Categorizations of Trust and Distrust in the Classifications and Social Representations of Food among Pregnant and Breastfeeding Women in Spain-Applying the Cultural Domains' Pile Sort Technique.

Food is fundamental in the decision making of pregnant and breastfeeding women to care for their own health and that of their child. In this paper, we explore some common food classification systems and certain attributes assigned to these categories, represented by values of trust and distrust. This study is based on an interdisciplinary research project in which we analysed discourses and practices regarding the dietary intake of pregnant and breastfeeding women in relation to the presence of chemical substances in foods. The results presented are part of the second phase of this research where we explored the results of our analysis of the pile sort technique based on an analysis of cultural domains in order to explore the categories and semantic relations among terms regarding trust and distrust in food. This technique was applied to the 62 pregnant and breastfeeding women of Catalonia and Andalusia. These women also participated in eight focus groups that provided information and narratives enabling us to analyse the meanings of the associative subdomains obtained in the pile sorts. They classified different foods and assigned certain attributes to them according to the level of trust and mistrust, providing a social representation of food risks. The mothers expressed great concern about the quality of the food they consume and about its possible effects on their own health and on that of their child. They perceive that an adequate diet is one based on the consumption of fruits and vegetables, preferably fresh. Fish and meat generate serious concern, as their properties are considered ambivalent depending on the food's origin and mode of production. These criteria are perceived by women as relevant to their food decisions and, therefore, emic knowledge should be taken into account when developing food safety programmes and planning actions aimed at pregnant and breastfeeding women.

Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study.

One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants' speech was digitally audio-recorded in digital format. In order to complete the codification of the participants' speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants' speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state.

The Sound of Silence: Unspoken Meaning in the Discourse of Pregnant and Breastfeeding Women on Environmental Risks and Food Safety in Spain.

(1) Background: In recent years, a growing number of qualitative health research studies have performed discourse analysis of data from participants' narratives. However, little attention has been paid to the gaps and silences within these narratives. The aim of the present study is to interpret the silences detected in the discourse of pregnant and breastfeeding women concerning environmental risks and food safety. (2) Methods: This descriptive, interpretive, observational study was conducted according to a qualitative research paradigm and from a phenomenological and ethnographic perspective. The study sample was composed of 88 intentionally selected women, among whom fifty interviews, three ethnographies and five focus groups were conducted. Data coding and analysis were performed using N-Vivo 12 software. (3) Results: The results obtained show that the women's discourse presented silences that reflected their minimisation of perceived environmental and food risks. However, these women were wary of food produced in the proximity of contaminated areas. Nevertheless, the participants believed they were powerless to overcome environmental pollution and the potential contamination of their own bodies. (4) Conclusions: The participants' minimisation of the environmental risks faced and their inaction in this respect are sustained by the biopolitical practices of public institutions, which have propelled these women into a situation of learned helplessness and social injustice.

COVID-19 pandemic, as experienced in the surgical service of a district hospital in Spain.

The coronavirus disease 2019, which is caused by severe acute respiratory syndrome coronavirus 2, was first identified in December 2019 in Wuhan, China, and has since spread rapidly, evolving into a full-blown pandemic. We would like to report our experience after 1 year of this pandemic in the surgical service of a district hospital in Spain. There have been many changes (including new protocols) that our service and the hospital have undergone, to adapt to the new situation. We believe that this experience can be useful for other professionals who have lived and are living a similar situation.

Citizen Consultation on Problematic Usage of the Internet: Ethical Considerations and Empirical Insights From Six Countries.

Citizens and scientists can work together to improve the collective well-being, if citizens are inspired to help the advancement of science, and researchers motivated to listen to the voices of citizens. The benefits of such collaboration are increasingly recognized by both citizens and scientists, as reflected in the growing number of related publications and initiatives. This is especially relevant for emerging areas of research, where early involvement of citizens could help to envision, prioritize, and plan prospective studies. The Problematic Usage of the Internet (PUI) is one such area, which is fast becoming a public mental health concern. However, there remains a lack of clarity regarding the practical guidelines and ethical requirements for citizen involvement at the earliest stages of PUI. In our paper, we propose a conceptual framework and a template for initial involvement of citizens in PUI. They are derived from our community case studies, conducted in six European countries (Georgia, Greece, Malta, North Macedonia, Portugal, and Spain) and consisting of consultation with diverse groups of interested citizens (students, parents, teachers, and health professionals). Informed by our consultation exercises, we also highlight four ethical aspects for citizen involvement in the research on PUI or novel disciplines in general. They follow simple guiding principles to ensure that scientists will: enable a long-term commitment and inclusive opportunities for citizens, challenge established power hierarchies, and support collaboration, co-production and co-authorship with citizens. We believe that the proposed practical guidelines and ethical considerations, provide a valuable foundation on which to advance our understanding and generate international strategies for citizen involvement in PUI.

