LIMPRINT in Australia.

Background and Study Objective: Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the number of people with chronic edema (CO) in local health services. Methods and Results: Data collection occurred through questionnaire-based interviews and clinical assessment with provided LIMPRINT tools. Four different types of services across three states in Australia participated. A total of 222 adults participated with an age range from 22 to 102 years, and 60% were female. Site 1 included three residential care facilities (54% of participants had swelling), site 2 was community-delivered aged care services (24% of participants had swelling), site 3 was a hospital setting (facility-based prevalence study; 28% of participants had swelling), and site 4 was a wound treatment center (specific patient population; 100% of participants had swelling). Of those with CO or secondary lymphedema, 93% were not related to cancer, the lower limbs were affected in 51% of cases, and 18% of participants with swelling reported one or more episodes of cellulitis in the previous year. Wounds were identified in 47% (n = 105) of all participants with more than half of those with wounds coming from the dedicated wound clinic. Leg/foot ulcer was the most common type of wound (65%, n = 68). Conclusions: Distances between services, lack of specialized services, and various state funding models contribute to inequities in CO treatment. Understanding the high number of noncancer-related CO presentations will assist health services to provide timely effective care and improve referral pathways.

Hygea y la virtud o recordando a Protágoras: diálogo sobre ética de la salud comunitaria. Informe SESPAS 2018 / Hygeia and virtue or remembering Protagoras: dialogue on community health ethics. SESPAS Report 2018

Conversación entre la ética y la salud pública sobre las implicaciones morales de la promoción de la salud comunitaria, en la que se destaca la importancia de respetar la autonomía y de contribuir al empoderamiento de la comunidad con la que se colabora, además de la conveniencia de establecer un compromiso explícito en el que consten los límites de la colaboración y de la oportunidad de una deontología específica

A dialogue between ethics and public health on the moral implications of the promotion of community health in which the importance of respecting autonomy and contributing to the empowerment of the community with which it collaborates is highlighted; in addition to the appropriateness of an explicit commitment that sets out the limits of collaboration and the opportunity for a specific deontology

Semen parameters and their influence on pregnancy after assisted reproduction: Report of the Hospital Centre of Porto / Parámetros seminales y su influencia en las técnicas de reproducción asistida: experiencia del Centro Hospitalario de Porto

Introduction: Several studies analyzed the possible relationships between semen parameters and assisted reproductive technologies (ART) treatments. However, none could establish a threshold to guide in the decision of which treatment technique will be better facing spermiogram values. Objectives: A database with spermiogram and clinical parameters was built in order to search for relevant interactions between semen parameters and different ART treatment techniques. Materials and methods: A general statistical analysis evaluated semen parameters, followed by correlations to study their influence on the pregnancy rate for each type of treatment technique. Results: A predominance of teratozoospermia and asthenozoospermia was observed, with strong positive correlations between age and total motility, as well as obvious correlations between concentration and motility. Of the studied population, 41.8% went for ART consultations and presented a mean time of infertility of 2.9 years, a mean male age of 33.4 years and a mean female age of 31.9 years. Of these, 17.1% achieved a spontaneous pregnancy. Of the treatment cycles, 13.1% were by intra-uterine insemination (10.2% of clinical pregnancy rate, CP, with six newborn, NB), 24.9% by in vitro-fertilization (21.7 CP, 18 NB) and 44.9% by intracytoplasmic sperm injection (25.3% CP, 40 NB). From the analysis between semen parameters and the pregnancy rates, per type of ART technique, a significant positive correlation between techniques was found, revealing thresholds associated with the probability of a successful clinical pregnancy. Conclusions: The present results suggest that spermiogram reference limits can be developed for each treatment technique that are associated with a higher probability of achieving a clinical pregnancy (AU)

