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El virus del papiloma humano (VPH). Un problema importante para la salud pública en vías de solución
(Fundación Index, 2007) Martínez Galiano, Juan Miguel
El virus del papiloma humano es el causante de numerosos tipos de cáncer como el cáncer de cuello uterino, cáncer de pene y cáncer orofaríngeo entre otros; este virus también es el causante de lesiones como las verrugas genitales y los papilomas. Actualmente en España, la prevención del cáncer de cuello uterino se hace mediante cribado (prevención secundaria). En el año 2006 dos vacunas, una bivalente y otra tetravalente fueron aprobadas por las autoridades; estas vacunas han demostrado su seguridad y eficacia en los estudios realizados. En nuestro país, aún esta pendiente de aprobar por el Ministerio de Sanidad y Consumo pero no es así en muchos países europeos y EEUU donde ya está implantada. Hay colectivos que son resistentes a que se produzca la vacunación, la información proporcionada por los sanitarios pueden vencer esta resistencia.
Mujeres que reciben asistencia preconcepcional en Granada
(Mayo, 2008) Bru, Cristina; Martinez-Galiano, Juan Miguel; de-Dios-Berlanga, Silvia
Objetivos: Determinar el porcentaje de mujeres que reciben asistencia preconcepcional, la información que tienen de ella, el número de componentes y el profesional que la realiza. Personas y método: Estudio transversal con una muestra de conveniencia de puérperas ingresadas en el Hospital Universitario «San Cecilio» de Granada. Resultados: Se estudiaron 109 mujeres, de las que 41 (37,6%) realizaron algún componente de la consulta preconcepcional. No se observaron diferencias entre las primigestas y multigestas. No habían tenido información previa de la asistencia preconcepcional 101 mujeres (92,66%). Conclusiones: Una tercera parte de las mujeres con deseo de embarazo acude a un profesional sanitario para prepararse para la gestación.
Prevención de las hemorragias posparto con el manejo activo del alumbramiento
(Ediciones Mayo, 2009) Martínez Galiano, Juan Miguel
El alumbramiento puede desarrollarse de forma espontánea o dirigida. El espontáneo puede considerarse como el final lógico de un proceso fisiológico. La reducción de la hemorragia posparto mediante un sistemático manejo activo del alumbramiento podría desempeñar un papel importante en la reducción de la morbimortalidad materna. La evidencia científica indica que el manejo activo se asocia con una reducción de dos veces el riesgo de hemorragia posparto. El efecto protector del manejo activo es válido para la población general
INFLUENCIA DE LA EPISIOTOMIA VERSUS EL DESGARRO PERINEAL SOBRE LA NORMALIZACION DE LAS RELACIONES SEXUALES EN PUERPERAS
(2009-12) Martínez Galiano, ´Juan Miguel
Durante el proceso de embarazo, parto y puerperio la mayoría de las mujeres experimentan una disminución de la frecuencia de las relaciones sexuales, de la libido y del placer que les proporciona estas relaciones. La presencia de la episiotomía hace que la normalización de las relaciones sexuales se retrase. No parece haber relación entre el tipo de parto (vaginal o cesárea) y la función sexual. Determinados factores influyen en la reanudación de las relaciones sexuales. Objetivos: Determinar el tiempo que tardan las mujeres en reiniciar las relaciones sexuales tras el parto vía vaginal, valorar que repercusión tiene la episiotomía y el desgarro sobre la regularización de la actividad sexual de las mujeres, conocer que tipo de relación sexual se mantiene de inicio tras el parto, detectar factores que influyen en la normalización de las relaciones sexuales tras el parto. Metodología: Estudio observacional, analítico, prospectivo en el área sanitaria del Hospital San Juan de la Cruz de Úbeda, mujeres que den a luz en el Hospital San Juan de la Cruz de Úbeda (Jaén) entre los meses de Julio y Diciembre del 2008, se realiza entrevista telefónica a los 60 días del parto. Se utilizará un cuestionario de elaboración propia. Discusión: Las relaciones sexuales de pareja aportan beneficios físicos, psíquicos y sociales, según los diferentes estudios, estas relaciones se ven afectadas por el proceso de embarazo, parto y puerperio, implantando una política de episiotomía selectiva que toda la evidencia científica recomienda se favorece la normalización de dicha actividad sexual. Es posible que nos encontremos con determinados sesgos como pueden ser los de no respuesta, sesgo de clasificación, etc. pero trataremos con herramientas metodológicas que su repercusión sobre los resultados sean mínimos.
