Estrés percibido en madres mexicanas de niños con necesidades especiales: un estudio etnográfico / Perceived stress among mexican mothers of children with special needs: an ethnographic study / Estresse percebido em mães mexicanas de crianças com necessidades especiais: um estudo etnográfico

RESUMEN Objetivo: Examinar las percepciones sobre los factores exploratorios, las manifestaciones y consecuencias del estrés en madres cuidadoras de niños con necesidades especiales en Veracruz, México. Métodos: Estudio cualitativo con diseño etnográfico focalizado. La muestra (n=20) se obtuvo de un grupo de madres cuidadoras del estado de Veracruz, México. El criterio de participación fue ser el tutor principal del niño dependiente. Los datos se recolectaron a través de cuatro grupos de discusión conformado cada uno por cinco cuidadoras. Las discusiones fueron audio-grabadas y los datos transcritos textualmente previo análisis. La información fue tratada mediante análisis temático, con el apoyo del programa QUIRKOS. Resultados: Las madres de los niños fueron el cien por ciento de las cuidadoras. La edad promedio de ellas fue de 36.95 años (DE= ±7.66). Las temáticas que surgieron del análisis inductivo fueron las siguientes: a) la situación económica familiar, b) el comportamiento de los niños, c) la falta de información sobre el diagnóstico del niño y, d) los problemas conyugales. Estas se identificaron como categorías que juegan un rol importante en el estrés percibido por las cuidadoras. Discusión y Conclusiones: Es claro que el rol y la responsabilidad de las madres cuidadoras es muy demandante, provocando manifestaciones físicas, mentales y emocionales. El profesional de enfermería juega un papel importante en el diseño de intervenciones de salud que favorezcan la reducción de los factores causales del estrés percibido, además de implementar estrategias que restrinjan sus manifestaciones.

ABSTRACT Objective: To explore factors, manifestations, and consequences related to the stress perceived by Mexican mothers of children with special needs in Veracruz, Mexico. Methods: This is a qualitative study with a focalized ethnographic design. The sample (n=20) was constituted by healthcare providing mothers of the state of Veracruz, Mexico. The participation requirement was being the main tutor of a dependent child. Data were collected in four discussion groups of 5 healthcare providing mothers each. The discussions were recorded and the data were transcribed. The information was produced through a thematic analysis using the QUIRKOS program. Results: The average age of these mothers was 36.95 years old (SD= ±7.66). The topics arising from the analysis were: a) the economical situation of the family; b) the behavior of the children; c) the lack of information regarding the child's diagnosis; and d) the marital problems. All these categories were important sources of the stress perceived by these healthcare providers. Discussion and Conclusions: It is clear that the role and the responsibility of healthcare mothers is very demanding, provoking diverse physical, mental, and emotional responses. The nursing professionals play an important role in the design of health interventions which can favor the reduction of the perceived stress causing factors and thus the reduction of their associated impacts.

RESUMO Objetivo: Examinar as percepções sobre os fatores exploratórios, as manifestações e consequências do estresse em mães cuidadoras de crianças com necessidades especiais em Veracruz, México. Métodos: Estudo qualitativo com desenho etnográfico focalizado. A amostra (n=20) foi obtida de um grupo de mães cuidadoras do estado de Veracruz, México. O critério de participação era ser o cuidador principal da criança dependente. Os dados foram coletados através de quatro grupos de discussão, cada um conformado por cinco cuidadoras. As discussões foram áudio-gravadas e os dados transcritos textualmente antes da análise. A informação foi tratada por meio de análise temática, com apoio do programa QUIRKOS. Resultados: As mães das crianças eram cem por cento das cuidadoras. A idade média delas era de 36.95 anos (DE= ±7.66). As temáticas que emergiram da análise indutiva foram as seguintes: a) a situação económica familiar, b) o comportamento das crianças, c) a falta de informação sobre o diagnóstico da criança, e d) os problemas conjugais. Estas foram identificadas como categorias que desempenham um papel importante no estresse percebido pelas cuidadoras. Discussão e Conclusões: Fica claro que o papel e a responsabilidade das mães cuidadoras é muito exigente, provocando manifestações físicas, mentais e emocionais. O profissional de enfermagem desempenha um papel importante no desenho de intervenções de saúde que favorecem a redução dos fatores causais do estresse percebido, além de implementar estratégias que restrinjam suas manifestações.

