Experience of primary care nurses applying nurse-led management of patients with acute minor illnesses.

AIM: The aim of this study is to determine the experience of primary health care nurses regarding the application of nurse-led management in patients with acute minor illnesses. BACKGROUND: Nursing leadership of care for acute minor illnesses is a new challenge faced by nurses in Spain. DESIGN: Qualitative, hermeneutical, interpretive phenomenological approach is used. The Consolidated criteria for reporting qualitative research guidelines were applied. METHODS: Twenty primary care nurses participated; three focus group discussions and nine semi-structured interviews were conducted between November 2019 and October 2020. All the focus group discussions and interviews were recorded, transcribed verbatim and analysed using content analysis. RESULTS: Seven main themes emerged from the focus group discussions and interviews: concept, perception of the other actors, practice, history and social context, competencies, training, and legality. CONCLUSION: The study shows the diversity and complexity of nurses' experience when applying nurse-led management in acute minor illnesses. This work has helped to show the gaps perceived by nurses, including the lack of training in the treatment of conditions historically attended by physicians, the lack of definition of the legal framework and the limitations on nurse prescribing. It also highlighted the power of the nursing profession in terms of autonomy, competencies and role expansion.

Empleo y resolución de la Gestión Enfermera de la Demanda en Cataluña / Use and resolution of Nurse Demand Management in Catalonia

Introducción: la gestión enfermera de la demanda (GED) es la atención a los problemas agudos leves liderada por la enfermera y llevada a cabo en los centros de atención primaria de Cataluña desde el 2009. El objetivo del estudio es evaluar el grado de implantación y resolución de la GED en los centros del Institut Català de la Salut. Métodos: estudio observacional descriptivo transversal. El ámbito de estudio ha sido el de atención primaria del Institut Català de la Salut de Cataluña. Análisis de datos secundarios. Los datos han sido extraídos de la plataforma Longview. Las variables de estudio han sido en cuanto a la GED: el número de visitas, la resolución, los motivos de consulta y protocolos implantados en los equipos. Resultados: la GED en el territorio catalán presenta variabilidad en los porcentajes de resolución entre las diferentes gerencias territoriales. Los protocolos pediátricos presentan mayor resolución que los de adultos. Los protocolos con mayor resolución son los relacionados con la práctica usual de la enfermera, y los menos, los que históricamente resolvía el médico. Por último, existe correlación positiva entre los protocolos implementados y el número de usuarios visitados por la enfermera. Conclusiones: el liderazgo enfermero en la atención a enfermedades agudas leves es una práctica afianzada por las enfermeras de atención primaria; aunque existe heterogeneidad en la resolución de los motivos de consulta especialmente entre los que habitualmente atendía la enfermera y los que históricamente resolvía el médico. (AU)

Introduction: Nursing leadership in users with acute minor illnesses (NLAMI) is the attention given by nurse to people with acute problems carried out in primary care centers in Catalonia since 2009. The aim of the study is to evaluate the degree of resolution of the NLAMI in the centers of the Institut Català de la Salut. Methods: cross-sectional descriptive observational study. The scope of the study was the primary care of the Institut Català de la Salut in Catalonia. Secondary data analysis. The data were extracted from the Longview platform. The study variables were related with NLAMI: number of visits, resolution, reasons for consultation and protocols implemented in the health centers. Results: The NLAMI is implemented in the Catalonia and there is variability in the percentages of resolution between territories. Pediatric protocols have higher resolution than adult protocols. The most resolved protocols are those related to the usual practice of the nurse, and the least resolved protocols are those historically resolved by the physician. Finally, there is a positive correlation between the protocols implemented and the number of users visited by the nurse. Conclusions: the leadership in the care of acute minor illnesses is an established practice of primary care nurses and there is heterogeneity in the resolution of the reasons for consultation, especially between those usually attended by the nurse and those historically resolved by the physician. (AU)

Impacto de la formación y aspectos legales en la aplicación de la gestión enfermera de la demanda por parte de las enfermeras de atención primaria de Cataluña / Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia

