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To test the effectiveness of an 8-month school-based multicomponent intervention (MOVI-KIDS) in improving health-related quality of life (HRQoL) in schoolchildren.A randomized cluster trial was conducted including 1168 children aged 4-6 years who attended 21 schools in two Spanish provinces (Cuenca and Ciudad Real). MOVI-KIDS study is a multicomponent physical activity intervention, which consisted of (i) 3 × 60-min sessions/week, (ii) educational materials for parents and teachers, and (iii) school playground modifications. The parent's proxy report of the KINDL-R Spanish version (6 subdimensions and a total score), and the KINDL-R self-reported by children (total score) was used to measure HRQoL. Mixed linear regression models were conducted to test differences in each HRQoL dimension between intervention and control groups, controlling for baseline values, cardiorespiratory fitness, and socioeconomic status, by gender.The boys in the intervention group presented better scores on total HRQoL than the control group in both the parent (ß = 1.46; 95% CI: 0.23-2.70) and self-reported (ß = 2.13; 95% CI: 0.53-3.74) versions, as well as on the emotional well-being dimension (ß = 2.43; 95% CI: 0.48-4.36). There was no significant effect of the intervention on physical well-being, self-esteem, family, and friends. In girls, no statistically significant differences were found between those who participated in MOVI-KIDS and those who did not.Our data support gender differences in the effect of MOVI-KIDS, such that while in boys the intervention was successful in increasing total scores of HRQoL, as well as emotional well-being scores, the intervention was not effective in improving girls' HRQoL.

To determine the prevalence and risk factors for dating violence and the correlations between dating violence and violence in social networks, anxiety and depression among nursing students.A cross-sectional and correlational study.This study was conducted with nursing degree students at Spanish university during May 2021. A total of 248 nursing students completed an online survey. The online survey included sociodemographic variables, the Conflict in Adolescent Dating Relationships Inventory, the Social Network Violence Scale and the Hospital Anxiety and Depression Scale. Chi-squared test, Pearson's correlation and logistic regression were used.Of the participants, 13.3% were men and 86.7% were women. A total of 53.2% had experienced and/or perpetrated dating violence. About violence in social networks, 22.2% of the participants had perpetrated it, and 20.2% had been victims of it. Strong correlations were found between experiencing and perpetrating dating violence. Significant associated factors were cohabitation with a partner, alcohol consumption, socioeconomic status and history of dating violence.Dating violence is a serious problem given its high prevalence among the surveyed nursing students, who, as future health professionals, must know how to recognize and react to possible cases of abuse.The study results add to international literature that men and women university nursing students are equally susceptible to intimate partner violence and report similar prevalence of dating violence. Also, dating violence is correlated with increased levels of anxiety and depression. It seems to be necessary to implement training programmes that help minimize the problem and identify possible cases.

Flash glucose monitoring (FGM) systems have been suggested to have clinical beneficial effects in patients with diabetes mellitus, although their improvements in terms of quality of life (QoL) and patients’ satisfaction are not always addressed or are considered a secondary outcome. Thus, the aim of this meta-review is to establish the benefits of FGM in terms of patients’ satisfaction and QoL in both type 1 and type 2 diabetes patients using evidence from past systematic reviews and meta-analyses. Major databases were searched for systematic reviews (with or without meta-analyses) that assessed the satisfaction or QoL of type 1 or 2 diabetes patients using FGM compared with other glucose monitoring systems. The quality of the included systematic reviews was addressed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Six systematic reviews (including two meta-analyses) were included in the meta-review. Evidence suggests that FGM systems seem to improve patients’ satisfaction and QoL compared with self-monitoring of blood glucose, although the high variability in the measurement tools, the clinical significance and the quality of the systematic reviews included do not allow us to state FGM benefits with any certainty. Further research, including high-quality randomised clinical trials, differentiating the needs of both type 1 and type 2 diabetes patients and focusing on psychosocial benefits for these patients is needed to optimise clinical decisions between patients and professionals by developing the right health technology assessment for FGM systems.

