Breast cancer survivors suffering from lymphedema: What really do affect to corporeality/body image? A qualitative study.

Breast cancer-related lymphedema is currently one of the most serious complications that most affect the quality of life of women undergoing breast cancer. The aim of this study was to explore in-depth the experience of women who suffer from lymphoedema after breast cancer and how does this condition affect corporeality, with no judgements. For this purpose, a qualitative methodology was followed. In-depth interviews, interviewer's field notes and participants' letters were used for data collection. The participants were twenty Spanish women with lymphoedema after overcome a breast cancer in the past. Healthcare specialists with experience in the topic were also included. Results showed 2 main categories: "From cancer to lymphedema, another disease another disease" and "Potential for transition and transformation towards a new way of life". As a conclusion, the difficulty in accessing adequate treatment, the need for greater awareness of lymphedema and the importance of the emotional and psychological dimension of this chronic disease. Highlighting the attitudes that these women develop for self-care and the concept of new corporeality. After breast cancer, women with lymphedema experience a drastic change that affects all areas of their lives. The adaptation process, and the search for resources and aid, play a fundamental role in overcoming this process.

Biobanking Legislation in Spain: Advancing or Undermining Its Ethical Values?

Biobanks are important resources for improving public health and individual care. Some legal frameworks can be more or less conducive to advancing the potential benefits of biobanks. The purpose of this article is to assess biobanking legislation and practices in Spain to determine how well they fare in such a regard. We focus here on some of the primary ethical values that ground relevant legislation and that we believe are consistent with promoting biobanking benefits: the value of scientific research; efficient use of scarce resources; and respect for the dignity of donors. We argue that although Spanish regulations advance these values in important ways, they also have provisions that undermine them and thus risk limiting the potential benefits of biobanks. We offer some suggestions for improvement.

Contribution of Telomere Length to Systemic Sclerosis Onset: A Mendelian Randomization Study.

Although previous studies have suggested a relationship between telomere shortening and systemic sclerosis (SSc), the association between these two traits remains poorly understood. The objective of this study was to assess the causal relationship between telomere length in leukocytes (LTL) and SSc using the two-sample Mendelian randomization approach, with the genome-wide association study data for both LTL and SSc. The results of inverse-variance weighted regression (OR = 0.716 [95% CI 0.528-0.970], p = 0.031) and the Mendelian randomization pleiotropy residual sum and outlier method (OR = 0.716 [95% CI 0.563-0.911], p = 0.035) indicate an association between telomere length and SSc. Specifically, longer genetically predicted LTL is associated with a reduced risk of SSc. Sensitivity tests highlight the significant roles of the variants rs10936599 and rs2736100 annotated to the TERC and TERT genes, respectively. Our findings suggest an influence of telomere length in leukocytes on the development of SSc.

Disclosing Conflicts of Interest to Potential Research Participants: Good for Nothing?

The growing commercialization of science has raised concerns about financial conflicts of interest (COIs). Evidence suggests that such conflicts threaten the integrity of research and the well-being of research participants. Trying to minimize these negative effects, federal agencies, academic institutions, and publishers have developed conflict-of-interest policies. Among such policies, recommendations or requirements to disclose financial COIs to potential research participants and patients have become commonplace. Here, I argue that disclosing conflicts of interest to potential research participants fails to achieve the weighty moral goals that presumably ground such policies. This is so either because disclosure is simply a wrong means for achieving some of the goals in question or because, although disclosure could be an appropriate means for some of those goals, the way in which it is implemented prevents fulfillment of the desirable moral aim.

Current Landscape and Potential Challenges of Immune Checkpoint Inhibitors in Microsatellite Stable Metastatic Colorectal Carcinoma.

Colorectal cancer (CRC) is the third most frequent cancer and the second most common cause of cancer-related death in Europe. High microsatellite instability (MSI-H) due to a deficient DNA mismatch repair (dMMR) system can be found in 5% of metastatic CRC (mCRC) and has been established as a biomarker of response to immunotherapy in these tumors. Therefore, immune checkpoint inhibitors (ICIs) in mCRC with these characteristics were evaluated with results showing remarkable response rates and durations of response. The majority of mCRC cases have high levels of DNA mismatch repair proteins (pMMR) with consequent microsatellite stability or low instability (MSS or MSI-low), associated with an inherent resistance to ICIs. This review aims to provide a comprehensive analysis of the possible approaches to overcome the mechanisms of resistance and evaluates potential biomarkers to establish the role of ICIs in pMMR/MSS/MSI-L (MSS) mCRC.

Moral Distress: What Are We Measuring?

While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals' moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change.

Occupational balance of Spanish occupational therapists - a challenge.

