Epithelial hypoxia maintains colonization resistance against Candida albicans.

Antibiotic treatment promotes the outgrowth of intestinal Candida albicans, but the mechanisms driving this fungal bloom remain incompletely understood. We identify oxygen as a resource required for post-antibiotic C. albicans expansion. C. albicans depleted simple sugars in the ceca of gnotobiotic mice but required oxygen to grow on these resources in vitro, pointing to anaerobiosis as a potential factor limiting growth in the gut. Clostridia species limit oxygen availability in the large intestine by producing butyrate, which activates peroxisome proliferator-activated receptor gamma (PPAR-γ) signaling to maintain epithelial hypoxia. Streptomycin treatment depleted Clostridia-derived butyrate to increase epithelial oxygenation, but the PPAR-γ agonist 5-aminosalicylic acid (5-ASA) functionally replaced Clostridia species to restore epithelial hypoxia and colonization resistance against C. albicans. Additionally, probiotic Escherichia coli required oxygen respiration to prevent a post-antibiotic bloom of C. albicans, further supporting the role of oxygen in colonization resistance. We conclude that limited access to oxygen maintains colonization resistance against C. albicans.

Exploring adolescents' experiences of continuing to wear face masks during COVID-19: A qualitative descriptive study in Barcelona (Spain).

BACKGROUND: The COVID-19 pandemic prompted the use of face masks as a social distancing measure. Although evidence supports their effectiveness in preventing infection, it remains unclear why some adolescents choose to continue wearing them postpandemic, even when it is no longer mandatory. This study aims to explore adolescents' experiences of wearing face masks during the COVID-19 pandemic when their use was no longer mandatory. METHOD: In this exploratory qualitative study, data were collected from 16 adolescents through face-to-face semistructured interviews. The participants were asked about the reasons and feelings associated with continuing to wear masks, as well as the contexts in which they felt safe without a mask. The collected data were analysed using Braun and Clarke's thematic analysis. RESULTS: Three main themes were identified: (1) Navigating complex decision-making: balancing safety and self-image, (2) peer influence dynamics and (3) managing the future: weather dynamics and pandemic evolution. DISCUSSION: The potential implications of withdrawing COVID-19 preventive measures, such as mask-wearing, beyond the pandemic remain understudied. It is crucial to further investigate the perceptions related to wearing masks and its cessation, especially amongst vulnerable individuals. PATIENT OR PUBLIC CONTRIBUTION: Due to methodological constraints associated with participants' age, they were not engaged in the design, data analysis, data interpretation or manuscript preparation phases of the study.

Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients.

STUDY OBJECTIVE: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients. DESIGN: Multicenter, retrospective review. DATA SOURCE: Electronic health records from participating institutions. PATIENTS: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti-Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital-specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. INTERVENTION: Dosing strategy used to determine initial prophylactic dose of enoxaparin. MEASUREMENTS: The primary end point was percentage of patients with peak anti-Xa levels within the target prophylactic range (0.2-0.4 units/mL). MAIN RESULTS: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti-Xa levels (72.1%). Multiple logistic regression demonstrated EBV-based dosing was significantly more likely to yield anti-Xa levels at or above target compared to BMI-based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29-5.62, p < 0.001). EBV-based dosing was also more likely than hybrid dosing to yield an anti-Xa level at or above target (aOR 2.30, 95% CI 1.33-3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. CONCLUSIONS: An EBV-based dosing strategy was associated with higher odds of achieving anti-Xa level within target range for enoxaparin VTE prophylaxis compared to BMI-based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients.

From a learning opportunity to a conscious multidimensional change: a metasynthesis of transcultural learning experiences among nursing students.

BACKGROUND: Several educational activities in nursing schools worldwide have been implemented to promote transcultural nursing and cultural competence. Despite the diversity of their experiences and outcomes, the available evidence has not been systematically reviewed and reinterpreted. This study aimed to review and reinterpret all rigorous qualitative evidence available, providing an opportunity to understand how students learn transcultural nursing and assisting faculties, researchers, managers, and practitioners in designing new interventions to improve transcultural training. METHODS: A meta-synthesis was conducted to review and integrate qualitative studies of these phenomena. English, Spanish and Portuguese articles were searched in Pubmed and Scopus databases. Only peer-reviewed journals in which qualitative approaches were used were included. Quality was assessed using the CASP qualitative version checklist. The metasynthesis technique proposed by Noblit and Hare was used to analyse the data. RESULTS: Twenty-nine studies were included in the analysis. Most studies used phenomenological approaches that were conducted in Australia and the United States of America, with international internships being the most popular learning method. The data revealed one central theme, "From learning opportunity to conscious multidimensional change," and six subthemes. The transcultural nursing learning experience is not a simple or linear process. Instead, it appears to be a complex process formed by the interaction between a) self-awareness, b) reflective thinking, c) Cultural Encounters, d) cultural skills, e) Cultural Desire, and f) Cultural Knowledge. CONCLUSIONS: Transcultural nursing learning is a multifaceted process that arises from specific learning opportunities. This process is still to evolving. Therefore, specific educational strategies should be implemented to encourage attitudinal change and promote reflective thinking.

