Significados y retos de la Terapia Ocupacional en cuidados paliativos: una perspectiva desde la experiencia práctica estudiantil / Meanings and challenges of Occupational Therapy in Palliative Care: a perspective from the student fieldwork experience / Significados e desafios da Terapia Ocupacional em cuidados paliativos: uma perspectiva a partir da experiência prática estudantil

Los cuidados paliativos buscan impactar en el bienestar de las personas que cursan una condición de salud crónico-degenerativa u otras que acorten su esperanza de vida. Considerando la escasez de terapeutas ocupacionales con formación en esta especialidad en Colombia y otros países, este artículo presenta reflexiones sobre los significados y retos que planteó a dos estudiantes de pregrado en Terapia Ocupacional y sus docentes, su experiencia en una práctica formativa en cuidados paliativos con personas adultas y adultas mayores hospitalizadas. Enlazando la subjetividad de cada estudiante con este contexto surgieron cinco ejes alrededor de los cuales se desarrolla el texto: relación terapéutica; ocupación significativa y espiritualidad; fatiga por compasión; reflexiones éticas, y formación profesional. Se concluye que en la formación de terapeutas ocupacionales es necesario implementar estrategias pedagógicas que enriquezcan el hacer humanizado, ético, crítico y centrado en la persona.

Palliative care seeks to impact the well-being of people with a chronic-degenerative health condition or others that shorten life expectancy. Considering the shortage of occupational therapists trained in this specialty in Colombia and other countries, this paper presents the reflections of two undergraduate Occupational Therapy students and their professors on the meanings and challenges of their fieldwork in palliative care training for practice with hospitalized adults and older adults. By linking the students' subjectivity with this formative context, five axes emer- ged: the therapeutic relationship, meaningful occupation and spirituality, compassion fatigue, ethical reflections, and professional training. The conclusion is that it is necessary to establish pedagogical strategies that enrich a humanized, ethical, critical, and person-centered practice in occupational therapists' training.

Os cuidados paliativos buscam impactar o bem-estar das pessoas que têm uma condição de saúde crônico-degenerativo ou outras que reduzem sua expectativa de vida. Considerando a escassez de terapeutas ocupacionais formados nesta especialidade na Colômbia e em outros países, este artigo apresenta reflexões sobre os significados e desafios colocados a dois alunos de graduação em Terapia Ocupacional e seus docentes, tendo em vista sua vivência numa prática discente em cuidados paliativos com adultos e idosos hospitalizados. Vinculando a subjetividade de cada aluno a esse contexto, emergiram cinco eixos em torno dos quais o texto se desenvolve: relação terapêutica, ocupação significativa e espiritualidade, fadiga por compaixão, reflexões éticas e formação profissional. Conclui-se que, na formação de terapeutas ocupacionais, é necessário implementar estratégias pedagógicas que enriqueçam o fazer humanizado, ético, crítico e centrado na pessoa.

Lineamientos del Colegio Colombiano de Terapia Ocupacional para la atención hospitalaria aguda y subaguda de pacientes con COVID-19 / Guidelines of the Colombian College of Occupational Therapy for acute and subacute hospital care of patients with COVID-19 / Diretrizes do Colégio Colombiano de Terapia Ocupacional para atendimento hospitalar de pacientes com COVID-19 na fase aguda e subaguda

El amplio espectro clínico de la enfermedad COVID-19 tiene importantes implicaciones funcionales para el cuidado hospitalario agudo y subagudo en unidades de cuidado inten-sivo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colom-biano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales que participan en la rehabilitación tem-prana de pacientes con COVID-19 en Colombia. Se realizó una revisión de literatura sobre la clasificación y las manifestaciones clínicas de la enfermedad, la efectividad de la reha-bilitación temprana adulta, pediátrica y neonatal, y el rol y la experiencia de profesionales en Terapia Ocupacional en el uso de guías de salud existentes. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. Terapia Ocupacio-nal, como parte del equipo de rehabilitación temprana, juega un papel fundamental en la restauración y el mantenimiento de la independencia funcional; la adaptación del ambiente y el acondicionamiento holístico gradual de las funciones respiratorias, cardiovasculares, sensoriomotoras y cognitivas durante las actividades básicas cotidianas, y la prevención del deterioro físico, mental, espiritual y social de la persona hospitalizada y su familia. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupa-cional hospitalaria.(AU)