BACKGROUND: Occupational balance is a central aspect in occupational therapy. Awareness of occupational balance/imbalance among occupational therapists could influence the orientation of their professional interventions. OBJECTIVE: To describe and compare the occupational balance status of occupational therapists working in Spain. MATERIAL AND METHODS: Cross-sectional descriptive study using an online questionnaire. Participants were occupational therapists working in Spain who answered a questionnaire including 22 questions on the sociodemographic and employment data and the Spanish version of the Occupational Balance Questionnaire (OBQ-E) ranging 0-65 where higher ratings equal better occupational balance. RESULTS: A total of 648 currently working occupational therapists participated. Mostly women, with median age of 32 years, without partner, children, or dependents. The median OBQ-E was 37 (IQR = 27; 45). Statistically significant differences were found between the medians of participants varying in the categories 'hired as an occupational therapist', weekly work hours, and population working with children and adults. CONCLUSIONS AND SIGNIFICANCE: Spanish occupational therapists presented a moderate occupational balance that varied between subgroups. Professional recognition, working hours, and the population they attend are aspects that influence their occupational balance. Knowledge of occupational therapists' occupational balance could contribute to the development of policies aimed at promoting it.

Reivindicative occupational practices of activist with disabilities / Práticas ocupacionais reivindicativas de ativistas com deficiência

Abstract Introduction The occupational praxis of activists with disabilities in the Latin America has presented actions of revindication from historically marginalised territories. Objective To explore and describe strategies used by Chilean activist with disabilities. Method Qualitative design via three research techniques: a) 11 in-depth interviews; b) six group chat sessions; c) content analysis of eight social networks belonging to collectives of activists with disabilities in Chile. Results Activists indicate various occupations for revindication as subjects with rights. These trajectories are exemplified with the following dimensions: 1) Interpellate full social participation: demanding justice and citizenship; 2) Showing defective bodies: public mobilisations; 3) Occupying institutional space by placing: bodies in the system. Conclusion Dissident occupational practices intervene and transform the limited comprehension about what human vulnerability and fragility is capable of. This situation is mainly appreciated in the Global South.

Resumo Introdução A práxis ocupacional de ativistas com deficiência na América Latina tem apresentado ações de reivindicação de territórios historicamente marginalizados. Objetivo Explorar e descrever as estratégias utilizadas por ativistas chilenos com deficiência. Método Desenho qualitativo por meio de três técnicas de pesquisa: a) 11 entrevistas em profundidade; b) seis sessões de chat em grupo; c) análise de conteúdo de oito redes sociais pertencentes a coletivos de ativistas com deficiência no Chile. Resultados Os ativistas indicam diversas ocupações para reivindicação como sujeitos de direitos. Essas trajetórias são exemplificadas com as seguintes dimensões: 1) Interpelar a participação social plena: reivindicar justiça e cidadania; 2) Mostrar corpos defeituosos: mobilizações públicas; 3) Ocupar o espaço institucional colocando: os corpos no sistema. Conclusão Práticas ocupacionais dissidentes intervêm e transformam a compreensão limitada sobre do que é capaz a vulnerabilidade e fragilidade humana. Esta situação é apreciada principalmente no Sul Global.

To Assess Technologies, Bioethicists Must Take Off Their Blinkers.

Assessing the safety of biomedical technologies is an essential aspect of any sound ethical assessment. It is, however, not sufficient. Technologies do significantly more than what they are designed to accomplish. Bioethicists should pay more attention to the many ways in which technologies transform our world and ourselves.

Reproductive Embryo Editing: Attending to Justice.

The use of embryonic genome editing tools is often touted as a way to ensure the birth of healthy and genetically related children. Many would agree that this is a worthy goal. Yet the purpose of this article is to argue that, if we are concerned with justice, accepting such a goal as morally appropriate commits one to rejecting the use of social resources for further development of embryo editing for reproductive purposes. This is so because there are safer and more effective means that can allow many more prospective parents to achieve the same valued goal and that can offer additional benefits.

Being and Becoming Pregnant: Valuing Risks.

Pregnant women are insistently urged to limit or eliminate risks to their fetuses. This is done even when the risks to fetuses are only theoretical or minimal, and the health and well-being of the pregnant woman is at stake. When using reproductive and reprogenetic technologies, however, evaluations about what risks are acceptable to impose on embryos change radically. In the context of these technologies, women are not only allowed to impose risks on embryos, but actively encouraged to do so-insofar as they can be urged to use these technologies for various reasons. This article explores the problematic beliefs and social norms regarding motherhood that shape these apparently inconsistent risk evaluations.

Long-Term Treatment Outcomes of Implant Prostheses in Partially and Totally Edentulous Patients.