Prácticas de autocuidado en el adulto mayor con Diabetes Mellitus Tipo II / Self-care prectices in the elderly with Diabetes Mellitus II

Objetivo: Describir la vivencia del cuidado y el autocuidado en el adulto mayor diagnosticado de diabetes mellitus II. Material y método: Estudio cualitativo fenomenológico de enfoque explicativo-interpretativo. Se persigue entender las vivencias ante los autocuidados en personas diabéticas mayores de 65 años. Se lleva a término en el CAP Les Planes de Sant Joan Despí, Barcelona (España). Se realizó un muestreo opinático, no probabilístico intencionado y razonado. La muestra final se compuso de 13 participantes. Para la recogida de datos se utilizó la entrevista semiestructurada e individual. Las entrevistas se llevaron a cabo entre junio del 2019 y diciembre del 2020. Se realizó un análisis temático siendo concomitante a la recogida de estos. Resultados: El diagnóstico de diabetes supone para la persona el conocimiento sobre la pérdida de su salud, de la vivencia de este momento dependerá la forma en que afrontará la enfermedad. La mayoría de los pacientes de este estudio afirman no haber recibido ningún tipo de información sobre los cuidados a realizar respecto a la dieta, el ejercicio físico o el cuidado de los pies, aunque sí que recuerdan el tratamiento farmacológico. Conclusiones: El cuidado de enfermería en las personas con Diabetes Mellitus tipo II debe incluir la consideración de los aspectos físicos, tecnológicos, económicos y educativos de la persona cuidada, adaptando la planificación de los cuidados a cada una de ellas, según dichos factores. (AU)

Objective: To describe the experience of care and self-care in the elderly diagnosed with diabetes mellitus II Material and method: Qualitative phenomenological study with an explanatory-interpretive approach. The aim is to understand the experiences of self-care in diabetic people over 65 years of age. It takes place at the CAP Les Planes de Sant Joan Despí, Barcelona (Spain). An opinionated, non-probabilistic intentional and reasoned sampling was carried out. The final sample consisted of 13 participants. For data collection, the semi-structured and individual interview was used. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out, concomitant with the collection of these. Results: Diagnosis of diabetes supposes for the person the knowledge about the loss of his health, the experience of this moment will depend on the way in which he will face the disease. Most of the patients in this study claim not to have received any type of information about the care to be taken regarding diet, physical exercise or foot care, although they do remember the pharmacological treatment Conclusions: Nursing care in people with type II Diabetes Mellitus should include the consideration of the physical, technological, economic and educational aspects of the person cared for, adapting the care planning to each one of them, according to these factors. (AU)

The Impact of COVID-19 on Adolescents' Mental Health in Catalonia (Spain): A Qualitative Study.

This study aimed to understand the experiences of adolescents regarding the perceived impact of COVID-19 on their mental health in Catalonia (Spain). A qualitative exploratory methodology was used with a purposive sample of 30 high-school students regarding their experiences of the self-perceived impact of COVID-19 on their mental health. Data were thematically analyzed using Braun and Clarke method. Three main themes emerged from the data: (a) the challenge of living confined, (b) the footprint of COVID-19 on adolescents' mental health, and (c) school dynamics during the lockdown. The COVID-19 pandemic negatively impacted adolescents' mental health, and adolescents perceived a lack of emotional support from educational centers. Therefore, incorporating emotional support in educational centers and offering emotional self-management tools to young students should be a priority. School nurses can play an essential role in recognizing and managing emotional needs and being the natural link between educational and primary care centers.