The broad clinical spectrum of COVID-19 disease has critical functional implications for acute and subacute hospital care in intensive care units. Faced with the health emergency triggered by this disease, the Colombian College of Occupational Therapy convened a group of professional experts in the area to provide guidelines for occupational therapists involved in the early rehabilitation of patients with COVID-19 in Colombia. A literature review was conducted on the classification and clinical manifestations of the disease, the effectiveness of early adult, pediatric and neonatal rehabilitation, and the occupational therapist's role and experience in the use of existing health guidelines. A consensus of experts determined the applicability of the guidelines to the Colombian context. Occu-pational Therapy, as part of the early rehabilitation team, plays a fundamental role in res-toring and maintaining functional independence, the adaptation of the environment and the gradual holistic conditioning of respiratory, cardiovascular, sensorimotor and cognitive functions during basic daily activities, and the prevention of physical, mental, spiritual and social deterioration of the hospitalized person and their family. These guidelines cons-titute a relevant technical and educational resource for hospital Occupational Therapy.(AU)

O amplo espectro clínico da doença COVID-19 tem implicações funcionais relevantes para os cuidados hospitalares agudos e subagudos em unidades de terapia intensiva. Diante da emergência sanitária desencadeada por esta doença, o Colégio Colombiano de Tera-pia Ocupacional reuniu um grupo de profissionais, especializados na área, para fornecer orientações aos terapeutas ocupacionais, envolvidos na reabilitação precoce de pacientes com COVID-19, na Colômbia. Foi realizada uma revisão da literatura sobre a classificação e as manifestações clínicas da doença, a eficácia da reabilitação adulta precoce, pediá-trica e neonatal, bem como o papel e experiência do terapeuta ocupacional no uso das diretrizes de saúde existentes. Um consenso de especialistas determinou a aplicabilidade das diretrizes ao contexto colombiano. A Terapia Ocupacional, como parte da equipe de reabilitação precoce, desempenha um papel fundamental na restauração e manutenção da independência funcional; a adaptação do meio ambiente e o condicionamento holístico gradual das funções respiratórias, cardiovasculares, sensório-motoras e cognitivas, durante as atividades diárias básicas; e a prevenção da deterioração física, mental, espiritual e so-cial da pessoa hospitalizada e sua família. Essas orientações constituem um recurso técnico e educacional relevante para a Terapia Ocupacional hospitalar.(AU)

Calidad de vida en personas con enfermedad renal crónica: una mirada desde terapia ocupacional / Quality of life in people with chronic renal disease: a look from occupational therapy

Objetivo: Realizar una revisión de la literatura entre el año 2007 y 2017 sobre la Enfermedad renal crónica y calidad de vida desde una mirada de Terapia Ocupacional a través de una perspectiva nacional e internacional.Material y métodos: Revisión sistemática en diferentes bases de datos, revistas sobre artículos internacionales y nacionales que cumplan con los requisitos de inclusión de palabras clave y estar dentro del rango seleccionado de año de publicación, para el posterior análisis. Resultados: De una muestra total de 206 artículos, fueron seleccionados 31 artículos que cumplían con todos los criterios de inclusión. Se evidencio que los estudios sobre enfermedad renal crónica y calidad de vida presentan diferentes variables como, el afrontamiento, factores emocionales, dependencia, costos de tratamientos, vida laboral y variables sociodemográficas. Se evidencia que el cuestionario SF-36 presenta mayor porcentaje de uso en las investigaciones. En los estudios de Terapia Ocupacional predomina la intervención directa, mientras, en psicología y medicina sobresalen de aplicación de instrumentos y análisis de resultados. Conclusiones: Existe gran cantidad de publicaciones sobre enfermedad renal crónica, en forma específica, sin embargo, sobre medición de la calidad de vida de las personas con esta enfermedad es reducida. Los profesionales con mayores publicaciones sobre enfermedad renal crónica relacionada con calidad de vida son enfermería, medicina y psicología, mientras, a nivel de terapia ocupacional se encontraron trabajos realizados por estudiantes de último año como trabajo de grado.