[Psychometric properties and diagnostic value of 'lexical screening for aphasias']. / Propiedades psicometricas y utilidad diagnostica del 'screening lexico para las afasias'

INTRODUCTION. Language assessment in persons with brain injury makes it possible to know whether they require language rehabilitation or not. Given the importance of a precise evaluation, assessment instruments must be valid and reliable, so as to avoid mistaken and subjective diagnoses. AIM. To validate 'lexical screening for aphasias' in a sample of 58 Chilean individuals. SUBJECTS AND METHODS. A screening-type language test, lasting 20 minutes and based on the lexical processing model devised by Patterson and Shewell (1987), was constructed. The sample was made up of two groups containing 29 aphasic subjects and 29 control subjects from different health centres in the regions of Biobio and Maule, Chile. Their ages ranged between 24 and 79 years and had between 0 and 17 years' schooling. Tests were carried out to determine discriminating validity, concurrent validity with the aphasia disorder assessment battery, reliability, sensitivity and specificity. RESULTS. The statistical analysis showed a high discriminating validity (p < 0.001), an acceptable mean concurrent validity with aphasia disorder assessment battery (rs = 0.65), high mean reliability (alpha = 0.87), moderate mean sensitivity (69%) and high mean specificity (86%). CONCLUSION. 'Lexical screening for aphasias' is valid and reliable for assessing language in persons with aphasias; it is sensitive for detecting aphasic subjects and is specific for precluding language disorders in persons with normal language abilities.

TITLE: Propiedades psicometricas y utilidad diagnostica del 'screening lexico para las afasias'Introduccion. La evaluacion del lenguaje en personas con lesion cerebral permite conocer si estas requeriran o no rehabilitacion de lenguaje. Debido a la importancia de una evaluacion precisa, los instrumentos de evaluacion deben ser validos y fiables, con el fin de evitar diagnosticos equivocados y subjetivos. Objetivo. Validar el 'screening lexico para las afasias' (SLA) en una muestra de 58 individuos chilenos. Sujetos y metodos. Se construyo una prueba de lenguaje, tipo cribado, de 20 minutos de duracion y basada en el modelo de procesamiento lexico de Patterson y Shewell de 1987. La muestra estuvo compuesta por dos grupos, 29 sujetos afasicos y 29 sujetos control, pertenecientes a distintos centros de salud de las regiones del Biobio y del Maule, Chile. Sus edades fluctuaban entre 24 y 79 años, y sus años de escolaridad, de 0 a 17. Se determino validez discriminante, validez concurrente con la bateria para la evaluacion de los trastornos afasicos (BETA), fiabilidad, sensibilidad y especificidad. Resultados. El analisis estadistico mostro una alta validez discriminante (p < 0,001), aceptable validez concurrente media con la BETA (rs = 0,65), una alta fiabilidad media (alfa = 0,87), una moderada sensibilidad media (69%) y una alta especificidad media (86%). Conclusion. El SLA es valido y fiable para evaluar el lenguaje de personas con afasias, es sensible para detectar sujetos afasicos y es especifico para descartar trastornos del lenguaje en personas con lenguaje normal.

Colestasis y listeriosis en el tercer trimestre de la gestación / Cholestasis and listeriosis in the third trimester of pregnancy

