Professional quality of life and fear of COVID-19 among Spanish nurses: A longitudinal repeated cross-sectional study.

AIM AND OBJECTIVES: To evaluate changes in compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and fear of COVID-19 among Spanish nurses by comparing two assessment points: before and after the COVID-19 vaccination campaign. BACKGROUND: The COVID-19 pandemic has produced a great impact in healthcare worker's professional quality of life, especially among nurses. CF, BO and fear of COVID-19 decisively affect the care provided by nurses and put them at risk for mental health problems, so longitudinal studies are essential. DESIGN: A repeated cross-sectional design was carried out with a time-lapse of 12 months. METHODS: A total of 439 registered nurses in December 2020 and 410 in December 2021 participated in this study through an online survey. Data were collected using the Professional Quality of Life Questionnaire and the Fear of COVID-19 Scale. Occupational and sociodemographic variables were also analysed. This article adheres to the STROBE guidelines for the reporting of observational studies. RESULTS: The fear of COVID-19 has not been reduced among nurses. The levels of BO remain stable and continue to be high in half of the professionals. CF has been reduced with a small effect size (d = 0.30), while CS has also decreased (d = 0.30). Positive correlations were found in both assessment points between fear of COVID-19 and BO (r = .44, p ≤ .001; r = .41, p ≤ .001) and also between fear of COVID and CF (r = .57, p ≤ .001; r = .50, p ≤ .001). Negative correlations between fear and CS were also found (r = - .16, p = .001; r = - .22, p ≤ .001). RELEVANCE TO CLINICAL PRACTICE: Programmes to reduce fear of COVID-19, BO and CF are needed to improve mental health and to prevent psychological distress among nurses, as well as to increase CS and preserve the productivity and quality of nursing care. PATIENT OR PUBLIC CONTRIBUTION: The nurses collaborated by participating in the present study anonymously and disinterestedly.

Temperature and salinity vertical profiles (CTD) data in the Ría de Vigo and adjacent shelf collected in the Radiales program, 1987-2020.

The Galician rías and their adjacent continental shelf form part of the northern boundary of the Canary Current upwelling system (CanCUS), one of the world's major eastern boundary upwelling ecosystems (EBUEs). During summer, prevailing northerly winds export surface water offshore, allowing deeper, cooler, nutrient-rich water to rise, creating a fertilizing effect on coastal waters that support valuable fisheries and aquaculture economy. This data article describes a time series of hydrographic data collected on a biweekly to monthly frequency from August 1987 to September 2020 in the interior of the Ría de Vigo (one of the aforementioned Galician rías) and its adjacent shelf. This monitoring effort results in the longest sampling series in the area up to 2020, providing high value for understanding the connectivity processes between the coastal embayment and the adjacent shelf, changes in ocean climate, as well as ecosystem structure and functioning. Data were collected with vertical pressure, temperature and conductivity profilers, varying the profiler instrument over time (MARK III, SBE 9 Plus, SBE 19, SBE 25). Data were collected at four stations with depths ranging from 29 m to 148 m, although only two of these stations cover the full temporal range of the monitoring program. Due to the temporal extent of the sampling, the data have been processed with different techniques and by different technicians throughout the duration of the monitoring program. To ensure data consistency and increase data reusability, all data have been now reprocessed under the same criteria, quality-controlled, and unified in this dataset. The dataset in both MedAtlas SeaDataNet ASCII and CF-compliant netcdf formats are available via SEANOE repository at: https://www.seanoe.org/data/00828/94008/.

Temperature and salinity trends in the northern limit of the Canary Current Upwelling System.