Aim: To conduct a review of the literature between 2007 and 2017 on chronic kidney disease and quality of life, from an occupational therapy perspective, through a national and international perspective. Material and methods: Systematic review in different databases, journals on international and national articles meeting inclusion criteria of key words and, additionally, being within the selected year of publication range, for further analysis. Results:From a total sample of 206 articles, 31 articles fulfilling all the inclusion criteria were selected. It was evidenced that the studies on chronic kidney disease and quality of life present different variables such as coping, emotional factors, dependency, treatment costs, work life and sociodemographic variables. It is evident that the SF-36 questionnaire presents a higher percentage of use in reserach. In occupational therapy studies, the direct intervention predominates, while in professions such as psychology and medicine they excel in the application of instruments and analisys of results Conclusions:There is a large number of publications specifically on chronic kidney disease; however, inquiry measuring the quality of life of people with chronic kidney disease is limited. Professions with more papers on chronic kidney disease related to quality of life are nursing, medicine and psychology. Those found in occupational therapy were performed by last-year students for their professional degree.

Occupation and health

Understanding and making visible the actions, activities or tasks that have a purpose or meaning in people's lives is one of the objectives of occupational therapy. This discipline also seeks to demonstrate which occupations actually cause a repairing effect, which increase motivation and which strengthen the immune system. The existing relationship between occupation and well-being is one of the aspects that help understanding human occupation. Case studies that allow expanding and consolidating the therapeutic evidence are also intended.

Terapia ocupacional en unidad de cuidados intensivos / Occupational Therapy in the Intensive Care Unit

Resumen Introducción. Desde su inicio, la terapia ocupacional ha actuado en ambientes intrahospitalarios. En la actualidad, una de las metas para la consolidación de campos de conocimiento, atención y prospectiva es profundizar en la intervención que realiza el respectivo profesional en la unidad de cuidados intensivos (UCI). Objetivo. Mostrar la evidencia científica de la intervención de terapia ocupacional en una UCI de adulto a través de una revisión bibliográfica entre el 2010 y 2015, durante la cual se analizaron las categorías de evaluación, modalidades de intervención y resultados. Materiales y métodos. Estudio de carácter investigativo mixto, el cual busca especificar las fuentes teóricas y prácticas que relacionan los términos de la investigación. Además, se realizó un proceso de análisis selectivo a partir de los intereses y la significancia. Resultados. La terapia ocupacional hace una caracterización de las actividades basándose en la movilización, cambios posicionales, actividades de la vida diaria, estimulación, ferulaje, tecnología de asistencia, entre otras; además trae beneficios como reducción de estancia, complicaciones y costos. Conclusión. Se evidencia la importancia del trabajo del terapeuta ocupacional en la UCI de adulto, pues beneficios como reducción de la estancia y mejora funcional de las personas, al momento del egreso, son claros en las investigaciones internacionales.

Abstract Introduction: Historically, occupational therapy has had an active role in the hospital environment. Today, one of its main goals for the consolidation of the fields of knowledge, care and future development is to strengthen the intervention of professionals in the intensive care unit (ICU). Objective: To expose scientific evidence related to the role of occupational therapy in an adult ICU by conducting a literature review of publications made between 2010 and 2015, in order to analyze the assessment and intervention categories. Materials and methods: Mixed research study, which seeks to specify the theoretical and practical sources related to the terms of the study. In addition, a selective analysis process was carried out based on interests and significance. Results: Occupational therapy characterizes activities based on mobilization, positional changes, activities of daily living, stimulation, feruling, and assistive technology, among others. It also brings benefits such as the reduction of in-hospital stay, complications and costs. Conclusion: The relevance of the work of occupational therapists in the adult ICU is evident since it brings benefits such as reduced stay and functional improvement of patients at discharge, which are clearly defined in different research works worldwide.

