Atención Primaria y promoción de la salud bucodental: evaluación de una intervención educativa en población infantil / Primary Care and oral health promotion: Assessment of an educational intervention in school children

Objetivo: Evaluar a corto y medio plazo la efectividad de una intervención de promoción de la salud bucodental impulsada desde Atención Primaria. Diseño: Ensayo comunitario de intervención no aleatorizado. Emplazamiento: Tres centros educativos de características sociodemográficas similares de un barrio empobrecido de Granada. Participantes: Participaron en el estudio 82 alumnos de entre 5 y 6 años del colegio intervención (CI) y 109 de los colegios control (CC), así como los profesores y padres/madres de los alumnos del CI. Intervención: Actividades escolares de promoción de la salud bucodental dirigidas a los alumnos, y reuniones periódicas con los profesores y padres/madres del CI durante 2 cursos consecutivos. Mediciones principales: Conocimientos sobre salud bucodental y hábitos higiénico-dietéticos de los alumnos, valorados mediante cuestionarios distribuidos antes de la intervención y transcurridos 6 y 18 meses. Resultados: Transcurridos 18 meses, los conocimientos adquiridos fueron significativamente superiores en el CI (OR 3,54; IC 95% 1,46-8,58) en comparación con los CC. El consumo de alimentos saludables aumentó significativamente en el desayuno (OR 2,95; IC 95% 1,26-6,89) y la merienda (OR 3,67; IC 95% 1,49-9,05) y disminuyó el consumo de bollería (OR 4,05; IC 95% 1,68-9,81) y refrescos azucarados (OR 3,79; IC 95% 1,57-9,12) respecto a los CC. No se observaron mejoras en relación con la higiene bucodental en el CI. Conclusiones: Las intervenciones escolares de educación sanitaria, desarrolladas de forma intersectorial, participativa y considerando los contextos socioeconómicos particulares, resultan eficaces en la mejora del conocimiento y los hábitos dietéticos de los alumnos

Objective: To evaluate the short and medium term effectiveness of a Primary Care-driven oral health promotion intervention. Design: A non-randomised community intervention trial. Setting: Three socio-demographically similar primary schools of a deprived neighborhood in Granada, Spain. Participants: Eighty-two intervention and 109 control students aged 5 to 6, as well as the teachers and the parent's association of the intervention school (IS) participated in the study. Intervention: School-based health promotion activities aimed at students, and regular meetings with the teachers and parents of the IS during 2 consecutive years. Main measurements: Students' oral health-related knowledge and behavior, assessed via questionnaires distributed before the intervention, and 6 and 18 months afterwards. Results: Compared to the control groups at 18 months, students belonging to the IS reported enhanced oral health knowledge (OR 3.54; 95% CI 1.46-8.58), and an increased consumption of healthy food at breakfast (OR 2.95; 95% CI 1.26-6.89) and during mid-afternoon snack (OR 3.67; 95% CI 1.49-9.05). A significant decrease was seen in the intake of pastries (OR 4.05; 95% CI 1.68-9.81) and sweetened soft drinks and juices (OR 3.79; 95% CI 1.57-9.12) amongst intervention compared to control students in the medium term (18 months). No significant improvements were observed concerning oral hygiene in the IS. Conclusions: School-based educational interventions, when developed through an intersectoral and participative approach and considering the socio-economic context, appear to be effective in improving students’ diet-related knowledge and behaviors

[Primary Care and oral health promotion: Assessment of an educational intervention in school children]. / Atención Primaria y promoción de la salud bucodental: evaluación de una intervención educativa en población infantil.

