The Spiritual Aspect of Pain: An Integrative Review.

Pain is an unpleasant sensory and emotional experience that affects individuals in various ways involving biological, psychological, social, and spiritual aspects. There is currently no comprehensive treatment that effectively addresses all aspects of pain. This integrative review aimed to analyze the spiritual aspect of pain relief. Following the specified methodological criteria, a total of 20 articles were selected. There evidenced a lack of spiritual care provided by healthcare professionals, even though its correlation with pain and its potential benefits have been widely demonstrated in the literature. Fortunately, some patients put into practice existential and religious tools to self-control and cope with their pain, although not always with a successful response.

Dosage of Physical Activity to Avoid Impairment of Activities Due to Pain: Analysis of Population-based Conditional Processes.

BACKGROUND: Physical activity's established health benefits include pain control, yet there is no consensus on the required dosage according to the literature. AIM: To test the influence of exercise on perceived health in patients whose daily activities are limited due to pain. Besides, analyze the possible moderating effect of age and find a formula for exercise dosage based on the perceived level of health. METHODS: Cross-sectional study based on the 2017 Spanish National Health Survey with 4,123 participants reporting activity limitations in their daily activities due to pain. The International Physical Activity Questionnaire (short version) was used to calculate energy expenditure. Data included age, sex, leisure-time physical activity, sitting time, pain-related impairments, pain medication, and perceived health. Mediation regression analysis was conducted using the SPSS PROCESS 4.0 macro. RESULTS: Results indicate a decline in perceived health with age. The relationship between exercise (energy expenditure) and perceived health was highly significant (d=-0.224, p<0.001). Age moderated the association between pain and energy expenditure up to 75.61 years (0.1568, p=0.05) and between energy expenditure and perceived health up to 75.74 years (-0.289, p=0.05), but this effect diminished afterwards. A formula was developed to estimate energy expenditure based on the desired level of health. CONCLUSIONS: The perception of health in people who are limited in their daily activities due to pain (moderate to very much) is mediated by the amount of physical activity they perform. Besides, this perception is moderated by age, up to 76 years.

Spiritual needs during COVID 19 pandemic in the perceptions of Spanish emergency critical care health professionals.

OBJECTIVES: To investigate the perceptions and attitudes of health professionals working in emergency services and critical care units in Spain about spiritual care provided during the COVID-19 pandemic. METHODS: A qualitative investigation was carried out using in-depth interviews. SETTING: Emergency and emergency and ICU health professionals from different regions of Spain. FINDINGS: The sample consisted of 47 nursing and one nursing assistant. The qualitative analysis yielded four main themes that reflect the following categories: "the experience with spirituality in clinical practice"; "resources and barriers to provide spiritual care"; "the COVID pandemic and spiritual care" and "training in spiritual care". In addition, two subdeliveries were also obtained: "ethical dilemma" and "rituals of death". CONCLUSIONS: The majority of emergency and critical care nurses believe spiritual care is important to their clinical practice, but there are still several barriers to address patients' spiritual needs. During the COVID-19 pandemic in Spain, professionals felt that spiritual beliefs have emerged as important needs of patients and the restrictions imposed by the pandemic made health professionals more exposed to ethical dilemmas and end-of-life religious issues. The general impression of health professionals is that more training and resources are needed on this topic. IMPLICATIONS FOR CLINICAL PRACTICE: Health professionals in emergency intensive care must provide nursing care that meets the spiritual needs of their patients to improve care in crisis situations such as the one suffered by the COVID-19 pandemic. For this, emergency services professionals must work and participate in the development of measures to overcome certain barriers present in emergency services, such as lack of time, lack of training and misconceptions that make it difficult to approach emergency services these needs.

Spiritual Dimension in Neurological and Neurodegenerative Diseases: A Systematic Mapping Review.

Previous studies have shown the benefits of spirituality/religiosity with regard to health and quality of life for people. The high prevalence of neurological disorders, which are the main diseases that cause disability and dependency around the world, makes neurological disorders especially relevant. This systematic mapping review aimed to map the knowledge of spirituality experienced by people with neurological/neurodegenerative disorders and its influence on outcomes and the ability to cope with the disease. Following specified methodological criteria, a total of 13 articles were selected. The spiritual dimension should be considered a fundamental component of the quality of life and well-being of neurological patients as it can significantly influence their ability to cope with their disease.