Objetivo: Conocer la experiencia de las enfermeras de atención primaria en la aplicación de la gestión enfermera de la demanda (GED). Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Atención primaria de Cataluña. Participantes: Enfermeras de atención primaria de Cataluña. Se estimó una muestra de 394 participantes alcanzando 405. La obtención de datos fue desde octubre de 2021 hasta enero de 2022. Mediciones principales: Se realizó un cuestionario ad hoc, el cual exploraba aspectos referentes a la experiencia de aplicación de la GED: definición y manejo del programa, formación y aspectos legales del programa. Resultados: Las enfermeras entienden la GED como un triaje. Además, consideran que la implantación de la prescripción enfermera no mejora la aplicación de la GED. Manifiestan una falta de formación especialmente las enfermeras más noveles. La formación ideal en GED, consideran, debería incluir fisiopatología y supuestos prácticos. Siete de cada 10 enfermeras desconocen el marco legal que ampara la GED y les provoca inseguridad no conocerlo. Seis de cada 10 han dejado de ser resolutivas por miedo a las repercusiones legales. Las enfermeras que sí conocen el marco legal son las que han dejado de resolver en menor proporción. Conclusiones: Se constata la necesidad de formación general en la GED y en los aspectos legales que dan cobertura al programa especialmente en las enfermeras más jóvenes y con menos experiencia en atención primaria. De esta manera se mejorará la aplicación y aceptación del rol autónomo enfermero en la gestión de enfermedades agudas leves.(AU)

Objective: To evaluate the experience of primary care nurses in the application of nurse demand management (NDM). Design: Observational, cross-sectional descriptive study. Location: Primary care in Catalonia. Participants: Nurses in the field of primary care in Catalonia. A sample of 394 responses was estimated and 405 were finally obtained. Data collection was from October 2021 to January 2022. Main measurements: An ad hoc questionnaire was developed which explored aspects related to the experience of applying NDM: definition and management of the program, training, and legal concerns of the program. Results: Nurses understand NDM as triage. In addition, they consider that the implementation of nurse prescription would not improve the application of NDM. They express a lack of training, especially among the younger nurses. They consider that the ideal training in NDM, should include physiopathology and practical cases. Seven out of ten nurses are unaware of the legal framework that protects NDM and feel insecure about not knowing it. Six out of ten nurses have stopped being resolutive due to fear of legal repercussions. Nurses who are aware of the legal framework are those who have stopped resolving in the lowest proportion. Conclusions: There is a need for general training in NDM and in the legal aspects that cover the program, especially for younger nurses with less experience in primary care. This will improve the application and acceptance of the autonomous nursing role in the management of acute minor illnesses.(AU)

[Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia]. / Impacto de la formación y aspectos legales en la aplicación de la gestión enfermera de la demanda por parte de las enfermeras de atención primaria de Cataluña.

OBJECTIVE: To evaluate the experience of primary care nurses in the application of nurse demand management (NDM). DESIGN: Observational, cross-sectional descriptive study. LOCATION: Primary care in Catalonia. PARTICIPANTS: Nurses in the field of primary care in Catalonia. A sample of 394 responses was estimated and 405 were finally obtained. Data collection was from October 2021 to January 2022. MAIN MEASUREMENTS: An ad hoc questionnaire was developed which explored aspects related to the experience of applying NDM: definition and management of the program, training, and legal concerns of the program. RESULTS: Nurses understand NDM as triage. In addition, they consider that the implementation of nurse prescription would not improve the application of NDM. They express a lack of training, especially among the younger nurses. They consider that the ideal training in NDM, should include physiopathology and practical cases. Seven out of ten nurses are unaware of the legal framework that protects NDM and feel insecure about not knowing it. Six out of ten nurses have stopped being resolutive due to fear of legal repercussions. Nurses who are aware of the legal framework are those who have stopped resolving in the lowest proportion. CONCLUSIONS: There is a need for general training in NDM and in the legal aspects that cover the program, especially for younger nurses with less experience in primary care. This will improve the application and acceptance of the autonomous nursing role in the management of acute minor illnesses.

Análisis de concepto: gestión enfermera de la demanda / Concept analysis: Nurse demand management

La gestión enfermera de la demanda (GED) es un concepto emergente que requiere una clarificación útil no solo para los profesionales y usuarios sino también para gestores. La GED nació en 2009 tras la necesidad de reorganizar los flujos de la demanda, pero se ha convertido en algo más que en eso. Se entiende la GED como un programa liderado por la enfermera de Atención Primaria para atender a personas con enfermedades agudas leves. La enfermera, bajo un protocolo consensuado y dentro de su ámbito competencial, puede ser autónoma en la atención al paciente y en la resolución de problemas agudos leves. Por tanto, siguiendo la filosofía de Atención Primaria, tanto el médico como la enfermera son los profesionales que darán continuidad en el proceso salud-enfermedad del usuario a lo largo de su vida. Este artículo ha sido escrito según la metodología descrita por Wilson

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson

[Concept analysis: Nurse demand management]. / Análisis de concepto: gestión enfermera de la demanda.

