Short-Term Pilot Study to Evaluate the Impact of Salbi Educa Nutrition App in Macronutrients Intake and Adherence to the Mediterranean Diet: Randomized Controlled Trial.

Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (-5.7% (95% CI: -10.4 to -1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: -1.0 to 5.8)), total fats (-5.9% (95% CI: -8.9 to -3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (-17.5 g/day (95% CI: -34.0 to -1.1)), and processed meat (-6.6 g/day (95% CI: -13.1 to -0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.

SAlBi educa (Tailored Nutrition App for Improving Dietary Habits): Initial Evaluation of Usability.

In recent years, the use of applications to improve dietary habits has increased. Although numerous nutrition apps are available on the market, only few have been developed by health and nutrition professionals based on scientific evidence and subsequently tested to prove their usability. The main objective of this study was to design, develop, and evaluate the usability of a tailored nutrition application to be used to promote healthy eating habits. In order to decide app design and content, three focus groups took place with fifteen professionals from primary healthcare, nutrition, and food science and computer science, as well as expert users. For the general and feedback message design, a reference model based on the scientific literature was developed. To address the multi-perspective approach of users' and external healthcare professionals' feedback, a one-day pilot testing with potential users and healthcare professionals was conducted with four focus groups. To evaluate the relevance and potential usability of the app a 1-month pilot test was conducted in a real-life environment. A total of 42 volunteers participated in the one-day pilot testing, and 39 potential users participated in the 1-month pilot test. The SAlBi educa app developed includes an online dietary record, a self-monitoring tool to evaluate dietary patterns, general and feedback messages, and examples of traditional Mediterranean recipes. The usability study showed that volunteers think that SAlBi educa is pleasant (59%) and easy to learn to use (94%). Over 84% of the volunteers declared that the nutritional messages were clear and useful. Volunteers stated that general and tailored recommendations, as well as self-monitoring, were SAlBi educa's most motivating and useful features. SAlBi educa is an innovative, user-friendly nutritional education tool with the potential to engage and help individuals to follow dietary habits based on the Mediterranean model.

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study.

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.

Aspectos éticos y legales ante la conspiración de silencio según los profesionales sanitarios / Ethical and legal aspects in the conspiracy of silence according to health professionals

OBJETIVOS: Conocer los discursos de los profesionales sanitarios sobre el marco normativo ético y legal en el contexto del pacto de silencio, como origen del fenómeno y sus consecuencias: participación en la toma de decisiones, obstinación terapéutica, limitación o adecuación del esfuerzo terapéutico y sedación paliativa. Estudio cualitativo descriptivo, enfoque fenomenológico. EMPLAZAMIENTO Y PARTICIPANTES: profesionales de enfermería y medicina de atención primaria, hospital y urgencias de Sevilla. MÉTODO: Entrevistas semiestructuradas. Áreas exploradas: comunicación inicial sobre diagnóstico, pronóstico y situación de últimos días, opinión sobre el pacto de silencio, consecuencias en el afrontamiento de la muerte y la participación en la toma de decisiones. Análisis de contenido interpretativo. RESULTADOS: Información a la familia de forma preferente, la mayoría desconocen los principios éticos al final de la vida, se confunde intimidad, autonomía y confidencialidad, si la conspiración de silencio está presente la mantienen. La autonomía está anulada, se aplica la beneficencia y la no maleficencia desde el punto de vista del profesional, se cita falta de justicia respecto a la comunicación e información según razones sociales. La participación del paciente en toma de decisiones imposible en este contexto; se sobreactúa para evitar la muerte cayendo en la obstinación terapéutica. No se suele practicar la adecuación del esfuerzo terapéutico y el rechazo del tratamiento es imposible. Aparece la eutanasia como categoría emergente, se confunde con la sedación paliativa. CONCLUSIONES: Desconocimiento del marco normativo ético y legal al final de la vida como causa del pacto de silencio, teniendo como consecuencias la falta de participación en la toma de decisiones, obstinación terapéutica y no aplicación de limitación del esfuerzo terapéutico