Thermohaline time series are crucial for detecting and quantifying abiotic changes in the marine environment, and even more so in the present global change scenario. This is particularly relevant for the Ría the Vigo and its adjacent shelf, a highly productive ecosystem at the northern limit of the Canary Current Upwelling System (CanCUS). This study analyses a 34-year time series (1987-2020) of Conductivity-Temperature-Depth (CTD) casts, the longest series available to date in the region. Long-term trends, shifts, and seasonal variability of temperature and salinity were assessed and investigated in relation to regional meteorological variability and basin-scale atmospheric teleconnection indices. Generalized Additive Models (GAM) allowed us to determine that monthly thermohaline variability can be largely explained by regional meteo-climatic variability, mainly upwelling index and river discharge. Trends and shifts in some teleconnection patterns, especially the East Atlantic (EA) pattern, may also be related to both the shift in salinity in 2013 and its long-term decrease below 50 m depth. Despite the current global warming context, no statistically significant trend was observed for either the upwelling index or temperature. The spatial analysis of sea surface temperature trends suggests that our study area has been responding to climate change differently from other surrounding near-shore areas, as the Finisterre Cape or the southern Bay of Biscay. Overall, this study highlights the importance of long-term observations to elucidate the impact of climate change in the northern limit of the CanCUS and encourages caution when extrapolating conclusions from ecosystem studies on a regional scale.

Experiences of Self-Stigma in People with Chronic Psychosis: A Qualitative Study.

We present the results of a phenomenological study understanding the personal meaning of self-stigma in people with chronic psychosis. Self-stigma is a frequent phenomenon in the lives of people with psychosis and their families and it functions as a barrier to recovery. Semi-structured in-depth interviews were conducted with fourteen outpatients that suffer from chronic psychosis during January 2020. Data analysis was carried out using an inductive approach as described by Graneheim and Lundman through the MAXQDA 2022 program. The themes observed were: "Contextual Stigma", "Components of Self-Stigma", "Skills Loss" and "Coping with Self-Stigma". The main categories and subcategories were avoidance and escape behaviours from their social environment, labelling, loss of social relationships, negative impact and self-concealment of the diagnosis. Our results revealed influence on each other, forming a looping effect that explains and amplifies the lived experience of self-stigma. These findings highlight the need to implement strategies in nursing practice aimed at training the acceptance and distancing necessary to minimize the impact of self-stigma on people with chronic psychosis. This study adheres to the EQUATOR guidelines for the Consolidated Criteria for Reporting Qualitative Research (COREQ).

The role of nurses' professional values during the COVID-19 crisis.

BACKGROUND: The COVID-19 pandemic has produced high stress in nurses, affecting their professional quality of life. Different variables affect psychological stress response and professional quality of life. In this context, the role of professional values represents an interesting object of research. OBJECTIVES: To analyze the relationship between professional values, perceived stress, and professional quality of life among nurses during the COVID-19 crisis. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: Descriptive cross-sectional study. Participants were 439 registered nurses from the public health system. Perceived stress, professional quality of life, and professional values were evaluated by using measuring instruments adapted and validated in the geographic context of research. Data were collected online in December 2020 during the second wave of the COVID-19 pandemic in Spain. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee on Clinical Research of the Principality of Asturias. FINDINGS: Within professional values, ethics obtained higher scores showing the primacy of ethical values among nurses. Moderate correlations between ethics, mastery, expertise, and compassion satisfaction were found. Frontline nurses informed high perceived stress. The correlations between professional values and compassion satisfaction were higher in non-frontline nurses. A moderate negative correlation between perceived stress and compassion satisfaction was found in both groups, which implies that the higher the stress, the lower the satisfaction in the helping relationship. CONCLUSION: Professional values positively influence compassion satisfaction during the COVID-19 pandemic. Compassion satisfaction presents a negative correlation with fatigue compassion and burnout in frontline and non-frontline nurses. Given the functionality of values both to guide clinical practice professionally and ethically, and prevent dissatisfaction with one's professional quality of life by reinforcing compassion satisfaction, it is necessary to reinforce them with an intensive and cross-sectional learning during the university training.

Depression symptom profiles and long-term response to cognitive behavioral therapy plus contingency management for smoking cessation.