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson.

Papel de las endoprótesis autoexpandibles en el tratamiento de la dehiscencia intratorácica tras el procedimiento de Ivor Lewis / Role of self-expanding stents in the treatment of intrathoracic dehiscence after Ivor Lewis esophagectomy

INTRODUCCIÓN: El papel que desempeñan las endoprótesis autoexpandibles en el tratamiento de las dehiscencias tras la esofagectomía transtorácica no está bien definido y resulta controvertido. Nuestro objetivo es mostrar la experiencia en un hospital de tercer nivel con el empleo de estos dispositivos en las dehiscencias tras la esofagectomía de Ivor Lewis. MÉTODOS: Estudio observacional descriptivo de los pacientes que han presentado una dehiscencia de anastomosis tras una esofagectomía transtorácica y, en especial, de aquellos tratados mediante endoprótesis, en el periodo comprendido entre 2011 y 2016 en nuestro centro hospitalario. RESULTADOS: Diez pacientes (11,8%) presentaron una dehiscencia anastomótica, 8 de los cuales recibieron endoprótesis. Un paciente portador de endoprótesis falleció por causas ajenas a la misma. En un paciente se objetivó migración del dispositivo, manteniéndose una media de permanencia de 47,3 días. La prótesis no fue efectiva en un paciente que tuvo una dehiscencia precoz por isquemia aguda gástrica. Fallecieron los 2 pacientes que no recibieron endoprótesis después de la reintervención. CONCLUSIONES: Las endoprótesis son dispositivos seguros y efectivos que no asocian mortalidad en nuestra serie. Están especialmente indicadas en dehiscencias intermedias o tardías y en pacientes frágiles, pues, junto con el drenaje mediastínico y pleural, evitan reintervenciones gravadas con morbimortalidad. Por tanto, las endoprótesis deben formar parte del arsenal terapéutico habitual para la resolución de la mayoría de las dehiscencias de sutura tras la esofagectomía de Ivor Lewis. La puesta en marcha de estudios prospectivos aleatorizados ayudaría a determinar con mayor precisión el papel que desempeñan estos dispositivos en el tratamiento de las dehiscencias tras una esofagectomía transtorácica

INTRODUCTION: The role that self-expanding stents play in the treatment of dehiscence after transthoracic esophagectomy is not well defined and controversial. Our aim is to describe the experience in a tertiary care hospital using these devices for treating dehiscence after Ivor Lewis esophagectomy. METHODS: Descriptive observational study of patients who suffered anastomotic dehiscence after a transthoracic esophagectomy, and especially those treated with stents, in the period between 2011-2016 at our hospital. RESULTS: Ten patients (11.8%) presented anastomotic dehiscence. Eight patients received stents, one of them died due to causes unrelated to the device. Stent migration was observed in one case, and the devices were maintained an average of 47.3 days. The stent was not effective only in one patient who suffered early dehiscence due to acute ischemia of the stomach. The two patients who did not receive stents died after reoperation. CONCLUSIONS: Stents are safe and effective devices that did not associate mortality in our series. They are especially indicated in intermediate or late-onset dehiscence and in fragile patients. The use of stents, together with mediastinal and pleural drainage, avoid reoperations with morbidity and mortality. Therefore, stents should be part of the usual therapeutic arsenal for the resolution of most suture dehiscences after Ivor Lewis esophagectomy. Randomized prospective studies would help to more precisely determine the role played by these devices in the treatment of dehiscence after transthoracic esophagectomy

Resultados de la encuesta nacional sobre cuidados perioperatorios en cirugía resectiva gástrica / Results of a national survey about perioperative care in gastric resection surgery