Health-related Quality of Life in Infants With Sickle Cell Disease.

Using historical cohorts of healthy, acutely ill, and chronically ill infants for comparison, we sought to determine whether infants with sickle cell disease (SCD) have impaired health-related quality of life (HRQL). We conducted a cross-sectional study at 2 sites: the Medical College of Wisconsin/Children's of Wisconsin and the University of Alabama School of Medicine/Children's of Alabama. Parents of 90 infants with SCD completed the PedsQL Infant Module corresponding to their infant's age (1 to 12 mo or 13 to 24 mo) during a regular clinic visit. At 1 to 12 months, infants with SCD displayed lower Physical HRQL than healthy infants, but better HRQL than chronically ill infants. By 13 to 24 months, infants with SCD had worse HRQL in all areas than healthy infants and worse Physical and Total HRQL than acutely ill infants. Compared with chronically ill infants in this age group, infants with SCD had similar Physical HRQL and better Psychosocial and Total HRQL. By 13 to 24 months, a greater proportion of infants with SCD had impaired Physical and Total HRQL compared with infants aged 1 to 12 months. All differences were significant at the (P<0.05) level. Impaired HRQL can be detected in infants with SCD.

El turismo, una opción de ocupación humana en la vejez / Tourism, an option of occupation in the old age

El ser humano es por naturaleza un ser ocupacional y busca durante toda su vida una armonía entre su actividad y el medio que lo rodea; el adulto mayor no es ajeno a este sentimiento, por lo que se plantea que las personas que se mantienen activas tendrán un mejor envejecimiento, estarán satisfechas con sus vidas y mejor adaptadas a su ambiente social. El objetivo de esta investigación fue establecer la incidencia del tiempo libre en la vejez y el soporte normativo sobre el tema, lo cual identifica al Turismo como una opción de ocupación; los diferentes conceptos sobre Tiempo libre, vejez y turismo también son señalados, además, de las implicaciones que tiene el turismo para el envejecimiento activo de la persona. Esta investigación es de carácter documental y para el desarrollo de la misma se efectúo una revisión de los últimos veinte años sobre las referencias de tipo teórico, normativo y conceptual. Esta información se orientó hacia el análisis de la relación existente entre el turismo y el adulto mayor bajo el modelo Ocupación-Persona-Contexto (Baum, Bass-Haugen y Christiansen, 2005).En los resultados existe una amplia normatividad que sustenta la actividad de turismo; éste puede ser concebido como una ocupación y analizado desde un modelo propio para Terapia Ocupacional. Así el turismo es entendido como una alternativa de actividad de tiempo libre para los y las adultos mayores.

Human being is by nature an occupational individual, and seeks during lifetime the harmony between his activity and the surrounding environment. The elderly is no stranger to this feeling, so it is suggested that people who are active, will have a better aging, will be satisfied with their lives and will be better adapted to their social environment. The objective of this research was to establish the importance of leisure time in old age, and the regulation about the subject, which identifies Tourism as an option for occupation. Different concepts of Leisure Time, Old age and Tourism are also marked, besides the implications of tourism for active aging person. This research is documentary, and its development is a review of the past 20 years on the theoretical, conceptual and normative references. This information was aimed to analyze the relationship between tourism and the elderly under the Occupation - Person - Context model (Baum, Bass- Haugen and Christiansen 2005).The results show a wide regulation that supports tourism, it can be conceived as an occupation and analyzed from an own model for Occupational Therapy. Therefore, tourism is understood as an alternative activity of leisure time for the elderly.

PedsQL™ Multidimensional Fatigue Scale in sickle cell disease: feasibility, reliability, and validity.