The efficacy of religious and spiritual interventions in nursing care to promote mental, physical and spiritual health: A systematic review and meta-analysis.

BACKGROUND: Spiritual interventions have proved to alleviate suffering, help the patient to prepare for end of life issues, improve quality of life, and well-being. OBJECTIVE: This study aims to investigate the efficacy of religious and spiritual interventions in nursing care to promote mental, physical and spiritual health as compared to control groups not receiving such care. METHODS: This is a systematic review and meta-analysis of clinical trials from SCOPUS, PUBMED, Web of Science and CINAHL databases. The searches were carried out between May and July 2020 without restrictions concerning the date of publication. Peer-reviewed articles published in English, Portuguese or Spanish, focusing on nurses were included. This study followed the PRISMA guidelines. In addition, the CONSORT and The Cochrane Collaborations tool for assessing risk of bias were followed. RESULTS: The search process identified 1308 publications, 18 randomized controlled trials were included for the systematic review and 9 for the meta-analysis. The meta-analyses revealed that spiritual interventions were associated with lower mental health symptoms (SMD = -6.91 [-9.83,-3.98], p < 0.001, I2 = 99 %), greater well-being (SMD = 1.26 [0.58, 1.93], p < 0.001, I2 = 94 %) and higher levels of spirituality (SMD = 0.48 [0.29, 0.67], p < 0.001, I2 = 31 %) as compared to individuals in the control group. CONCLUSIONS: Spiritual interventions seem to be effective to promote health, as seen for mental health, spirituality, well-being and physical outcomes. Nevertheless, more than half of the studies have a high risk of bias in any of the dimensions evaluated and there is an important heterogeneity among interventions and outcomes. This is particularly important to nurses and nurse managers who want to provide a holistic care to their patients.

The Role of Spirituality and Religiosity in Healthcare During the COVID-19 Pandemic: An Integrative Review of the Scientific Literature.

The pandemic caused by the new coronavirus SARS-CoV-2 has been affecting populations globally since the end of 2019. Previous studies have indicated that spirituality in these times of crisis serves as a source of hope and well-being that helps people get through the day. This study investigated the role of spirituality and religiosity in healthcare during the COVID-19 pandemic. An integrative review of the scientific literature available on PubMed, Scopus, and Web of Science databases and a review of the gray literature in the Information System on Gray Literature in Europe (OpenGrey) were carried out. From a total of 1,338 articles searched; 25 articles were included in this review (22 quantitative observational, 2 qualitative and one randomized controlled trial). Our findings revealed the importance of including spirituality in clinical practice for both health professionals and patients. On the one hand, spirituality can be considered a good coping strategy used by healthcare professionals to promote mental health and well-being during the COVID-19 pandemic and resulting in greater patient satisfaction with the care given. On the other hand, addressing spiritual needs of individuals leads to a reduction in stress, anxiety, depression, and an increase in resilience and hope among patients.

The Use of Spiritual and Religious Interventions for the Treatment for Insomnia: A Scoping Review.

Insomnia is a common problem, affecting individuals' health and quality of life. Among several therapies used to treat this condition, spiritual interventions are suggested to have beneficial outcomes on sleep disturbances. Nevertheless, a systematic compilation of the evidence available is still needed in the literature in order to scientifically investigate the topic. To examine the most common spiritual interventions proposed to treat sleep disorders and to assess the scientific evidence of these interventions. This is a scoping literature review conducted by independent researchers on the following databases: PubMed, SCOPUS, Web of Science, Cochrane Library and OpenGrey. A boolean expression was used, and all studies published in the last 5 years investigating the role of spiritual or religious interventions on insomnia were included. From a total of 3257 articles retrieved in our search, ten studies were included in the final analysis. There is a wide array of techniques used to treat insomnia or the mental disorders associated with insomnia, such as mantra, yoga, mindfulness, praying/meditation, daily spiritual experiences, psycho-religious training and intervention. The included studies showed a positive influence of spiritual/religious interventions on insomnia directly and indirectly. However, there is a scarcity of clinical trials and most studies have small sample sizes and used only subjective measures, resulting in a low evidence. The results of the present review point to a promising role of spirituality and religion on better sleep outcomes, particularly in the improvement in insomnia. However, the heterogeneity and the quality of these studies suggest caution while interpreting these findings. More clinical trials are needed in this area to provide a recommendation of these methods in clinical practice.

