Validation of the Health Index in the Postoperative Period: Use of the Nursing Outcome Classification to Determine the Health Level.

BACKGROUND: The postoperative period is the recovery time after surgery and is defined as an individual process whose purpose is to return the person to the state of normality and integrity that they had prior to surgery. AIM: Demonstrate the modification of the level of health of people in the early postoperative period through the development and validation of the Health Index Instrument, which is built from the Nursing Outcomes Classification (NOC) standardized language. DESIGN: The design used a mixed method, which involved a first phase of instrument development and a second phase of instrument validation. METHODS: The methods was based on focus group techniques with text analysis techniques, internal validation with a group of care language experts, external validation with a group of clinical nursing experts and a clinical validation with quantitative and qualitative analysis. A panel of experts in Language of Care evaluated the (NOC) labels and their correlation with the 11 Health Variables to construct the instrument. The instrument developed was subjected to external validation with a panel of clinical nurse experts in post-anesthesia care. The clinical validation included a cross-sectional descriptive study in a postoperative unit. The final sample of the cross-sectional descriptive study was 139 cases. RESULTS: Of the 89 NOCs proposed in the preliminary construction phase of the instrument, 36 passed through the first round. Of those 36 NOCs, 25 passed through to the second round with a review performance and 11 directly as approved. The total number of approved NOCs were 4. The results of the research show that there are changes in the global score of the health level and in each health variable. It is observed that there was a significant increase in the scores of the health variables at admission and discharge (p < 0.001). CONCLUSIONS: The results of the data analysis show that six groups present a similar pattern of evolution of the health variables. A correlation was found between the time of stay in the unit with the scores obtained in the health variables, the physical functioning, comfort status and the presence of symptoms being particularly significant.

Impacts of Organic Emerging Contaminants (Erythromycin, Ibuprofen, and Diclofenac) on the Performance of a Membrane Bioreactor Treating Urban Wastewater: A Heterotrophic Kinetic Investigation.

The occurrence of emerging organic contaminants, such as pharmaceuticals, is a growing global concern. In this research, for a membrane bioreactor (MBR) laboratory plant operating at a hydraulic retention time (HRT) of 24 h, fed with real urban wastewater, the heterotrophic biomass behaviour was analysed for two concentrations of erythromycin, ibuprofen, and diclofenac. The concentrations studied for the first phase were erythromycin 0.576 mg L-1, ibuprofen 0.056 mg L-1, and diclofenac 0.948 mg L-1. For Phase 2, the concentrations were increased to erythromycin 1.440 mg L-1, ibuprofen 0.140 mg L-1, and diclofenac 2.370 mg L-1. Heterotrophic biomass was affected and inhibited by the presence of pharmaceutical compounds in both phases. The system response to low concentrations of pharmaceutical compounds occurred in the initial phase of plant doping. Under these operating conditions, there was a gradual decrease in the concentration of mixed liquor suspended solids and the removal of chemical oxygen demand of the system, as it was not able to absorb the effect produced by the pharmaceutical compounds added in both phases.

Kinetic Effects of Ciprofloxacin, Carbamazepine, and Bisphenol on Biomass in Membrane Bioreactor System at Low Temperatures to Treat Urban Wastewater.

This study analysed the kinetic results in the presence and absence of micropollutants (bisphenol A, carbamazepine, ciprofloxacin, and the mixture of the three compounds) obtained with respirometric tests with mixed liquor and heterotrophic biomass in a membrane bioreactor (MBR) working for two different hydraulic retention times (12-18 h) and under low-temperature conditions (5-8 °C). Independently of the temperature, the organic substrate was biodegraded faster over a longer hydraulic retention time (HRT) with similar doping, which was probably due to the longer contact time between the substrate and microorganisms within the bioreactor. However, low values of temperature negatively affected the net heterotrophic biomass growth rate, with reductions from 35.03 to 43.66% in phase 1 (12 h HRT) and from 37.18 to 42.77% in phase 2 (18 h HRT). The combined effect of the pharmaceuticals did not worsen the biomass yield compared with the effects caused individually.

Sentimientos y emociones de los pacientes en el proceso de alta de UCI / Feelings And Emotions That Emerge From The Experience Of Being Discharged From An ICU

Introducción El alta de la Unidad de Cuidados Intensivos (UCI) a la sala de hospitalización activa el sistema afectivo de los pacientes provocando la aparición de sentimientos asociados al proceso de transición. Los objetivos de este trabajo son conocer los sentimientos y emociones que emergen de la experiencia de ser dado de alta de una UCI e identificar los factores que desencadenan bienestar y malestar emocional en los pacientes. Método Estudio cualitativo y descriptivo con enfoque fenomenológico en un hospital de tercer nivel de Barcelona. Se realizaron 20 entrevistas en profundidad para la recogida de datos. Resultados Se identificaron sentimientos y emociones agradables que provocan bienestar cuando se produce la transferencia: Alegría, satisfacción y seguridad, y sentimientos desagradables que producen malestar: Ansiedad, tristeza, miedo, rabia, desprotección y ambivalencia de sentimientos. Conclusiones Es necesaria una reflexión sobre el gran número de sentimientos que evoca el alta de la UCI a la sala de hospitalización y cuáles son los desencadenantes que los provocan para poder trabajar en ellos y propiciar un alta de UCI emocionalmente saludable. (AU)