Motivating Pregnant and Breastfeeding Women in Spain to Avoid Persistent Toxic Substances in Their Diet.

The objective of this study was to explore what motivates pregnant and breastfeeding women to make changes in their diet, specifically to examine how their perceptions regarding diet facilitate or act as obstacles to introducing healthy eating habits. For the optimal development of the mother, the fetus, or breastfeeding baby, it is important to avoid foods containing substances, such as persistent toxic substances (PTSs), that are harmful to health during pregnancy and after the baby's birth. This study used a qualitative research methodology, based on semi-structured individual interviews, food diaries, free lists, and focus groups with 111 pregnant and breastfeeding women in Spain. This approach was followed by a systematic and exhaustive exploitation of the qualitative data obtained, following the methodological principles of grounded theory. From the study results, we conclude that the motivation for a change in diet to avoid PTSs is based on the desire to promote good health, beliefs about the importance of having a varied diet, and the avoidance of potential risks. The main obstacles to change can be attributed to inadequate information, contradictory discourses, and socioeconomic difficulties.

Trust and distrust in relation to food risks in Spain: An approach to the socio-cultural representations of pregnant and breastfeeding women through the technique of free listing.

In this paper, we explore the socio-cultural representations of trust and distrust in relation to food risks among pregnant and breastfeeding women. We have conducted a study based on an analysis of cultural domains in order to understand how mothers incorporate different social meanings and explore the most important categories they use when talking about trust/distrust in relation to food. We use the technique of free listings to analyse the main shared items or elements regarding trust and distrust in food among these mothers. Through an analysis of cultural domains that refers to concepts and themes related to trust and distrust of foods that are important to these women, and through the study of shared knowledge about these domains, we examine their socio-cultural representations related to health and diet of the 65 free listings on trust and the 64 on distrust collected from mothers. The pregnant and breastfeeding women who participated in the free listings cite foods they trust or distrust based on the specific properties they perceive them to have or other characteristics related to their origin, their handling, processing and distribution. Additionally, trust/distrust often depends on the qualities they attribute to the product. This paper shows aspects of the socio-cultural representations of food risks in periods in the life cycle of women -pregnancy and breastfeeding-characterized by a risk discourse where the precautionary principle is frequently used to manage uncertainty. These results might help the development of public health campaigns as well as adapting the messages of the health authorities to the general population.

Influencia de variables psicológicas en pacientes obesos mórbidos operados con cirugía bariátrica tras 24 meses de evolución / Influence of psychological variables in morbidly obese patients undergoing bariatric surgery after 24 months of evolution

Introducción: El tratamiento de la obesidad mórbida mediante la cirugía bariátrica es más efectivo que las opciones no quirúrgicas. Las tasas de fracaso o recaída oscilan entre el 20 y el 30%. El estudio pretende analizar la influencia de determinadas variables psicológicas (autoestima, apoyo social, estrategias de afrontamiento y personalidad) en el mantenimiento de la pérdida de peso de los pacientes después de la cirugía bariátrica. Métodos: Se realizó un estudio de cohorte compuesta por 64 pacientes intervenidos mediante cirugía bariátrica con 24 meses de seguimiento. Al final del periodo, los pacientes fueron divididos en 2subcohortes según fueran éxitos o fracasos. Se consideró éxito o evolución favorable cuando el valor del porcentaje de sobrepeso perdido era 50 o superior. Resultados: No se observaron diferencias estadísticamente significativas entre los 2 grupos en ninguna variable estudiada. Todos los pacientes tuvieron alta la autoestima (87,3 los que fracasan y 88,1 los que tienen éxito) y el apoyo social (90,2 frente a 90,9). Los pacientes que tuvieron éxito presentaron puntuaciones más altas para la reestructuración cognitiva (57,1) y eran más introvertidos (47,1); mientras que los que fracasaron anotaron más alto en pensamiento desiderativo (65,7) y eran más propensos a la agresión (50,7) y el neuroticismo (51,7). Conclusiones: Una alta autoestima y un alto apoyo social no garantizan el éxito del tratamiento. Los grupos difieren en la forma en que hicieron frente a la obesidad, pero los datos obtenidos no justifican la evolución del peso. En ausencia de psicopatología, la variación de los rasgos de personalidad entre los grupos de pacientes es insuficiente para predecir los resultados (AU)