Burnout and spirituality among nurses: A scoping review.

OBJECTIVE: To investigate the relationship between spirituality / religiousness and Burnout Syndrome in nurses, as well as to examine the current evidence for spiritual/religious interventions to alleviate their symptoms. DATA SOURCES: A scoping review was conducted using CINAHL, SCOPUS, Web of Science, Pubmed databases, and grey literature, between January and July 2020. STUDY SELECTION: Two researchers performed the searches with a 95% agreement rate for the inclusion and exclusion of the studies. Both quantitative and qualitative studies published in peer-reviewed journals, using Spanish, Portuguese or English language were included. Restriction on publication date was not applied. DATA EXTRACTION: A total of 1143 articles were identified and 18 were included in the final analysis. Quality assessment was performed, following CONSORT, STROBE, PRISMA and COREQ guidelines. Finally, the following data were extracted: authors, year, country, study design and sample characteristics, purpose of the study, and major findings. DATA SYNTHESIS: The results of the present review show that spirituality / religiousness is a common strategy used by nurses when coping with stress and burnout. Most studies reveal that spiritual and religious beliefs are correlated with lower levels of burnout, exhaustion and depersonalization in different settings. Nevertheless, two studies have not found any relationship and one study has found worse outcomes. CONCLUSIONS: There is a lack of experimental studies trying to examine if spiritual interventions could modify burnout levels in clinical practice. Health managers should be aware of the spirituality / religiousness of their nurses and provide the appropriate spiritual support.

Health Problems and the Use of Medications and Traditional Therapies among Chinese Immigrants Living in Spain.

In this study, we investigate the health problems and the use of medications and traditional therapies among Chinese immigrants in the Southern region of Spain. A qualitative study using semi-structured interviews and including 133 immigrants and 7 stakeholders was conducted in 2017. Transcription, literal reading, and theoretical categorization were performed, and a narrative content analysis was carried out. The most common health problems were musculoskeletal (28.6%) and allergies (25.6%) related to work activity and unhealthy lifestyles. Key informants also reported gastric problems, stress, and changes in eating habits, mostly related to their work activity. For these problems, a large number of traditional remedies (herbs, diet therapy, acupuncture, vitamins, etc.) were used, usually combined with pharmaceutical drugs used for colds, flu, general malaise (29%), pain and fever (23%), and allergy drugs (9.2%). Chinese immigrants reported health conditions associated with their working conditions and life habits in Spain, using Traditional Chinese Medicine instead of pharmacological drugs. Understanding these health problems and promoting awareness towards traditional therapies in the healthcare system may help to design public policies and Health Promotion strategies targeting this group.

Acculturation, Health Behaviors, and Social Relations among Chinese Immigrants Living in Spain.

This study aims to identify acculturation experiences about social relations and health behaviors of first-generation Chinese immigrants in the South of Spain, including food patterns, physical exercise, and tobacco and alcohol use. A phenomenological qualitative study was conducted using semi-structured interviews, informal conversations, and field notes. All data were analyzed under the Berry's Model of Acculturation. A total of 133 Chinese immigrants were included. Our findings show that separation was the dominant acculturation strategy, followed by integration and assimilation, while marginalization was not present in this immigrant population. Most of the immigrant population maintains a link to the customs of their home country, favoring the process of identity and collective self-esteem. These results can help health managers and the government to further understand Chinese immigrants in Europe and to establish appropriate health interventions to this group.

The effectiveness of spiritual interventions in the workplace for work-related health outcomes: A systematic review and meta-analysis.

