Generatividad y autocuidado en personas mayores en diálisis / Generativity and self-care in older adults on dialysis

Introducción: La cantidad de personas mayores en trata-miento crónico de diálisis, ya sea en hemodiálisis o diálisis peritoneal está aumentando considerablemente. Vincular el estudio de la generatividad y autocuidado con el envejeci-miento en diálisis propicia una mirada positiva sobre la vejez y la vivencia de la cronicidad en diálisis. Este abordaje ayuda no sólo a promover y facilitar específicamente el autocuidado de las personas mayores en diálisis, sino que visibiliza el impacto positivo que tiene en la sociedad la actitud generativa de las personas mayores.Objetivos: Describir la vivencia del autocuidado en la cronici-dad en personas mayores en diálisis. Explorar cómo la gene-ratividad puede influir y dar sentido a la experiencia de vivir con diálisis.Material y Método: Investigación narrativa-biográfica que utiliza el registro de Historias de Vida de las personas inves-tigadas.Resultados: En las Historias de Vida de las personas mayo-res, la generatividad ha sido practicada en el pasado: cuidado de hijos, de familiares enfermos, estando implicados cívica-mente en el cambio político y social y desean preservar ese pasado como un legado generativo. Pero también se expresa en el presente por su voluntad y determinación para el pro-pio autocuidado. La actitud generativa durante esta etapa de vivir con diálisis está enfocada de una forma directa hacia su propio autocuidado. Conclusiones: El autocuidado personal se convierte en un acto generativo que hace que las personas mayores en diáli-sis afronten las diferentes pérdidas experimentadas durante la vivencia de la cronicidad en diálisis con un sentimiento de autonomía.(AU)

Introduction: The number of older adults undergoing chronic dialysis treatment, either hemodialysis or peritoneal dialysis, is increasing considerably. Linking the study of generativity and self-care with aging in dialysis promotes a positive outlook on old age and the experience of living with chronic illness on dialysis. This approach not only helps to promote and facilitate specific self-care practices among older adults on dialysis but also highlights the positive impact that the generative attitude of older individuals has on society.Objectives: To describe the experience of self-care in chronic illness among older adults on dialysis. To explore how generativity can influence and give meaning to the experience of living with dialysis. Materials and Method: Narrative-biographical research utilizing the Life Stories of the individuals under investigation.Results:In the Life Stories of older adults, generativity has been practiced in the past through caring for children, and sick relatives, and civic involvement in political and social change, and they wish to preserve that past as a generative legacy. However, it is also expressed in the present through their will and determination for self-care. The generative attitude during this stage of living with dialysis is directly focused on their self-care.Conclusions:Personal self-care becomes a generative act that enables older adults on dialysis to confront the various losses experienced during the journey of chronic illness on dialysis with a sense of autonomy.(AU)

Bienestar laboral y su correlación con el compromiso organizacional / Labor Well-Being and its Correlation with the Organizational Commitment / Bem-estar no local de trabalho e sua correlação com o comprometimento organizacional

Introducción: El bienestar laboral es un tema importante en las organizaciones, pues con este se busca mejorar las condiciones laborales y sociales en los contextos de trabajo, motivar al trabajador y promover el desarrollo personal, con el fin de desarrollar la salud, generando como ganancia el compromiso de los trabajadores Objetivo: Establecer la correlación entre el bienestar laboral y el compromiso organizacional Metodología: Revisión de la literatura. La información se obtuvo en diferentes bases de datos, considerando los descriptores y la conjunción de estos con operadores booleanos; así como con criterios de inclusión y exclusión. La información se organizó en una matriz de Excel, y se utilizó un diagrama de procesos para su elección. El análisis se ejecutó mediante un resumen analítico de investigación. Desarrollo y discusión: Se converge en que para una organización es importante el bienestar de los trabajadores y las intervenciones que puede realizar la gerencia para desarrollarlo. El compromiso de los trabajadores con la organización permite el crecimiento productivo Conclusión: La correlación que se establece entre el bienestar laboral y el compromiso organizacional es de conse-cuencia y en ambas vías: si un trabajador goza de bienestar laboral, se siente comprometido con la organización y da lo mejor de sí mismo hacia el logro de los objetivos organizacionales. A su vez, se alcanzan las metas personales, porque la organización se centra en promover el bienestar de sus empleados. Palabras clave: calidad de vida; compromiso laboral; promoción de la salud; salud laboral; satisfacción en el trabajo