Background: Bariatric surgery is considered a more effective means of achieving weight loss than non-surgical options in morbid obesity. Rates of failure or relapse range from 20 to 30%. The study aims to analyse the influence of psychological variables (self-esteem, social support, coping strategies and personality) in the maintenance of weight loss after bariatric surgery. Methods: A cohort study was conducted involving 64 patients undergoing bariatric surgery for 24 months. At the end of the follow-up period, patients were divided into 2 sub-cohorts classified as successes or failures. Success or favorable development was considered when the value of percent excess weight loss was 50 or higher. Results: No statistically significant differences were observed between the 2 groups in any variable studied. All patients had high self-esteem (87,3 those who failed and 88,1 those who are successful) and social support (90,2 and 90,9). Patients who succeed presented higher scores for cognitive restructuring (57,1) and were more introverted (47,1), while those who failed scored more highly in desiderative thinking (65,7) and were more prone to aggression (50,7) and neuroticism (51,7). Conclusions: High self-esteem and social support does not guarantee successful treatment. The groups differed in how they coped with obesity but the data obtained do not justify the weight evolution. In the absence of psychopathology, personality trait variability between patients is insufficient to predict the results (AU)

Influence of psychological variables in morbidly obese patients undergoing bariatric surgery after 24 months of evolution. / Influencia de variables psicológicas en pacientes obesos mórbidos operados con cirugía bariátrica tras 24 meses de evolución.

BACKGROUND: Bariatric surgery is considered a more effective means of achieving weight loss than non-surgical options in morbid obesity. Rates of failure or relapse range from 20 to 30%. The study aims to analyse the influence of psychological variables (self-esteem, social support, coping strategies and personality) in the maintenance of weight loss after bariatric surgery. METHODS: A cohort study was conducted involving 64 patients undergoing bariatric surgery for 24 months. At the end of the follow-up period, patients were divided into 2sub-cohorts classified as successes or failures. Success or favorable development was considered when the value of percent excess weight loss was 50 or higher. RESULTS: No statistically significant differences were observed between the 2groups in any variable studied. All patients had high self-esteem (87,3 those who failed and 88,1 those who are successful) and social support (90,2 and 90,9). Patients who succeed presented higher scores for cognitive restructuring (57,1) and were more introverted (47,1), while those who failed scored more highly in desiderative thinking (65,7) and were more prone to aggression (50,7) and neuroticism (51,7). CONCLUSIONS: High self-esteem and social support does not guarantee successful treatment. The groups differed in how they coped with obesity but the data obtained do not justify the weight evolution. In the absence of psychopathology, personality trait variability between patients is insufficient to predict the results.

Nosocomial Rhinocerebral Mucormycosis: Two Cases with a Temporal Relationship.

Mucormycosis is an unusual fungal infection that usually affects immunosuppressed patients. Small outbreaks of mucormycosis have been previously reported. We present two clinical cases of fatal rhinocerebral mucormycosis with a close temporal relationship between them and a possible nosocomial transmission: case 1 was a 75-year-old male with diabetes and COPD, treated with antibiotics and systemic corticosteroids, who developed rhinocerebral mucormycosis. Case 2 was an 88-year-old woman who was treated with systemic antibiotics and corticosteroids and developed the same infection after insertion of a nasogastric tube. Both patients concurred at the same time in our hospital, and healthcare staff was common to both of them. These cases, along with previously reported cases, highlight that, although infrequent, transmission of the fungus in the hospital environment is a real possibility that should be taken into account in order to initiate contact and air isolation precautions that could avoid nosocomial transmission of this infection.

Human adipose tissue levels of persistent organic pollutants and metabolic syndrome components: Combining a cross-sectional with a 10-year longitudinal study using a multi-pollutant approach.