AIM: To investigate the effectiveness of spiritual interventions in the workplace for different health outcomes through the use of a meta-analysis of randomized controlled trials. BACKGROUND: Most studies including spirituality in the workplace investigated it at the organisational/business level, while giving a secondary value to the well-being and quality of life of the workers. METHODS: Systematic review and meta-analysis carried out on the following databases: SCOPUS, PubMed and Web of Science. Spiritual interventions investigating work-related health outcomes were included. Then, meta-analyses were conducted. RESULTS: From a total of 2,832 studies, 7 articles were included in the systematic review and 6 in the meta-analysis. Spiritual interventions, as compared to controls, improved the health outcomes of the workers (standard mean difference (SMD), -1.42; 95% CI, -1.98, -0.86; p < .001; I2  = 96%). Subanalyses revealed that yoga was an effective intervention and that stress was reduced by these interventions. CONCLUSION: Spiritual interventions in the workplace seem to be effective in improving workers' health. Nevertheless, the high heterogeneity and limited number of studies may hinder more robust conclusions at the moment. IMPLICATIONS FOR NURSING MANAGEMENT: The use of spiritual interventions should be considered in workplaces in order to reduce the stress and other negative outcomes.

Food Patterns among Chinese Immigrants Living in the South of Spain.

This article aims to explore the food patterns of Chinese immigrants living in Spain and to understand the factors associated with these behaviors. This qualitative ethnographic study included 133 Chinese immigrants; using interviews with scripts were based on the National Health Survey of Spain. Three categories were defined: "Differences between Chinese food and Western food"; "Products and dishes consumed by Chinese immigrants" and "Modification of eating habits". Participants found a remarkable difference between eastern (i.e., vegetables and rice) and western (i.e., dairy, high-fat, bread) foods. They also experienced a change in their eating habits, mostly related to acculturation and lack of time. Chinese immigrants have different eating patterns as compared to the native population in Spain and this information could help in future healthcare strategies. Knowing the food culture could infer aspects, such as insertion or integration, and promoting health and well-being.

"Looking for Better (Job) Opportunities": A Qualitative Analysis of the Occupational Health of Immigrants in Southern Spain.

BACKGROUND: Spain hosts the fourth largest number of immigrants in Europe, resulting in a large proportion of migrant workers. To date, few studies have examined the working conditions of immigrants in Southern Spain who are known to be at risk for adverse working conditions. This study aimed to investigate the patterns of work and working conditions of immigrants living in southern Spain and to understand how these factors may affect their health. METHODS: A qualitative study using semi-structured interviews was conducted throughout 2019 and included 93 immigrants. Transcription, literal reading, and theoretical categorization were performed and a narrative content analysis was carried out. RESULTS: Three themes emerged on working conditions of this study population, including social and labor-related characteristics, working conditions, and occupational health issues. Four employment sectors were most commonly occupied by these immigrants, including caregiving and food service for women and agriculture and construction for men. Most immigrants were from Latin America, unemployed or working part-time jobs, and not hired under an employment contract. Most worked in low-qualified jobs, and were exposed to occupational hazards such as falls from heights, manual handling of materials, and psychological strain. The lack of training on occupational risk prevention and labor rights was related to a low identification of work situations having a negative impact on the health of immigrants. CONCLUSIONS/APPLICATION TO PRACTICE: These findings should be taken into account by the government and public health managers to provide better assistance to immigrant workers in Europe.

The Occupational Health of Female Immigrant Caregivers: A Qualitative Approach.

In general, immigrants suffer poor working conditions. This is particularly true in the case of women, who constitute 48% of international migrants, and these poor conditions are closely linked to the sectors they mainly occupy, such as domestic and care-giving services. The aim of the present study was to investigate the working conditions of the female immigrant population living in southern Spain and how these conditions may affect their health. A qualitative study using semi-structured interviews and discussion groups was conducted over one year in 2019, with 61 immigrant women recruited. The sectors occupied by immigrant women were caregiving for dependent people and domestic services. Most of the female immigrants interviewed were working (63.94%), although the majority were employed in an irregular situation, with a very long working day. Among the main risks identified were biological risks, physical attacks, falls, wounds and musculoskeletal complaints related to handling patients and carrying out household chores. Most of them had not taken an occupational health test and did not report accidents occurring in the workplace for fear of losing their jobs. The main health problems were related to physical and mental health (such as musculoskeletal diseases and stress). These findings highlight the importance of making a major change in our perspective regarding the social value of including immigrant women in the labour market and the different aspects related to their health.

