Reasons Not to Turf a Patient Whose "Belonging" in a Hospital Is Unclear.

Through the lens of metaphor and the arts, this article aims to illuminate how persons who are ill tarry through uncertainty to receive care, and, in response, clinicians must resist turfing such patients in a health system that often confers upon patients unclear criteria for belonging. In addition, this article considers relationships among clinicians, patients, and their loved ones through the perspectives of Maris and Ludlow, characters in the book, A Hospital Odyssey, by Gwyneth Lewis. The article suggests that engaged curiosity and empathy are helpful responses to clinical detachment, distraction, and disengagement.

Effects of mindfulness training on posttraumatic stress symptoms from a community-based pilot clinical trial among survivors of intimate partner violence.

Objective: Exposure to intimate partner violence (IPV) is a significant public health issue associated with deleterious mental and medical health comorbidities, including posttraumatic stress disorder (PTSD). The hallmark symptoms of posttraumatic stress (PTS), even when not meeting the threshold for a diagnosis of PTSD, appear to be underpinned by poor self-regulation in multiple domains, including emotion, cognitive control, and physiological stress. Mindfulness-based stress reduction (MBSR) holds promise for treating PTS symptoms because evidence suggests it targets these domains. The current study was a pilot randomized clinical trial designed to examine changes in emotion regulation, attentional function, and physiological stress dysregulation among women IPV survivors with elevated PTS symptoms after participation in a group-based, 8-week MBSR program. Method: In total, 29 participants were randomized to receive MBSR (n = 19) or an active control (n = 10). Assessments were conducted at study entry, as well as 8 and 12 weeks later. Results: Between-group differences on primary outcomes were nonsignificant; however, when exploring within groups, statistically significant decreases in PTS symptoms, F(1.37, 16.53) = 5.19, p < .05, and emotion dysregulation, F(1.31, 14.46) = 9.36, p < .01, were observed after MBSR but not after the control intervention. Further, decreases in PTSD and emotion dysregulation were clinically significant for MBSR participants but not control participants. Conclusions: These preliminary data signal that MBSR may improve PTS symptoms and emotion regulation and suggest further study of the effectiveness of PTSD interventions guided by integrative models of MBSR mechanisms and psychophysiological models of stress regulation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Riesgo cardiovascular en una población escolar con exceso de peso / Cardiovascular risk in a school population with excess weight

RESUMEN Objetivo. Determinar factores de riesgo cardiovascular en escolares con exceso de peso y medir su asociación con variables sociodemográficas. Métodos. Estudio transversal, analítico. Se encuestó a 2001 escolares mujeres de 6 a 17 años de un Centro Educativo de Lima Metropolitana. Se utilizó el índice de masa corporal para el diagnóstico de exceso de peso (sobrepeso entre 85 y 95p y obesidad ≥ 95p) y la circunferencia de cintura para obesidad abdominal (≥ 90p). HOMA-I para la resistencia a la insulina (RI) (≥ 3,16) y para las alteraciones lipídicas: colesterol total (≥ 200 mg/dL), C-HDL bajo (≤ 40 mg/dL), C-LDL alto (≥ 130 mg/dL), C no HDL (≥ 145 mg/dL) y triglicéridos (≥ 100 y 130 mg/dL) para niñas menores de 9 y de 10 a 19 años, respectivamente. Resultados. El exceso de peso se presentó mayormente en las escolares de 10 a 17 años, en las que nacieron con más de 2500 gr, con más de un antecedente familiar, con lactancia materna exclusiva y en aquellas cuyas madres no tuvieron instrucción. Las alteraciones lipídicas más frecuentes fueron hipertrigliceridemia y C-HDL bajo. El 82% presentó dislipidemia y el 55,4% de obesos RI. La obesidad abdominal estuvo asociada con los antecedentes familiares y la instrucción de la madre. Conclusión. Cuatro de cada cinco niñas con exceso de peso presentó por lo menos una alteración de los lípidos. Una de cada dos obesas tuvo RI.

ABSTRACT Objective. To determine the cardiovascular risk factors in overweight schoolchildren and to measure their association with sociodemographic variables. Methods. Cross-sectional, analytical study. 2001 female schoolchildren from 6 to 17 years of age from an Educational Center in Metropolitan Lima were surveyed. The Body Mass Index was used for the diagnosis of excess weight (overweight between 85 and 95p and obesity ≥ 95p) and the Waist Circumference for abdominal obesity (≥ 90p). HOMA-I for insulin resistance (≥ 3,16) and for lipid abnormalities: total cholesterol (≥ 200 mg / dL), low HDL-C (≤ 40 mg/dL), high LDL-C (≥ 130 mg / dL), non-HDL C (≥ 145 mg / dL) and triglycerides (≥ 100 and 130 mg / dL) for girls younger than 9 and 10 to 19 years old, respectively. Results. Excess weight occurred mainly in schoolgirls aged 10 to 17 years, in those who were born with more than 2500 gr, with more than one family history, with exclusive breastfeeding and in those whose mothers had no instruction. The most frequent lipid alterations were hypertriglyceridemia and low HDL-C. 82% had dyslipidemia and 55,4% of obese patients had insulin resistance (IR). Abdominal obesity was associated with family history and mother's instruction. Conclusion. Four out of five girls with excess weight presented at least one alteration of the lipids. One in two obese women had IR.