Autocuidado de los pies en personas con diabetes tipo 2. Un estudio cualitativo / "Self-care of the feet in people with type 2 diabetes. A qualitative study"

Objetivo: Entender las vivencias de los adultos mayores de 65 años con diabetes mellitus tipo 2 respecto al autocuidado de los pies. Método: Estudio cualitativo fenomenológico de enfoque descriptivo. Se lleva a término en las dependencias del Centro de Atención Primaria de Les Planes de Sant Joan Despí, Barcelona, perteneciente al Instituto Catalán de la Salud. Para la recogida de datos se utilizó una entrevista semiestructurada e individual, con un guion de aspectos básicos a explorar, no cerrado y centrado en los objetivos de la investigación. Las entrevistas se llevaron a cabo entre junio del 2019 y diciembre del 2020. Se realizó un análisis temático siendo concomitante a la recogida de estos. Resultados: Una muestra final de 13 personas (4 hombres y 9 mujeres) participaron en el estudio. La adherencia a las recomendaciones del autocuidado del pie diabético es irregular. Los participantes explican conductas de riesgo a pesar de saber que pueden suponer una lesión para unos pies considerados previamente de alto riesgo. La valoración del podólogo supone un coste económico que no pueden permitirse algunas personas. Conclusiones: La enfermera ha de hacer un seguimiento exhaustivo de cómo las personas con diabetes cuidan sus pies, insistiendo en las recomendaciones preventivas no solo en la revisión anual, sino cada vez que la persona acude a la consulta de seguimiento de la diabetes. Es necesaria una comunicación efectiva enfermera-podólogo para mejorar la prevención y el seguimiento de las personas con riesgo de sufrir pie diabético.(AU)

Objective: To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care. Method: Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these. Results: A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviors despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford. Conclusions. The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.

5-ASA can functionally replace Clostridia to prevent a post-antibiotic bloom of Candida albicans by maintaining epithelial hypoxia.

Antibiotic prophylaxis sets the stage for an intestinal bloom of Candida albicans , which can progress to invasive candidiasis in patients with hematologic malignancies. Commensal bacteria can reestablish microbiota-mediated colonization resistance after completion of antibiotic therapy, but they cannot engraft during antibiotic prophylaxis. Here we use a mouse model to provide a proof of concept for an alternative approach, which replaces commensal bacteria functionally with drugs to restore colonization resistance against C. albicans . Streptomycin treatment, which depletes Clostridia from the gut microbiota, disrupted colonization resistance against C. albicans and increased epithelial oxygenation in the large intestine. Inoculating mice with a defined community of commensal Clostridia species reestablished colonization resistance and restored epithelial hypoxia. Notably, these functions of commensal Clostridia species could be replaced functionally with the drug 5-aminosalicylic acid (5-ASA), which activates mitochondrial oxygen consumption in the epithelium of the large intestine. When streptomycin-treated mice received 5-ASA, the drug reestablished colonization resistance against C. albicans and restored physiological hypoxia in the epithelium of the large intestine. We conclude that 5-ASA treatment is a non-biotic intervention that restores colonization resistance against C. albicans without requiring the administration of live bacteria.

Self-care of the feet in people with type 2 diabetes. A qualitative study.

OBJECTIVE: To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care. METHOD: Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these. RESULTS: A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviours despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford. CONCLUSIONS: The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.

Chemsex in Barcelona: A qualitative study of factors associated with the practice, the perception of the impact on health and prevention needs. / Chemsex en Barcelona: Estudio cualitativo sobre factores asociados a la práctica, percepción del impacto en salud y necesidades de prevención.

Chemsex is defined as use of psychoactive drugs with the aim of having sexual relations between gay men, bisexuals and men who have sex with men for a long period of time. To study this phenomenon, this qualitative descriptive study was proposed with the objective of describing the practice of chemsex from the perspective of users, to determine the main factors associated with its practice, the perception of the impact on their health and to establish prevention needs. Data were obtained using conversational techniques: 12 semi-structured interviews and 3 focus groups. The purposive sample was made up of GBMSM with a mean age of 40.1 years, 78% born in Spain, and 68% with completed university studies. The qualitative analysis focused on three thematic areas: factors associated with the practice of chemsex, the impact of chemsex on health, and prevention and risk reduction needs. It is concluded that the practice of chemsex should be understood as multifactorial and multicausal, associated with the sociocultural context. Sexual satisfaction, increased libido and the search for more intense pleasure are identified as key factors among people who practice it. These men are still scared of being judged, even by specialists who may lack knowledge or training. A reanalysis and rethinking of the interventions and policies directed towards this population is necessary, putting the focus of action on shared decision-making, self-care, cultural competence and the humanization of care.