The identification of research priorities in line with current health needs and nursing competencies is a priority. Nevertheless, barriers and facilitators perceived by nurses to performing nursing research have scarcely been investigated. The main aim of this study was to explore the situation in nursing research in Spain, as perceived by Spanish experts. A Delphi study technique in two phases was applied using an online survey tool. A panel of 20 nursing experts in nursing, teaching and management positions participated. The strengths highlighted were the possibility of reaching the PhD level, the possibility of receiving continuous training in research methodology, and access to scientific knowledge through the Internet. The weaknesses identified were the lack of Spanish nursing journals in which to publish the research results, the lack of funding in nursing care research, and the lack of connection between the healthcare institutions and the university. According to the experts, elements that could enhance leadership in research are the creation of nursing research units in hospitals, the economic recognition of nurses with PhDs, and considering research work as part of their daily tasks in clinical settings. The idea of being subordinated to physicians still remains in nurses&rsquo, ways of thinking.

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to theMDshowed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct e ect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength., European Union (EU) DOCM 26/02/20, University of Castilla-La Mancha 2018-CPUCLM-7813

To determine satisfaction with life (LISAT) and self-esteem in women with breast cancer and the relation between sociodemographic and clinical variables with LISAT and self-esteem. Cross-sectional study with 514 Spanish women with breast cancer. Data were collected using an online questionnaire that included the Satisfaction with Life Questionnaire (LISAT-8) and the Rosenberg self-esteem scale. Variables are age, education, occupation, marital status, surgical treatment, breast reconstruction, adjuvant treatment, time since diagnosis, the self-esteem scale, and the LISAT. A multinomial logistic regression was performed to identify possible factors associated with the LISAT and self-esteem after breast cancer. The average age was 46.34 (SD ± 8.28), average age at diagnosis was 42.26 (SD ± 8.56), and average time since diagnosis was 4.05 years (SD ± 5.23). Reports showed the following: good general LISAT (61.7%), economic LISAT (44.7%), and social life LISAT (75.9%) and medium sexual LISAT (41.2%). Of the respondents, 39% had lower self-esteem (p

Resumen: Objetivo: Conocer la frecuencia de la realización de mamografías con finalidad preventiva del cribado de cáncer de mama en mujeres en España, su evolución entre los años 2006-2014, el perfil sociodemográfico de las mujeres que se realizan la mamografía y analizar los factores que influyen en su adhesión. Diseño: Estudio descriptivo de tipo transversal. Emplazamiento: España. Participantes: Un total de 53.628 mujeres mayores de 15 años encuestadas en la Encuesta Nacional de Salud en España de 2006 y 2011/12 y la Encuesta Europea de Salud en España de 2009 y 2014. Mediciones: Se utilizaron las variables: realización de mamografía, frecuencia de realización de mamografías y motivo de realización, además de las variables sociodemográficas. La clase social se obtuvo a partir de la última ocupación del sustentador principal de la unidad familiar. Se realizó un análisis de regresión logística con las variables sociodemográficas. Resultados: La realización de mamografías ha ido en aumento desde 2006 a 2014, y su realización se ha incrementado por el hecho de que las participantes hayan recibido una carta, hayan sido llamadas por teléfono o se les haya dicho en su centro de salud si querían hacerse esta prueba. Existen diferencias significativas en la realización de mamografías en las diferentes comunidades autónomas. Conclusiones: La realización de las mamografías ha aumentado considerablemente de 2006 a 2014, aunque siguen existiendo diferencias entre comunidades autónomas, siendo Ceuta y Melilla donde los porcentajes son más bajos. Los factores que se relacionan con mayor realización de mamografías son: mayor nivel educativo, mayor clase social, estado civil casada, nacionalidad española y edad. Abstract: Objective: To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. Design: Transversal study. Sites: Spain. Participants: A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. Measurements: The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. Results: The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. Conclusions: Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age. Palabras clave: Mamografía, Neoplasias de la mama, Encuestas epidemiológicas, Demografía, Prevalencia, España, Keywords: Mammography, Breast neoplasms, Health surveys, Demography, Prevalence, Spain

The aims of this study were to assess the association of adherence to the Mediterranean diet (MD) with physical fitness and body composition in Spanish university students and to determine the ability to predict the MD adherence of each Mediterranean Diet Adherence Screener (MEDAS) item. A cross-sectional study was performed involving 310 first-year university students. Adherence to the MD was evaluated with MEDAS-14 items. Anthropometric variables, body composition, and physical fitness were assessed. Muscle strength was determined based on handgrip strength and the standing long jump test. Cardiorespiratory fitness (CRF) was measured using the Course&ndash, Navette test. Only 24% of the university students had good adherence to the MD. The ANCOVA models showed a significant difference between participants with high adherence to the MD and those with medium and low adherence in CRF (p = 0.017) and dynamometry (p = 0.005). Logistic binary regression showed that consuming &gt, 2 vegetables/day (OR = 20.1, CI: 10.1&ndash, 30.1, p &lt, 0.001), using olive oil (OR = 10.6, CI: 1.4&ndash, 19.8, p = 0.021), consuming &lt, 3 commercial sweets/week (OR = 10.1, IC: 5.1&ndash, 19.7, 0.001), and consuming &ge, 3 fruits/day (OR = 8.8, CI: 4.9&ndash, 15.7, 0.001) were the items most associated with high adherence to the MD. In conclusion, a high level of adherence to the MD is associated with high-level muscular fitness and CRF in Spanish university students.