Tending the Field of Mindfulness-Based Programs: The Development of International Integrity Guidelines for Teachers and Teacher Training.

Since Jon Kabat-Zinn first introduced a contemporary, secularized application of mindfulness for the relief of pain and stress in physical health-care settings, there has been a significant and rapid expansion of the range of mindfulness-based programs (MBPs) designed for various health care, education, workplace, and other settings. As is common with developing programs, these often run ahead of carefully considered and researched effectiveness evaluations. This raises questions of how to best train mindfulness teachers to skillfully facilitate such interventions while minimizing the potential for harm. In this article, we describe the work of an international group of senior teacher trainers who met to develop guidelines on the ethics and standards for teacher trainers and their training pathways. In this article, we will define MBPs; describe the process by which these international guidelines were developed; and share details of the collaborative team who made up the international network that worked on them. We offer these guidelines as "living documents" that specifically set out: (1) ethical standards for mindfulness teachers and trainers; (2) criteria and standards for teacher trainers; and (3) criteria and standards for training pathways. As "living documents," these will continue to be commented on and refined over time. Given that MBPs offered within secular settings in most countries currently have limited oversight or accreditation processes, we hope these guidelines will provide support and clarity to the teachers of all established and emerging MBPs, and their trainers and supervisors.

[Epidermolysis bullosa in peru: clinical and epidemiological study of patients treated in a national reference pediatric hospital, 1993-2015]. / Epidermólisis bullosa en el perú: estudio clínico y epidemiológico de pacientes atendidos en un hospital pediátrico de referencia nacional, 1993-2015.

OBJECTIVES: To describe the clinical and epidemiological characteristics of patients diagnosed with epidermolysis bullosa (EB) at the Instituto Nacional de Salud (INSN) in Lima, Peru; a National Reference Center for this disease. MATERIALS AND METHODS: Observational, descriptive and transversal study. We reviewed the clinical histories and laboratory tests of patients diagnosed with EB treated in INSN from 1993 to 2015. RESULTS: 93 patients were registered. The average age was 7.9 ± 5.6 years; 53.8% (n = 50) were boys. Clinical forms corresponded to dystrophic EB with 41 (44.1%) cases, simple EB with 39 (41.9%), union EB cases with 8 (8.6%) and Kindler syndrome with 4 (4.3%) cases. The clinical form could not be identified in a case. A total of 48 cases (51.6%) came from Lima and Callao, and 45 cases (48.4%) from other provinces of the country. Extracutaneous manifestations involved gastrointestinal (44.1%), ocular (37.6%), odontogenic (87.1%), and nutritional (79.6%) involvement, as well as pseudosindactilia (16.1%). Chronic malnutrition (71.6%), acute malnutrition (17.6%) and anemia (62.4%) were found. Mortality corresponded to 6 cases (6.5%). CONCLUSIONS: 93 cases of EB were reported in INSN, the predominant clinical presentation was the dystrophic form.

OBJETIVOS: Describir las características clínicas y epidemiológicas de los pacientes diagnosticados con epidermólisis bullosa (EB), en el Instituto Nacional de Salud del Niño (INSN) en Lima, Perú; centro de referencia nacional para esta enfermedad. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal. Se revisaron las historias clínicas y exámenes de laboratorio de los pacientes diagnosticados de EB atendidos en el INSN desde 1993 al 2015. RESULTADOS: Fueron registrados 93 pacientes. La edad promedio fue de 7,9 ± 5,6 años; el 53,8% (n=50) fueron hombres. Las formas clínicas correspondieron a EB distrófica con 41 (44,1%) casos, EB simple con 39 (41,9%) casos, EB de la unión con 8 (8,6%) y al síndrome de Kindler con 4 (4,3%) casos. No se pudo identificar la forma clínica en un caso. Procedían de Lima y Callao 48 casos (51,6%) y 45 casos (48,4%) de otras provincias del país. Entre las manifestaciones extracutáneas se registraron compromiso gastrointestinal (44,1%), ocular (37,6%), odontogénico (87,1%), nutricional (79,6%), además de pseudosindactilia (16,1%). Se halló desnutrición crónica (71,6%), desnutrición aguda (17,6%) y anemia en (62,4%). La mortalidad correspondió a 6 casos (6,5%). CONCLUSIONES: Se reportan 93 casos de EB en el INSN, la presentación clínica predominante fue la forma distrófica.

Health care Professionals' Experiences and Needs When Delivering End-of-Life Care to Children: A Qualitative Study.

Pediatric end-of-life care (EOL care) entails challenging tasks for health care professionals (HCPs). Little is known about HCPs' experiences and needs when providing pediatric EOL care in Switzerland. This study aimed to describe the experiences and needs of HCPs in pediatric EOL care in Switzerland and to develop recommendations for the health ministry. The key aspect in EOL care provision was identified as the capacity to establish a relationship with the dying child and the family. Barriers to this interaction were ethical dilemmas, problems in collaboration with the interprofessional team, and structural problems on the level of organizations. A major need was the expansion of vocational training and support by specialized palliative care teams. We recommend the development of a national concept for the provision of EOL care in children, accompanied by training programs and supported by specialized pediatric palliative care teams located in tertiary children's hospitals.

Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

AIM: To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. BACKGROUND: In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. DESIGN: This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. METHODS: The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. CONCLUSION: This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01983852.