BACKGROUND: Depression is heterogeneous in nature and using diagnostic categories limits insight into understanding psychopathology and its impact on treatment efficacy. This secondary analysis sought to: 1) identify distinct subpopulations of cigarette users with depression, and 2) examine their response to cognitive-behavioral treatment (CBT) + contingency management (CM) for smoking cessation at one year. METHOD: The sample comprised 238 (74 % females) adults who smoke receiving CBT only or CBT + CM. A latent class analysis was conducted on baseline depressive symptoms measured using the Beck Depression Inventory-II. Generalized estimating equations assessed the main and interactive effects of class, time, treatment, and sex on smoking abstinence. RESULTS: Three distinct classes were identified: C1 (n= 76/238), characterized by mild depression, loss of energy, pessimism, and criticism, C2 (n= 100/238) presenting moderate severity and decreased appetite, and C3 (n= 62/238) showing severe depression, increased appetite, and feelings of punishment. There was a significant cluster × treatment interaction, which indicated additive effects of CM over CBT alone for Class 1 and 2. Persons in Class 1 and 2 were 3.60 [95 % CI: 1.62, 7.97] and 2.65 [95 % CI: 1.19, 5.91] times more likely to be abstinent if CBT + CM was delivered rather than CBT only. No differential sex effects were observed on treatment response according to cluster. CONCLUSIONS: Profiling depression symptom subtypes of cigarette users may be more informative to improve CM treatment response than merely focusing on total scores.

Efectividad de un programa de enfermería en autocuidados y mindfulness, para el abordaje del trastorno mental común, en atención primaria / Effectiveness of a nursing program of self-care and Mindfulness, in the approach to the common mental disorder in primary care

OBJETIVO: Evaluar la efectividad de la implantación de un programa de mindfulness y autocuidados en atención primaria para el abordaje del trastorno mental común. DISEÑO: Estudio cuasiexperimental no controlado, no aleatorizado, con medidas repetidas. EMPLAZAMIENTO: Siete centros de salud del Área V del Principado de Asturias entre 2014 y 2018. PARTICIPANTES: Sujetos entre 18-75 años, con trastornos de ansiedad, depresivos y adaptativos mixtos, sin enfermedad mental grave. Muestreo no probabilístico por conveniencia. Intervención: Nueve sesiones grupales semanales de 90min, práctica diaria y sesiones de refuerzo al mes, 3, 6 y 12 meses. Mediciones principales: Medidas antes-después, evaluadas por cuestionarios validados y autoadministrados, a medio plazo (3-6 meses) y largo plazo (>12 meses) de las variables: ansiedad rasgo/ansiedad estado (Cuestionario de ansiedad estado-rasgo -STAI-); ansiedad/depresión (Escala de Ansiedad y Depresión de Goldberg -GHQ28-), atención plena (Five Facet Mindfulness Questionnaire -FFMQ-), reducción del tratamiento farmacológico (preguntas abiertas). RESULTADOS: Muestra final de 314 sujetos. Se halló una diferencia de medias estadísticamente significativa en los 3 periodos de seguimiento respecto a los valores basales para todas las escalas/subescalas. Hubo una reducción en la toma de medicación basal de ansiolíticos/antidepresivos del 54,3% en el seguimiento a largo plazo (p < 0,001). CONCLUSIONES: Una disminución moderada de los síntomas, junto con la reducción de la medicación, indican que la intervención en mindfulness dirigida por enfermeras de atención primaria puede ser una opción de tratamiento para el trastorno mental común en este nivel asistencial