Healthcare and Health Problems from the Perspective of Indigenous Population of the Peruvian Amazon: A Qualitative Study.

Indigenous communities usually experience higher levels of mortality and poorer access to healthcare services compared to non-indigenous communities. This study aims to understand the most prevalent health problems and their treatment in the Asháninka indigenous communities of the Peruvian Amazon. We conducted an ethnographic study in order to explore the perceived health problems, the use of traditional medicine and the resources offered by the official Peruvian healthcare system. Field notes and semi-structured interviews were used. A total of 16 indigenous and four non-indigenous people were interviewed, and interpretative analysis was used to identify themes. The Asháninka community is an overlooked population, which, due to distance restrictions, misconceptions and ethnical disparities, is far away from an appropriate healthcare system and is subjected to acute medical conditions such as infections and gastrointestinal problems. This group tends to seek traditional medicine, mostly herbal medications and traditional healers. The use of a health professional is seen as a last resort. Although the official Peruvian health system incorporates community participation strategies to improve the healthcare of indigenous people, the shortage of material, human resources and cultural sensitivity makes this difficult. Healthcare strategies should be devised and implemented in order to minimize health inequality in this population.

Insomnia Interventions in the Workplace: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to identify and evaluate the impact of interventions to improve or reduce insomnia in the workforce through randomized clinical trials. Following the recommendations of the PRISMA and MARS statement, a systematic literature search was carried out on the PubMed, Web of Science, CINHAL, and PsycINFO databases, with no restrictions on the language or publication date. For the meta-analysis, a random-effects model and the Insomnia Severity Index were used as outcome measures. To assess the risk of bias and the quality of evidence, the Cochrane Collaboration tool and the GRADE method were used, respectively. Twenty-two studies were included in the systematic review and 12 studies in the meta-analysis, making a total of 14 intervention groups with a sample of 827 workers. Cognitive behavioral therapy was the most widely used intervention. According to the estimated difference between the means, a moderate effect for the reduction of insomnia symptoms after the intervention (MD -2.08, CI 95%: [-2.68, -1.47]) and a non-significant degree of heterogeneity were obtained (p = 0.64; I2 = 0%). The quality of the evidence and the risk of bias were moderate. The results suggest that interventions on insomnia in the workplace are effective for improving workers' health, and that improvements in the quality of sleep and a decrease in the symptoms of insomnia are produced, thanks to an increase in weekly sleeping hours and a reduction in latency at sleep onset. As regards work, they also led to improvements in productivity, presenteeism, and job burnout.

[Turnicity as a determining factor in the occurrence of insomnia in the working population: a systematic review.] / La turnicidad como factor determinante en la aparición de insomnio en población laboral: revisión sistemática.

BACKGROUND: Insomnia is the most frequent sleep disorder in the adult population with a prevalence of around 30% being responsible for the deterioration in the quality of life. At work level, shift work is the main risk factor associated with the onset of insomnia. Despite its clinical relevance, it usually goes unnoticed by healthcare professionals due to lack of time, resources or information. The aim of this study was to analyze the influence of shift work in the occurrence of insomnia in the working population. METHODS: Systematic review following the PRISMA statement. A bibliographic search using the DeCS terms "Insomnia", "Occupational Health" and "Shift Work" was carried out in the Pubmed, Scopus, Web of Science and CINAHL databases, as well as in other sources such as the base of doctoral thesis data (TESEO). Articles published until November 2019 in English and Spanish were included. The methodological quality was evaluated through the CONSORT and STROBE guides. RESULTS: 13 studies that met the inclusion criteria were included. The methodological quality of the articles was high (STROBE: 18/22, CONSORT: 20/25). Based on the selected records, a prevalence of insomnia related to turnicity between 25% and 53% was identified. The duration and rotation of the shifts work influenced the onset of insomnia, with 12-hour shifts or fast and forward rotation systems being more beneficial. Other factors such as stress, anxiety, perceived health, healthy lifestyles and toxic habits, workplace accidents, fatigue or workload level were analyzed together with the turnicity. CONCLUSIONS: Insomnia influenced by turnicity is a public health problem worldwide that affects the quality of personal and work life. The characteristics and the context in which the work takes place in shifts, sometimes together with other factors, influence this affectation.