BACKGROUND: Sickle cell disease (SCD) is an inherited blood disorder characterized by a chronic hemolytic anemia that can contribute to fatigue and global cognitive impairment in patients. The study objective was to report on the feasibility, reliability, and validity of the PedsQL™ Multidimensional Fatigue Scale in SCD for pediatric patient self-report ages 5-18 years and parent proxy-report for ages 2-18 years. PROCEDURE: This was a cross-sectional multi-site study whereby 240 pediatric patients with SCD and 303 parents completed the 18-item PedsQL™ Multidimensional Fatigue Scale. Participants also completed the PedsQL™ 4.0 Generic Core Scales. RESULTS: The PedsQL™ Multidimensional Fatigue Scale evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.90; parent proxy-report α = 0.95), and acceptable reliability for the three individual scales (patient self-report α = 0.77-0.84; parent proxy-report α = 0.90-0.97). Intercorrelations of the PedsQL™ Multidimensional Fatigue Scale with the PedsQL™ Generic Core Scales were predominantly in the large (≥0.50) range, supporting construct validity. PedsQL™ Multidimensional Fatigue Scale Scores were significantly worse with large effects sizes (≥0.80) for patients with SCD than for a comparison sample of healthy children, supporting known-groups discriminant validity. Confirmatory factor analysis demonstrated an acceptable to excellent model fit in SCD. CONCLUSIONS: The PedsQL™ Multidimensional Fatigue Scale demonstrated acceptable to excellent measurement properties in SCD. The results demonstrate the relative severity of fatigue symptoms in pediatric patients with SCD, indicating the potential clinical utility of multidimensional assessment of fatigue in patients with SCD in clinical research and practice.

PedsQL™ sickle cell disease module: feasibility, reliability, and validity.

BACKGROUND: Sickle cell disease (SCD) is an inherited chronic disease that is characterized by complications such as recurrent painful vaso-occlusive events that require frequent hospitalizations and contribute to early mortality. The objective of the study was to report on the initial measurement properties of the new PedsQL™ SCD Module for pediatric patient self-report ages 5-18 years and parent proxy-report for ages 2-18 years. PROCEDURE: The 43-item PedsQL™ SCD Module was completed in a multisite study by 243 pediatric patients with SCD and 313 parents. Participants also completed the PedsQL™ 4.0 Generic Core Scales and PedsQL™ Multidimensional Fatigue Scale. RESULTS: The PedsQL™ SCD Module Scales evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.95; parent proxy-report α = 0.97), and good reliability for the nine individual scales (patient self-report α = 0.69-0.90; parent proxy-report α = 0.83-0.97). Intercorrelations with the PedsQL™ Generic Core Scales and PedsQL™ Multidimensional Fatigue Scales were medium (0.30) to large (0.50) range, supporting construct validity. PedsQL™ SCD Module Scale Scores were generally worse for patients with severe versus mild disease. Confirmatory factor analysis demonstrated an acceptable to excellent model fit. CONCLUSIONS: The PedsQL™ SCD Module demonstrated acceptable measurement properties. The PedsQL™ SCD Module may be utilized in the evaluation of SCD-specific health-related quality of life in clinical research and practice. In conjunction with the PedsQL™ Generic Core Scales and the PedsQL™ Multidimensional Fatigue Scale, the PedsQL™ SCD Module will facilitate the understanding of the health and well-being of children with SCD.

HLA-B27 and clinical features of acute anterior uveitis in Cuba.

BACKGROUND: There are few data about the epidemiology of acute anterior uveitis (AAU) from Latin America. In Cuba, the genetic admixture of the population could modify the HLA-B27-AAU association. In this study, the authors compared the distribution of the HLA-B27 allele in patients and controls and described some clinical outcomes. MATERIALS AND METHODS: The clinical features of patients were collected from their medical records. HLA-B27 genotyping was performed using the polymerase chain reaction. HLA-B27 allele distribution was compared between patients and controls. RESULTS: HLA-B27 allele was present in 55.4% of the patients and 0.87% of the controls. AAU HLA-B27 positivity was associated with males, frequent episodes, and a systemic disease. There is no difference in ocular complications between HLA-B27-positive and -negative patients. CONCLUSIONS: Results from this study are similar to data described in other countries. HLA-B27 allele distribution in controls is lower than other reports in Caucasian populations.