Implant dental therapy is a clinical procedure used for treating patients with tooth loss with known clinical success. This clinical study aimed to evaluate the long-term clinical outcomes of dental implants in partially and totally edentulous patients. A total of 544 Microdent (Microdent SU, Implant Microdent System®, Santa Eulàlia de Ronçana Barcelona, Spain) screw implants were placed in 111 patients using a two-stage surgical technique and a conventional loading protocol (lasting 3 months). Implant and prosthetic clinical findings were evaluated during a 15-year follow-up. A total of 6 implants were lost during the healing period, and 124 prostheses were placed over the 538 implants that remained: 20 single crowns, 52 partially fixed bridges, 45 full-arch fixed restorations, and 7 overdentures. A total of 20 of these were lost during the follow-up period. The cumulative survival rate for all implants was 96.4%. The data underwent statistical analysis (significance level: p < 0.05). The mean marginal bone loss was 1.82 ± 0.54 mm, ranging from 1.2 to 3.1 mm. The most frequent complications were mechanical prosthodontic complications (16.2%). In all, 11.8% of implants showed periimplantitis as the primary biological complication. Dental implants inserted in both the maxillary and mandibular areas produce long-term favorable outcomes and stable tissue conditions when a delayed loading protocol is followed.

Is a Video Worth a Thousand Words?

Bodily imagery elicits strong affective responses and is highly salient, potentially altering viewers' decision making. When clinicians engage surrogates in video calls showing the patient's body, several competing ethical issues must be considered. On the one hand, surrogates may require visual information to make informed decisions, and video technology closes crucial information gaps. On the other, video technology puts an increased amount of control in the hands of clinicians over how the patient's condition is perceived. This article explores some situations that can result in manipulation due to the affective impact of bodily images and the potential for selectivity and framing. Focusing on goals of care, the paper outlines the foremost ethical considerations for clinicians and provides recommendations for clinicians on how to reduce possible manipulation when making these video calls.

Common Variation in the PIN1 Locus Increases the Genetic Risk to Suffer from Sertoli Cell-Only Syndrome.

We aimed to analyze the role of the common genetic variants located in the PIN1 locus, a relevant prolyl isomerase required to control the proliferation of spermatogonial stem cells and the integrity of the blood-testis barrier, in the genetic risk of developing male infertility due to a severe spermatogenic failure (SPGF). Genotyping was performed using TaqMan genotyping assays for three PIN1 taggers (rs2287839, rs2233678 and rs62105751). The study cohort included 715 males diagnosed with SPGF and classified as suffering from non-obstructive azoospermia (NOA, n = 505) or severe oligospermia (SO, n = 210), and 1058 controls from the Iberian Peninsula. The allelic frequency differences between cases and controls were analyzed by the means of logistic regression models. A subtype specific genetic association with the subset of NOA patients classified as suffering from the Sertoli cell-only (SCO) syndrome was observed with the minor alleles showing strong risk effects for this subset (ORaddrs2287839 = 1.85 (1.17-2.93), ORaddrs2233678 = 1.62 (1.11-2.36), ORaddrs62105751 = 1.43 (1.06-1.93)). The causal variants were predicted to affect the binding of key transcription factors and to produce an altered PIN1 gene expression and isoform balance. In conclusion, common non-coding single-nucleotide polymorphisms located in PIN1 increase the genetic risk to develop SCO.

Understanding the role and importance of occupational therapy in mental health services in Morocco: Perspectives from mental health professionals.

BACKGROUND: Across the global landscape, mental health care still exhibits challenges because of the lack of human and professional resources to face its consequences. In Morocco, mental health problems affect mainly adolescents and young adults, with a clear impact on functional engagement in their daily lives. Occupational therapy, as a holistic and person-centered practice, may be an ideal mental health strategy to promote health and well-being through occupation, thereby enabling individuals to participate in regular daily activities. OBJECTIVE: To understand, from an intercultural perspective, the point of view of mental health professionals regarding the role and importance of occupation-based practices in Errazi Mental Health Hospital in Salé(Rabat) Morocco. METHOD: A qualitative research design was used for this study. Data collection consisted of semi-structured interviews with 12 mental health care professionals (non-occupational therapists). These results were used to gain an understanding of their perspectives regarding the main role of human occupation in mental health services in Morocco, and to incorporate an intercultural outlook in terms of occupational therapy. Data analysis was conducted in three phases, by following the grounded theory methodology. RESULTS: Two categories, "dimensions of occupation in Moroccan mental health" and "the interplay between traditional and western perspectives involving mental health" emerged from this research. Both categories included five subcategories. CONCLUSION: This study identifies how occupation-based services in Moroccan mental health care require considering not only the cultural perspective of mental health, and the sociocultural meaning rooted in occupations, but also the relevance of incorporating a community-centered approach. Moreover, it discusses how occupational therapy education in Morocco must incorporate an intercultural perspective of the therapy's theory and practice.