Introduction: Labor well-being is an important issue in organizations, with this it seeks to improve working and social conditions in work contexts, motivate the worker and promote personal develop-ment in order to develop health, generating as a profit the commitment of workers Objective: Establish the correlation between the well-being work and the organizational commitment Methodology: A review of the literature was carried out, the information was obtained in different databases, considering the descriptors and the conjunction of these with Boolean operators; inclusion and exclusion criteria, the information was organized in an Excel matrix, a process diagram was used for the choice. The analysis was executed using an analytical summary of research. Development and Discussion: It converges on the importance that the well-being of workers has for an organization and the interventions that management can carry out to develop it. Conclusion: The correlation that is established between work well-being and organizational commit-ment is consequential and in both ways, if a worker enjoys work well-being he feels committed to the organization, gives the best of himself, towards the achievement of organizational objectives, in turn personal goals are achieved, because the organization focuses on promoting the well-being of its employees.

Introdução: O bem-estar no local de trabalho é uma questão importante nas organizações, pois busca melhorar as condições de trabalho e sociais nos contextos de trabalho, motivar o trabalhador e promover o desenvolvimento pessoal, com o objetivo de desenvolver a saúde, gerando como ganho o comprometimento dos trabalhadores. Objetivo: Estabelecer a correlação entre bem-estar no trabalho e comprometimento organizacional. Metodologia: Revisão da literatura. As informações foram obtidas em diferentes bancos de dados, considerando os descritores e a conjugação desses com operadores booleanos, bem como os critérios de inclusão e exclusão. As informações foram organizadas em uma matriz do Excel, e um diagrama de processo foi usado para sua eleição. A análise foi realizada por meio de um resumo analítico de pesquisa. Desenvolvimento e discussão: Há uma convergência sobre a importância do bem-estar dos fun-cionários para uma organização e as intervenções que a gerência pode fazer para desenvolvê-lo. O compromisso dos funcionários com a organização possibilita o crescimento produtivo. Conclusão: A correlação entre bem-estar no trabalho e o comprometimento organizacional é bidi-recional: se um funcionário desfruta de bem-estar no trabalho, ele se sente comprometido com a organização e dá o melhor de si para atingir as metas organizacionais. Por sua vez, as metas pessoais são alcançadas, porque a organização se concentra em promover o bem-estar de seus funcionários.

Edadismo: la barrera invisible / Ageism: the invisible barrier

La enfermedad renal crónica es frecuente en las personas mayores y su prevalencia se incrementa conforme aumenta la edad. El envejecimiento de la población en diálisis tiene unas características que no se pueden extrapolar a la población en general. Esta patología además es un reto para la salud pública con importantes implicaciones sociales y económicas. Las enfermeras nefrológicas solemos ser los primeros profesionales en detectar numerosas problemáticas sociales, relacionales, incluso económicas que presentan las personas en diálisis. El edadismo es uno de los retos emergentes al que las enfermeras nefrológicas vamos a tener que enfrentarnos en nuestra práctica diaria. Para ello necesitaremos formarnos, sensibilizarnos, educarnos y educar a los demás, tareas que no nos son ajenas y para las que necesitaremos usar los recursos de divulgación de que disponemos para acompañar a la sociedad en el proceso de visibilización, denuncia y transformación de una discriminación que nos afecta a todos. Utilizar esta editorial para hablar del edadismo es un ejemplo de cómo las enfermeras nefrológicas se hacen eco de la necesidad de cuidar no sólo de los aspectos técnicos, sino de liderar los cambios necesarios para vivir y cuidar en una sociedad justa y solidaria. (AU)

"Validation of a cyberbullying questionnaire as a screening tool for other forms of intimate-partner violence towards young women".