OBJETIVE: to collect the discourses of health professionals about the ethical and legal regulatory framework in the context of the pact of silence as origin of the phenomenon, and its consequences: participation in decision making, therapeutic obstinacy, limitation or adjustment of therapeutic efforts, and palliative sedation. A qualitative, descriptive study using a phenomenological approach. PLACE AND PARTICIPANTS: nurses and physicians in primary care, palliative care, hospital care, and emergency care in Seville. METHODS: Semi-structured interviews. Explored areas: breaking bad news regarding diagnosis, prognosis, and end of life; opinions about the conspiracy of silence, consequences for coping with death, and participation in decision making. Interpretive content analysis. RESULTS: Families are preferentially informed; most are unaware of ethical principles at the end of life; intimacy, autonomy, and confidentiality are mixed up terms; when present, the conspiracy of silence is maintained. Autonomy is overridden, beneficence and nonmaleficence are applied from the professional's perspective, lack of justice is mentioned regarding communication and information according to social reasons. Patient participation in decision making is impossible in this setting; overreacting occurs to avoid death, leading to therapeutic obstinacy. Therapeutic effort adjustment is not practiced and treatment refusal is impossible. Euthanasia appears as an emergent category, and is confused with palliative sedation. CONCLUSION: Ignorance of the ethical and legal regulatory framework for end-of-life care, as a cause of the pact of silence. Consequences include absence of patient participation in decision making, therapeutic obstinacy, and failure to implement therapeutic effort limitations

Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM / Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

Objetivo: Describir las características de la gestión de casos en cuanto a población atendida, intervenciones, utilización de servicios y los desenlaces mortalidad, reingresos, úlceras por presión, caídas, problemas con medicamentos e institucionalización. Método: Estudio de seguimiento de una cohorte a partir del registro multicéntrico RANGECOM de Andalucía. La población de estudio son pacientes atendidos en la cartera de servicios de gestión de casos de centros de salud y sus cuidadores familiares. Resultados: Se presentan datos de 835 pacientes con edad media de 76,8años (DE:12,1), un 50,24% mujeres. Presentan una comorbilidad importante (Charlson 3,1; DE:2,5) y dependencia elevada (Barthel 37,5; DE:31,4). El 60,2% de las intervenciones desplegadas por las gestoras de casos se aglutina en tres dominios: conductual (26,0%), sistema sanitario (20,2%) y seguridad (14,1%). La mortalidad fue del 34,4% y los ingresos hospitalarios, del 38,1%. Los pacientes con más reingresos hospitalarios tenían más visitas a urgencias (OR:1,41; IC95%: 1,22-1,63), más intervenciones telefónicas de las gestoras de casos (OR:1,12; IC95%: 1,02-1,24) y pruebas de imagen (OR:1,37; IC95%: 1,17-1,60), junto con un mayor cansancio en la cuidadora (OR:1,31; IC95%: 1,08-1,59), la presencia de dispositivos médicos en domicilio (OR:1,69; IC95%: 1,00-2,87) y recibían menos la intervención «Gestión de Casos». Conclusiones: Los pacientes que absorben la demanda de las enfermeras gestoras de casos presentan una alta complejidad, frente a la cual despliegan intervenciones conductuales, de navegación por el sistema sanitario y de seguridad clínica

Objective: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Method: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Results: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. Conclusions: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry. / Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM.

OBJECTIVE: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. METHOD: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. RESULTS: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. CONCLUSIONS: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

RATIONALE, AIMS AND OBJECTIVES: Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. METHODS: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. RESULTS: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. CONCLUSIONS: The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events.