El chemsex se define como el uso de drogas psicoactivas con el objetivo de mantener relaciones sexuales entre hombres gay, bisexuales y otros hombres que tienen sexo con hombres (GBHSH), por un largo periodo de tiempo. El objetivo de este estudio cualitativo exploratorio es describir la práctica del chemsex desde la perspectiva de los usuarios, determinar los principales factores asociados a su práctica, la percepción del impacto en su salud y establecer necesidades de prevención. Se obtuvieron los datos mediante técnicas conversacionales: 12 entrevistas semiestructuradas y 3 grupos focales. El análisis cualitativo se centró en tres áreas temáticas: factores asociados a la práctica de chemsex, impacto del chemsex en la salud y necesidades prevención y reducción de riesgos. La muestra intencionada fue conformada por hombres GBHSH con una edad media de 40,1 años, 78% nacidos en España, y 68% con estudios universitarios finalizados. Los resultados del estudio ponen de manifiesto que la práctica de chemsex debe comprenderse como multifactorial y multicausal, y asociada al contexto sociocultural. La satisfacción sexual, del aumento de la libido y de la búsqueda de placer más intenso se identifican como factores clave entre las personas que lo practican. Sigue existiendo miedo en estos hombres a ser juzgados, incluso por los especialistas que pueden carecer de conocimiento o formación. Es necesario un reanálisis y replanteamiento de las intervenciones y políticas dirigidas hacia esta población, poniendo el foco de acción en la toma de decisiones compartidas, el autocuidado, la competencia cultural y la humanización del cuidado.

Expectations of patients awaiting lung transplantation: A qualitative study.

AIM: The main aim of the present study is to examine the expectations and feelings of people awaiting lung transplantation. BACKGROUND: The assessment of the benefits of lung transplant should consider, among other things, the subjective perceptions of patients about the procedure, especially in relation to the context and to their values, goals and expectations. This is an issue that has not been studied in depth, especially in Spain. DESIGN: Exploratory qualitative study. METHODS: Data were collected through semi-structured interviews during the period of being on the waiting list for transplantation. Thematic analysis of the data was supported by the Atlas.ti software. RESULTS: The study population comprised 16 patients awaiting lung transplant, a number sufficient to reach data saturation. Four categories were identified to describe patients' feelings and expectations: (1) reasons for undergoing the transplant, (2) expectations about life post-transplant, (3) emotional state, and (4) relationship with the healthcare team. CONCLUSIONS: Patients have high expectations of lung transplantation. They see it as offering them a second chance at life, although the future creates uncertainty. The healthcare professionals are identified as key actors, providing essential support and information throughout the various stages of the process. Future research should explore recipients' experiences of lung transplant at later stages. RELEVANCE TO CLINICAL PRACTICE: It is important to adapt care through all the lung transplant process, which is accompanied by intense and complex emotions since the beginning. Thus, providing social and psychological support from the beginning may contribute to their health status, helping them deal with all the emotions and feelings experienced, and find balance between expectations and reality. PATIENT OR PUBLIC CONTRIBUTION: Sixteen patients awaiting lung transplant were interviewed. Interview transcripts were returned to participants to check for accuracy with their experiences.

Effectiveness of Narrative Photography in Increasing Nursing Students' Empathy: A Pretest-Posttest Study.

BACKGROUND: Narrative photography is a method that can enhance nursing students' empathy when caring for individuals with HIV. METHOD: This quasiexperimental pre-test-posttest study included 28 first-year nursing students from a public university in Barcelona, Spain. Empathy was assessed using the Spanish validated version of the Interpersonal Reactivity Index. RESULTS: Empathy scores were higher in the intervention group (p = .01). Women scored higher on empathy and also on the fantasy, empathic concern, and personal distress dimensions. A significant relationship was found between the perspective taking dimension and students choosing nursing as their first option at university. Having no experience in the health field was associated with higher scores on the empathic concern dimension (p = .027). CONCLUSION: Narrative photography is an effective learning method to promote nursing students' empathy when caring for individuals with HIV. [J Nurs Educ. 2022;61(12):701-705.].

The nursing critical thinking in clinical practice questionnaire for nursing students: A psychometric evaluation study.