OBJECTIVE: To evaluate the effectiveness of the implementation of a mindfulness and self-care program to treat common mental health disorders in primary care. DESIGN: Quasi-experimental non-controlled, non-randomised study, with repeated measurements. SETTING: Seven health centres, in area V of the Principality of Asturias, between 2014 and 2018. PARTICIPANTS: Subjects between 18-65 years with mixed anxiety, depressive, and adaptive disorders, with no serious mental disease. Non-probabilistic convenience sampling was used. Intervention: A group intervention was made, consisting of 9 weekly sessions of 90 min, daily practice, and reinforcement sessions at one month, 3, 6, and 12 months. MAIN MEASUREMENTS: Pre-post measurements using validated and self-administered questionnaires; medium-term (3-6 months) and long-term (>12 months) of the variables: trait anxiety/state anxiety (Status-Trait Anxiety Questionnaire -STAI-); anxiety/depression (Goldberg Anxiety and Depression Scale -GHQ28-), mindfulness (Five Facet Mindfulness Questionnaire -FFMQ-), reduction of pharmacological treatment (open questions). RESULTS: The study included a final sample of 314 subjects. A statistically significant difference in means was found in the 3 follow-up periods as regards the baseline values for all the scales/subscales. There was a reduction of 54.3% in the taking of anxiolytic/antidepressant baseline medication in the long-term follow-up (P < .001). CONCLUSIONS: A moderate reduction of the symptoms, together with the reduction of the medication, indicate that the intervention of mindfulness supervised by the primary care nurse can be a treatment option for the mental disorders common in this level of care

[Effectiveness of a nursing program of self-care and Mindfulness, in the approach to the common mental disorder in primary care]. / Efectividad de un programa de enfermería en autocuidados y mindfulness, para el abordaje del trastorno mental común, en atención primaria.

OBJECTIVE: To evaluate the effectiveness of the implementation of a mindfulness and self-care program to treat common mental health disorders in primary care. DESIGN: Quasi-experimental non-controlled, non-randomised study, with repeated measurements. SETTING: Seven health centres, in area v of the Principality of Asturias, between 2014 and 2018. PARTICIPANTS: Subjects between 18-65 years with mixed anxiety, depressive, and adaptive disorders, with no serious mental disease. Non-probabilistic convenience sampling was used. INTERVENTION: A group intervention was made, consisting of 9 weekly sessions of 90min, daily practice, and reinforcement sessions at one month, 3, 6, and 12 months. MAIN MEASUREMENTS: Pre-post measurements using validated and self-administered questionnaires; medium-term (3-6 months) and long-term (>12 months) of the variables: trait anxiety/state anxiety (Status-Trait Anxiety Questionnaire -STAI-); anxiety/depression (Goldberg Anxiety and Depression Scale -GHQ28-), mindfulness (Five Facet Mindfulness Questionnaire -FFMQ-), reduction of pharmacological treatment (open questions). RESULTS: The study included a final sample of 314 subjects. A statistically significant difference in means was found in the 3 follow-up periods as regards the baseline values for all the scales/subscales. There was a reduction of 54.3% in the taking of anxiolytic/antidepressant baseline medication in the long-term follow-up (P<.001). CONCLUSIONS: A moderate reduction of the symptoms, together with the reduction of the medication, indicate that the intervention of mindfulness supervised by the primary care nurse can be a treatment option for the mental disorders common in this level of care.

Additive effectiveness of contingency management on cognitive behavioural treatment for smokers with depression: Six-month abstinence and depression outcomes.

BACKGROUND: Depression and smoking co-occur at high rates and there is a lack of evidence on the efficacy of treatments specifically tailored to this population. This randomized controlled trial sought to compare the effectiveness of cognitive behavioural treatment (CBT) combined with behavioural activation (BA) and the same treatment protocol plus contingency management (CM). METHODS: A sample of 120 adult smokers (70.8%: females) with severe depressive symptoms were randomly allocated to: CBT + BA (n = 60) or CBT + BA + CM (n = 60). Smoking and depression outcomes were reported at end of treatment, 1-, 2-, 3-, and 6-month follow-ups. Self-reported smoking status was biochemically verified, and depression was assessed using the Beck Depression Inventory-II. RESULTS: At end of treatment, the overall quit rate was 69.2% (83/120). CM showed an additive effect on CBT + BA in enhancing abstinence rates. The significant effect of group [F(1,155) = 9.55, p =  .0024], time [F(4,96) = 7.93, p < .0001], and group by time interaction [F(4,96) = 6.12, p =  .0002], indicated that CM is more effective for generating longer durations of abstinence beyond those of CBT+BA. All treatment conditions equally promoted sustained reductions in depression across time [F(1,111) = 0.53, p =  .4665]. A greater number of days of continuous abstinence and lower depressive symptoms mutually influenced each other. CONCLUSIONS: Depressed smokers achieve high cessation rates without suffering negative mood changes. Quitting smoking is not detrimental and adding CM to CBT + BA enhances long-lasting abstinence rates while promoting large depression improvements.