PURPOSE To analyse: 1) the differences in health-related quality of life (HRQoL) between typically developing (TD) children and children with developmental coordination disorder (DCD) according to parents' and children's perception, and 2) the differences and level of agreement between parents and children's perceptions in HRQoL in both children's samples. METHODS Cross-sectional analysis in 115 Spanish schoolchildren 4-to-7 years. Motor competence and HRQoL were assessed using the MACB-2 and the KINDL-R questionnaire, respectively. RESULTS ANCOVA model showed that children with DCD children obtained lower scores in physical well-being, friends, school and total HRQoL dimensions than TD peers after controlling for covariates (p < 0.05). Moreover, parents' perception scores in HRQoL were lower in children with DCD than in TD peers (79.7 vs 84.8; p = 0.022). Student T-tests for repeated-measures showed non-significant differences between children and parents' perceptions in mean HRQoL scores, by motor competence categories. The intraclass correlations coefficients between parents and children's perception of HRQoL was moderate in DCD category (0.62; p = 0.024) and small in TD category (0.29; p = 0.049). CONCLUSIONS Children under 6 years old with DCD have lower HRQoL scores than their TD peers. No differences were found between children's and parents' perceptions in total HRQoL, although the perceptions of children and parents in DCD category showed a significantly higher level of agreement than TD children. Interventions aimed at promoting motor skills in school settings during the preschool age seem necessary to improve children's quality of life.

INTRODUCTION: Recent immunological and transgenic advances are a promising alternative using limited materials of human origin for transplantation. However, it is essential to achieve social acceptance of this therapy. OBJECTIVE: To analyze the attitude of nursing students from Spanish universities toward organ xenotransplantation (XTx) and to determine the factors affecting their attitude. MATERIALS AND METHODS: Type of study: A sociological, multicentre, and observational study. STUDY POPULATION: Nursing students enrolled in Spain (n = 28,000). SAMPLE SIZE: A sample of 10 566 students estimating a proportion of 76% (99% confidence and precision of ±1%), stratified by geographical area and year of study. Instrument of measurement: A validated questionnaire (PCID-XenoTx-RIOS) was handed out to every student in a compulsory session. This survey was self-administered and self-completed voluntarily and anonymously by each student in a period of 5-10 min. STATISTICAL ANALYSIS: descriptive analysis, Student's t test, the chi-square test, and a logistic regression analysis. RESULTS: A completion rate: 84% (n = 8913) was obtained. If the results of XTx were as good as in human donation, 74% (n = 6564) would be in favor and 22% (n = 1946) would have doubts. The following variables affected this attitude: age (P

Purpose To determine whether there are changes in sexuality after breast cancer, to better understand the sexual function of women with breast cancer, and to investigate the potential relationship between sexual dysfunction and socio-demographic and clinical variables. Methods A cross-sectional study. This study included 514 women with breast cancer between 21- and 66-years-old. The cases were gathered between June 2016 and January 2017. The instruments used were the questionnaire on Women’s Sexual Function and a questionnaire to collect socio-demographic and clinical data. Results The average age (± standard deviation, SD) of participants was 46.34 ± 8.28 years. Their average age at date of diagnosis was 42.26 ± 8.56 years, and the average time suffering from cancer was 4.05 ± 5.23 years. There were significant differences (p = 0.002) in the presence of sexual dysfunction before (32.1%) and after (91.2%) cancer. The primary sexual dysfunctions were due to penetration pain (50.6%), lubrication (50.6%), dysfunctional desire (44.6%), and dysfunctional excitement (44.6%). Two-thirds of participants were satisfied with their sexual relations. The women who presented most sexual dysfunction were those that had a bilateral mastectomy (p = 0.009) and those who received chemotherapy, radiotherapy and hormonal-therapy (p < 0.001). Conclusion Sexual function was changed in women with breast cancer. The main problems included penetration pain, desire, lubrication, and dysfunctional excitement. It is important that Health professionals recognize which circumstances influence the sexual function of women with breast cancer and to make interventions that facilitate sexual adjustment.