Introduction: Discharge from the Intensive Care Unit (ICU) to the hospitalization ward activates the affective system of patients, causing the appearance of feelings associated with the transition process. The objectives of this thesis are to know the feelings and emotions that emerge from the experience of being discharged from an ICU and to identify the factors that trigger well-being and emotional discomfort in patients. Methodology: Qualitative and descriptive study with a phenomenological approach in a third level hospital in Barcelona. Twenty in-depth interviews were conducted for data collection. Results: The pleasant feelings and emotions that cause wellbeing when the transfer occurs identified were: Joy, satisfaction and security. The unpleasant feelings that cause discomfort identified were: Anxiety, sadness, fear, anger, lack of protection and ambivalence of feelings. Conclusions: It is necessary to reflect on the large number of feelings that being discharged from the ICU to the hospital ward evokes and what are the triggers that provoke them in order to work on them and promote an emotionally healthy discharge from the ICU. (AU)

Bioresorbable Chitosan-Based Bone Regeneration Scaffold Using Various Bioceramics and the Alteration of Photoinitiator Concentration in an Extended UV Photocrosslinking Reaction.

Bone tissue engineering (BTE) is an ongoing field of research based on clinical needs to treat delayed and non-union long bone fractures. An ideal tissue engineering scaffold should have a biodegradability property matching the rate of new bone turnover, be non-toxic, have good mechanical properties, and mimic the natural extracellular matrix to induce bone regeneration. In this study, biodegradable chitosan (CS) scaffolds were prepared with combinations of bioactive ceramics, namely hydroxyapatite (HAp), tricalcium phosphate-α (TCP- α), and fluorapatite (FAp), with a fixed concentration of benzophenone photoinitiator (50 µL of 0.1% (w/v)) and crosslinked using a UV curing system. The efficacy of the one-step crosslinking reaction was assessed using swelling and compression testing, SEM and FTIR analysis, and biodegradation studies in simulated body fluid. Results indicate that the scaffolds had comparable mechanical properties, which were: 13.69 ± 1.06 (CS/HAp), 12.82 ± 4.10 (CS/TCP-α), 13.87 ± 2.9 (CS/HAp/TCP-α), and 15.55 ± 0.56 (CS/FAp). Consequently, various benzophenone concentrations were added to CS/HAp formulations to determine their effect on the degradation rate. Based on the mechanical properties and degradation profile of CS/HAp, it was found that 5 µL of 0.1% (w/v) benzophenone resulted in the highest degradation rate at eight weeks (54.48% degraded), while maintaining compressive strength between (4.04 ± 1.49 to 10.17 ± 4.78 MPa) during degradation testing. These results indicate that incorporating bioceramics with a suitable photoinitiator concentration can tailor the biodegradability and load-bearing capacity of the scaffolds.

What Competencies Does a Community Occupational Therapist Need in Neurorehabilitation? Qualitative Perspectives.

More than three million people in Chile suffer from neurological conditions, and many of these become permanent users of health services with a community approach. In this way, disciplinary competencies in this area are relevant. We seek to characterize the competencies for community occupational therapy intervention in neurorehabilitation. Using a qualitative approach, interviews were conducted with eighteen professionals and were analyzed using content analysis. The main results are associated with the competencies of knowledge associated with theoretical biomedical and community elements. Skills range from health evaluation and intervention on micro- and macrosocial levels. Attitude is also an important skill, stemming from personal and relational spheres. These findings suggest that interventions are essentially on a personal and microsocial level, focusing first on pathology and treatment, and later comprehending the interactions with a patient's close social environment, such as family, schoolmates, and workmates and their physical environment at home, school, and the workplace. Although the final objective of community intervention is present in the discourse as being able to generate structural changes that favor well-being and social inclusion, concrete competencies are not appreciated on a macrosocial level.