A randomized controlled trial of contingency management for smoking abstinence versus contingency management for shaping cessation: One-year outcome.

This study analyzed whether a contingency management (CM) for shaping cessation period implemented prior to an abstinence-only period (CMS) improves outcomes relative to CM that reinforces only a fixed abstinence criteria (CMA) among treatment-seeking patients in a community setting. A total of 110 patients were randomly assigned to 1 of 2 treatment conditions: CMA (N = 55) or CMS (N = 55). All participants received cognitive-behavioral treatment (CBT) implemented in 6 group-based sessions. CMA participants earned voucher-based incentives contingent on providing biochemical evidence of smoking abstinence. CMS reinforced closer approximations to smoking abstinence. At posttreatment, patients assigned to the CMA group achieved the same rates of smoking abstinence (point-prevalence) as those in the CMS group (94.5%; p > .05). At the 6-month follow-up, 43.6% of the patients who received CMA maintained smoking abstinence in comparison to 32.7% in the CMS group (p > .05). At the 12-month follow-up, 40% of the participants assigned to the CMA group were abstinent, in comparison to 29.1% who received CMS (p > .05). There were no statistically significant differences in continuous smoking abstinence between the treatment conditions in any of the follow-ups (p > .05). These results offer a novel contribution by suggesting that CM was associated with enduring effects up to 12 months after the end of treatment and that CM for shaping cessation period implemented prior to an abstinence-only period (CMS) improves outcomes relative to CM that reinforces only a fixed abstinence criteria (CMA) among treatment-seeking patients in a community setting. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effects of Delay Discounting and Other Predictors on Smoking Relapse.

Despite the substantial decrease in the prevalence of tobacco smoking and the availability of effective smoking cessation treatments, smoking relapse after formal treatments remains extremely high. Evidence regarding clinical predictors of relapse after quitting is essential to promote long-term abstinence among those who successfully quit. This study aimed to explore whether baseline delay discounting (DD) rates and other sociodemographic, psychological, and smoking-related variables predicted relapse to smoking at six-month follow-up. Participants were 188 adult smokers (mean age = 42.9, SD = 12.9; 64.4% females) who received one of three treatment conditions: 6-weeks of cognitive-behavioral treatment (CBT) alone; or combined with contingency management (CBT + CM); or combined with cue exposure treatment (CBT+CET). Smoking status was biochemically verified. Logistic regression was conducted to examine prospective predictors of smoking relapse at six months after an initial period of abstinence. Greater DD rates (OR: 0.18; 95% CI [0.03, 0.93]), being younger (OR: 0.96; 95% CI [0.94, 0.99]), high nicotine dependence (OR: 1.34; 95% CI [1.13, 1.60]), and a higher number of previous quit attempts (OR: 4.47; 95% CI [1.14, 17.44]) increased the likelihood of smoking relapse at six-month follow-up. Besides sociodemographic and smoking-related characteristics, greater DD predisposes successful quitters to relapse back to smoking. These results stress the relevance of incorporating specific treatment components for reducing impulsivity.

Prevalencia y datos asistenciales de la diabetes mellitus tipo 1 en menores de 15 años en Asturias / Type 1 diabetes mellitus prevalence and care in children under 15 years old in Asturias