OBJETIVO: El insomnio es el trastorno del sueño más frecuente en la población adulta, con una prevalencia de alrededor del 30%, siendo responsable del deterioro en la calidad de vida. A nivel laboral, el trabajo a turnos es el principal factor de riesgo asociado en la aparición del insomnio. A pesar de su relevancia clínica, suele pasar inadvertido para los profesionales sanitarios debido a falta de tiempo, recursos o información. El objetivo de este estudio fue analizar la influencia del trabajo a turnos en la aparición de insomnio en la población laboral. METODOS: Se efectuó una revisión sistemática siguiendo la declaración PRISMA. Se realizó una búsqueda bibliográfica, utilizando los términos DeCS "Insomnia", "Occupational Health" y "Shift Work", en las bases de datos Pubmed, Scopus, Web of Science y CINAHL, así como en otras fuentes como la base de datos de tesis doctorales (TESEO). Se incluyeron artículos publicados hasta noviembre de 2019, tanto en ingles como en castellano. La calidad metodológica se evalúo por medio de las guías CONSORT y STROBE. RESULTADOS: Se incluyeron 13 estudios que cumplieron los criterios de inclusión. La calidad metodológica de los artículos fue alta (STROBE: 18/22, CONSORT: 20/25). En base a los registros seleccionados, se identificó una prevalencia para el insomnio relacionada con la turnicidad entre el 25% y el 53%. La duración y la rotación de los turnos influyeron en la aparición del insomnio, siendo mas beneficiosos los turnos de 12 horas o con sistemas de rotaciones rápidas y hacia adelante. Junto a la turnicidad se analizaron otros factores como el estrés, la ansiedad, la salud percibida, los estilos de vida saludable y hábitos tóxicos, la siniestralidad laboral, la fatiga o el nivel de carga laboral. CONCLUSIONES: El insomnio influenciado por la turnicidad es un problema de salud pública a nivel mundial que afecta a la calidad de vida personal y laboral. Las características y el contexto en el que se desarrolla el trabajo a turnos, a veces juntos a otros factores, influyen en dicha afectación.

Development and Validation of the Operational Definitions of the Defining Characteristics of the Nursing Diagnosis of Insomnia in the Occupational Health Setting.

PURPOSE: To develop and validate the operational definition (ODs) for each defining characteristic (DC) contained in the Nursing Diagnosis (ND) "insomnia" (00095) in the occupational health context. METHODS: Methodological study carried out in two stages, including a consensus of experts to develop the ODs (Stage 1) and an online Delphi panel, performed in two rounds, to validate them (Stage 2). FINDINGS: The 15 ODs proposed in Stage 1 were narrowed down to six validated ODs in the first round (diagnostic content validity index [DCVI] = 0.80-0.89). In the second round, five ODs were validated (DCVI = 0.80-0.94). Finally, the remaining four ODs were validated by the general consensus of experts. CONCLUSIONS: The ODs were validated, although there remains some doubt as to whether some of the DCs can be applied to the field of occupational health. IMPLICATIONS FOR NURSING PRACTICE: The ODs developed and validated could improve the diagnostic accuracy of the ND "insomnia" (00095) in the context of occupational health.

