiple characteristics of the individual and the environment, as well as beliefs and ideologies about this behavior. Objective: Identify patterns of alcohol consumption and explore the social representations of alcohol consumption constructed by university students. Methodology. A descriptive study was carried out with a qualitative approach. In the quantitative collection, 59 participants were obtained, to whom a personal data and alcohol consumption card and the AUDIT questionnaire were applied; In the qualitative collection, seven semi-structured online interviews were conducted. Results. Of the 59 participants, it was identified that 93.2% consumed alcohol at some point in their lives, 83.1% in the last year, 55.9% in the last month and 28.8% in the last seven days. 36.7% presented low-risk consumption, 34.7% dependent or risky, and 28.6% harmful. Seven categories emerged from the seven interviews: previous related behavior, perception of benefits from alcohol consumption, perception of barriers to alcohol consumption, self-efficacy of resistance to alcohol consumption, positive affects related to alcohol consumption, interpersonal influences and situational influence of social relations. networks. Discussion. The results show the important role that beliefs, perceptions and ideologies can have on alcohol consumption behavior in university students; findings that become an important contribution to the development of future prevention strategies focused university students.

Vivencias de personas con disforia de género sobre la transición y reasignación de sexo

Objetivo principal: Conocer las vivencias ante intervenciones para la transición de género y reasignación sexual. Metodología: Revisión panorámica de artículos publicados en Cinahl, Cuiden, PubMed, BDEnf y Elsevier en los últimos 10 años. Resultados principales: Existe un amplio rango de edad y abanico de profesiones entre las personas que se someten a cirugía de reasignación de sexo. El apoyo de la familia y amistades es indispensable para asegurar una transición social y mejorar el padecimiento de la disforia. Al comenzar el trata-miento hormonal, el sufrimiento disminuye y, prácticamente, desaparece al realizar una cirugía de reasignación genital, a pesar de que no todas optan por dicha cirugía. Conclusión principal: Las personas transgénero presentan una visibilidad creciente que la asemeja a la población general y el proceso de transición y/o reasignación es vivido como una superación de la disforia de género, lo que les permite disfrutar una vida lo más normal y parecida al resto de personas cisgénero.

Creencias sobre la Educación Afectivo Sexual en los estudiantes de Ciclos Formativos sanitarios y sociosanitarios

Objetivo principal: Evaluar las competencias en Educación Afectivo-Sexual de los estudiantes de Formación Profesional. Metodología: Estudio observacional descriptivo que comparó las actitudes hacia la sexualidad entre 68 alumnos de ciclos sanitarios con 38 de ciclos sociosanitarios. Los instrumentos de evaluación fueron la Double Standard Scale, el Inventario de Actitudes Negativas hacia la Masturbación y la Escala de Actitudes hacia la Sexualidad. Resultados principales: La prueba de Mann-Whitney demostró significativamente que las mujeres tenían actitudes más positivas hacia la sexualidad (U=424.50, z=-2.00, p=.045) y una menor adherencia a los roles de género (U=350.00, z=-3.02, p=.003) que los varones. Sin embargo, no se encontraron diferencias significativas por ciclo formativo. Conclusión principal: La educación impartida en los ciclos formativos a diferencia del sexo parece no tener impacto en las actitudes hacia la sexualidad del alumnado, mostrando la necesidad de mejorar su formación para abordarla.

Comorbilidad entre duelo complicado, sintomatología ansiosa y depresiva en dolientes de primer grado

Objetivo principal: valorar la presencia de duelo complicado (DC), la sintomatología ansiosa y depresiva, en dolientes de primer grado. Meto-dología: fueron evaluados 26 dolientes (84,60% mujeres), de 19 a 73 años (M=44,04; DT= 14,21), mediante: el Inventario de Duelo Complicado y la Escala Hospitalaria de Ansiedad y Depresión. Se realizaron análisis descriptivos, pruebas t, d de Cohen y correlaciones de Pearson. Resultados principales: un gran porcentaje (85,70%) mostraron DC, así como problemas clínicos de ansiedad (59,10%) y depresión (45,50%). El DC y la sintomatología emocional, fue mayor en hombres y cuando la pérdida era repentina. La presencia de DC se asoció con mayor ansiedad, depresión y malestar emocional general. Conclusión principal: es necesario conocer los factores de riesgo para desarrollar programas de intervención que incidan en ellos y favorezcan la salud física y mental de los dolientes.

Commentary: Creating a Definition for Global Midwifery Centers

Midwifery centers were developed by communities to increase women's access to acceptable facility-based care during childbirth (Cole, 2017). Midwifery centers are health care facilities that provide birth and sexual and reproductive health care using the midwifery model of care. They provide safe, satisfying, women-centered care, and reduce interventions (Stapleton et al. 2013) (Hermus et al. 2017). While the services offered, and their integration within the health system can vary greatly (Kirkham, 2003), midwifery centers offer a strong alternative for respectful, facility-based birth, in a woman's community.

Vivencias del duelo en niños y estrategias de abordaje

La pérdida de un ser querido es una de las situaciones más difíciles que deberá afrontar todo ser humano en algún momento de sus vidas. Cuando se produce el fallecimiento de un progenitor o un hermano en la etapa infantil, ocasiona una afectación mayor, debido a la pérdida de su rutina diaria y a una falta de información y entendimiento de las actuaciones que se llevan a cabo relacionadas con el luto y la despedida al ser querido. Metodología: Se lleva a cabo una revisión panorámica a través de una búsqueda sistemática de artículos originales en las principales bases de datos de ciencias de la salud: Cuiden, Scielo, Dialnet, Scopus, BVS, Psicodoc, Pubmed y CINAHL. Idiomas: español e inglés. Años 2008-2019. Resultados principales: Se localizan 12 artículos. Las respuestas de los niños ante el duelo más comunes son: el temor, la culpa y el absentismo escolar recurrente. Es de suma importancia el papel de los familiares más cercanos, personal sanitario y profesores en la superación del duelo, destacando como intervenciones principales: la comunicación de lo ocu-rrido al menor y la intervención grupal con niños en su misma situación. Conclusión principal: Las respuestas del niño ante la muerte de un familiar, variará según la edad. Entre las vivencias más comunes se encuentran la desprotección o la ansiedad. Además, se obtienen como resultado que el apoyo emocional por parte de los profesionales sanitarios y las familias es fundamental. La intervención más valorada es el counselling.

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