OBJECTIVE: To evaluate the short and medium term effectiveness of a Primary Care-driven oral health promotion intervention. DESIGN: A non-randomised community intervention trial. SETTING: Three socio-demographically similar primary schools of a deprived neighborhood in Granada, Spain. PARTICIPANTS: Eighty-two intervention and 109 control students aged 5 to 6, as well as the teachers and the parent's association of the intervention school (IS) participated in the study. INTERVENTION: School-based health promotion activities aimed at students, and regular meetings with the teachers and parents of the IS during 2 consecutive years. MAIN MEASUREMENTS: Students' oral health-related knowledge and behavior, assessed via questionnaires distributed before the intervention, and 6 and 18 months afterwards. RESULTS: Compared to the control groups at 18 months, students belonging to the IS reported enhanced oral health knowledge (OR 3.54; 95% CI 1.46-8.58), and an increased consumption of healthy food at breakfast (OR 2.95; 95% CI 1.26-6.89) and during mid-afternoon snack (OR 3.67; 95% CI 1.49-9.05). A significant decrease was seen in the intake of pastries (OR 4.05; 95% CI 1.68-9.81) and sweetened soft drinks and juices (OR 3.79; 95% CI 1.57-9.12) amongst intervention compared to control students in the medium term (18 months). No significant improvements were observed concerning oral hygiene in the IS. CONCLUSIONS: School-based educational interventions, when developed through an intersectoral and participative approach and considering the socio-economic context, appear to be effective in improving students' diet-related knowledge and behaviors.

Evolución de indicadores de cuidados tras una intervención de alta precoz en recién nacidos prematuros / Evolution of care indicators after an early discharge intervention in preterm infants

Objetivo: Evaluar la evolución de resultados en salud en recién nacidos prematuros (RNP) incluidos en un programa de alta precoz. Método: Ensayo controlado no aleatorizado con grupo de intervención y grupo control. Se incluyen en el estudio los niños ingresados en la Unidad de Cuidados Neonatales del Hospital Universitario Virgen de las Nieves de Granada. El grupo intervención son niños ingresados en la Unidad Neonatal clínicamente estables, cuyo domicilio familiar esté situado en un radio de 20 kilómetros de distancia del hospital. Se adelanta dos semanas el alta hospitalaria y se realiza un seguimiento en domicilio por una enfermera experta en cuidados neonatales. El grupo control son niños que no se puedan incluir en seguimiento domiciliario por criterio de distancia al centro hospitalario o por falta de aceptación de la familia, los cuales recibirán la atención habitual hasta el momento del alta. Las variables de estudio son los indicadores de resultado de la Nursing Outcomes Classification. Resultados: Se han encontrado diferencias en evolución de la puntuación de las etiquetas de la Nursing Outcomes Classification en el grupo intervención respecto al grupo control. Conclusiones: El alta precoz de recién nacidos prematuros, seguidos en domicilio por una enfermera experta en cuidados neonatales, es un servicio sanitario que tiene resultados positivos sobre la preparación de los padres en los cuidados del hijo, sobre el conocimiento de recursos sanitarios, en la adaptación al cambio de vida y en el tiempo de lactancia materna. Se comporta como una actuación segura para los niños y beneficiosa para los padres (AU)

Objective: To evaluate the evolution of health outcomes in preterm infants included in an early discharge programme. Method: Controlled, non-randomised trial with an intervention group and a control group children admitted to the Neonatal Intensive Care Unit of the University Hospital Virgen de las Nieves of Granada were included in the study. The intervention group comprised preterm infants admitted to the neonatal unit clinically stable, whose family home was located within 20km. from the hospital. They were discharged two weeks before the established time and a skilled nurse in neonatal care monitored them at home. The control group comprised infants who could not be included in home monitoring due to the distance to the hospital criterion or because their families did not give their consent and who received the usual care until their discharge. The study variables were the outcome indicators of the Nursing Outcomes Classification. Results: Differences were found in the Nursing Outcomes Classification scores in the intervention group compared to the control group. Conclusions: The early discharge of preterm infants followed up at home by an expert nurse in neonatal care is a health service that achieves results in preparating parents for the care of their child, enabling them to learn about the health services, adapt to their new life, and establish breastfeeding times. It constitutes safe intervention for children and is beneficial to parents (AU)

Evolution of care indicators after an early discharge intervention in preterm infants. / Evolución de indicadores de cuidados tras una intervención de alta precoz en recién nacidos prematuros.