Importancia del sistema sanitario en la identificación de casos de violencia de género
(2010) Martínez Galiano, Juan Miguel
La violencia contra las mujeres es un problema de salud pública con graves costos, además de ser también un problema social y de derechos humanos. Se sabe que la violencia contra las mujeres representa la pérdida de hasta una quinta parte de los años de vida saludables en el período reproductivo de las mujeres afectadas. A los profesionales sanitarios no nos resulta fácil detectar víctimas de malos tratos y por supuesto abordar el problema. Desde los servicios sanitarios se puede desempeñar un papel crucial para ayudar a las mujeres que sufren violencia, ya que la mayoría de las mujeres están en contacto con ellos.
Revisitando a Florence Nightingale desde una perspectiva de género
(Fundación Index, 2010) Narvaez Traverso, Alicia; Martinez Galiano, Juan Miguel; Perez Martin, Blanca
En 2010 conmemoramos el centenario de la muerte de Florence Nightingale. En la época en la que vivió, la situación de la mujer era difícil con un ideal de feminidad que imponía su exclusión de la vida pública y laboral, reservada al varón; a pesar de esta situación social Nightingale fue una figura destacada, entre sus méritos destacan la demostración de la importancia que otras ciencias, como la estadística, proporcionaban para controlar, aprender y mejorar la asistencia hospitalaria. Fue pionera en la recogida, almacenamiento y uso de la información para analizar y gestionar la atención al paciente; precursora de una informática sanitaria sostenible y ubicua. Florence modeló una nueva profesión para las mujeres extraída de siglos de ignorancia y superstición.
Influencia de la obesidad en la salud sexual y reproductiva
(ROL, 2011) Fernandez Valero, Maria Jose; Martinez Galiano, Juan Miguel; Herrera Gomez, Antonio
Resumen Introducción. La epidemia mundial del sobrepeso y la obesidad se está convirtiendo, dado su crecimiento, en un importante problema de salud pública en muchas partes del mundo; afecta aproximadamente a la mitad de la población y por lo tanto resulta un problema común entre la franja de edad fértil. Exposición. La obesidad y el sobrepeso son condiciones comunes que tienen consecuencias no sólo en la salud en general, sino también en gran medida sobre la salud reproductiva. Existe una alta prevalencia de mujeres obesas en la población estéril y numerosos estudios han puesto de relieve el vínculo entre la obesidad y la infertilidad. También aumenta los riesgos de atención obstétrica y complicaciones neonatales, disminuye la fecundidad, incluso en mujeres que ovulan, y está asociada a trastornos menstruales y mayor riesgo de abortos espontáneos de repetición. Conclusiones. Cambios en el estilo de vida, la realización de una dieta y un programa de ejercicio, constituyen la primera línea de tratamiento para la obesidad.
Subjective burden and cultural motives for caregiving in informal caregivers of older people
(Wiley, 2011) del-Pino-Casado, Rafael; Frias-Osuna, Antonio; Palomino-Moral, Pedro A.