La dieta mediterránea y el ejercicio físico mejoran el bienestar durante la menopausia en mujeres de Almería (España) / Adherence to Mediterranean diet and physical activity improve well-being during menopause in women from Almeria (Spain)

Objetivo principal: Evaluar la sintomatología menopáusica, hábitos de vida y condiciones sociodemográficas de una muestra poblacional de mujeres entre 45 y 60 años de Almería (España), y analizar qué variables influyen en la aparición de síntomas climatéricos. Metodología: Se obtuvieron datos de 130 mujeres participantes a través de cuestionarios. La severidad de los síntomas menopáusicos se evaluó con el cuestionario Menopause Rating Scale (MRS). Resultados principales: En promedio, las mujeres postmenopáusicas presentaron mayor edad, Índice de Masa Corporal (IMC) y frecuencia de no tener pareja estable. Se observó una sintomatología total mayor (moderada), así como somático-vegetativa y urogenital en mujeres postmenopáusicas. La adherencia a la dieta mediterránea y el ejercicio físico redujeron la sintomatología somático-vegetativa y psicológica, respectivamente. Conclusión principal: Mantener hábitos de vida saludables como el ejercicio y la dieta mediterránea pueden disminuir la sintomatología menopáusica y mejorar la calidad de vida de mujeres en esta fase.(AU)

Objective: To evaluate menopause symptomatology, lifestyle habits and sociodemographic conditions of women between 45 and 60 years old in the province of Almeria (Spain), and to analyse which variables are related with the manifestation of climacteric symptoms. Methods: Data was obtained by carrying out surveys with 130 participating women. The severity of menopausal symptoms was evaluated with the Menopause Rating Scale (MRS) questionnaire. Results: On average, postmenopausal women were older, had higher Body Mass Index values, and higher frequency of not having a partner, compared with premenopausal women. Postmenopausal women had higher total symptoms, associated with higher somatic-vegetative and urogenital symptoms. Adherence to Mediterranean diet and physical exercise reduced somatic-vegetative and psychological symptoms, respectively. Conclusions: Maintaining specific healthy lifestyle habits such as Mediterranean diet and physical exercise can reduce menopause symptoms and increase the quality of life of menopausal women.(AU)

Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula.

BACKGROUND: Fistulotomy with immediate sphincteroplasty is a technique that can heal fistulas and decrease fecal incontinence more effectively than fistulotomy alone, in selected patients. OBJECTIVE: We aimed to perform a long-term evaluation of fecal incontinence after fistulotomy and immediate sphincteroplasty in patients with complex anal fistula. DESIGN: This prospective study included patients undergoing fistulotomy and immediate sphincteroplasty for complex anal fistula from January 2000 to December 2010. SETTINGS: The study was conducted by 2 colorectal surgeons in the coloproctology unit of the General Hospital of Elche. PATIENTS: We included patients aged ≥18 years with complex anal fistulas of cryptoglandular origin. MAIN OUTCOME MEASURES: Main outcomes were recurrence and continence after fistulotomy and immediate sphincteroplasty, according to fistula tract height and preoperative continence status. RESULTS: A total of 107 patients were included; 68.2% were men, with a mean age of 48 years and mean fistula duration of 12.8 months. The range and median follow-up period were 84 to 204 and 96 months. Thirty-seven fistulas were not primary. The overall healing rate was 84.1%. Primary fistulas healed by the end of follow-up in 58 (82.9%) of 70 patients; recurrent fistulas healed in 32 (86.5%) of 37; high tracts healed in 31 (83.8%) of 37, and nonhigh fistulas healed in 59 (84.3%) of 70. Male sex (OR = 0.66 (95% CI, 0.20-2.13); p > 0.05) and recurrent fistulas (OR = 0.43 (95% CI, 0.11-1.68); p > 0.05) could have a protective effect against postoperative fecal incontinence; however, more studies with larger sample sizes are necessary to confirm this result, whereas high fistulas showed a 4-fold increased risk of incontinence (range, 1.22-13.06; p < 0.01). One in 5 high-tracts patients experienced continence deterioration. LIMITATIONS: This was a prospective study, and randomized clinical trials with more patients and longer follow-up are needed to compare fistulotomy and immediate sphincteroplasty with other sphincter-preserving techniques. CONCLUSIONS: Fistulotomy and immediate sphincteroplasty are good options for treating complex anal fistulas, especially for recurrent fistulas, men, and patients with nonhigh tracts, with acceptable recurrence and incontinence rates. See Video Abstract at http://links.lww.com/DCR/B498. EVALUACIN A LARGO PLAZO DE LA FISTULOTOMA Y LA ESFINTEROPLASTIA INMEDIATA COMO TRATAMIENTO PARA LA FSTULA ANAL COMPLEJA: ANTECEDENTES:La fistulotomía y la esfinteroplastia inmediata es una técnica que puede curar las fístulas y disminuir la incontinencia fecal de manera más efectiva que la fistulotomía sola, en pacientes seleccionados.OBJETIVO:Nuestro objetivo fue realizar una evaluación a largo plazo de la incontinencia fecal después de la fistulotomía y la esfinteroplastia inmediata en pacientes con fístula anal compleja.DISEÑO:Este estudio prospectivo incluyó pacientes sometidos a fistulotomía y esfinteroplastia inmediata por fístula anal compleja, desde enero de 2000 hasta diciembre de 2010.ENTORNO CLINICO:El estudio fue realizado por dos cirujanos colorrectales de la Unidad de Coloproctología del Hospital General de Elche.PACIENTES:Se incluyeron pacientes ≥ 18 años con fístulas anales complejas de origen criptoglandular.PRINCIPALES MEDIDAS DE VALORACION:Los principales resultados fueron la recurrencia y la continencia después de la fistulotomía y la esfinteroplastia inmediata, de acuerdo con la altura del trayecto de la fístula y el estado de continencia preoperatoria.RESULTADOS:Se incluyeron un total de 107 pacientes; El 68,2% eran varones, con una edad media de 48 años y una duración media de la fístula de 12,8 meses. El rango y la mediana del período de seguimiento fue de 84-204 y 96 meses, respectivamente. Treinta y siete fístulas no fueron primarias. La tasa de curación general fue del 84,1%. Las fístulas primarias cicatrizaron al final del seguimiento en 58/70 (82,9%) pacientes; las fístulas recurrentes cicatrizaron en 32/37 (86,5%); los tractos altos cicatrizaron en 31/37 (83,8%) y las fístulas no altas cicatrizaron en 59/70 (84,3%). El sexo masculino (razón de posibilidades: 0,66 [0,20-2,13], p > 0,05) y las fístulas recurrentes (razón de posibilidades: 0,43 [0,11-1,68], p > 0,05) podrían tener un efecto protector contra la incontinencia fecal postoperatoria, sin embargo, más estudios con una muestra más grande son necesarios para confirmar este resultado. Fistulas altas mostraron un riesgo cuatro veces mayor de incontinencia ([1.22-13.06], p < 0.01). Uno de cada cinco pacientes con tractos altos experimentó un deterioro de la continencia.LIMITACIONES:Este fue un estudio prospectivo y se necesitan ensayos clínicos aleatorios con más pacientes y un seguimiento más prolongado para comparar la fistulotomía y la esfinteroplastia inmediata con otras técnicas de preservación del esfínter.CONCLUSIÓN:La fistulotomía y la esfinteroplastia inmediata son buenas opciones para el tratamiento de fístulas anales complejas, especialmente para fístulas recurrentes, varones y pacientes con tractos no altos, con tasas aceptables de recurrencia e incontinencia. Consulte Video Resumen en http://links.lww.com/DCR/B498.