OBJECTIVE: To evaluate the evolution of health outcomes in preterm infants included in an early discharge programme. METHOD: Controlled, non-randomised trial with an intervention group and a control group children admitted to the Neonatal Intensive Care Unit of the University Hospital Virgen de las Nieves of Granada were included in the study. The intervention group comprised preterm infants admitted to the neonatal unit clinically stable, whose family home was located within 20km. from the hospital. They were discharged two weeks before the established time and a skilled nurse in neonatal care monitored them at home. The control group comprised infants who could not be included in home monitoring due to the distance to the hospital criterion or because their families did not give their consent and who received the usual care until their discharge. The study variables were the outcome indicators of the Nursing Outcomes Classification. RESULTS: Differences were found in the Nursing Outcomes Classification scores in the intervention group compared to the control group. CONCLUSIONS: The early discharge of preterm infants followed up at home by an expert nurse in neonatal care is a health service that achieves results in preparating parents for the care of their child, enabling them to learn about the health services, adapt to their new life, and establishbreastfeeding times. It constitutes safe intervention for children and is beneficial to parents.

Needs Perceived by Parents of Preterm Infants: Integrating Care Into the Early Discharge Process.

UNLABELLED: The birth of a preterm infant can have a great emotional impact on the parents when the length of stay is long. Early discharge programs facilitate the transition to the home and have beneficial effects on both the parents and children. However, only a few studies have been conducted to identify the real needs of parents of preterm infants and to determine whether early discharge programs meet such needs. The main objective of this study was to identify the experiences and obstacles, during hospitalization and after discharge, of fathers and mothers of preterm infants who did or did not participate in an early discharge program. METHOD: A qualitative study using semi-structured interviews was performed and included 23 parents of preterm infants. Thematic analysis was performed with the assistance of Atlas.ti 6.2 software. RESULTS: Two main themes were identified: the emotional experience and obstacles to care during hospitalization and the emotional experiences and obstacles at home related to the early discharge program. The results indicated that preterm birth initially has a deep emotional impact on parents. DISCUSSION: There is a remarkable lack of coordination regarding the information provided to parents on their infant's health status. Being first-time parents seems to be an important factor, although further evidence supporting this notion should be provided. CONCLUSION: Parents considered early discharge programs to be very useful in addressing the emotional aspects of hospitalization and the acquisition of neonatal care skills. Parents claim that the coordination and the information provided should be improved.

Sesiones clínicas de cuidados para profundizar en el pensamiento enfermero / Clinical sessions on patient care in order to probe into what nurses think

Desde 2009 el Hospital Universitario Virgen de las Nieves (HUVN), en Granada, viene realizando sesiones clínicas de cuidados con el objetivo de profundizar en el uso de la metodología enfermera, y crear el hábito de la reflexión continua sobre la calidad de los cuidados que se aplican. Con este trabajo se pretende dar a conocer la experiencia desarrollada durante los años 2011-2012 en la realización de sesiones clínicas de cuidados. Durante el periodo estudiado se han desarrollado un total de 35 sesiones clínicas de este tipo, distribuidas en los centros asistenciales del complejo hospitalario, de las cuales 19 han sido casos clínicos, 12 actualizaciones en cuidados, tres revisiones de guías de práctica clínica y una revisión de proceso asistencial integrado. La media de asistencia a las sesiones ha sido de 16 profesionales por sesión. Los temas tratados incluyen situaciones de salud específicas de interés en las unidades asistenciales, la indagación en diagnósticos diferénciales y la incorporación de la evidencia científica. Como mejora se propone la incorporación de criterios para la evaluación del proceso enfermero y de la estructura de las sesiones clínicas de cuidados