Purpose: The aims of this study were to investigate variables related to cultural caregiving motives (obligation and reciprocity) and to analyze the relationship between these cultural caregiving motives and subjective burden in informal caregivers of disabled older people. Design and Methods: A secondary analysis of the last cross-sectional Spanish survey of informal caregivers of older people (n= 1,284, probability sample) was performed. Measurements included sociodemographic characteristics of caregivers (gender, age, relationship with care recipient, primary caregiver status, and duration of caregiving), intensity of care (hours per week, type of care, and number of activities of daily living [ADL] assisted), cultural motives for caregiving (obligation and balanced reciprocity), and caregiver subjective burden. Statistical analyses included descriptive (means, percentages, and 95% confidence intervals), bivariate (chi-square test), and multivariate (binary logistic regression) analyses. Findings: Obligation and reciprocity were higher in spouses than in other relatives and in nonrelatives and obligation increased with age as well as providing help with ADL. Balanced reciprocity was high in men. Obligation was not related with subjective burden, whereas balanced reciprocity was positively related. Conclusions: Reciprocity had a protective effect on subjective burden. No cultural differences have been found on this issue. Obligation may be a multidimensional concept that encompasses personal beliefs and social demands. Clinical Relevance: Balanced reciprocity is useful for early prevention and early intervention of subjective burden and must be included in nursing care plans for caregivers. Cultural factors support the comprehension of the caregiving process.
Detección y atención a la violencia de género en el embarazo. Una asignatura pendiente
(Universidad de Murcia, 2011-10) Martínez Galiano, Juan Miguel
Objetivos: Determinar el número de casos de violencia de género (VG) que el personal sanitario encargado del control de embarazo era consciente que se habia atendido. Identificar la existencia o no de recursos de los que dispone este personal para abordar este problema. Conocer la prioridad que este personal asigna a la VG dentro del sistema sanitario. Método: estudio observacional descriptivo, sujetos de estudio: personal sanitario con funciones en el control del embarazo. Se utilizó un cuestionario de elaboración propia. Se realizó un análisis descriptivo de los datos. Resultados: El 93,10% (81) creen que son menos de diez al año las mujeres atendidas El 95,40% (83) afirma que no tiene los recursos necesarios para poder actuar Se otorga una media de 8,14 + 1,45 sobre 10 en el orden de priorización. Conclusión: El
Gender Differences Regarding Informal Caregivers of Older People
(Wiley, 2012) Del-Pino-Casado, Rafael; Frias-Osuna, Antonio; Palomino-Moral, Pedro A.; Martinez-Riera, José Ramón
Purpose: The aim of this study was to examine differences related to gender among informal caregivers serving older disabled individuals. Design and Methods: A secondary analysis of the most recent national cross-sectional survey, which was conducted in Spain on informal caregivers who served older individuals (65 years of age or older), was conducted in 2011 (N= 1,272, probability sample). The relationships between gender and intensity of care (amount and type of care provided), duration of caregiving, subjective burden, and satisfaction with caregiving were analyzed by bivariate and multivariate procedures. Findings: No statistically significant gender differences were found with regard to the intensity of care, duration of caregiving, or satisfaction; however, subjective burden was found to differ between men and women, and this difference was statistically significant (odds ratio = 1.98; p= .012). Conclusions: Because this study was conducted in Spain, a country with strong patriarchal norms with regard to caregiving and familism, whereas gender differences in intensity of care have been reported in countries with low familism, we conclude that cultural diversity can influence the relationship between gender and intensity of care. On the other hand, our study increases the evidence in support of there being gender-based differences in subjective burden among family caregivers serving older people in Western industrial countries. Finally, the results of our study support the hypothesis that sources of satisfaction are more strongly related to the caregiver's personal context and characteristics than to his or her gender. Clinical Relevance: These findings support the following recommendations regarding nursing interventions: (a) nurses should take into account specific cultural patterns in caregiving to improve their understanding concerning the relationships between gender and intensity of care, and (b) gender should be taken into account in interventions that are tailored toward addressing subjective burden.