Introduction The World Health Organization recognizes sexual health as a fundamental right that should be guaranteed to all individuals. Sexual dysfunction affects various aspects in the lives (physical, psychic, and social) of affected persons. Aims To assess the different types of sexual dysfunction, the quality of life (QOL), depression, anxiety, and levels of self-esteem observed in 165 men with sexual dysfunction, both with and without spinal cord injury (SCI). Methods Case control study of 85 men with SCI and sexual dysfunction, and 80 men without SCI that have sexual dysfunction. Main Outcomes Measures The Sexual Health Evaluation Scale, the Fugl-Meyer Life Satisfaction Questionnaire scale, the Hospital Anxiety and Depression Scale, the Evaluation of the Sexual Health Scale, and Rosenberg's Self-esteem Scale were all used for data collection. Results Of the members in group A (with SCI), 89.4% (76) showed erectile dysfunction, and 75.2% (64) reported anejaculation. In group B (without SCI), 75 (96.8%) showed erectile dysfunction, and 58.7% (47) had disorders of sexual desire. In group A, 16.47 % (14) showed signs of depression, and 35.3% (30) had signs of anxiety. In group B, 30% (24) had elevated scores regarding depression, and 48.75% (39) had high scores for anxiety. All of the participants reported a high general QOL and a high satisfaction with their QOL but reported that their satisfaction with their sexual lives was only at the acceptable level. Social QOL is significantly higher in the SCI group (t Student P = 0.031). The QOL, self-esteem, and anxiety and depression levels are significantly correlated. Conclusions Men with sexual dysfunction strive to adapt to their situations, with the relationship between the type of sexual dysfunction and the QOL, mood (depression), and self-esteem all being important considerations. Sexuality and employment status are the areas where men with spinal cord injuries report less satisfaction.

The impact of spinal cord injury and its sequels requires important efforts of adaptation. In several studies, people with spinal cord injury claim to have covered most of their needs at physical, emotional and social level, but they are not yet fully satisfied with their sexual life. Sexual function is usually impaired in men with spinal cord injuries, and is sometimes related to problems of erection, ejaculation and/or orgasm. This issue is not a priority in the first phase, but it appears over the subsequent periods when patients often ask for a solution to this problem. A case-study is presented of a 25 year old male with chronic complete spinal cord injury (ASIA A), L4-L5 level, who reported sexual dysfunction and attended an annual review in the National Hospital for Paraplegics. After performing a nursing assessment using the functional health patterns of Gordon, the team proposed a nursing care plan according to the taxonomy of NANDA (North American Nursing Association), NOC (Nursing Outcome Classification) and NIC (Nursing Intervention Classification). Nurses are the healthcare professionals who have more direct and continuous contact with these patients. Specific programs need to be designed to provide them with the sexual education, which should contain adequate emotional and sexual information. We believe that an appropriate and systematic assessment of patient's sexuality, as well as the application of the (NANDA, NOC, NIC) nurse methodology, may be very helpful in improving the outcomes of these specific interventions.

Resumen Objetivo Conocer la frecuencia de la realización de mamografías con finalidad preventiva del cribado de cáncer de mama en mujeres en España, su evolución entre los años 2006-2014, el perfil sociodemográfico de las mujeres que se realizan la mamografía y analizar los factores que influyen en su adhesión. Diseño Estudio descriptivo de tipo transversal. Emplazamiento España. Participantes Un total de 53.628 mujeres mayores de 15 años encuestadas en la Encuesta Nacional de Salud en España de 2006 y 2011/12 y la Encuesta Europea de Salud en España de 2009 y 2014. Mediciones Se utilizaron las variables: realización de mamografía, frecuencia de realización de mamografías y motivo de realización, además de las variables sociodemográficas. La clase social se obtuvo a partir de la última ocupación del sustentador principal de la unidad familiar. Se realizó un análisis de regresión logística con las variables sociodemográficas. Resultados La realización de mamografías ha ido en aumento desde 2006 a 2014, y su realización se ha incrementado por el hecho de que las participantes hayan recibido una carta, hayan sido llamadas por teléfono o se les haya dicho en su centro de salud si querían hacerse esta prueba. Existen diferencias significativas en la realización de mamografías en las diferentes comunidades autónomas. Conclusiones La realización de las mamografías ha aumentado considerablemente de 2006 a 2014, aunque siguen existiendo diferencias entre comunidades autónomas, siendo Ceuta y Melilla donde los porcentajes son más bajos. Los factores que se relacionan con mayor realización de mamografías son: mayor nivel educativo, mayor clase social, estado civil casada, nacionalidad española y edad.