Development of the PedsQL™ Sickle Cell Disease Module items: qualitative methods.

PURPOSE: The objective of this qualitative study was to develop the items and support the content validity of the PedsQL™ Sickle Cell Disease Module for pediatric patients with sickle cell disease (SCD). METHODS: The iterative process included multiphase qualitative methodology. A literature review on SCD was conducted to generate domains of interest for the individual in-depth interviews. Ten healthcare experts with clinical experience in SCD participated in the development of the conceptual framework. A total of 13 pediatric patients with SCD ages 5-18 and 18 parents of patients ages 2-18 participated in the individual in-depth interviews. A total of 33 pediatric patients with SCD ages 5-18 and 39 parents of patients ages 2-18 participated in individually conducted cognitive interviews that included both think aloud and cognitive debriefing techniques to assess the interpretability and readability of the item stems. RESULTS: Six domains were derived from the qualitative methods involving patient/parent interviews and expert opinion, with content saturation achieved, resulting in 48 items. The six domains consisted of items measuring Pain Intensity/Location (9 items), Pain Interference (11 items), Worry (7 items), Emotions (3 items), Disease Symptoms/Treatment, (12 items), and Communication (6 items). CONCLUSIONS: Qualitative methods involving pediatric patients and parents in the item development process support the content validity for the PedsQL™ SCD Module. The PedsQL™ SCD Module is now undergoing national multisite field testing for the psychometric validation phase of instrument development.

Off-season physiological profiles of elite National Collegiate Athletic Association Division III male soccer players.

The purpose of this study was to develop a profile of soccer-related fitness parameters on elite National Collegiate Athletic Association (NCAA) Division III male soccer players during the off-season. Sixteen underclassmen from a recent NCAA Division III national championship soccer team completed a series of tests across 3 separate occasions over a 15-day period, with adequate recovery time between sessions to eliminate any carryover effect. Physiological parameters measured included aerobic endurance, anaerobic power and capacity, jumping power, agility, hamstring flexibility, and body composition. Descriptive statistics such as the mean (±SD) and range were calculated for each test. Two-tailed Pearson correlations were run to determine significant relationships that existed between variables. Test results were T-Tests (9.9 ± 0.4), Active Knee Extension degrees (-34.2 ± 11.9 right, -34.0 ± 13.9 left), vertical jump (61.8 ± 7.2 cm), percent fat (5.6 ± 1.6), Progressive Aerobic Cardiovascular Endurance Run (PACER) laps (113.2 ± 12.3), estimated VO2max (53.6 ± 2.9 ml · kg(-1) · min(-1)), Wingate peak (802.7 ± 155.6 W), Wingate peak (10.9 ± 1.2 W · kg(-1)), Wingate mean (651.2 ± 101.6 W), Wingate mean (8.9 ± 0.6 W · kg), and Wingate fatigue rate (35.9 ± 8.4%). Strong correlations existed between PACER laps and percent fat, between peak W and peak W · kg(-1), and between peak W and fatigue rate. These results suggest that elite Division III soccer players maintain relatively high fitness levels during the off-season. Additionally, they provide coaches with preliminary norms that can be used to determine off-season training expectations and adjust programs accordingly for their athletes.

Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors.