AIM: To adapt and validate the N-CT-4 Practice for use with Spanish nursing students. BACKGROUND: Promoting critical thinking is one of the primary objectives of nursing education programs all over the world. Using reliable and valid instruments to measure critical thinking is essential. The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) is used internationally to assess critical thinking in nursing practice. However, little is known about the possible applications of this instrument in the context of nursing education. METHODS: Two-phase study: Phase I, adaptation of the N-CT-4 Practice for use with nursing students and verification of its content validity; phase 2, cross-sectional study to validate its psychometric properties in a sample of 331 nursing students from three university nursing schools. A subsample of 34 students completed the questionnaire on two occasions, with a time interval of two weeks. The construct validity and reliability of the instrument were tested using confirmatory factor analysis, convergent validity, internal consistency reliability and test-retest reliability. The STROBE guidelines and the COSMIN checklist were followed. RESULTS: All items obtained optimal content validity values. The model fit indices obtained from the confirmatory factor analysis supported the hypothesis of the four-dimensional structure on which the original questionnaire was based. Cronbach's alpha of 0.96 indicated high reliability. The correlations between the total score and the scores for the dimensions were statistically significant, positive and high, with values above r = 0.78 (p < 0.05). Lin's concordance correlation coefficient was 0.6 (p < 0.001). CONCLUSIONS: The adapted version of the N-CT-4 Practice is suitable for measuring critical thinking skills in the educational context of the degree course in nursing in Spain. Its psychometric validation yielded satisfactory results.

Autonomy and isolation experienced by patients and primary caregivers during COVID-19 hospitalization in Barcelona (Spain).

This study aims to describe patients' and family caregivers' hospitalization experiences during the COVID-19 pandemic. Using qualitative exploratory descriptive methods, 13 patients admitted to the largest hospital in Barcelona (Spain) due to COVID-19 were interviewed by telephone once discharged, as were eight primary caregivers. Data were analyzed using the content analysis method proposed by Krippendorff. Two main themes were identified: (i) Acceptance of mandatory isolation for patients and family caregivers, which refers to the verbalization of a feeling that justifies the imposed isolation and the need for the use of personal protective equipment by the health team for everyone's safety; and (ii) Limited autonomy during hospitalization for patients and family caregivers, which describes participants' perceptions of autonomy during hospitalization. Patients and caregivers experienced feelings of loneliness, which negatively affected their emotional health. In addition, they experienced reduced autonomy due to new habits and routines intended to control the pandemic for the benefit of public and global health.

TRANSALUD: A qualitative study of the healthcare experiences of transgender people in Barcelona (Spain).

Transgender identities are still considered a psychiatric pathology in many countries according to the prevailing biomedical model. However, in recent years, this pathologizing vision has begun to shift towards a perspective that focuses on the diversity of transgender peoples' experiences. However, some transgender people still face denial of services, discrimination, harassment, and even violence by healthcare professionals, causing them to avoid seeking ongoing or preventive healthcare. This article describes the health experiences of transgender people in Barcelona regarding their access and use of non-specialized health services. Semi-structured interviews were conducted using a descriptive phenomenological approach with sixteen transgender people between December 2018 and July 2019. The data were analyzed descriptively and thematically following the method proposed by Colaizzi with the help of the Atlas.ti8 software. Transgender people care experiences were divided into three categories: overcoming obstacles, training queries, and coping strategies. Participants identified negative experiences and difficulties with the health system due to healthcare providers' lack of competence. Discriminatory, authoritarian, and paternalist behaviors are still present and hinder the therapeutic relationship, care, and access to healthcare services. There is a fundamental need for the depathologization of transgender reality and training for healthcare professionals in the field of sexual diversity. Training in sexual and gender diversity must be included in the curricula of university courses in the health sciences.

Narrative photography with an expert patient as a method to improve empathy: a satisfaction study with health sciences students.

OBJECTIVES: To assess health sciences students' satisfaction with narrative photography with an expert patient as an empathy-fostering teaching method. METHODS: Nineteen students from a public medical sciences university in Barcelona (Spain) voluntarily completed six online training sessions using narrative photography and expert patient. Data were collected using an anonymous online satisfaction questionnaire verified by experts, including 29 quantitative and qualitative questions that were analyzed descriptively. RESULTS: Eighteen valid questionnaires were obtained (90% response rate). All students evaluated the teaching method as highly satisfactory. The main positive aspects of the teaching method were being able to express one's emotions and reflections. Students felt the activity enhanced their empathy and helped them minimize their prejudices, specifically to patients living with HIV. Students also evaluated the online format as less optimal than if it were delivered in person. CONCLUSION: The students found the teaching method to have a personal and professional impact, which facilitated the integration of empathy in their daily practice when caring for people living with HIV.

Reproductive decision-making of Black women living with HIV: A systematic review.

BACKGROUND: Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. OBJECTIVE: The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. METHODS: This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). RESULTS: Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decision-making were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. CONCLUSION: No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.