We aimed to assess the influence of long-term exposure to POPs on the risk of metabolic syndrome, combining a cross-sectional with a 10-year longitudinal follow-up design. Residues of eight POPs were quantified in adipose tissue samples from 387 participants recruited between 2003 and 2004 in Granada province (Spain). The outcome ("metabolically compromised") was defined as having ≥1 diagnosis of type 2 diabetes, hypertension, hypertriglyceridemia, and/or low HDL cholesterol. The cross-sectional analysis was conducted in the initial cohort, while the 10-year longitudinal analysis was conducted in those 154 participants free of any of the so-mentioned metabolic diseases and classified as "metabolically healthy" at recruitment. Statistical analyses were performed using single and multi-pollutant approaches through logistic and Cox regression analyses with elastic net penalty. After adjusting for confounders, ß-hexachlorocyclohexane (ß-HCH) and hexachlorobenzene (HCB) were independently associated with an increased risk of being metabolically compromised (unpenalized ORs=1.17, 95% CI=1.01-1.36 and 1.17, 95% CI=0.99-1.38, respectively). Very similar results were found in the 10-year longitudinal analysis [HRs=1.28, 95% CI=1.01-1.61 (ß-HCH); 1.26, 95% CI=1.00-1.59 (HCB)] and were in line with those obtained using elastic net regression. Finally, when the arithmetic sum of both compounds was used as independent variable, risk estimates increased to OR=1.25, 95% CI=1.03-1.52 and HR=1.32, 95% CI=1.02-1.70. Our results suggest that historical exposure to HCB and ß-HCH is consistently associated with the risk of metabolic disorders, and that these POPs might be partly responsible for the morbidity risk traditionally attributed to age and obesity.

La epidemia de la obesidad en España: la retórica de su discurso y riesgos potenciales / A epidemia de obesidade na Espanha: a retórica do seu discurso e riscos potenciais / The obesity epidemic in spain: the rhetoric of its discourse and potential risks

Resumen: La obesidad se ha convertido en una prioridad para las políticas de salud pública en España. Basándose en el aumento de su prevalencia ha sido catalogada como una epidemia. A pesar de estas afirmaciones, las investigaciones no parecen siempre tan concluyentes. El objetivo de este artículo es revisar algunas de las 'verdades' en torno a la obesidad: a) que la obesidad va en aumento y es una epidemia en España; b) que existe una relación directa entre peso y salud; y c) que la obesidad tenga su consecuencia única en el desequilibrio entre gasto y consumo energético. Además, dado que las ideas vertidas en torno a la epidemia de la obesidad, y el modo exagerado y alarmista en que se produce, pueden tener consecuencias dañinas e impredecibles sobre la salud de las personas, un segundo objetivo es delinear algunos de los posibles riesgos de estas prácticas de comunicación. (AU)

Resumo: A obesidade tornou-se uma prioridade para as políticas de saúde pública na Espanha. Com base no aumento da prevalência foi classificada como uma epidemia. Apesar dessas afirmações, as investigações nem sempre parecem tão conclusivas. O objetivo deste artigo é analisar algumas das 'verdades' sobre a obesidade: a) que a obesidade está aumentando e é uma epidemia em Espanha; b) existe uma relação direta entre peso e saúde; e c) que a obesidade tenha uma consequência única em um desequilíbrio entre gasto e consumo de energia. Além disso, uma vez expressas as ideias sobre a epidemia da obesidade, a maneira exagerada e alarmista que ocorre pode ter consequências imprevisíveis sobre a saúde das pessoas; um segundo objetivo é delinear alguns dos possíveis riscos dessas práticas de comunicação. (AU)

Abstract: Obesity has become a top priority for public health policies in Spain. Based on increasing prevalence, it has been classified as an epidemic. Despite these claims, research does not always seem so conclusive. The purpose of this article is to review some of the 'truths' about obesity: a) that it is on the rise and is an epidemic in Spain; b) that there is a direct relationship between weight and health; c) that its sole effect is the imbalance between energy expenditure and intake. In addition, since the ideas expressed about the obesity epidemic and the exaggerated and alarmist way they are produced might have harmful and unpredictable consequences on people's health, a second aim is to point out some of the possible risks inherent in those communication practices. (AU)

Fundamentos teóricos a problemas clínicos en los trastornos de la personalidad y su proyección en el DSM-5/CIE-11 / Theoretical background in personality disorders: clinical problems and their projection in DSM-5/ICD-11

More research needs to be carried out into the theoretical backgrounds of the various specialities in Medicine, and particularly in Psychiatry. Since new classifications for mental disorders are soon to be introduced, we will briefly examine the history of personality disorders and our interest will be directed to problems we might encounter using the current diagnostic criteria, i. e., DSM-IV/ICD-10.

Profundizar en los fundamentos teóricos de la propia especialidad es algo necesario para la labor asistencial de cualquier facultativo en Medicina. Ante las ya inminentes nuevas clasificaciones sobre las enfermedades mentales, hacemos un breve repaso de la historia de los trastornos de personalidad y nos planteamos las principales dificultades que se ponen de manifiesto al hacer el diagnóstico de trastorno de personalidad siguiendo los actuales criterios DSM-IV/CIE-10.