Social exclusion of the adolescent with overweight: study of sociocentric social networks in the classroom.

BACKGROUND: Multiple studies have shown the social consequences of suffering overweight, with social exclusion or isolation as some of the most important. In order to study the social patterns among adolescents, we have set as objectives to analyse the position of the individual within their network from a sociocentric perspective, comparing the relational pattern of the adolescents suffering from overweight with those who are normal weight. METHOD: This was a cross-sectional descriptive study using logistic regression and social network analysis. We analysed the contact patterns of 235 adolescents in 11 social networks, classifying contact into three levels of intensity: minimum, intermediate and maximum (friendship). The WHO reference was used for the variable of overweight. RESULTS: The prevalence of overweight was 30.2% (25.5% overweight and 4.7% obesity). An analysis of the relational patterns of individuals with overweight showed that at the minimum contact level, they established fewer relationships and less closeness (odds ratio [OR]: 2.32; confidence interval [CI] 95%: 1.17-4.66; p-value: 0.016). This effect was more marked in female adolescents. At intermediate contact level, they had few relationships and low prestige (OR: 3.29; CI: 95%; 1.03-10.51; p-value: 0.045, OR: 3.18; CI: 95%; 1.00-10.04; p-value: 0.049, respectively). At maximum contact level (friendship), female adolescents related little with other adolescents (OR: 3.78; CI: 95%; 1.07-13.32; p-value: 0.038). CONCLUSIONS: Adolescents with overweight take up peripheral positions within their social network, choosing by themselves not to establish contact with others. Social network analysis is crucial to detect adolescents with overweight at risk of exclusion and help alleviate psychological and social deficits.

How to address smoking cessation in HIV patients.

Tobacco consumption is the modifiable risk factor contributing most to the development of non-AIDS-defining events among persons living with HIV/AIDS (PLWHA). Clinicians' awareness of this problem is critical and not yet adequate. Practical information issued by public health authorities or contained in experts' clinical guidelines regarding how to address smoking cessation in PLWHA is scarce. The aim of this review is to provide physicians with comprehensive and practical information regarding how to identify HIV-positive patients willing to stop smoking and those more likely to succeed, how to choose the most suitable strategy for an individual patient, and how to help the patient during the process. In the light of current evidence on the efficacy and benefits of stopping smoking in PLWHA, physicians must actively pursue smoking cessation as a major objective in the clinical care of PLWHA.

El derecho a la Declaración Anticipada de Voluntade se Instrucciones Previas. Conocimiento y competencia profesional / The right to the Advance Directive Statement and Prior Instructions. Knowledge and professional competence

OBJETIVO: determinar el conocimiento del profesional de Enfermería sobre el documento de Instrucciones Previas (IP);identificar el acceso a los documentos del registro formal deI P existentes en la Comunidad Autónoma de Castila y León(CyL), Espańa; conocer la percepción de los profesionales sobre las competencias enfermeras en relación a dicho documento y si estos actúan con plena autonomía técnica y científica conforme a la legislación vigente. MÉTODO: estudio descriptivo transversal, durante el primer trimestre del ańo 2010 y cuya población a estudio eran las/os enfermeras/os de Castilla y León, sobre una población total de16.002 profesionales inscritos en los nueve colegios oficiales de Enfermería provinciales, fueron seleccionados 850 por cuotas de sexo y edad. Para la recogida de información se utilizó un cuestionario construido ad hoc para el estudio (diez ítems).RESULTADOS: se cumplimentaron 816 encuestas válidas. Los profesionales afirman conocer en un 79% el documento de IP. Un29% desconoce cuáles son sus competencias según determina la legislación vigente. El 80% considera que los cuidados expresados en el documento de IP son de su competencia. El 98%reconoce que la alimentación e hidratación de un paciente terminal son competencias enfermeras. En la desconexión del respirador o en suspender la alimentación e hidratación, un 52%lo harían si mediara una orden médica, un 16% alegarían objeción de conciencia y un 32% lo haría sin condición. Solamente el 9% afirma tener acceso al registro formal y manifiestan necesario incrementar el nivel de formación sobre el tema. CONCLUSIONES: los profesionales enfermeros conocen mayoritariamente la normativa vigente sobre las IP y la consideran como derecho del paciente, si bien existen dudas razonables sobre si una competencia propia puede ser realizada de forma autónoma, constatando que no existe acceso al registro formal, no tienen problemas en participar activamente en la desconexión o no proporcionar alimentación o nutrición por orden del paciente, apreciando la necesidad de mayor formación e investigación

OBJECTIVE: to determine the knowledge by nursing professionals about the Prior Instructions (PI) document; to identify the access to documents in the formal PI registry existing in the Comunidad Autónoma de Castilla y León (CyL), Spain; to understand the perception by professionals about nursing competence regarding said document, and whether they are acting with complete technical and scientific autonomy according to current legislation. METHOD: transversal descriptive study, during the first trimester of 2010; the study population was nurses from Castilla y León. From a total population of 16,002 professionals registered in the nine official Associations of Nurses in the province, 850nurses were selected by gender and age quotas. A questionnaire prepared ad hoc for the study (10 items) was used for data collection. RESULTS: 816 valid surveys were completed. A 79% of professionals claim to know the PI document. A 29% does not know which their competence is, as determined by current legislation. An 80% considers that those cares stated in the PI document fall within their competence. A 98% acknowledges that feeding and hydrating a terminal patient are nursing competences. Regarding the disconnection of the ventilator or the interruption of feeding and hydration, 52% would do it if there was a medical order, 16% would allege conscientious objection, and 32% would do it without any condition. Only 9% state that they have access to the formal registry, and claim it is necessary to increase the level of training about this matter. Conclusions: the majority of nursing professionals is aware of the current legislation about PIs, and considers them as a right of the patient, even though there are reasonable doubts about whether this competence can be conducted in an autonomous way, confirming there is no access to the formal registry. They have no problems in being actively involved in disconnection or discontinuation of feeding or nutrition by patient order, and they acknowledge the need for higher training and research

Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case-control studies.

OBJECTIVES: The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV-infected adults relative to uninfected adults. METHODS: Two parallel case-control studies were carried out. In the first study, HIV-positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV-positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV-negative individuals diagnosed with ACS between 1997 and 2009 (HIV-/ACS). Each individual in the HIV-/ACS group was then matched for age and gender with an HIV-negative adult without ACS (HIV-/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV-/ACS and HIV-/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case-control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV-positive and HIV-negative individuals. RESULTS: There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV-/ACS group, and 171 in the HIV-/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086-8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976-32.168; P = 0.0003) in HIV-positive subjects, and smoking (OR 4.310; 95% CI 2.425-7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393-15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554-12.700; P < 0.0001) in HIV-negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV-positive and HIV-negative individuals, respectively. CONCLUSIONS: The contribution of smoking to ACS in HIV-positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV-negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV-positive adults.