Correlates of Burden in Primary Caregivers of Older Relatives: A Cross-sectional Study
(Wiley, 2014) Del-Pino-Casado, Rafael; Millan-Cobo, Martín D.; Palomino-Moral, Pedro A.; Frias-Osuna, Antonio
PURPOSE: To analyze the effect of cultural factors on the subjective burden of primary home caregivers of older relatives. DESIGN: Cross-sectional study. Primary home caregivers (N = 208) of older relatives were recruited in Spain using systematic random sampling. METHODS: The data were collected in 2010 through interviews. The measures included sociodemographic characteristics, stressors (the intensity of care provided and the care-recipient's needs; the latter were assessed using the Barthel Index, the Pfeiffer Short Portable Mental Status Questionnaire and the Cummings Neuropsychiatric Inventory), cultural factors (kinship ties, common residence, perceived social support, and cultural motives for caregiving), and caregiver subjective burden (Caregiver Strain Index). The data were analyzed using bivariate procedures and multiple linear regression. FINDINGS: After controlling for caregiver age, caregiver gender, stressors, and duration of caregiving, subjective burden was negatively associated with perceived social support and reciprocity, and in the subgroup of adult children, it was positively associated with common residence. Cultural factors explained 29% of the variance in burden. CONCLUSIONS: Our findings add to the existing evidence regarding the influence of cultural factors in the perception of burden in caregiving situations. CLINICAL RELEVANCE: A risk profile could be proposed for subjective burden in primary family caregivers. Individuals who are at risk are characterized as young, offspring who live with the care recipient, care for a care recipient with behavioral problems, are unsatisfied with the social support received, and have a low balanced reciprocity.
Perception of HIV Prevention Programs Among Ayoreo Sex Workers in Bolivia
(SAGE, 2014-05-20) López Entrambasaguas, Olga Maria; Fernández Sola, Cayetano; Granero Molina, Jose
The Ayoreo population constitutes one of Bolivia’s most vulnerable ethnic groups in terms of HIV/AIDS. Being a woman, indigenous, and a sex worker signifies belonging to a high-risk group. The aim of this study is to explore the Ayoreo sex workers’ and health agents’ perceptions of HIV/AIDS prevention programs in order to identify variables that could influence their success or failure. This study used an ethnographic methodology that included participant observation and semistructured interviews. In the data collection, participant observation and semistructured interviews with sex workers and key informants were conducted. Three themes emerged from the inductive data analysis: health prevention efforts, cultural inadequacy of prevention programs, and the eventuality of interventions. We conclude that nursing can develop culturally-adequate HIV/AIDS prevention interventions and programs as well as promote health within these populations.
Obligation and negative consequences in primary caregivers of dependent older relatives
(2018-09-07) Del-Pino-Casado, Rafael; López-Martínez, Catalina; Serrano-Ortega, Natalia; Del Mar Pastor-Bravo, María; Parra-Anguita, Laura
The purpose of this study was to analyse the multidimensional nature of obligation and the relations between each dimension of obligation and both anxiety and depression. A secondary analysis of data from two cross-sectional studies of primary home caregivers (N = 400; probabilistic sample) of older adult relatives in Spain was conducted. Data regarding obligation (four categories basing on beliefs of obligation and social pressure: low pressure and low beliefs, low pressure and high beliefs, high pressure and low beliefs and high pressure and high beliefs), stressors, anxiety and depression were collected by interview in 2013. The combination of high pressure and low beliefs had the highest levels of anxiety and depression, and the combination of low pressure and high beliefs had the lowest levels of anxiety and depression. When the relation of behavioural problems with anxiety and depression stratified by the previous four categories of obligation was analysed, behavioural problems were associated with anxiety and depression in the subgroups with low beliefs of obligation, whereas this association disappeared in the subgroups with high beliefs of obligation.
The start of caring for an elderly dependent family member: A qualitative metasynthesis
(Springer Nature, 2018-09-25) Moral-Fernández, Lourdes; Frías-Osuna, Antonio; Moreno-Cámara, Sara; Palomino-Moral, Pedro Ángel; Del-Pino-Casado, Rafael
Background: The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers’ lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. Methods: A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. Results: Three categories were developed to explain the process of becoming a caregiver ‘taking on the role’ (life changes, uncertainty and confusion, and acceptance or resistance); ‘beginning to realise’ (new needs, impact, and appraisal); and ‘implementing strategies’ (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). Conclusions: The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.