Prevalencia de la lactancia materna exclusiva en un hospital Best Practice Spotlight Organization / Prevalence of exclusive breastfeeding in a hospital Best Practice Spotlight Organization

Objetivo: Conocer la prevalencia de la lactancia materna exclusiva al alta de los recién nacidos sanos, y determinar el nivel de satisfacción de las mujeres puérperas con las intervenciones realizadas para la promoción de la lactan- cia materna según recomendaciones de la guía Lactancia materna de la Re- gistered Nurses’ Association of Ontario (RNAO) aplicadas desde 2017. Método: Estudio descriptivo transversal, llevado a cabo entre junio de 2018 y junio de 2019. La muestra fue de mujeres puérperas ingresadas en la Unidad de Obstetricia del Hospital de la Mujer del Hospital Universitari Vall d’Hebron de Barcelona. Se analizaron variables sociodemográficas y relacionadas con el grado de satisfacción de las intervenciones de promoción de la lactancia ma- terna que habían recibido todas las madres, tanto si ofrecían el pecho como lactancia artificial, recogidas a través de un cuestionario diseñado ad hoc. Resultados: Se analizaron 337 encuestas realizadas por mujeres que recibie- ron intervenciones de promoción de la lactancia materna. Un total de 306 mu- jeres (90,8 %) alimentaron a su recién nacido con lactancia materna exclusiva en el momento del alta. La proporción de madres que dieron lactancia ma- terna exclusiva al alta fue significativamente superior en el grupo que ya lo había hecho anteriormente. El grado de satisfacción sobre las intervencio- nes de promoción recibidas obtuvo una puntuación media de 5,41 ± 0,88 en la escala de Likert, siendo 1 totalmente insatisfecha y 6 totalmente satisfe- cha. El grado de satisfacción fue alto tanto en el grupo que alimentó con lactancia materna exclusiva como en el que no lo hizo. Conclusiones: Casi la totalidad de las mujeres es dada de alta ofreciendo lactancia materna exclusiva a sus recién nacidos, siendo la lactancia mater- na previa un factor de predisposición hacia la misma. El grado de satisfac- ción con las intervenciones de promoción de la lactancia materna fue alto. (AU)

Objective: To identify the prevalence of exclusive breastfeeding at discharge of healthy newborns and to determine the level of satisfaction of postpartum women with the interventions carried out to promote breastfeeding accord- ing to the recommendations by the Registered Nurses’ Association of Ontario (RNAO) applied since 2017. Methodology: Cross-sectional descriptive study, carried out between June 2018 and June 2019. The sample was postpartum women admitted to the Obstetrics Unit of the Maternity Hospital of Vall d'Hebron University Hospital in Barcelona. Sociodemographic variables and those related to breastfeeding promotion interventions were collected through an ad hoc designed ques- tionnaire and analysed, which included those mothers who were breastfeed- ing and those choosing to bottle feed their newborn neonates. Results: 337 surveys completed by women who received breastfeeding pro- motion interventions were analysed. 306 women (90.8 %) exclusively breast- fed their newborn at discharge. The proportion of mothers who exclusively breastfed at discharge was significantly higher in multiparous women who breastfed previous siblings. The degree of satisfaction with the interventions received had a mean score of 5.41 ± 0.88 on the Likert scale, with 1 being totally unsatisfied and 6 totally satisfied. The degree of satisfaction was high regardless of having breastfed or not. Conclusions: Almost all women are discharged with exclusive breastfeeding, with previous breastfeeding being a predisposing factor towards it. The de- gree of satisfaction with breastfeeding promotion interventions was high. (AU)

The ATENción Plena en Enfermedad de Alzheimer (ATENEA-Mindfulness in Alzheimer's Disease) Program for Caregivers: Study Protocol for a Randomized Controlled Trial.

A person affected by Alzheimer's disease (AD) gradually loses the ability to perform activities of daily living and becomes dependent on caregivers, thereby having a negative impact on the caregivers' quality of life. There is evidence that suggests that interventions aimed at caregivers, such as mindfulness, may be effective at reducing this burden and emotional issues, such as depression and anxiety, and improving their quality of life. However, there is a lack of consistency in the findings and conclusions remain tentative. In addition, as neuropsychiatric symptoms (NPSs) of AD are major determinants of the caregiver's burden, these interventions should examine the relationship between these symptoms and caregiver outcomes. Importantly, to improve the design of therapeutic interventions for caregivers and complement the treatment of AD, aspects related to occupational performance and the participation of people with AD and their caregivers should also be considered. Therefore, this study will aim to examine first, the effects of a mindfulness-based program designed for caregivers on NPSs of AD and caregivers' anxiety and depression; second, the effects of this program on patients' functional capacity, cognitive performance, executive functions, and quality of life, and on caregivers' burden, quality of life, occupational balance, executive functions, psychological wellbeing, and self-compassion. We believe that the findings of this study will have significant implications for future healthcare strategies focused on improving the quality of life and wellbeing of caregivers.