¿Es la fuerza de prensión manual un buen indicador de condición física y composición corporal en pacientes con cáncer de mama que han terminado los tratamientos centrales de la enfermedad? Estudio EFICAN / A força de preensão manual é um bom indicador da condição física e da composição corporal em doentes com cancro da mama que completaram os tratamentos centrais da doença? Estudo EFICAN / Is handgrip strength a good indicator of physical fitness and body composition in breast cancer patients who have completed their core treatments? The EFICAN study

Objetivo: evaluar la asociación entre la fuerza de prensión manual (FPM) y diversos parámetros de condición física y composición corporal en mujeres supervivientes de cáncer de mama.Método: se realizó un estudio transversal con los datos basales del ensayo clínico EFICAN (Ejercicio FÍsico para supervivientes de CÁNcer de mama). Participaron 60 mujeres supervivientes de cáncer de mama que habían terminado los tratamientos centrales de la enfermedad en los 10 años previos al comienzo del estudio, que no presentaban enfermedad pulmonar o cardiovascular, cáncer de mama metastásico, ni tenían prevista una intervención para reconstrucción mamaria en un plazo de 3 meses desde el comienzo del estudio. Se evaluó la fuerza de prensión manual mediante dinamometría manual, la fuerza muscular isométrica pico mediante dinamometría electromecánica funcional, el fitness cardiorrespiratorio (VO2máx) se estimó a través del Siconolfi step test, la amplitud de movimiento (ADM) en flexión de hombro mediante goniometría digital, y la composición corporal mediante bioimpedancia.Resultados: se observó una asociación positiva de la FPM con la masa muscular (r=0.423), y con la fuerza isométrica de miembro superior (r=0.523) e inferior (r=0.335), y una asociación negativa de la FPM con el porcentaje de grasa corporal (r=-0.405). Sin embargo, no se encontró asociación entre FPM y VO2máx ni ADM del hombro (P>0.05).Conclusiones: estos resultados sugieren que la FPM puede ser un buen indicador de fuerza muscular, así como de composición corporal en mujeres supervivientes de cáncer de mama. Futuros estudios prospectivos deberán evaluar el valor predictivo de la FPM en esta población. (AU)