INTRODUCCIÓN: Las medidas de rehabilitación multimodal en cirugía abdominal se están instaurando progresivamente. El objetivo del estudio es evaluar la aplicación de diferentes cuidados perioperatorios en la cirugía gástrica por parte de los cirujanos españoles. MÉTODOS: Estudio descriptivo de 162 encuestas contestadas desde septiembre a diciembre de 2017 acerca del manejo y cuidados perioperatorios en cirugía de resección gástrica no bariátrica. RESULTADOS: Las profilaxis antibiótica y antitrombótica son empleadas siempre por el 96,9 y 99,4%, respectivamente. El tiempo de ayuno para líquidos es mayor de 6 horas para el 62,7%, empleando solo bebidas con sobrecarga de hidratos de carbono prequirúrgicamente el 3%. Tan solo el 32,4 y el 13,3% de las gastrectomías subtotales y totales son realizadas laparoscópicamente. El 56,8% emplea analgesia epidural y los drenajes son colocados siempre por un 53,8% en la gastrectomía total. La sonda nasogástrica es empleada selectivamente por el 34,6% y siempre por el 11,3%. La retirada del catéter vesical es realizada durante las primeras 48 horas por el 77,2%. En las primeras 24 horas postoperatorias, menos del 20% indica la ingesta oral y un 15,4% moviliza a sus pacientes, comenzando la deambulación a partir de las 24 horas el 49,3%. El 30,4% emplea una vía clínica para el cuidado de estos pacientes y solo un 15,2% utiliza un protocolo de recuperación intensificada. CONCLUSIONES: La aplicación de medidas de rehabilitación multimodal en la cirugía de resección gástrica no bariátrica se encuentra poco extendida en nuestro país

INTRODUCTION: Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. METHODS: A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. RESULTS: Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6 hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48 hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24 hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. CONCLUSIONS: The implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country

Role of self-expanding stents in the treatment of intrathoracic dehiscence after Ivor Lewis esophagectomy. / Papel de las endoprótesis autoexpandibles en el tratamiento de la dehiscencia intratorácica tras el procedimiento de Ivor Lewis.

INTRODUCTION: The role that self-expanding stents play in the treatment of dehiscence after transthoracic esophagectomy is not well defined and controversial. Our aim is to describe the experience in a tertiary care hospital using these devices for treating dehiscence after Ivor Lewis esophagectomy. METHODS: Descriptive observational study of patients who suffered anastomotic dehiscence after a transthoracic esophagectomy, and especially those treated with stents, in the period between 2011-2016 at our hospital. RESULTS: Ten patients (11.8%) presented anastomotic dehiscence. Eight patients received stents, one of them died due to causes unrelated to the device. Stent migration was observed in one case, and the devices were maintained an average of 47.3 days. The stent was not effective only in one patient who suffered early dehiscence due to acute ischemia of the stomach. The two patients who did not receive stents died after reoperation. CONCLUSIONS: Stents are safe and effective devices that did not associate mortality in our series. They are especially indicated in intermediate or late-onset dehiscence and in fragile patients. The use of stents, together with mediastinal and pleural drainage, avoid reoperations with morbidity and mortality. Therefore, stents should be part of the usual therapeutic arsenal for the resolution of most suture dehiscences after Ivor Lewis esophagectomy. Randomized prospective studies would help to more precisely determine the role played by these devices in the treatment of dehiscence after transthoracic esophagectomy.

Results of a national survey about perioperative care in gastric resection surgery. / Resultados de la encuesta nacional sobre cuidados perioperatorios en cirugía resectiva gástrica.

INTRODUCTION: Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. METHODS: A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. RESULTS: Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. CONCLUSIONS: The implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country.

Phylogeography above the species level for perennial species in a composite genus.

In phylogeography, DNA sequence and fingerprint data at the population level are used to infer evolutionary histories of species. Phylogeography above the species level is concerned with the genealogical aspects of divergent lineages. Here, we present a phylogeographic study to examine the evolutionary history of a western Mediterranean composite, focusing on the perennial species of Helminthotheca (Asteraceae, Cichorieae). We used molecular markers (amplified fragment length polymorphism (AFLP), internal transcribed spacer and plastid DNA sequences) to infer relationships among populations throughout the distributional range of the group. Interpretation is aided by biogeographic and molecular clock analyses. Four coherent entities are revealed by Bayesian mixture clustering of AFLP data, which correspond to taxa previously recognized at the rank of subspecies. The origin of the group was in western North Africa, from where it expanded across the Strait of Gibraltar to the Iberian Peninsula and across the Strait of Sicily to Sicily. Pleistocene lineage divergence is inferred within western North Africa as well as within the western Iberian region. The existence of the four entities as discrete evolutionary lineages suggests that they should be elevated to the rank of species, yielding H. aculeata, H. comosa, H. maroccana and H. spinosa, whereby the latter two necessitate new combinations.

Pleistocene refugia and polytopic replacement of diploids by tetraploids in the Patagonian and Subantarctic plant Hypochaeris incana (Asteraceae, Cichorieae).