OBJECTIVE: Because asthma disproportionately affects minorities, we evaluated the effects of parent mentors (PMs) on asthma outcomes in minority children. METHODS: This randomized, controlled trial allocated minority asthmatic children to the PM intervention or traditional asthma care. Intervention families were assigned PMs (experienced parents of asthmatic children who received specialized training). PMs met monthly with children and families at community sites, phoned parents monthly, and made home visits. Ten asthma outcomes and costs were monitored for 1 year. Outcomes were examined by using both intention-to-treat analyses and stratified analyses for high participants (attending >or=25% of community meetings and completing >or=50% of PM phone interactions). RESULTS: Patients were randomly assigned to PMs (n = 112) or the control group (n = 108). In intention-to-treat analyses, intervention but not control children experienced significantly reduced rapid-breathing episodes, asthma exacerbations, and emergency department (ED) visits. High participants (but not controls or low participants) experienced significantly reduced wheezing, asthma exacerbations, and ED visits and improved parental efficacy in knowing when breathing problems are controllable at home. Mean reductions in missed parental work days were greater for high participants than controls. The average monthly cost per patient for the PM program was $60.42, and net savings of $46.16 for high participants. CONCLUSIONS: For asthmatic minority children, PMs can reduce wheezing, asthma exacerbations, ED visits, and missed parental work days while improving parental self-efficacy. These outcomes are achieved at a reasonable cost and with net cost savings for high participants. PMs may be a promising, cost-effective means for reducing childhood asthma disparities.

Urban minority children with asthma: substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care.

BACKGROUND: Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children. OBJECTIVE: To examine asthma morbidity and access to specialty care in urban minority children. METHODS: A consecutive series was recruited in 2004-2007 of urban minority children 2 to 18 years old seen for asthma in four emergency departments (EDs) or admitted to a children's hospital. Outcomes assessed included asthma symptom and attack frequency; missed school and parental work; asthma ED visits and hospitalizations; severity of illness; and asthma specialty care. RESULTS: Of 648 children assessed, 220 were eligible. The mean age was 7 years; 68% were poor, 83% had Medicaid, 84% were African-American, and 16% were Latino. Sixty-eight percent of children were not in excellent/very good health, 73% had persistent asthma (moderate/severe = 52%), and only 44% had asthma care plans. The mean number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms, is 12 and 12, respectively. The mean annual number of asthma doctor visits was 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 7; and missed parent work days, 6. Eighty-three percent of children have no asthma specialist, and 62% use EDs as the usual asthma care source. Poor children were less likely than the non-poor to have asthma specialists (13 vs. 26%; p < 0.03). African-Americans were more likely than Latinos to use EDs for usual asthma care (68% vs. 44%; p < 0.01). In multivariable analyses, poverty was associated with greater odds and having an asthma care plan with lower odds of an asthma attack in the past year; poverty also was associated with half the odds of having an asthma specialist. African-American children were significantly more likely to report the ED as the usual source of asthma care, and having an asthma specialist and male gender were associated with greater odds of having an asthma care plan. CONCLUSIONS: Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans.

Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation.

CONTEXT/OBJECTIVES: We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs. METHODS: Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services. RESULTS: Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would be beneficial, by reducing costs, adding interpreters, meeting population growth, and improving communication. CONCLUSIONS: Most NJ hospitals have no full-time interpreters, interpreter services department, or staff training on working with interpreters, and deficiencies exist in hospital signage and translation services. Most NJ hospitals stated third-party reimbursement for interpreter services would be beneficial.

El consentimiento informado en rehabilitación / The informed consent in rehabilitation

El término de consentimiento informado es algo realmente novedoso; trata de ser un parámetro de medición de la calidad ética de las relaciones clínicas de la actividad asistencial e investigativa; este ensayo propone en forma general cómo cada profesional de rehabilitación que inicia una intervención terapéutica debe tener en cuenta los derechos y deberes de la persona con discapacidad. El consentimiento Informado se ha convertido en un elemento fundamental de la regulación legal y ética. Las observaciones clínicas indican que el Consentimiento Informado se convierte a menudo en un mero trámite ya que se les presenta a los pacientes una información compleja que no puede comprender y que por ello tiene poco repercusión en el proceso de toma de decisiones; lo importante es la participación activa de la persona con discapacidad en el proceso de la rehabilitación desde el principio hasta el final.