Objectives: this study evaluated the association between handgrip strength (HGS) and various parameters of physical fitness and body composition in female breast cancer survivors.Methods: a cross-sectional study was conducted with the baseline data from the EFICAN (Ejercicio FÍsico para supervivientes de CÁNcer de mama) clinical trial. 60 female breast cancer survivors who had completed the core treatments of the disease in the 10 years prior to the study beginning, who didn’t have any cardiovascular or pulmonary disease, metastatic breast cancer or awaited breast cancer reconstruction in the following 3 months, participated. Handgrip strength was assessed using a digital dynamometer, peak isometric strength was determined using an electromechanical dynamometer, cardiorespiratory fitness (VO2máx) was estimated through the Siconolfi step test, shoulder flexion mobility was assessed through digital goniometry and body composition was determined using a bioelectrical impedance device.Results: positive associations between HGS and muscle mass (r=0.423), isometric upper-limb (r=0.523) and lower-limb (r=0.335) strength were found, and a negative association between HGS and fat mass percentage (r=-0.405) was also found. However, no associations between HGS and VO2máx or shoulder flexion mobility were found (P>0.05).Conclusions: these results suggest that HGS may be a good indicator of muscular strength and body composition in female breast cancer survivors. Future prospective studies are needed to assess the predictive value of HGS in this population. (AU)

Objetivo: avaliar a associação entre a força de preensão manual (FPM) e vários parâmetros de condição física e composição corporal em mulheres sobreviventes de cancro da mama.Método: foi realizado um estudo transversal utilizando dados de base do ensaio clínico EFICAN (Physical Exercise for Breast Cancer Survivors). Participaram sessenta mulheres sobreviventes de cancro da mama que tinham concluído os tratamentos centrais da doença nos 10 anos anteriores ao início do estudo, que não tinham doenças pulmonares ou cardiovasculares, cancro da mama metastásico, ou que não estavam programadas para se submeterem à reconstrução da mama nos 3 meses seguintes ao início do estudo. A força de preensão manual foi avaliada por dinamometria manual, o pico de força muscular isométrica por meio de dinamometria electromecânica funcional, a capacidade cardiorrespiratória (VO2máx) foi estimada pelo Siconolfi step test, a amplitude de movimento (ADM) em flexão do ombro por meio de goniometria digital, e a composição corporal por bioimpedância.Resultados: observámos uma associação positiva de FPM com massa muscular (r=0,423), e com força isométrica de membro superior (r=0,523) e membro inferior (r=0,335), e uma associação negativa de FPM com percentagem de gordura corporal (r=-0,405). Contudo, não foi encontrada qualquer associação entre FPM e VO2max ou ADM de ombro (P>0.05).Conclusões: estes resultados sugerem que a FPM pode ser um bom indicador da força muscular, bem como da composição corporal das mulheres sobreviventes de cancro da mama. Os futuros estudos prospectivos devem avaliar o valor preditivo do FPM nesta população. (AU)

Monitoring the Frequency and Duration of Hypoglycemia in Preterm Infants and Identifying Associated Factors.

BACKGROUND: Hypoglycemia is common in very low birth weight neonates and may have adverse effects. Material and Method: Sixty preterm infants were monitored using continuous glucose monitoring (CGMS) and capillary techniques during the first week of life. Hypoglycemia was defined as glucose ≤47 mg/dL (≤2.6 mmol/L). Results: Hypoglycemic episodes were detected in 41.66% (95% CI: 29.07-55.12). In 69.64% the duration was greater than thirty minutes, in 26.78% (95% CI: 15.83-40.3) hypoglycemia exceeded two hours. Hypoglycemia was observed most frequently during the first 48 hours. In 35.7%, hypoglycemia was not detected with capillary tests. The agreement between the two techniques was good (r = 0.77, p < 0.001), Hypoglycemia was associated with a lower birth weight (OR: 0.99, p = 0.06). Conclusions: Hypoglycemia is frequent with significant duration in very low birth weight neonates. CGMS could be considered for use in these neonates to improve their glycemic control and prevent the associated morbidity.

Burnout in Spanish Security Forces during the COVID-19 Pandemic.

Since the beginning of the COVID-19 pandemic in Spain, members of the State Security Forces and the Armed Forces have been mobilized to guarantee the security and mobility of the population and to support health institutions by providing personnel for care, creating field hospitals, transferring the sick and the dead, etc. The objective of this study was to determine the levels of burnout in these professionals using the Maslach Burnout Inventory (MBI) scale, both in its different subscales and its total value. The study was developed using a quantitative methodology through a simple random sample (n = 2182). An ad hoc questionnaire was administered including variables related to: (a) socio-demographic issues, (b) subjective perceptions about their working conditions and the need for psychological and psychiatric treatment, and (c) the Death Anxiety Scale developed by Collett-Lester, and the MBI. The results show high levels of burnout (28.5%) in all its subscales: emotional exhaustion (53.8%), depersonalization (58.0%), and lack of personal development (46.3%). The logistic regression verifies a series of predictive variables that coincide in each of the subscales. These data indicate the need to implement prevention and treatment measures for workers so that their, stress, and anxiety to which they are subjected during their professional activity does not become a norm that can have negative repercussions for them, especially given the risk of new pandemic waves.

COVID-19 Pandemic and Death Anxiety in Security Forces in Spain.