Introducción: La prevalencia de diabetes mellitus 1 (DM1) está aumentando en todo el mundo. La atención recibida parece tener influencia en la evolución de la enfermedad. El objetivo es conocer la prevalencia de DM1, así como los recursos y datos asistenciales que se están utilizando en Asturias. Material y métodos: Estudio descriptivo, transversal, siendo la población a estudio los nacidos entre el 2000 y el 2014, con diagnóstico de DM1 a 31/12/2014. Se identificó a los pacientes a través de dos fuentes de datos independientes. La información se recogió a través de las historias clínicas. Se realizó un análisis descriptivo de los datos proporcionando distribuciones de frecuencias y medidas de posición y dispersión. Resultados: Se identificaron 146 pacientes, la prevalencia total fue de 1,25/1.000 niños. Por grupos de edad fue de 0,21; 1,15 y 2,40 por cada 1.000 en los niños de 0-4; 5-9 y 10-14 años respectivamente. El 8,2% presentaban alteraciones tiroideas autoinmunes y el 6,8% padecían enfermedad celíaca. El 14,4% tenían antecedentes familiares de DM1 y el 29,4% de DM2. Noventa y dos niños eran atendidos por pediatras y 34 por endocrinólogos. El 100% seguía terapia con múltiples dosis de insulina y ninguno utilizaba sistemas de monitorización continua de glucosa. El 37,7% recibió educación para la salud. Conclusiones: Este estudio recoge los primeros datos de prevalencia de DM1 en menores de 15 años en Asturias y aporta datos asistenciales que permiten dar cuenta de la disparidad en cuanto a la atención recibida según área sanitaria

Introduction: Prevalence of type 1 diabetes mellitus (T1DM) is increasing worldwide. Care provided appears to have an influence on the course of disease. The aim of this study was to ascertain the prevalence of T1DM and to collect data on the resources and care used in Asturias. Material and methods: A descriptive, cross-sectional study including patients born between 2000 and 2014 with diagnosis of T1DM at 31/12/2014. Patients were identified using two independent data sources. Information was collected from medical records. A descriptive data analysis was performed to provide frequency distributions and measures of position and dispersion. Results: 146 patients were identified, with a total prevalence of 1.25/1.000 children. Prevalence rates by age group were 0.21, 1.15, and 2.40 by 1000 in children aged 0-4, 5-9, and 10-14 years respectively. Autoimmune thyroid disorders and celiac disease were found in 8.2% and 6.8% respectively, while 14.4% had a family history of T1DM and 29.4% of T2DM. Ninety-two children were treated by pediatricians and 34 by endocrinologists. All children were receiving multiple dose insulin treatment and none of them used self-monitoring blood glucose systems. Health education was provided to 37.7% of children. Conclusions: This study reports the first data on T1DM prevalence in children under 15 years old in Asturias and provides care data that show the disparity in care received depending on healthcare area

Type 1 diabetes mellitus prevalence and care in children under 15 years old in Asturias. / Prevalencia y datos asistenciales de la diabetes mellitus tipo 1 en menores de 15 años en Asturias.

INTRODUCTION: Prevalence of type 1 diabetes mellitus (T1DM) is increasing worldwide. Care provided appears to have an influence on the course of disease. The aim of this study was to ascertain the prevalence of T1DM and to collect data on the resources and care used in Asturias. MATERIAL AND METHODS: A descriptive, cross-sectional study including patients born between 2000 and 2014 with diagnosis of T1DM at 31/12/2014. Patients were identified using two independent data sources. Information was collected from medical records. A descriptive data analysis was performed to provide frequency distributions and measures of position and dispersion. RESULTS: 146 patients were identified, with a total prevalence of 1.25/1.000 children. Prevalence rates by age group were 0.21, 1.15, and 2.40 by 1000 in children aged 0-4, 5-9, and 10-14 years respectively. Autoimmune thyroid disorders and celiac disease were found in 8.2% and 6.8% respectively, while 14.4% had a family history of T1DM and 29.4% of T2DM. Ninety-two children were treated by pediatricians and 34 by endocrinologists. All children were receiving multiple dose insulin treatment and none of them used self-monitoring blood glucose systems. Health education was provided to 37.7% of children. CONCLUSIONS: This study reports the first data on T1DM prevalence in children under 15 years old in Asturias and provides care data that show the disparity in care received depending on healthcare area.