BACKGROUND: The use of electronic media is widespread among young people and is a potential tool for the perpetration of intimate-partner violence (IPV) towards women. The aim of this study is to validate two questions focused on harassment and control by electronic tools (HCE-2) as a screening tool for the detection of IPV in young women. METHODS: The data source was the third Community of Madrid IPV survey in 2014. The screening tool consisted of two questions with five possible answers prepared by a group of experts. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The validity indices (with 95% confidence intervals) were compared between two age groups: 18-24 and 25-29 years. RESULTS: Six hundred ninty-four women were sampled. The response rate was 68.7%, and 477 surveys were analyzed. The prevalence of IPV was 10.7% (95% CI: 8.2-13.8). HCE-2 was positive in 5.9% (95% CI: 4.1-8.4). The overall efficiency of the test was 93.5% (95% CI: 91.1-96.7), sensitivity 47.1% (95% CI: 33.7-60.8), specificity 99.1% (95% CI: 97.5-99.6), and positive predictive value 85.7% (95% CI: 67.1-94.6). The best validity indices of the questionnaire were observed in women aged 18 to 24 years: overall efficiency of the test 95.1% (95% CI: 92.6-97.7), sensitivity 62.5% (95% CI: 44.5-77.6), specificity 99.6% (95% CI: 97.0-99.9), and positive predictive value 95.2% (95% CI: 71.7-99.4). CONCLUSIONS: The existing need to improve the detection of IPV in young women and the good validity indices observed here justify the recommendation of the HCE-2 questionnaire as a screening tool in young women.

Validación de la versión corta del Woman Abuse Screening Tool (WAST) en población general / Validation of the short version of the Woman Abuse Screening Tool (WAST) in the general population

OBJETIVO: Realizar una validación concurrente de la versión corta del Woman Abuse Screening Tool (WAST), un instrumento utilizado en la detección de violencia de pareja hacia la mujer, estimando los índices de validez en población general. MÉTODO: La fuente de información fue la tercera Encuesta de violencia de pareja hacia la mujer de la Comunidad de Madrid de 2014, realizada a mujeres de 18 a 70 años. Como referencia se utilizó la definición de violencia de pareja hacia la mujer basada en un cuestionario de 26 preguntas. La versión corta del WAST incluye dos preguntas con tres respuestas posibles. Se calculan y comparan la prevalencia de violencia de pareja hacia la mujer y los índices de validez del cuestionario según dos criterios de puntuación con intervalos de confianza del 95% (IC95%). RESULTADOS: La tasa de respuesta fue del 60%. Se analizaron 2979 encuestas. La prevalencia de violencia de pareja hacia la mujer fue del 7,6% (IC95%: 6,6-8,5%). Se encontró un 21,1% (IC95%: 19,6-22,5) de test positivos según el criterio 1 y un 11,0% (IC95%: 9,9-12,1) según el criterio 2. El criterio 2 presentó una mayor eficiencia global del test (81,5% [IC95%: 80,1-82,9] para el criterio 1 vs. 88,8% [IC95%:87,7-89,9] para el criterio 2). Los mejores índices se obtuvieron en mujeres a partir de 30 años de edad. CONCLUSIONES: La versión reducida del cuestionario WAST presentó índices de validez aceptables para ser utilizados como cuestionario de cribado de violencia de pareja hacia la mujer. Recomendamos utilizar el criterio 2 de puntuación en la estimación de la prevalencia de violencia de pareja hacia la mujer en encuestas dirigidas a población general

OBJECTIVE: To perform a concurrent validation of the short version of the Woman Abuse Screening Tool (WAST), used to detect intimate partner violence, estimating the validity indexes in the general population. METHOD: The information source was the third Intimate partner violence survey in the Region of Madrid (Spain) conducted on women aged 18-70 in 2014. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The short version of WAST includes two questions with three possible answers. The prevalence of intimate partner violence and the validity indexes were calculated and compared according to two scoring criteria with 95% confidence intervals (95%CI). RESULTS: The response rate was 60.0%, and 2979 surveys were analysed. The prevalence of intimate partner violence was 7.6% (95%CI: 6.6-8.5). We showed 21.1% (95%CI: 19.6-22.5) positive test results according to WAST criterion 1 and 11.0% (95%CI: 9.9-12.1) according to criterion 2. Criterion 2 presented higher overall efficiency of the test (81.5% [95%CI: 80.1-82.9] criterion 1 vs. 88.8% [95%CI: 87.7-89.9] criterion 2). The best indexes were obtained in women ≥30 years old. CONCLUSIONS: The short version of the WAST showed acceptable validity indexes for use as a screening tool of intimate partner violence in the general population. We recommend using scoring criterion 2 to estimate prevalence of intimate partner violence in surveys on the general population

[Validation of the short version of the Woman Abuse Screening Tool (WAST) in the general population]. / Validación de la versión corta del Woman Abuse Screening Tool (WAST) en población general.