The pandemic caused by the SARS-CoV-2 coronavirus, which produces COVID-19 disease, has revealed to political and social circles a series of needs that have not yet been met. The workers of the State Security Forces and the Armed Forces have done an extraordinary job to try to alleviate the effects that the pandemic has had on the population and to return stability to the citizenry as much as possible. In this context, the following investigation is developed based on two objectives: (PO1) to know the level of anxiety in the face of death in these professionals; (PO2) to determine the predictive variables in the above-mentioned phenomenon. Professionals from all over Spain have participated in the study (n = 2079). From a quantitative perspective, a questionnaire was developed from the Collet-Lester death anxiety scale. The results show a total level of 69.2% in the scale, as well as some higher levels about the fear of death of others (82.1%) and the fear of the process of dying of others (78.2%). On the other hand, from the binary logistic regressions, four variables are evidenced that condition the risk of suffering death anxiety: (a) certainty of needing psychological treatment in the future; (b) absence of Individual Protection Equipment (PPE); (c) high levels of Emotional Exhaustion; (d) high levels of depersonalization-these last two come from the Maslach and Jackson Burnout scale. These data show a need for training and intervention in the emotional and psychological demands of the professionals of the Armed Forces and State Security Forces, as well as the obligation to develop a continuous dialogue with the institutions they represent to foster the feeling of belonging to them. It is essential, regardless of the serious consequences that the virus has caused, to understand the psychosocial and emotional demands of enforcement agents and to improve their occupational health.

Online education about end-of-life care and the donation process after brain death and circulatory death. Can we influence perception and attitudes in critical care doctors? A prospective study.

Impact of training on end-of-life care (EOLC) and the deceased donation process in critical care physicians' perceptions and attitudes was analysed. A survey on attitudes and perceptions of deceased donation as part of the EOLC process was delivered to 535 physicians working in critical care before and after completion of a online training programme (2015-17). After training, more participants agreed that nursing staff should be involved in the end-of-life decision process (P < 0.001) and that relatives should not be responsible for medical decisions (P < 0.001). Postcourse, more participants considered 'withdrawal/withholding' as similar actions (P < 0.001); deemed appropriate the use of pre-emptive sedation in all patients undergoing life support treatment adequacy (LSTA; P < 0.001); and were favourable to approaching family about donation upon LSTA agreement, as well as admitting them in the intensive care unit (P < 0.001) to allow the possibility of donation. Education increased the number of participants prone to initiate measures to preserve the organs for donation before the declaration of death in patients undergoing LSTA (P < 0.001). Training increased number of positive terms selected by participants to describe donation after brain and circulatory death. Training programmes may be useful to improve physicians' perception and attitude about including donation as part of the patient's EOLC.

Psychological Impact of COVID-19 Emergency on Health Professionals: Burnout Incidence at the Most Critical Period in Spain.

BACKGROUND: The health profession is a burnout producer due to the continuous contact with pain and suffering. In addition, excessive workloads can generate stress and psychological distress. OBJECTIVES: The aim of this study was to determine the degree of burnout and its main triggers in health professionals in Spain at the most critical period of the COVID-19 emergency. METHOD: A quantitative research was developed through a simple random sampling in different Spanish hospitals through the period of greatest impact of the pandemic (N = 157). Data were collected using a standardized questionnaire from Maslach burnout inventory (MBI) containing 22 items, which measures three subscales: emotional burnout, depersonalization, and self-fulfillment. RESULTS: depersonalization values reached 38.9%. A total of 90.4% of the health professionals considered that psychological care should be provided from the work centers. Furthermore, 43.3% of the health professionals estimated that they might need psychological treatment in the future. Finally, 85.4% stated that the lack of personal protective equipment (PPE) generated an increase in stress and anxiety. CONCLUSION: This study demonstrates the need to consider specific mental health care services and training in crises to avoid possible psychological disorders. The information obtained is also valuable for the development of future prevention protocols and training of health personnel to face pandemics of these characteristics or emergency scenarios. Having the necessary physical means for their protection, as well to updated regular and accurate information, is essential to avoid feelings of fear and uncertainty. This would promote the health of these professionals.

Monitoring the incidence, duration and distribution of hyperglycaemia in very-low-birth-weight newborns and identifying associated factors.

