Summary Our objective was to use formal systematic review methods to evaluate the efficacy of interventions to reduce faecal shedding of Escherichia coli O157 in post‐weaned ruminants by increasing animal resistance. The methodology consisted of an extensive search to identify all potentially relevant research, screening of titles and abstracts for relevance to the research question, quality assessment of relevant research, extraction of data from research of sufficient quality, and qualitative summarization of results. The interventions evaluated included probiotics, vaccination, antimicrobials, sodium chlorate, bacteriophages and other feed additives. There was evidence of efficacy for the probiotic combination Lactobacillus acidophilus NP51 (NPC 747) and Propionibacterium freudenreichii and for sodium chlorate in feed or water. The effectiveness of vaccination varied among studies and among vaccine protocols and there was no consistent evidence to suggest that antibiotic use was associated with a decrease in faecal shedding of E. coli O157, or that current industry uses of antimicrobials were associated with increased faecal shedding. There were an insufficient number of studies available to address the effectiveness of bacteriophages and several other feed additives. In general, few of the primary studies evaluated the interventions under commercial housing conditions with a natural disease challenge, there were inconsistencies in the results among study designs and in some cases among studies within study designs, and a relatively large proportion of publications were excluded based on quality assessment criteria. Few studies reported on associations between the proposed intervention and production parameters, such as average daily gain and feed: gain ratio. While the results suggest that some interventions may be efficacious, there are knowledge gaps in our understanding of the efficacy of pre‐harvest interventions to increase animal resistance to E. coli O157 that require further targeted research.
Existe un considerable bagaje teórico y metodológico para desarrollar investigación cualitativa en salud siguiendo la diversidad de tradiciones analíticas que aportan principalmente las ciencias sociales. Sin embargo este maridaje que se produce en torno a lo socio-sanitario abre un espacio multidisciplinar no suficientemente explorado aún que suscita numerosos interrogantes. En este artículo se realiza una visión panorámica de los principales paradigmas, metodologías y orientaciones teóricas que han inspirado los análisis cualitativos en el contexto de las ciencias de la salud. Partiendo de una clasificación primaria, se proponen los dos polos que delimitan el continuum del análisis cualitativo: desde los diseños que ponen énfasis en la descripción de los datos, con un carácter puramente exploratorio, hasta aquéllos que se adentran en las formas de teorización para establecer interpretaciones e inferencias.La investigación cualitativa abre un espacio en el análisis de los problemas de salud desde una perspectiva social y cultural, adoptando para ello diversos procedimientos, como el análisis de contenido o el análisis del discurso, que permiten un acercamiento a las formas de comunicación y escudriña en la ideología que se oculta tras el lenguaje. La tradición sociológica y antropológica aportan de esta manera metodologías singulares que permiten conocer el contexto donde surgen los fenómenos y elaborar propuestas teóricas para explicarlos, como es el caso de la etnometodología, la inducción analítica o la teoría fundamentada. Por último se proponen algunas claves para construir un espacio común desde el que construir nuevas perspectivas epistemológicas a partir de la confluencia multidisciplinar.
Objective:to describe the coping of stoma patients with the news about the ostomy, as well as to analyze the meaning and the experience of their new bodily reality. Method:qualitative phenomenological study undertaken through semistructured interviews with 21 stoma patients. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stomal therapy nurses. The software Atlas.ti was used. Results:two main categories emerge: "Coping with the news about receiving a stoma" and "Meaning and experience of the new bodily reality". The informants' answer varies, showing situations that range from the natural acceptance of the process to resignation and rejection. The previous experiences of other family members, the possible reconstruction of the stoma or the type of illness act as conditioning factors. Conclusions:the coping with the news about the stoma is conditioned by the type of illness, although the normalization of the process is the trend observed in most informants. Nursing plays a fundamental role in the implementation of cognitive-behavioral interventions and other resources to promote the patients' autonomy in everything related to care for the stoma.
BackgroundThe predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based.MethodsA maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities.ResultsThe results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a “patient-centred” approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed.ConclusionsPatients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.
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