La listeriosis es una infección producida por Listeria monocytogenes. Poco frecuente, afecta a personas en edades extremas de la vida, gestantes, inmunodeprimidos y, ocasionalmente, a individuos sanos. Su incidencia ha aumentado en los últimos años y presenta cierta tendencia a la estacionalidad, aumentando en verano. Puede aparecer de forma esporádica o a brotes. En gestantes, la infección se produce más frecuentemente en el tercer trimestre y la clínica suele ser leve. Sin embargo, la infección sobre el feto es severa, pudiendo producir abortos, muertes fetales, corioamnionitis y partos pretérmino con recién nacidos infectados, manifestándose en forma de granulomatosis infantiséptica con abscesos y granulomas diseminados o, tardíamente, como meningitis y sepsis. La colestasis intrahepática es una forma reversible de colestasis, de causa desconocida y específica de la gestación, siendo mas frecuente en multíparas, en el tercer trimestre y rara antes de la semana 26ª. Desaparece tras el parto y constituye la segunda causa de ictericia en la gestación, por detrás de la hepatitis. El diagnóstico de colestasis es fundamentalmente clínico. Se manifiesta por prurito palmo plantar pero también puede cursar con náuseas, vómitos y molestias abdominales localizadas en hipocondrio derecho. Dado que la listeriosis y colecistitis pueden compartir sintomatología, habrá que tener en cuenta la posibilidad de listeriosis para poner en marcha los mecanismos de confirmación diagnóstica (cultivo de fluidos o tejidos estériles: sangre, LCR neonatal, líquido amniótico o placenta)y el tratamiento específico precozmente. Se presenta un caso de colestasis y listeriosis en el tercer trimestre con buen resultado maternofetal (AU)

Listeriosis is an infection produced by Listeria monocytogenes. It is infrequent and affects people at extreme ages, pregnant women, immune compromised people and, occasionally, healthy people. Its incidence has increased in recent years and shows a certain tendency to seasonality, increasing in summer. It can appear sporadically or as outbreaks.In pregnant women the infection is most frequently produced in the third trimester and the symptoms are usually light. Nonetheless, the infection of the fetus is severe, and can produce miscarriages, fetal deaths, corioamnionitis and premature births with the newborn infected, manifested in the form of granulomatosis infantiseptica with abscesses and scattered granulomas or at a later stage , as meningitis or sepsis. Intrahepatic cholestasis is a reversible form of cholestasis, its cause is unknown, it is specific to pregnancy and is more frequent in multiparous women, in the third trimester and rarely before the 26th week. It disappears following childbirth and is the second cause of jaundice in pregnancy, after hepatitis. The diagnosis of cholestasis is basically clinical. It appears as palmoplantar pruritus but can also produce nausea, vomiting and abdominal discomfort localized in the right hypochondrium. Given that listeriosis and cholestasis can have a shared symptomology, the possibility of listeriosis must be borne in mind in order for early implementation of the mechanisms of diagnostic confirmation (cultivation of sterile fluids or tissues: blood, neonatal CSF, amniotic liquid or placenta) and specific treatment. We present a case of cholestasis and listeriosis in the third trimester with a good maternofetal result (AU)

[Cholestasis and listeriosis in the third trimester of pregnancy]. / Colestasis y listeriosis en el tercer trimestre de la gestación.

Listeriosis is an infection produced by Listeria monocytogenes. It is infrequent and affects people at extreme ages, pregnant women, immunocompromised people and, occasionally, healthy people. Its incidence has increased in recent years and shows a certain tendency to seasonality, increasing in summer. It can appear sporadically or as outbreaks. In pregnant women the infection is most frequently produced in the third trimester and the symptoms are usually light. Nonetheless, the infection of the fetus is severe, and can produce miscarriages, fetal deaths, corioamnionitis and premature births with the newborn infected, manifested in the form of granulomatosis infantiseptica with abscesses and scattered granulomas or at a later stage , as meningitis or sepsis. Intrahepatic cholestasis is a reversible form of cholestasis, its cause is unknown, it is specific to pregnancy and is more frequent in multiparous women, in the third trimester and rarely before the 26th week. It disappears following childbirth and is the second cause of jaundice in pregnancy, after hepatitis. The diagnosis of cholestasis is basically clinical. It appears as palmoplantar pruritus but can also produce nausea, vomiting and abdominal discomfort localized in the right hypochondrium. Given that listeriosis and cholestasis can have a shared symptomology, the possibility of listeriosis must be borne in mind in order for early implementation of the mechanisms of diagnostic confirmation (cultivation of sterile fluids or tissues: blood, neonatal CSF, amniotic liquid or placenta) and specific treatment. We present a case of cholestasis and listeriosis in the third trimester with a good maternofetal result.