Nursing students' perceptions of the efficacy of narrative photography as a learning method: A cross-sectional study.

Although active learning methodologies promote students' creativity and motivation regarding learning objectives, traditional unidirectional teaching methods remain more common. The objective of this study was to determine nursing students' perceptions regarding the efficacy of narrative photography as a learning method, including self-perceived satisfaction. Narrative photography is an art-based technique inspired by Photovoice that promotes empathy, creativity, and reflection. A cross-sectional study was conducted using a nonprobabilistic sample of 66 nursing students from a public university in Barcelona, Spain. Quantitative and qualitative data were collected anonymously using an electronic tool. Descriptive statistics and thematic analyses were used to analyze the data. Sixty valid questionnaires were returned. The respondents found narrative photography's ability to promote creativity and assist understanding of theory to be its most satisfying aspect (>95% somewhat/totally agree). Narrative photography's usefulness, ability to foster self-criticism, and the associated workload was the least satisfactory aspect (>55% somewhat/totally agree). Significant differences regarding satisfaction levels were found for both age and sex. Narrative photography is a helpful and satisfactory learning method, especially for promoting creativity and understanding theoretical concepts.

Zika virus disrupts gene expression in human myoblasts and myotubes: Relationship with susceptibility to infection.

The tropism of Zika virus (ZIKV) has been described in the nervous system, blood, placenta, thymus, and skeletal muscle. We investigated the mechanisms of skeletal muscle susceptibility to ZIKV using an in vitro model of human skeletal muscle myogenesis, in which myoblasts differentiate into myotubes. Myoblasts were permissive to ZIKV infection, generating productive viral particles, while myotubes controlled ZIKV replication. To investigate the underlying mechanisms, we used gene expression profiling. First, we assessed gene changes in myotubes compared with myoblasts in the model without infection. As expected, we observed an increase in genes and pathways related to the contractile muscle system in the myotubes, a reduction in processes linked to proliferation, migration and cytokine production, among others, confirming the myogenic capacity of our system in vitro. A comparison between non-infected and infected myoblasts revealed more than 500 differentially expressed genes (DEGs). In contrast, infected myotubes showed almost 2,000 DEGs, among which we detected genes and pathways highly or exclusively expressed in myotubes, including those related to antiviral and innate immune responses. Such gene modulation could explain our findings showing that ZIKV also invades myotubes but does not replicate in these differentiated cells. In conclusion, we showed that ZIKV largely (but differentially) disrupts gene expression in human myoblasts and myotubes. Identifying genes involved in myotube resistance can shed light on potential antiviral mechanisms against ZIKV infection.

Sexuality in people living with a serious mental illness: A meta-synthesis of qualitative evidence.

WHAT IS KNOWN ON THE SUBJECT: A serious mental illness influences sexual life and people affected have worries about their sexual health. People living with a serious mental illness can and want to participate in interventions related to sexual health. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: People who suffer a serious mental illness are interested in maintaining an active sex life. People who suffer a serious mental illness experience rejection when they open up and they lose intimate relationships or possibilities of meeting other people because of ignorance and prejudices surrounding mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Mental health services must respond to this need, that is including sexual needs assessment among routine standard practices or training nurses on sexual education to allow them to advise patients and their families and friends. Health systems should promote awareness programmes and reduce the stigma surrounding mental health and sexuality. ABSTRACT: INTRODUCTION: Sexuality-related nursing care is scarce and mainly focuses on biological issues. There is also a lack of knowledge about how serious mental illnesses affect sexuality. AIM: To explain how people with a serious mental illness perceive and experience their sexuality. METHOD: A meta-synthesis was conducted to integrate qualitative studies. Four databases were used to perform the search, focused in the last ten years. Nine articles were included, and their results analysed thematically. RESULTS: Four categories were identified: "Pathologized sexuality," which explains how the disorder and treatment affect sexuality; "Not my sexuality anymore," which describes feelings emerging from the perceived limitations and the role of self-acceptance; "Learning to manage intimate relationships," which explains the desire to establish intimate personal relationships and define their meaning; and "Reconstructing my sexuality," which elucidates the influence of the environment on sexuality. DISCUSSION: Sexuality is influenced by several factors, the main ones being: the clinical complications, the side effects of drug treatment, the social support, the relationship with the health sector and stigma. IMPLICATIONS FOR PRACTICE: Having a serious mental illness affects sexuality and can provoke suffering and social isolation. Mental health services should address this issue and carry out community interventions to reduce stigma.