Effects of delay discounting and other predictors on smoking relapse

Despite the substantial decrease in the prevalence of tobacco smoking and the availability of effective smoking cessation treatments, smoking relapse after formal treatments remains extremely high. Evidence regarding clinical predictors of relapse after quitting is essential to promote long-term abstinence among those who successfully quit. This study aimed to explore whether baseline delay discounting (DD) rates and other sociodemographic, psychological, and smoking-related variables predicted relapse to smoking at six-month follow-up. Participants were 188 adult smokers (mean age = 42.9, SD = 12.9; 64.4% females) who received one of three treatment conditions: 6-weeks of cognitive-behavioral treatment (CBT) alone; or combined with contingency management (CBT + CM); or combined with cue exposure treatment (CBT+CET). Smoking status was biochemically verified. Logistic regression was conducted to examine prospective predictors of smoking relapse at six months after an initial period of abstinence. Greater DD rates (OR: 0.18; 95% CI [0.03, 0.93]), being younger (OR: 0.96; 95% CI [0.94, 0.99]), high nicotine dependence (OR: 1.34; 95% CI [1.13, 1.60]), and a higher number of previous quit attempts (OR: 4.47; 95% CI [1.14, 17.44]) increased the likelihood of smoking relapse at six-month follow-up. Besides sociodemographic and smoking-related characteristics, greater DD predisposes successful quitters to relapse back to smoking. These results stress the relevance of incorporating specific treatment components for reducing impulsivity

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Meridional overturning circulation conveys fast acidification to the deep Atlantic Ocean.

Since the Industrial Revolution, the North Atlantic Ocean has been accumulating anthropogenic carbon dioxide (CO2) and experiencing ocean acidification, that is, an increase in the concentration of hydrogen ions (a reduction in pH) and a reduction in the concentration of carbonate ions. The latter causes the 'aragonite saturation horizon'-below which waters are undersaturated with respect to a particular calcium carbonate, aragonite-to move to shallower depths (to shoal), exposing corals to corrosive waters. Here we use a database analysis to show that the present rate of supply of acidified waters to the deep Atlantic could cause the aragonite saturation horizon to shoal by 1,000-1,700 metres in the subpolar North Atlantic within the next three decades. We find that, during 1991-2016, a decrease in the concentration of carbonate ions in the Irminger Sea caused the aragonite saturation horizon to shoal by about 10-15 metres per year, and the volume of aragonite-saturated waters to reduce concomitantly. Our determination of the transport of the excess of carbonate over aragonite saturation (xc[CO32-])-an indicator of the availability of aragonite to organisms-by the Atlantic meridional overturning circulation shows that the present-day transport of carbonate ions towards the deep ocean is about 44 per cent lower than it was in preindustrial times. We infer that a doubling of atmospheric anthropogenic CO2 levels-which could occur within three decades according to a 'business-as-usual scenario' for climate change-could reduce the transport of xc[CO32-] by 64-79 per cent of that in preindustrial times, which could severely endanger cold-water coral habitats. The Atlantic meridional overturning circulation would also export this acidified deep water southwards, spreading corrosive waters to the world ocean.

Diminished emotional expression in schizophrenia: an interdisciplinary approach based on behavioral interventions / Expresión emocional disminuida en la esquizofrenia: un abordaje interdisciplinar basado en intervenciones conductuales

Background: Negative symptoms represent the main cause of disability in schizophrenia, having recently been grouped into two general dimensions: avolition and diminished emotional expression, which includes affective flattening and alogia. The aim of this study was to explore the response of these two symptoms to a set of behavioral interventions based on contingency management, performed in an interdisciplinary context. Method: Behaviors of interest were monitored and evaluations before and after the treatment were performed on 9 schizophrenic inpatients with persistent negative symptoms. The program included 12 group double sessions aimed at developing facial expression and verbal communication, and a nursing care plan to generalize and strengthen these behaviors synergistically. Results: there were appreciable differences in facial expression, which were less clear for alogia. The clinical evaluation using PANSS-N did not find notable differences at group level, but the nursing assessment using NOC indicators did. Conclusions: although difficult to modify, negative symptoms are not insensitive to the influence of behavioral interventions. Specific psychological interventions that address negative symptoms as a priority focus of attention and care need to be promoted and developed, particularly when considering the crucial role of context in their progression (AU)