Since 2009, the Hospital Universitario Virgen de las Nieves (HUVN) has been conducting clinical sessions on patient care, with the objective of achieving a deep understanding about the use of nursing methodology, and creating the habit of continuous reflection about the quality of careapplied. This paper intends to make public the experience developed during the years 2011-2012 in terms of clinical sessions on patient care. During the period studied, 35 clinical sessions on patient care have been conducted, distributed among the healthcare centres of the hospital complex; 19 of these have been clinical cases, 12 have been patient care updates, three reviews of clinical practice guidelines, and one review of integrated healthcare system. The average attendance to these sessions was of 16 professionals per session. The topics covered included specific health situations of interest for patient care units, investigation into differential diagnoses, and the incorporation of scientific evidence. As an improvement, it has been suggested to incorporate criteria forthe assessment of the nursing process, and of the structure of clinical sessions on patient care

La evolución del pensamiento enfermeroa través de los escritos de Pilar Arcas / Evolution of nursing thinking through the writings of Pilar Arcas

El presente artículo pretende realizar una revisión crítica del pensamientode una enfermera española, Pilar Arcas Ruiz (Granada 1951-1998), queen las últimas dos décadas del siglo XX desarrolló un intenso trabajoconsiderado de gran interés por su contribución al desarrollo de la profesiónenfermera actual. A través de la revisión de varios documentoshemos podido constatar aportaciones de excepcional importancia para eldesarrollo profesional de las enfermeras, como son sus reflexiones sobreel significado de cuidar y la aportación específica de la enfermera a la salud,la defensa de la necesidad de investigar en cuidados, la utilizaciónde metodología en el proceso de atención y la formación superior.Igualmente, este artículo pretende ser un homenaje y un reconocimientoa su trayectoria, además de dejar constancia, en forma de documentoescrito, para las nuevas generaciones de enfermeras (AU)

This article aims to perform a critical review of the thinking of a Spanishnurse, Pilar Arcas Ruiz (Granada, 1951-1998), who, in the last two decadesof the 20th century developed a comprehensive work that is deemedto be of great interest due to its contributions to the development ofthe current nursing profession. By means of the review of several documentswe have been able to find extremely important contributions tothe professional development of nurses, such as her reflections on the meaningof providing care and the specific contribution of nurses to health,the need to carry out research on care, the use of methodology inthe care delivery process and higher training.Likewise, this article aims to be a tribute and recognition of her trajectory,in addition to being a written record for new generations of nurses (AU)

Advance directives and proxies' predictions about patients' treatment preferences.

The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form.

[Life support treatment preferences in critical health situations]. / Preferencias de tratamiento de soporte vital en condiciones críticas de salud.

OBJECTIVE: To explore citizens' treatment preferences in critical health situations. METHOD: We performed a cross-sectional study through a questionnaire administered to 306 participants, randomly selected from nursing consultations, cultural centers, nursing homes and the university. Treatment preferences in critical health situations were measured through the Life Support Preferences Questionnaire (LSPQ). A descriptive bivariate and multivariate analysis was performed. RESULTS: The mean age of participants was 39.28 years (SD: 24.52), 37% had primary school or no education, and 29.1% were male. Age was inversely correlated with accepting treatments; thus acceptance of life support measures was lower among participants older than 55 years than among the youngest participants and was also lower among those with a lower educational level than those with a higher educational level. No differences were found between men and women. In serious diseases with no possibility of recovery, all age groups rejected treatment. When there was the potential for recovery or for non-invasive treatments, participants aged 21 years old or older would prefer to be treated. CONCLUSION: There is wide variability among the population when accepting or rejecting life support treatment. The view that treatment should be accepted at all costs is inappropriate. Disseminating knowledge of advance directives and the use of these documents is recommended as the most effective way to respect patients' wishes when they are unable to express themselves.