We report the phylogeographic pattern of the Patagonian and Subantarctic plant Hypochaeris incana endemic to southeastern South America. We applied amplified fragment length polymorphism (AFLP) and chloroplast DNA (cpDNA) analysis to 28 and 32 populations, respectively, throughout its distributional range and assessed ploidy levels using flow cytometry. While cpDNA data suggest repeated or simultaneous parallel colonization of Patagonia and Tierra del Fuego by several haplotypes and/or hybridization, AFLPs reveal three clusters corresponding to geographic regions. The central and northern Patagonian clusters (approximately 38-51 degrees S), which are closer to the outgroup, contain mainly tetraploid, isolated and highly differentiated populations with low genetic diversity. To the contrary, the southern Patagonian and Fuegian cluster (approximately 51-55 degrees S) contains mainly diploid populations with high genetic diversity and connected by high levels of gene flow. The data suggest that H. incana originated at the diploid level in central or northern Patagonia, from where it migrated south. All three areas, northern, central and southern, have similar levels of rare and private AFLP bands, suggesting that all three served as refugia for H. incana during glacial times. In southern Patagonia and Tierra del Fuego, the species seems to have expanded its populational system in postglacial times, when the climate became warmer and more humid. In central and northern Patagonia, the populations seem to have become restricted to favourable sites with increasing temperature and decreasing moisture and there was a parallel replacement of diploids by tetraploids in local populations.

AFLP and breeding system studies indicate vicariance origin for scattered populations and enigmatic low fecundity in the Moroccan endemic Hypochaeris angustifolia (Asteraceae), sister taxon to all of the South American Hypochaeris species.

We used Amplified Fragment Length Polymorphism markers (AFLP) and breeding system studies to investigate the population structure and reproductive biology of Hypochaeris angustifolia (Asteraceae: Cichorieae). This species is endemic to altiplanos of the Atlas Mountains (Morocco) where it occurs in scattered populations, and it is the sister species to c. 40 species of this genus in South America. PCoA, NJ, and Bayesian clustering, revealed that the populations are very isolated whilst AFLP parameters show that almost all populations have marked genetic divergence. We contend that these features are more in accord with a vicariance origin for the scattered populations of H. angustifolia, rather than establishment by long-distance dispersal. The breeding system studies revealed that H. angustifolia is a self-incompatible species, with low fecundity in natural and in experimental crosses, probably due to a low frequency of compatible phenotypes within and between the populations.

Self-incompatibility and floral parameters in Hypochaeris sect. Hypochaeris (Asteraceae).

We studied the relationships between self-incompatibility mechanisms and floral parameters in the genus Hypochaeris L. sect. Hypochaeris (consisting of H. glabra, H. radicata, H. arachnoidea, and H. salzmanniana). We assessed at intra- and interspecific levels (1) the self-incompatibility (SI) mechanism and its distribution among populations, (2) the relationship between SI and floral parameters, and (3) the relationship of SI to reproductive success. Hypochaeris salzmanniana is semi-incompatible, H. glabra is self-compatible, and H. arachnoidea and H. radicata are self-incompatible. Floral parameters differed among populations of H. salzmanniana: plants in self-compatible populations had fewer flowers per head, a smaller head diameter on the flower, and a shorter period of anthesis than self-incompatible populations. We also detected this pattern within a semi-compatible population of H. salzmanniana, and these differences were also found between species with different breeding mechanisms. Fruit to flower ratio in natural populations was generally high (>60%) in all species, regardless of breeding system. It is hypothesized that self-compatibility may have arisen through loss of allelic diversity at the S locus due to bottleneck events and genetic drift.

Nuclear ribosomal DNA and karyotypes indicate a NW African origin of South American Hypochaeris (Asteraceae, Cichorieae).

Hypochaeris has a disjunct distribution, with more than 15 species in the Mediterranean region, the Canary Islands, Europe, and Asia, and more than 40 species in South America. Previous studies have suggested that the New World taxa have evolved from ancestors similar to the central European H. maculata. Based on internal transcribed spacer (ITS) sequences and fluorescence in situ hybridization (FISH) with 5S and 18S-25S rDNA of the previously overlooked Hypochaeris angustifolia from Moyen Atlas, Morocco, we show that it is sister to the entire South American group. A biogeographic analysis supports the hypothesis of long-distance dispersal from NW Africa across the Atlantic Ocean for the origin of the South American taxa rather than migration from North America, through the Panamian land bridge, followed by subsequent extinction in North America. With the assumption of a molecular clock, the trans-Atlantic dispersal from NW Africa to South America is roughly estimated to have taken place during Pliocene or Pleistocene.