Cultura y espiritualidad en la vivencia del cáncer de mama y la mastectomía / Culture and spirituality in the experience of breast cancer and mastectomy / Cultura e espiritualidade na experiência do câncer de mama e mastectomía

INTRODUCCIÓN: Las cada vez más crecientes cifras de cáncer de mama, la alta supervivencia y la diversidad cultural y religioso-espiritual actual hacen que en la vivencia de esta patología confluyan una gran cantidad de factores que deben ser considerados. OBJETIVO: Conocer la influencia de los elementos culturales en la vivencia del cáncer de mama y la mastectomía. METODOLOGÍA: Revisión integradora en bases de datos nacionales e internacionales de bibliografía científica publicada entre 2006 y 2018. RESULTADOS: Los principales hallazgos identificados fueron los aspectos emocionales y sexuales, y su influencia en la vivencia del cáncer de mama/mastectomía , los factores sociales y culturales estresantes en la mujer con cáncer de mama/mastectomía y los mecanismos de adaptación al cáncer de mama en relación a su cultura Respecto a los dos primeros hallazgos, se evidencia pérdida de la feminidad, autoestima y percepción negativa de la imagen corporal así como un descenso de la satisfacción, la funcionalidad sexual y la libido. También temor a la recaída y al cambio de rol familiar en países como Jordania, Líbano y en la cultura afroamericana. En cuanto a los mecanismos de adaptación, la enfermedad es entendida desde lo espiritual como voluntad de Dios en culturas imperantes en Indonesia, Jordania y Hawái, aunque, por el contrario, mujeres en Bahréin conciben el cáncer como un castigo o un mal de ojo. CONCLUSIÓN: Existe la necesidad de prestar una atención más especializada atendiendo aspectos emocionales y sobre la sexualidad, actuando sobre conciencia social para evitar el estigma que padecen y valorando el significado de la enfermedad y las estrategias espirituales de afrontamiento llevadas a cabo. Estudios futuros podrían profundizar en el abordaje culturalmente competente de esta patología

INTRODUCTION: The increasing numbers of breast cancer, the high survival and the current cultural and religious- spiritual diversity make a large number of factors that must be considered in the experience of this pathology. OBJECTIVE: To know the influence of cultural elements in the experience of breast cancer and mastectomy. METHODOLOGY: Integrative review in national and international databases of scientific literature published between 2006 and 2018. RESULTS: The main findings identified were the emotional and sexual aspects, and their influence on the experience of breast cancer / mastectomy, stressful social and cultural factors in women with breast cancer / mastectomy and the mechanisms of adaptation to breast cancer in relation to its culture Regarding the first two findings, there is evidence of loss of femininity, self- esteem and negative perception of body image as well as a decrease in satisfaction, sexual functionality and libido. Also fear of relapse and family role change in countries such as Jordan, Lebanon and in African-American culture. As for the mechanisms of adaptation, the disease is understood from the spiritual as God's will in prevailing cultures in Indonesia, Jordan and Hawaii, although, on the contrary, women in Bahrain conceive of cancer as a punishment or an evil eye. CONCLUSION: There is a need to pay more specialized attention attending to emotional and sexual aspects, acting on social awareness to avoid the stigma they suffer and assessing the meaning of the disease and the spiritual coping strategies carried out. Future studies could deepen the culturally competent approach to this pathology

INTRODUÇÃO: O crescente número de câncer de mama, a alta sobrevivência e a atual diversidade cultural e religiosa- espiritual constituem um grande número defatores que devem ser considerados na experiênciadessa patología. OBJETIVO: Conhecer a influência de elementos culturais na experiência do câncer de mama e mastectomia. METODOLOGIA: Revisão integradora em bancos de dados nacionais e internacionais da literatura científica publicados entre 2006 e 2018. RESULTADOS: Os principais achados identificados foram os aspectos emocionais e sexuais, e sua influência na experiência do câncer de mama / mastectomia, fatores sociais e culturais estressantes em mulheres com câncer de mama / mastectomia e os mecanismos de adaptação ao câncer de mama em relação à à sua cultura Em relação aos dois primeiros achados, há evidências de perda de feminilidade, auto-estima e percepção negativa da imagem corporal, além de diminuição da satisfação, funcionalidade sexual e libido. Também o medo de recaídas e mudanças no papel da família em países como Jordânia, Líbano e na cultura afro-americana. Quanto aos mecanismos de adaptação, a doença é entendida do ponto de vista espiritual como vontade de Deus nas culturas predominantes na Indonésia, Jordânia e Havaí, embora, pelo contrário, as mulheres no Bahrein concebam o câncer como um castigo ou um mau- olhado. CONCLUSÃO: É necessário prestar uma atenção mais especializada, atendendo aos aspectos emocionais e sexuais, agindo com consciência social para evitar o estigma que sofrem e avaliando o significado da doença e as estratégias de enfrentamento espiritual realizadas.Estudos futuros poderão aprofundar a abordagem culturalmente competente para essa patología