Objectives Hyperglycaemia is a common metabolic disorder in very-low-birth-weight (VLBW) infants and is associated with increased morbidity and mortality. The objective is to describe the incidence, duration, episodes and distribution of hyperglycaemia during the first 7 days of life of VLBW infants. Methods This is a prospective cohort study of 60 newborns weighing <1,500 g. Blood glucose levels were monitored with a continuous glucose monitoring system (CGMS) during the first 7 days of life. Hyperglycaemia was defined as glucose ≥180 mg/dL (≥10 mmol/L). Results Incidence of hyperglycaemia recorded with the CGMS was 36.6% (95%CI: 24.6-50.1). In almost 74.6±5.48% of these cases the duration of the episode exceeded 30 min and in 45.25% (95%CI: 2.26-57.82) it exceeded 2 h. The condition occurred most frequently during the first 72 h of life. One-fifth of cases were not detected with scheduled capillary tests and 84.6% of these had hyperglycaemic episode durations of 30 min or more. Agreement between the two techniques was very good (r=0.90, p<0.001) and the CGMS proved to be reliable, accurate and safe. Hyperglycaemia detected by a CGMS is associated with lower gestational age (OR: 0.66, p=0.002), lower birth weight (OR: 0.99, p=0.003), the use of ionotropic drugs (OR: 11.07, p=0.005) and death (OR: 10.59, p=0.03), and is more frequent in preterm infants with sepsis (OR: 2.73, p=0.1). No other association was observed. Conclusions A CGMS could be useful during the first week of life in VLBW infants due to the high incidence and significant duration of hyperglycaemia and the high proportion of cases that remain undetected. The advantage of the CGMS is that it is able to detect hyperglycaemic episodes that the capillary test does not.

Effects of a 12-week resistance and aerobic exercise program on muscular strength and quality of life in breast cancer survivors: Study protocol for the EFICAN randomized controlled trial.

BACKGROUND: The number of people living with the side effects of breast cancer treatment (eg, loss of muscular mass and muscular strength, upper-limb mobility and disability, lymphedema, cardiac toxicity, and reduced quality of life) is increasing yearly. These consequences can be improved through exercise, specially combining resistance and aerobic training. Previous exercise trials have not been consistent in applying training principles and standardized reporting, and this partly explains the variability in obtained results. The aim of this study is to assess the effect of a 12-week supervised resistance exercise program combined with home-based aerobic exercise, compared with home-based aerobic exercise only, on muscular strength and several aspects of health-related quality of life in breast cancer survivors. To maximize transparency, replicability, and clinical applicability, the intervention is described following the consensus on exercise reporting template. METHODS: This study is a parallel-group randomized controlled trial in which 60 female breast cancer survivors, who have completed central treatments of the disease in the last 5 years, will be randomly assigned to either an experimental group that will perform a total of 24 progressive resistance training sessions for 12 weeks (ie, 2 weeks of individual training and 10 weeks of micro-group training) and will be requested to undertake 10,000 steps/d, or a control group that will be requested to undertake 10,000 steps/d, only. Outcomes will be evaluated at baseline and at week 12. Primary outcome measure is peak isometric muscular strength of the lower- and upper-body, assessed with several exercises through an electromechanical dynamometer. Secondary outcomes include cardiorespiratory fitness, upper-joint mobility and disability, health-related quality of life, cancer-related fatigue, depression, life satisfaction, and presence of lymphedema. DISCUSSION: This study aims to investigate the extent to which a 12-week supervised and progressive resistance exercise program, in addition to home-based aerobic physical activity, might improve muscular strength and health-related quality of life in breast cancer survivors. The comprehensive description of the intervention will likely contribute to enhancing exercise prescription in this population. TRIAL REGISTRATION NUMBER: ISRCTN14601208.

A comprehensive analysis of cost of an active surveillance cohort compared to radical prostatectomy as primary treatment for prostate cancer.

INTRODUCTION: Active surveillance (AS) seems to be a cost-effective strategy. However, most publications are based on simulation models of theoretical cohorts, and long-term implications are not usually considered. OBJECTIVE: To assess the real cost differences of two cohorts of men with low-risk prostate cancer (PCa) treated with AS or laparoscopic radical prostatectomy (LRP) in a public health system. MATERIALS AND METHODS: Patients diagnosed from 2005 to 2009 were included in an AS program (Group 1) or treated with LRP at diagnosis (Group 2), with a minimum follow-up of 5 years. Actual costs for each patient were calculated on an individual basis: Group 1: semiannual PSA measurements and repeat biopsies are scheduled every 1-3 years. Costs of outpatient clinic visits were calculated, as well as all tests required for monitoring or active treatment. Group 2: costs of the procedure, emergency visits, re-admissions and outpatient clinic visits were calculated, as well as costs of oncological salvage therapies or functional surgical procedures. RESULTS: Out of 151 men diagnosed with low-risk PC, 54 (35.8%) were included in an AS (Group 1) and 97 (64.2%) were submitted to LRP (Group 2). Mean follow-up for both groups was 6.5 years (SD 1.8) and 6.7 years (SD 1.4), respectively, p = 0.49. Group 1 had a total cost per patient of 2970.47€. Group 2 had a total cost per patient of 5694.06€. CONCLUSIONS: AS was associated with cost-saving over LRP. This cost reduction of AS in the management of low-risk PCa is based on the accounting of real costs of individual patients and confirms previously published estimation-based reports.

[Not Available]. / Efectividad de un programa de educación e intervención nutricional y de actividad física sobre la salud integral de mujeres posmenopáusicas.