Student nurses' knowledge and skills of children's environmental health: Instrument development and psychometric analysis using item response theory
(Elsevier, 2018-10) Álvarez-García, Cristina; Álvarez-Nieto, Carmen; Pancorbo, Pedro Luis; Sanz-Martos, Sebastián; López-Medina, Isabel María
Background: Climate change has an important impact on health, particularly in children. Therefore, the inclusion of environmental issues in the undergraduate nursing curriculum is essential. Knowledge and skills in environmental sustainability can be measured through questionnaires. Objectives: The aim of this study was to develop and validate the Children's Environmental Health Knowledge Questionnaire (ChEHK-Q) and the Children's Environmental Health Skills Questionnaire (ChEHS-Q) to measure knowledge and skills, respectively, about children's environmental health in nursing students. Design: This was an observational, cross-sectional study undertaken in four phases: (1) Development of the questionnaire and item wording, (2) content validation by an expert panel, (3) pilot test and (4) psychometric evaluation. Settings: A Faculty of Health Sciences in Spain. Participants: 308 nursing students enrolled in the first, third and fourth years of study. Methods: The development and validation of the children's environmental health questionnaires was carried out based on the item response theory. Results: The 26-item ChEHK-Q shows good fit and reliability of 0.98 for items and 0.70 for people based on the Rasch Model. The 12-item ChEHS-Q also shows good fit and reliability of 0.87 for items and 0.76 for people based on Andrich's rating scale model. The temporal stability measured using the intraclass correlation coefficient was 0.86 in the ChEHK-Q and 0.73 in the ChEHS-Q. Both questionnaires present enough evidence for construct validity; they work well to distinguish between nursing students with low or high knowledge of or skills in children's environmental health. Conclusions: The Children's Environmental Health Knowledge Questionnaire and the Children's Environmental Health Skills Questionnaire are useful tools for measuring knowledge and skills, respectively, among nursing students. This validation study obtained good psychometric properties concerning validity and reliability.
Dry care versus chlorhexidine cord care for prevention of omphalitis. Systematic review with meta-analysis
(2019) López-Medina, María Dolores; Linares-Abad, Manuel; López-Araque, Ana Belén; López-Medina, Isabel M
Objective: to compare the effect of dry care and the application of chlorhexidine to the umbilical cord of newborns at risk of developing omphalitis. Method: systematic review with meta-analysis. Clinical trials comparing dry care with the application of clorexidine to evaluate omphalitis were selected. Methodological quality was evaluated using the Consolidated Standards of Reporting Trials. Results: the joint analysis of the studies shows a significant decrease in the risk of omphalitis in the chlorhexidine group compared to the dry care group (RR=0.58, CI: 0.53-0.64). However, in the analysis by subgroups, chlorhexidine umbilical cord care did not reduce the risk of omphalitis in hospital births (RR=0.82, CI: 0.64-1.05), in countries with a low infant mortality rate (RR=0.8, CI: 0.5-1.28), or at chlorhexidine concentrations below 4% (RR=0.55, CI: 0.31-1). Chlorhexidine acted as a protective factor at a concentration of 4% (RR=0.58, CI: 0.53-0.64), when applied in cases of home births (RR=0.57, CI: 0.51-0.62), in countries with a high infant mortality rate (RR=0.57, CI: 0.52-0.63). Conclusion: dry cord care is effective in countries with low infant mortality rate and in hospital births. However, 4% chlorhexidine for umbilical cord care protects against omphalitis in home births, in countries with a high infant mortality rate.
Is it possible to become a midwife in a refugee camp?
(ELSEVIER, 2019) Martínez Linares, Jose Manuel; Linares Abad, Manuel; Calero García, María José; López Entrambasaguas, Olga María
The historical backdrop of Western Sahara has meant that, for the last 43 years, part of its indigenous population has survived in refugee camps located in the Algerian desert. International aid from abroad has become the main source of sustenance for all people living in this hostile environment. Since the beginning of this type of settlement, the Sahrawi Arab Democratic Republic has been con cerned with creating the necessary infrastructures to meet the health needs of the people living in these conditions. As a result, the Ahmed Abdel-Fatah School of Nursing was created in the Sahrawi refugee camps, which began to train midwives to care for women during the stages of pregnancy, childbirth and postpartum in 2002. The aim of this paper is to provide an approach to the origin and evolution of midwifery education for the Sahrawi refugee camps, in the only school of nursing that exists worldwide in a refugee camp.