Introducción: Varios estudios han examinado las posibles relaciones entre los parámetros seminales y los resultados derivados de los tratamientos de infertilidad. Sin embargo, no hemos logrado establecer umbrales que puedan guiar a la hora de la decisión de que técnica de reproducción asistida (ART) se debe elegir. Objetivos: Se construyó una base de datos con los parámetros seminales y los resultados clínicos de los tratamientos de infertilidad para que se puedan investigar las interacciones relevantes entre ellos. Materiales y métodos: Después de un análisis estadístico general de los parámetros seminales, se realizó un estudio de correlación entre aquellos y las tasas de embarazo por la técnica de tratamiento. Resultados: Hubo un predominio de teratospermia y astenozoospermia, con fuertes correlaciones entre la edad y la motilidad total, así como correlaciones evidentes entre la concentración y la motilidad. En la población de estudio, el 41,8% ha visitado las consultas de infertilidad, presentando un tiempo medio de 2,9 años de infertilidad, y una edad media de 33,4 (hombres) y 31,9 (mujeres) años. De éstas, el 17,1% logró un embarazo espontáneo. De los tratamientos de ART realizados, 13,1% se debieron a la inseminación intrauterina (tasa de embarazo clínico del 10,2%, GC, con 6 recién nacidos, RN), el 24,9% en la fertilización in vitro (21.7 GC, RN 18) y 44,9% por microinyección intracitoplasmática de espermatozoides (25,3% GC, RN 40). Del análisis entre los parámetros seminales y las tasas de embarazo, para cada tipo de técnica de tratamiento, se observó una correlación significativa entre las técnicas, revelando los umbrales asociados a la probabilidad de lograr con éxito un embarazo clínico. Conclusiones: Los datos sugieren que pueden ser creados los umbrales de referencia de los parámetros seminales para cada técnica de tratamiento, los cuales están más fuertemente asociados con la capacidad de lograr con éxito un embarazo clínico (AU)

Ethical considerations for conducting health disparities research in community health centers: a social-ecological perspective.

Community health centers (CHCs) provide optimal research settings. They serve a high-risk, medically underserved population in the greatest need of intervention. Low socioeconomic status renders this population particularly vulnerable to research misconduct. Traditional principles of research ethics are often applied to participants only. The social-ecological model offers a comprehensive framework for applying these principles across multiple levels (participants, providers, organizations, communities, and policy). Our experience with the Trial Using Motivational Interviewing, Positive Affect and Self-Affirmation in African-Americans with Hypertension, a randomized trial conducted in CHCs, led us to propose a new platform for discussing research ethics; examine the social, community, and political factors surrounding research conducted in CHCs; and recommend how future research should be conducted in such settings.

Ethics in human resource management: potential for burnout among healthcare workers in ART and community care centres.

This paper examines ethical dilemmas in providing care for people with HIV/AIDS. Healthcare providers in this sector are overworked, particularly in the high prevalence states. They are faced with the dual burden of the physical and the emotional risks of providing this care. The emotional risks result from their inability to control their work environment, while having to deal with the social and cultural dimensions of patients' experiences. The physical risk is addressed to some extent by post exposure prophylaxis. But the emotional risk is largely left to the individual and there is little by way of institutional responsibility for minimising this. The guidelines for training workers in care and support programmes do not include any detailed institutional mechanisms for reducing workplace stress. This aspect of the programme needs to be examined for its ethical justification. The omission of institutional mechanisms to reduce the emotional risks experienced by healthcare providers in the HIV/AIDS sector could be a function of lack of coordination across different stakeholders in programme development. This can be addressed in further formulations of the programme. Whatever the reasons may be for overlooking these needs, the ethics of this choice need to be carefully reviewed.

Pasado, presente y futuro de las intervenciones psicoeducativas para cuidadores familiares de personas mayores dependientes / Past, present and future of psychoeducational interventions of family caregivers for dependent elderly people

Las intervenciones psicoeducativas son consideradas como uno de los procedimientos más efectivos para reducir el malestar de los cuidadores. Sin embargo, y a pesar de que mediante ellas se obtiene beneficios significativos para la salud de los cuidadores, es un hecho aceptado que su éxito ha sido limitado. En este trabajo se analizan diferentes limitaciones de las intervenciones que han sido señaladas en la bibliografía y se propone diferentes vías de mejora de los programas, como ajustar las intervenciones a modelos teóricos respaldados empíricamente, mejorar el diseño y evaluar la implementación de las intervenciones. Además, son especialmente necesarios estudios rigurosos realizados con población de habla hispana con tamaños muestrales amplios que permitan obtener información sobre la eficacia de los programas para cuidadores. Se destaca, finalmente, la necesidad de una convergencia entre servicios formales e informales que mejore la atención disponible al colectivo de los cuidadores de personas mayores dependientes (AU)

Psychoeducational interventions are considered to be one of the most effective procedures for reducing caregiver distress. Although these interventions can produce significant positive effects in caregivers’ health, it is generally accepted that their success is limited. Several limitations of these interventions that have been pointed out in the literature are analyzed in the present article. In addition, ways to improve the interventions are suggested (adjusting the interventions to solid theoretical frameworks, improving their designs, and assessing treatment implementation). Moreover, intervention studies with extensive samples of Spanish speaking caregivers that would provide information about the efficacy of the intervention programs are needed. Finally, the need for convergence between formal and informal services in order to improve the assistance received by caregivers is emphasized (AU)