Objetivos: el objetivo de este estudio fue comprobar la eficacia de un programa de educación e intervención nutricional, de salud integral y ejercicio físico en mujeres posmenopáusicas, incidiendo especialmente en el sector de mujeres fumadoras con el fin de reducir el riesgo cardiovascular de este sector de población. Materiales y métodos: la población objeto de estudio estuvo constituida por 96 mujeres (46-79 años) residentes en Granada (sur de España).Al comienzo del estudio se recogieron las características sociodemográficas y se realizó una valoración nutricional; el consumo de alimentos se evaluó mediante una encuesta de 48 preguntas y un estudio de adhesión a la dieta mediterránea. Se determinaron datos antropométricos: índice de masa corporal, porcentaje de masa grasa y magra. Determinamos también el colesterol total, el colesterol LDL, HDL y los triglicéridos.Una vez obtenidos los primeros resultados, se realizó una intervención personalizada, para cada mujer participante en el estudio, de educación nutricional y de hábitos saludables. Transcurridos tres meses, se volvieron a determinar todos los parámetros anteriormente estudiados. Resultados: al comienzo del estudio se observó que la dieta de la población se adecuaba a los patrones de dieta saludable y tras la intervención nutricional se produjo una mejora del perfil calórico y lipídico y un descenso de la obesidad. En el grupo de las mujeres fumadoras además se encontró una mejora de los parámetros lipídicos séricos, alcanzando valores semejantes a los de las no fumadoras. Conclusiones: se observó que las mujeres posmenopáusicas andaluzas participantes en este estudio tenían una adecuada adhesión a la dieta mediterránea. La intervención nutricional mejoró en todo el grupo la calidad de la dieta y el porcentaje de obesidad y, además en las mujeres fumadoras mejoró el perfil lipídico.

The effectiveness of an education program and nutritional intervention, integrated health and physical activity in postmenopausal women / Efectividad de un programa de educación e intervención nutricional y de actividad física sobre la salud integral de mujeres posmenopáusicas

Objectives: The aim of this study was to test the effectiveness of a nutritional education and intervention programme, promoting holistic health and physical exercise in postmenopausal women, with special emphasis on women who smoke, in order to test whether greater adherence to the diet and increased physical activity and healthy lifestyles reduce cardiovascular risk in this population group. Material and methods: The study population consisted of 96 women (aged 46-79) living in Granada (southern Spain). At baseline, the sociodemographic characteristics were compiled and a nutritional assessment conducted, in which food consumption was assessed by 48h recall and the Mediterranean diet score (MDS) was calculated. Anthropometric data were also measured. Other data compiled included serum lipid parameters. When the initial results were obtained, a tailored intervention programme concerning nutrition and healthy lifestyle was provided to each participant. After three months, all the above parameters were re-assessed. Results: At the beginning of the study, it was observed that the diet of the study population complied with recommended patterns. However, the nutritional intervention resulted in an improved caloric and lipid profile and decreased obesity. Among the group of smokers, serum lipid parameters also improved, reaching values similar to those of the non-smokers. Conclusions: An appropriate adhesion to the Mediterranean diet score (MDS) was observed in the Andalusian postmenopausal women assessed in this study. For the whole study population, the nutritional intervention improved the quality of diet and reduced the percentage of obesity, while smokers also improved their lipid profile (AU)

Objetivos: el objetivo de este estudio fue comprobar la eficacia de un programa de educación e intervención nutricional, de salud integral y ejercicio físico en mujeres posmenopáusicas, incidiendo especialmente en el sector de mujeres fumadoras con el fin de reducir el riesgo cardiovascular de este sector de población. Materiales y métodos: la población objeto de estudio estuvo constituida por 96 mujeres (46-79 años) residentes en Granada (sur de España). Al comienzo del estudio se recogieron las características sociodemográficas y se realizó una valoración nutricional; el consumo de alimentos se evaluó mediante una encuesta de 48 preguntas y un estudio de adhesión a la dieta mediterránea. Se determinaron datos antropométricos: índice de masa corporal, porcentaje de masa grasa y magra. Determinamos también el colesterol total, el colesterol LDL, HDL y los triglicéridos. Una vez obtenidos los primeros resultados, se realizó una intervención personalizada, para cada mujer participante en el estudio, de educación nutricional y de hábitos saludables. Transcurridos tres meses, se volvieron a determinar todos los parámetros anteriormente estudiados. Resultados: al comienzo del estudio se observó que la dieta de la población se adecuaba a los patrones de dieta saludable y tras la intervención nutricional se produjo una mejora del perfil calórico y lipídico y un descenso de la obesidad. En el grupo de las mujeres fumadoras además se encontró una mejora de los parámetros lipídicos séricos, alcanzando valores semejantes a los de las no fumadoras. Conclusiones: se observó que las mujeres posmenopáusicas andaluzas participantes en este estudio tenían una adecuada adhesión a la dieta mediterránea. La intervención nutricional mejoró en todo el grupo la calidad de la dieta y el porcentaje de obesidad y, además en las mujeres fumadoras mejoró el perfil lipídico (AU)