Burn injuries are tissue injuries originated as a result of a physical or chemical trauma. They can cause from a mild skin affectation to the total destruction of the affected tissues, depending on various levels of severity. Moreover, if the affected body surface is very large, patient life can seriously be compromised. In this chapter, the intention is to clarify the nursing care for the affected area, once patient's life risk is stabilized and controlled. This care should be based on an adequate approach to local handling of burn injuries, after their severity and prognosis have been stated. To do this, it will be used the standardized nursing language NNN, referring to Nursing Diagnosis NANDA (North American Nursing Diagnosis Association), Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). This taxonomy is very useful to describe the Nursing clinical practice of burns care because it can easily be used by nurses participating in the care of this type of patients. Nursing plans using the NNN taxonomy can be designed using existing software applications.

The aim of this work is to analyze the mortality and its causes in the abandoned children of the Children’s home of Toledo, who were born in the Maternity House, because it was a homogeneous group which had the same conditions in their delivery and they were abandoned at the moment of their birth. It allows us to compare the mortality of this group of foundlings with the mortality of the general population and with the mortality of those abandoned in other Charity Institutions. This paper explains the different factors which could determine the mortality., El objetivo de este trabajo es analizar la mortalidad expósita y sus causas en una cohorte de niños abandonados en la inclusa toledana, aquellos que nacieron en la Maternidad aneja, como grupo homogéneo que partía de unas condiciones de alumbramiento similares y fueron institucionalizados al nacer. Ello permite comparar esta mortalidad expósita con la de otras inclusas españolas y con la mortalidad poblacional, a la vez que explica los distintos factores que pudieron condicionarla.

Resumen Se trata de un trabajo presentado en la Jornada de «mejora continua de la calidad de los cuidados en ulceras por presion y heridas cronicas» celebrada en Toledo en el ano 2009. Se ha realizado la valoracion de una mujer de 76 anos (grupo de edad que con frecuencia sufre esta alteracion) que vive en un centro sociosanitario y que presenta una ulcera por presion a nivel sacro en estadio III. A traves de la valoracion por patrones funcionales de salud de M. Gordon se ha descrito el diagnostico de enfermeria de «dolor agudo» y se presenta el plan de cuidados segun taxonomia NANDA (North American Nursing Association), NIC (Nursing Intervention Classification), NOC (Nursing Outcome Classification). Se pretende incidir en la importancia de valorar el dolor en los pacientes que sufren este tipo de lesiones, ya que aunque se sabe que esta presente en la mayor parte de las heridas cronicas, en numerosas ocasiones ha sido minusvalorado por los profesionales de enfermeria, lo que ha hecho que no se tratase, empeorando la calidad de vida del paciente, por sus repercusiones tanto fisicas como psicologicas. Este caso, pone de manifiesto como valorar el dolor en una paciente que presenta una ulcera por presion, ayuda a establecer un plan de cuidados individualizado en el que el tratamiento y alivio del dolor se convierte en una de las prioridades de dicho plan. Como resultado de las intervenciones realizadas, la percepcion de dolor mejora, ayudando a mejorar la movilidad de la paciente y su descanso nocturno.

Sleep seems to have a significant influence on the metabolic syndrome (MetS). However, results in this association are still inconsistent in children. The aim of this study was to examine the influence of sleep characteristics in the MetS (index and factors) in Spanish children. Cross-sectional study including a sample of 210 children aged 8-to-11-years belonging to 20 schools from the province of Cuenca, Spain was conducted. Cardiometabolic risk and actigraphy sleep patterns were determined and analysed using correlation coefficients, ANCOVA models and a propensity score derivation model. Overall, children in the lower time in bed category and those who went to bed later (> 23:15h) showed worse values in the cardiometabolic profile and risk index. Differences were observed when the total time in bed was below 9h 15mins. Our study shows that short sleep duration could be a risk factor for cardiometabolic risk in children, and bedtime may independently influence this risk. In addition, our data suggests that children's sleep hygiene should be incorporated in parenting educational programs.