Antecedentes: los síntomas negativos representan la principal causa de discapacidad en la esquizofrenia, habiendo sido agrupados recientemente en dos dimensiones: avolición y expresión emocional disminuida, que incluye el aplanamiento afectivo y la alogia. El objetivo del estudio fue explorar la respuesta de estos dos síntomas a un conjunto de intervenciones conductuales basadas en el manejo de contingencias en un contexto interdisciplinario. Método: se monitorizaron conductas de interés y realizaron medidas pre y post a 9 participantes con esquizofrenia negativa persistente ingresados en dispositivos de rehabilitación. El programa incluyó 12 sesiones grupales dobles dirigidas a trabajar la expresión facial y la comunicación verbal, y un plan de cuidados para fortalecer y generalizar estas conductas. Resultados: se obtuvieron diferencias relevantes en la expresión facial, que fueron menos claras para la alogia. La evaluación clínica mediante la PANSS-N no obtuvo diferencias notables a nivel de grupo, pero sí la valoración mediante indicadores NOC. Conclusiones: aunque difíciles de modificar, los síntomas negativos no son insensibles a la influencia de intervenciones conductuales. Resulta necesario potenciar intervenciones psicológicas específicas que aborden estos síntomas como un foco prioritario de atención y cuidado, considerando el papel crucial del contexto en su evolución (AU)

Diminished emotional expression in schizophrenia: an interdisciplinary approach based on behavioral interventions.

BACKGROUND: Negative symptoms represent the main cause of disability in schizophrenia, having recently been grouped into two general dimensions: avolition and diminished emotional expression, which includes affective flattening and alogia. The aim of this study was to explore the response of these two symptoms to a set of behavioral interventions based on contingency management, performed in an interdisciplinary context. METHOD: Behaviors of interest were monitored and evaluations before and after the treatment were performed on 9 schizophrenic inpatients with persistent negative symptoms. The program included 12 group double sessions aimed at developing facial expression and verbal communication, and a nursing care plan to generalize and strengthen these behaviors synergistically. RESULTS: there were appreciable differences in facial expression, which were less clear for alogia. The clinical evaluation using PANSS-N did not find notable differences at group level, but the nursing assessment using NOC indicators did. CONCLUSIONS: although difficult to modify, negative symptoms are not insensitive to the influence of behavioral interventions. Specific psychological interventions that address negative symptoms as a priority focus of attention and care need to be promoted and developed, particularly when considering the crucial role of context in their progression.

Cost-effectiveness of a voucher-based intervention for smoking cessation.

BACKGROUND: Contingency management (CM) has been shown to be effective in reducing smoking consumption, but has traditionally been criticized for its costs. OBJECTIVES: This study assessed the cost-effectiveness of using a voucher-based CM protocol added to a cognitive behavioral treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. METHODS: A total of 92 patients were randomly assigned to CBT or CBT plus CM for abstinence. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the increase in costs by the increase in effects (continuous abstinence, longest duration of abstinence at 6-month follow-up and cotinine results during the treatment). An acceptability curve illustrated the statistical uncertainty surrounding the cost-effectiveness estimate. We also determined the optimum cost per participant for predicting the smoking status at 6-month follow-up. RESULTS: The average cost per participant in the CBT condition was €138.73 (US$ 150.23) as opposed to €411.61 (US$ 445.73) in the CBT plus CM condition (p < 0.01). The incremental cost of using voucher-based CM to increase the number of participants that maintained abstinence at 6-month follow-up by one extra participant was €68.22 (US$ 73.88), and to lengthen the longest duration of abstinence by 1 week was €53.92 (US$ 58.39). The incremental cost to obtain an extra cotinine-negative result was €181.90 (US$ 196.98). CONCLUSION: Compared with CBT alone, the voucher-based protocol required additional costs but achieved significantly better outcomes. These results will allow stakeholders to make policy decisions about CM implementation for smoking cessation in the broader community.