OBJECTIVE: To perform a concurrent validation of the short version of the Woman Abuse Screening Tool (WAST), used to detect intimate partner violence, estimating the validity indexes in the general population. METHOD: The information source was the third Intimate partner violence survey in the Region of Madrid (Spain) conducted on women aged 18-70 in 2014. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The short version of WAST includes two questions with three possible answers. The prevalence of intimate partner violence and the validity indexes were calculated and compared according to two scoring criteria with 95% confidence intervals (95%CI). RESULTS: The response rate was 60.0%, and 2979 surveys were analysed. The prevalence of intimate partner violence was 7.6% (95%CI: 6.6-8.5). We showed 21.1% (95%CI: 19.6-22.5) positive test results according to WAST criterion 1 and 11.0% (95%CI: 9.9-12.1) according to criterion 2. Criterion 2 presented higher overall efficiency of the test (81.5% [95%CI: 80.1-82.9] criterion 1 vs. 88.8% [95%CI: 87.7-89.9] criterion 2). The best indexes were obtained in women ≥30 years old. CONCLUSIONS: The short version of the WAST showed acceptable validity indexes for use as a screening tool of intimate partner violence in the general population. We recommend using scoring criterion 2 to estimate prevalence of intimate partner violence in surveys on the general population.

Desde la exclusión se busca la libertad / From exclusion to the search of freedom

En nuestra época encontramos enunciados que promulgan una libertad propia de lo humano; las diferentes guerras y movimientos sociales giran en torno a una liberación buscada; los individuos dicen querer liberarse… ¿Qué está en juego tras la ‘libertad’? ¿Qué puede decir el psicoanálisis al respecto cuando entendemos que en el fundamento hay un sujeto? ¿Hay un sujeto libre? En esta aproximación, tras detenerme en lo que estructura al sujeto como fundamentalmente excluido, me dirijo a lo que de esto intenta decirse en la afirmación de la libertad. Este escrito hace parte de la investigación en curso El derecho a ser libre de Otro realizada como tesis para aspirar al título de Maestra en Psicoanálisis, subjetividad y cultura en la Universidad Nacional de Colombia.

There are nowadays some statements in favor of a freedom specific of humans, wars and social movements tend towards freedom, individuals say they want to be free... What is at stake in “freedom”? What can psychoanalysis say about it provided that in its basis there is a subject? Is there a free subject? This approach, after considering the structure of the subject as fundamentally excluded, addresses to what it is said about that in the assertion of freedom. This paper is part of the ongoing research named The right to be free of Other, carried out as thesis to claim the Master's Degree in Psychoanalysis, Subjectivity, and Culture at Universidad Nacional de Colombia.

À l'heure actuelle, des énoncés qui prônent une liberté propre à l'être humain sont faciles à trouver; les guerres et les mouvements sociaux tournent autour d'une libération recherchée; les individus veulent se libérer, mais... Quel est l'enjeu de la ® liberté ¼? Qu'est-ce que la psychanalyse peut en dire lorsque l’on comprend que le sujet est au cœur de la liberté ? Y a-t-il un sujet libre? Cet article, après avoir examiné ce qui structure le sujet en tant qu'être fondamentalement exclu, en explore les idées développées dans l'affirmation de la liberté. Ce texte fait partie du projet de recherche en cours Le droit d'être libre d'Autre, réalisé en vue de l'obtention du diplôme du Master Psychanalyse, Subjectivité et Culture de l'Université Nationale de Colombie.

A randomized clinical trial comparing nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients (the Combine Study).