Deaths resulting from heart failure are just as frequent, if not more frequent, than deaths resulting from certain types of cancer. Patients suffering from end stageheartfailure tend to go directly to the emergency room. ER Multidisciplinary medical teams (doctors, nurses, psychologists) should be adequately trained to provide comfort, symptom management, and spiritual well-being for the patients and their families. This article presents a case concerning an 87-year-old man suffering from cardiac arrest and congestive heart failure due to ischemic cardiomyopathy.

La asistencia sanitaria se vinculaba a acciones benéficas hacia los pobres. Hasta el siglo XX fue frecuente el abandono de niños en inclusas, donde las cifras de mortalidad eran catastróficas. El objetivo de esta investigación es estudiar la mortalidad infantil y sus causas en los niños abandonados en la inclusa de Toledo entre 1900 y 1910. Es un trabajo histórico que analiza las fuentes primarias (libros de lactancias y destetes, con datos sobre el momento de la muerte y su causa) a partir de los presupuestos teóricos de la historia social y cultural. Excluidas las muertes perinatales, la tasa de mortalidad fue de 587 por mil. El 39 % murió antes de cumplir un año. La mortalidad en el grupo entre 1 y 5 años es la mitad de la que se da hasta el año de vida. Las causas de esta mortalidad fueron las enfermedades infecciosas, falta de desarrollo físico, eclampsia y atrepsia. La mortalidad infantil de estos niños era muy superior a la que tenía la provincia de Toledo en la misma fecha. La causalidad de los fallecimientos aparece vinculada a la falta de salubridad y de higiene tanto de la institución como de las familias de acogida. The study of the medical care is closely connected to the charitable actions with poor people. It was very common the abandonment of the children in the foundlings until the first decades of the 20th century. In them, the rates of infant mortality were catastrophic. The aim of this research is the study of the infant mortality and its causes in the abandoned children in the foundling of Toledo between 1910 and 1910. It is a historical research that analyses the primary sources (the books of breastfeeding and weaning of the institution have been used to collect the data because in them there are some references about the moment of the death and its etiology) using the principles of Social and Cultural History. If we exclude the perinatal deaths, the infant mortality rate was 537 per thousand. The 39% died before being one year old. The mortality rate between one and five years is the half than in the other group of age. This mortality was caused by infections, rickets, “eclampsia and atrepsia”. The mortality of these children was higher than the mortality of the kids who live in the county of Toledo in the same date. The causes of the death are related to the lack of healthiness and hygiene both in the institution and in the foster families. O estudo dos cuidados de saúde deve estar vinculado à acções benéficas dos pobres. Foi frequente até o século XX o abandono de crianças em orfanatos, onde as taxas de mortalidade infantil era muito altas. O objectivo desta pesquisa é estudar a mortalidade infantil e suas causas em crianças abandonados em um orfanato em Toledo (Espanha) entre 1900 e 1910. É um trabalho histórico que analisa as fontes primárias (livros de lactancias e desmame da instituição, porque recolher dados sobre o tempo de morte e sua etiologia) usando dos fundamentos teóricos da história social e cultural. Excluídas as mortes perinatais, a taxa de mortalidade foi de 587 por mil. O 39 % morreram no primeiro ano. A mortalidade no grupo entre 1 e 5 anos é metade do que no primeiro ano do vida. As causas de morte foram doenças infecciosas, a falta de desenvolvimento físico, eclampsia e atrepsia. A mortalidade infantil dessas crianças foi muito maior do que à mortalidade de crianças em Toledo na mesma data. As causas da morte parecem estar asociadas à falta de saneamento e higiene da instituição assim como das famílias de acolhimento.

This is a summary of a presentation made in the symposium "Improved Continuous Quality Care in Patients with Pressure Ulcers and Chronic Injuries", which was held in Toledo in 2009. A 76 year old woman had been assessed (she belonged to the age group that frequently suffers this condition). She lived in a social healthcare centre and had a III stage sacral pressure ulcer. Using Gordon's Functional Health Patterns for assessing "Acute pain", a nursing diagnosis is described and the nursing care plan has been presented according to NANDA, NIC, NOC taxonomy. The aim of this article is to show the importance of considering the pain in patients who suffer from this type of lesion, which, although almost always present, it is often undervalued by nursing staff, resulting in an even worse quality of life for the patient, due to both physical and psychological effects. This case shows how to assess pain in a patient with ulcers, and helps establish an individualised care plan with a priority on pain treatment and relief. As as result of the interventions carried out, a better perception of pain is achieved, thus helping to improve patient's mobility and night rest.