El pacto de silencio desde la perspectiva de las personas cuidadoras de pacientes paliativos / Silence pact from the perspective of caretakers of palliative care patients

La conspiración o pacto de silencio es el acuerdo por parte de familiares y profesionales de ocultar información sobre su proceso al paciente en situación terminal. OBJETIVOS: Conocer por qué se produce el pacto de silencio entre pacientes en situación terminal, sus cuidadores y profesionales sanitarios, explorar e identificar las actitudes, vivencias y opiniones de las personas cuidadoras familiares al mantener la conspiración de silencio a pacientes paliativos. METODOLOGÍA: Estudio cualitativo con enfoque fenomenológico. Realizado en Atención Primaria en la provincia de Sevilla. Recogida de datos mediante entrevista semiestructurada audiograbadas. Exploración de las áreas de la comunicación: conocimiento sobre diagnóstico y pronóstico de la enfermedad; transmisión de la información; reacción sobre las noticias recibidas; información conocida por el paciente, motivos; comunicación con la familia; comunicación con los profesionales sanitarios y afrontamiento ante la muerte. Análisis interpretativo. Población de estudio: Personas cuidadoras familiares de pacientes en cuidados paliativos, con sospecha de pacto de silencio. Elección de los participantes de forma intencional, hasta saturación de la información. Los resultados son: Bloqueo de la comunicación profesional-paciente por parte de la familia; engaños, mentiras para mantener el ocultamiento; sospecha de que el paciente conoce la verdad; ocultamiento del médico/a responsable de su proceso al paciente, atención paternalista; sentimientos de tristeza, pena, resignación, tranquilidad ante la enfermedad. CONCLUSIONES: El pacto de silencio tiene consecuencias en el afrontamiento de la muerte, calidad de vida de los últimos días y duelo. La comunicación entre pacientes, sus familias y profesionales sanitarios debería mejorar para prevenir el pacto de silencio y así ayudarles a afrontar la muerte

OBJECTIVES: To determine why terminally-ill patients, family caregivers and health care providers make a pact of silence about the terminal status of the patient, and to identify the attitudes, experiences and opinions of family caregivers concerning the conspiracy of silence in palliative care. METHODS: A qualitative phenomenological study based on an interpretive analysis, conducted in Primary Health Care, Seville, Spain. Study dimensions: knowledge of the diagnosis and prognosis of the condition; disclosure of information; reaction to information received, feelings and approach to death; information disclosed to the patient and reasons behind partial disclosure; communication between patients, families, and health care providers. Study population: Family caregivers of patients on palliative care suspicious about a pact of silence. RESULTS: Family caregivers hamper professional-patient communication; use of deceit to conceal the truth; suspicion that the patient knows the truth; the clinician conceals the truth; paternalist attitudes; feelings of sadness, grief, resignation, acceptance of the disease. CONCLUSIONS: The pact of silence has negative effects on coping with death, quality of life in the last days of life, and mourning.communication between patients, health care providers, and families should be improved to prevent the pact of silence, and help patients cope with death

[Silence pact from the perspective of caretakers of palliative care patients]. / El pacto de silencio desde la perspectiva de las personas cuidadoras de pacientes paliativos.

OBJECTIVES: To determine why terminally-ill patients, family caregivers and health care providers make a pact of silence about the terminal status of the patient, and to identify the attitudes, experiences and opinions of family caregivers concerning the conspiracy of silence in palliative care. METHODS: A qualitative phenomenological study based on an interpretive analysis, conducted in Primary Health Care, Seville, Spain. Study dimensions: knowledge of the diagnosis and prognosis of the condition; disclosure of information; reaction to information received, feelings and approach to death; information disclosed to the patient and reasons behind partial disclosure; communication between patients, families, and health care providers. STUDY POPULATION: Family caregivers of patients on palliative care suspicious about a pact of silence. RESULTS: Family caregivers hamper professional-patient communication; use of deceit to conceal the truth; suspicion that the patient knows the truth; the clinician conceals the truth; paternalist attitudes; feelings of sadness, grief, resignation, acceptance of the disease. CONCLUSIONS: The pact of silence has negative effects on coping with death, quality of life in the last days of life, and mourning. Communication between patients, health care providers, and families should be improved to prevent the pact of silence, and help patients cope with death.