BACKGROUND: Non-nucleoside reverse transcriptase inhibitor-containing regimens may be a valid alternative to protease inhibitor-containing regimens for initial antiretroviral therapy, but to date few studies comparing these two strategies have been performed. OBJECTIVE: To evaluate the efficacy and safety of nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients. DESIGN: Randomized, open-label, multicentre trial. SETTING: Twelve centres in Spain (9) and Argentina (3). PATIENTS: One hundred and forty-two HIV-infected naive patients without AIDS. INTERVENTIONS: Patients received combivir (zidovudine 300 mg/lamivudine 150 mg, twice-daily) plus either nelfinavir (1250 mg) twice-daily (zidovudine/lamivudine/nelfinavir, n=70) or nevirapine (200 mg) twice-daily (zidovudine/lamivudine/nevirapine, n=72), and were followed for 12 months. The primary endpoint was the proportion of patients with a plasma HIV-1 RNA (pVL) of less than 200 copies/ml by PCR at 12 months. pVL of less than 20 copies/ml (PCR), changes in CD4 counts, clinical progression and adverse events were also evaluated. Efficacy was assessed using intent-to-treat (ITT) (missing=failure) and on-treatment analysis. RESULTS: At 12 months in the ITT analysis the proportion of patients with pVL below 200 copies/ml was 60% (95% CI 48.5-71.5) in the zidovudine/lamivudine/nelfinavir arm and 75% (95% CI 65-85) in the zidovudine/lamivudine/nevirapine arm (P=0.06), and the proportion below 20 copies/ml was 50% (95% CI 38.3-61.7) and 65% (95% CI 54.2-76.2), respectively (P=0.06). No differences were found when comparing the subgroup of patients with baseline pVL of more than 100,000 copies/ml. A gain of +173 and +162 CD4 cells/mm3, respectively, was observed. Zidovudine/lamivudine/nelfinavir was discontinued in 21% of patients, and zidovudine/lamivudine/nevirapine in 25%, due to toxicity (P>0.2). CONCLUSIONS: Our results suggest that zidovudine/lamivudine/nevirapine is at least as effective as zidovudine/lamivudine/nelfinavir as first-line therapy for HIV disease.

Serum levels of beta2-microglobulin, neopterin, TNF-alpha and soluble receptors of TNF-alpha and interleukin-2 in intravenous drug abusers according to HIV-1 status and stage of the HIV-1 infection.

OBJECTIVE: To compare the serum levels of beta2-microglobulin (beta2M), neopterin (NP), TNF-alpha and soluble receptors of TNF-alpha (sTNF-R55 and sTNF-R75) and interleukin-2 (sIL-2R) in a population of intravenous drug abusers according to whether or not they had HIV-1 infection and to the stage of the HIV-1 infection. METHODS: A cross-sectional study was performed at four drug detoxification centers in Barcelona, and the HIV outpatient clinic at Hospital Clínic in Barcelona. Three cohorts of intravenous drug abusers (IVDAs)-105 HIV-1-uninfected patients (cohort A), 174 with asymptomatic HIV-1 infection (cohort B) and 39 with AIDS (cohort C)-were enrolled. On the first visit, the following laboratory tests were performed: hemogram and platelet count, hepatitis B surface antigen (HBsAg), anti-hepatitis C antibodies, B2M, NP, sIL-2R, TNF-alpha, and TNF receptors (sTNF-R55 and sTNF-R75). RESULTS: The three cohorts were homogeneous according to sex, type of drug, average number of intravenous doses of drug in 1 day, and hepatitis B infection. Patients with AIDS were older than those of cohort A and B (p<0.0001). HIV-negative IVDAs were co-infected with hepatitis C virus less frequently than were HIV-positive IVDAs (80% versus 91%, p<0.03). Among HIV-1-negative IVDAs (cohort A), almost all (from 86% to 95%, depending on the marker) individual values were within the normal boundaries of our laboratory. With a single exception (level of sTNF-R55 in cohort B compared with cohort A, p=0.15), levels of all markers were significantly higher in asymptomatic HIV-1-infected (cohort B) when compared with uninfected patients (cohort A), and in AIDS patients (cohort C) when compared with both cohorts A and B. There was a significant positive correlation between levels of ss2M and NP (r=0.56; p<0.01), ss2M and TNF (r=0.65, p<0.01) and NP and TNF (r=0.76, p<0.01). There was no correlation between levels of sIL-2R and levels of ss2M, NP or TNF and its receptors. CONCLUSIONS: Intravenous drug abuse does not modify serum levels of ss2M, NP, sIL-2R, TNF-alpha, and TNF receptors (sTNF-R55 and sTNF-R75). Levels of these markers increase significantly when an HIV-1 infection occurs and when there is progression to AIDS.