La turnicidad como factor determinante en la aparición de insomnio en población laboral: revisión sistemática / Turnicity as a determining factor in the occurrence of insomnia in the working population: a systematic review

OBJETIVO: El insomnio es el trastorno del sueño más frecuente en la población adulta, con una prevalencia de alrededor del 30%, siendo responsable del deterioro en la calidad de vida. A nivel laboral, el trabajo a turnos es el principal factor de riesgo asociado en la aparición del insomnio. A pesar de su relevancia clínica, suele pasar inadvertido para los profesionales sanitarios debido a falta de tiempo, recursos o información. El objetivo de este estudio fue analizar la influencia del trabajo a turnos en la aparición de insomnio en la población laboral. MÉTODOS: Se efectuó una revisión sistemática siguiendo la declaración PRISMA. Se realizó una búsqueda bibliográfica, utilizando los términos DeCS "Insomnia", "Occupational Health" y "Shift Work", en las bases de datos Pubmed, Scopus, Web of Science y CINAHL, así como en otras fuentes como la base de datos de tesis doctorales (TESEO). Se incluyeron artículos publicados hasta noviembre de 2019, tanto en ingles como en castellano. La calidad metodológica se evalúo por medio de las guías CONSORT y STROBE. RESULTADOS: Se incluyeron 13 estudios que cumplieron los criterios de inclusión. La calidad metodológica de los artículos fue alta (STROBE: 18/22, CONSORT: 20/25). En base a los registros seleccionados, se identificó una prevalencia para el insomnio relacionada con la turnicidad entre el 25% y el 53%. La duración y la rotación de los turnos influyeron en la aparición del insomnio, siendo mas beneficiosos los turnos de 12 horas o con sistemas de rotaciones rápidas y hacia adelante. Junto a la turnicidad se analizaron otros factores como el estrés, la ansiedad, la salud percibida, los estilos de vida saludable y hábitos tóxicos, la siniestralidad laboral, la fatiga o el nivel de carga laboral. CONCLUSIONES: El insomnio influenciado por la turnicidad es un problema de salud pública a nivel mundial que afecta a la calidad de vida personal y laboral. Las características y el contexto en el que se desarrolla el trabajo a turnos, a veces juntos a otros factores, influyen en dicha afectación

BACKGROUND: Insomnia is the most frequent sleep disorder in the adult population with a prevalence of around 30% being responsible for the deterioration in the quality of life. At work level, shift work is the main risk factor associated with the onset of insomnia. Despite its clinical relevance, it usually goes unnoticed by healthcare professionals due to lack of time, resources or information. The aim of this study was to analyze the influence of shift work in the occurrence of insomnia in the working population. METHODS: Systematic review following the PRISMA statement. A bibliographic search using the DeCS terms "Insomnia", "Occupational Health" and "Shift Work" was carried out in the Pubmed, Scopus, Web of Science and CINAHL databases, as well as in other sources such as the base of doctoral thesis data (TESEO). Articles published until November 2019 in English and Spanish were included. The methodological quality was evaluated through the CONSORT and STROBE guides. RESULTS: 13 studies that met the inclusion criteria were included. The methodological quality of the articles was high (STROBE: 18/22, CONSORT: 20/25). Based on the selected records, a prevalence of insomnia related to turnicity between 25% and 53% was identified. The duration and rotation of the shifts work influenced the onset of insomnia, with 12-hour shifts or fast and forward rotation systems being more beneficial. Other factors such as stress, anxiety, perceived health, healthy lifestyles and toxic habits, workplace accidents, fatigue or workload level were analyzed together with the turnicity. CONCLUSIONS: Insomnia influenced by turnicity is a public health problem worldwide that affects the quality of personal and work life. The characteristics and the context in which the work takes place in shifts, sometimes together with other factors, influence this affectation