Effectiveness of the e-NurSus Children Intervention in the Training of Nursing Students.
(2019) Álvarez-García, Cristina; Álvarez-Nieto, Carmen; Kelsey, Janet; Carter, Rachel; Sanz-Martos, Sebastián; López-Medina, Isabel María
The paediatric population is the most vulnerable to exposure to environmental risk factors. Institutions of higher education have to equip nursing students with the attitudes, knowledge, and skills to respond to this using blended learning. The aim of this study was to evaluate the effect of e-NurSus Children intervention on student nurses’ attitudes, knowledge, and skills. A quasi-experimental study of time series was designed using pre and post educational intervention evaluation in 2018. The participants were nursing students (N = 267) from Spain (n = 110) and the United Kingdom (n = 157). Three instruments were used: the Sustainability Attitudes in Nursing Survey, the Children’s Environmental Health Knowledge Questionnaire, and the Children’s Environmental Health Skills Questionnaire. The attitudes (15.81%), knowledge (39.02%), and skills (29.98%) of nursing students improved following the e-NurSus Children intervention. It is necessary to include topics on children’s environmental health in nurse education as students are aware of this issue but do not have the knowledge or skills required to manage problems or illness caused by the environment. The e-NurSus Children intervention is an effective tool to address this educational gap.
Assessment of nursing care and teaching: A qualitative approach
(MDPI, 2019) Martínez-Linares, José Manuel; Martínez-Yébenes, Rocío; Andújar, Francisco Antonio; López-Entrambasaguas, Olga María
Background: The reform of the Spanish higher education to adapt to the European Higher Education Area involves, among other issues, the students’ participation in the curriculum assessment. The aim is to understand the insights of both nursing professionals and current undergraduate students of nursing on the connection between the knowledge acquired throughout the degree and the professional healthcare practice. Methods: An exploratory, descriptive qualitative study was carried out at a Spanish University. By convenience sampling, twelve nursing professionals and twelve 4th-year students of the Degree in Nursing were included. In two phases, twelve semi-structured interviews and two focus groups were conducted in order to triangulate data. A thematic analysis of data was carried out, later to be coded by two researchers. Results: Two main themes were identified: Evidence-based nursing vs. experience-based nursing, and a theory-practice gap. The topics that were specifically highlighted were the coexistence between professionals who work according to evidence and those whose work is based on experience, and the lack of connection between the training received during the degree and actual healthcare practice. Conclusion: Nursing care work varies in terms of the implementation of evidence-based care. Nursing training is perceived as being affected by a theory-practice gap. To achieve the linking between nursing theory and practice, a great effort on stakeholders would be needed.
Competencies On Environmental Health And Pedagogical Approaches In The Nursing Curriculum: A Systematic Review Of The Literature
(2019) López-Medina, Isabel María; Álvarez-Nieto, Carmen; Grose, Jane; Elsbernd, Astrid; Huss, Norma May; Huynen, Maud; Richardson, Janet
It has been suggested that climate change is the biggest threat to public health for the 21st Century; increased demand on health services will impact on already overstretched resources and systems will need to be able to respond. However limited attention is given to climate change and sustainability in nursing education; there is no clear guidance on curricula content for nurses or recommendations regarding the skills and competencies that will be required. Literature published in Dutch, English, German, and Spanish was searched and 32 papers met the inclusion criteria for the review. Results suggests that holistic/systems thinking is relevant to healthcare so bringing a ‘sustainability lens’ to nursing curricula could be seen as being consistent with wider determinants of health. The literature review has identified the educational approaches necessary to provide a broad based curriculum and a cross-disciplinary approach. The findings suggest that topics such as the use of resources, food, health promotion, globalism, disease management, and the environmental impact of delivering healthcare, if embedded in nursing education could support the nursing profession's response for this new and important aspect of healthcare.

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