Nirsevimab immunization's real-world effectiveness in preventing severe bronchiolitis: A test-negative case-control study.

BACKGROUND: Several clinical trials have shown that nirsevimab, an antibody targeting the respiratory syncytial virus (RSV), reduces RSV bronchiolitis requiring admission. In 2023-2024, Catalonia and Andorra adopted immunization strategies for children <6 months and those born during the epidemic season. This study evaluates the effectiveness of nirsevimab in preventing hospitalizations from RSV bronchiolitis. METHODS: In the epidemic season of 2023-2024, a test-negative case-control study was conducted in three hospitals from Catalonia and Andorra. Patients <12 months old admitted with bronchiolitis and tested for RSV using molecular microbiology tests were included. The effectiveness in preventing RSV bronchiolitis hospitalization and severe disease was estimated using multivariate models. Comparisons between immunized, non-immunized, and non-eligible patients were made in prospectively collected epidemiological, clinical, and microbiological variables. RESULTS: Two hundred thirty-four patients were included. RSV was detected in 141/234 (60.2%), being less common in the immunized group (37% vs 75%, p < .001). The rate of immunized patients among those eligible was 59.7%. The estimated effectiveness for RSV-associated lower respiratory tract infection was 81.0% (95% confidence interval: 60.9-90.7), and for preventing severe disease (the need for NIV/CMV), 85.6% (41.7-96.4%). No significant differences by immunization status were observed in patients with RSV concerning viral coinfections, the need for NIV/CMV or length of hospital stay. CONCLUSIONS: This study provides real-world evidence of the effectiveness of nirsevimab in preventing RSV-lower respiratory tract infection hospitalization and severe disease in infants during their first RSV season following a systematic immunization program. Immunized patients did not exhibit a higher rate of viral coinfections nor differences in clinical severity once admitted.

The Wish to Hasten Death in Patients With Life-Limiting Conditions. A Systematic Overview.

CONTEXT: A systematic review of the wish to hasten death among people with life-limiting conditions was published in 2011. Since then, other reviews and primary studies have been published that have added to knowledge regarding the conceptual definition, aetiology and assessment of the wish to hasten death. OBJECTIVES: To provide an updated synthesis of the literature on the wish to hasten death in people with life-limiting conditions. METHODS: An overview of systematic reviews and primary studies was conducted, using an integrative review method. PubMed, CINAHL, Scopus and Web of Science databases were searched, from their inception until 2023. We included all systematic reviews published to date and all primary studies not included in these systematic reviews. RESULTS: Eleven systematic reviews and 35 primary studies were included. We propose that the phenomenon may usefully be considered as existing along a continuum, defined by the extent to which thoughts of dying are linked to action. A total of nine assessment tools have been described. The reported prevalence of the wish to hasten death appears to be influenced by the wording used in assessment instruments, as well as by the cut-off used when applying a particular tool. Depression, pain, functional disability, decreased sense of meaning in life, the sense of being a burden and reduced quality of life are the most widely reported related factors. CONCLUSION: This overview underscores the need for clinical strategies that can identify different manifestations of the wish to hasten death among people with life-limiting conditions.

Development of a Guide to Multidimensional Needs Assessment in the Palliative Care Initial Encounter (MAP).

CONTEXT: Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention. OBJECTIVES: To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP). METHODS: A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain. RESULTS: The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5). CONCLUSION: MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter.

Association between soluble angiotensin-converting enzyme 2 in saliva and SARS-CoV-2 infection: a cross-sectional study.

This study aimed to investigate the association between saliva soluble angiotensin-converting enzyme 2 (sACE2) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adults. We selected a convenience sample of adults with post-acute SARS-CoV-2 infection and their household children living in quarantined family households of the metropolitan Barcelona region (Spain) during the spring 2020 pandemic national lockdown. Participants were tested for saliva sACE2 quantification by western blot and nasopharyngeal SARS-CoV-2 RT-PCR detection. A total of 161 saliva samples [82 (50.9%) from children; 79 (49.1%) from females] yielded valid western blot and RT-PCR results. Saliva sACE2 was detected in 79 (96.3%) children and 76 (96.2%) convalescent adults. Twenty (24.4%) children and 20 (25.3%) convalescent adults were positive for SARS-CoV-2 in nasopharynx by RT-PCR. SARS-CoV-2 RT-PCR-negative children had a significantly higher mean proportional level of saliva sACE2 (0.540 × 10-3%) than RT-PCR-positive children (0.192 × 10-3%, p < 0.001) and convalescent adults (0.173 × 10-3%, p < 0.001). In conclusion, children negative for nasopharyngeal SARS-CoV-2 RT-PCR appear to exhibit a higher concentration of saliva sACE2 than SARS-CoV-2 RT-PCR-positive children and convalescent adults. Release of adequate levels of sACE2 in saliva could play a protective role against SARS-CoV-2.

Pharmacological interventions for preventing complications in patients with idiopathic hypercalciuria: A systematic review / Intervenciones farmacológicas para prevenir complicaciones en pacientes con hipercalciuria idiopática: una revisión sistemática

Objective: To assess the effects of pharmacological interventions in patients with idiopathic hypercalciuria. Methods: We performed a search of multiple databases, trial registries, grey literature and conference proceedings up to October 2019. We included randomized and quasi-randomized controlled trials that examined any pharmacological intervention for preventing complications of idiopathic hypercalciuria (given for at least four months and six of follow-up). The primary outcomes were stone-free patients, urinary symptoms and severe adverse events. Results: We included five RCTs (n=446 patients, all adults, 4 in individuals with kidney stones and 1 in postmenopausal women with osteoporosis). Diuretics were likely to increase the number of stone-free patients (RR 1.61, 95% CI 1.33–1.96, moderate quality of evidence (QoE)); 274 more stone-free patients/1000 patients treated (95% CI: 148–432) and produced a slight decrease in the stone formation rate (mean difference −0.18, 95% CI −0.30 to −0.06, low QoE); 180 fewer stones/year/1000 patients treated (95% CI: 300 r to 60). No data on urinary symptoms were reported. The association between diuretic use and severe adverse events was uncertain (RR 5.00, 95% CI 0.60–41.88, very low QoE); 4 more severe adverse events/1000 patients treated (95% CI: 0 fewer to 39 more). Conclusions: The addition of diuretics to a normal or modified diet probably reduces the number of stone recurrences and may decrease the stone formation rate. It is uncertain whether diuretics increase the occurrence of severe adverse events. There were no studies investigating other outcomes or in children. (AU)

Objetivo: Evaluar los efectos de intervenciones farmacológicas en pacientes con hipercalciuria idiopática. Métodos: Realizamos una búsqueda en múltiples bases de datos, registros de ensayos, literatura gris y actas de congresos hasta octubre de 2019. Incluimos ensayos clínicos aleatorizados y cuasialeatorizados que examinaban cualquier intervención farmacológica para prevenir las complicaciones de la hipercalciuria idiopática (mínimo 4 meses de intervención y 6 meses de seguimiento). Los outcomes primarios fueron pacientes libres de cálculos, síntomas urinarios y efectos adversos graves. Resultados: Incluimos 5 RCT (n=446 pacientes, todos adultos, 4 en individuos con cálculos renales y uno en mujeres posmenopáusicas con osteoporosis). Los diuréticos aumentaban probablemente el número de pacientes libres de cálculos (RR 1,61; IC 95%: 1,33 a 1,96, moderada calidad de evidencia [QoE]); 274 más pacientes libres de cálculos/1.000 pacientes tratados (IC 95%: 148 a 432) y producían una ligera disminución en la tasa de formación de cálculos (diferencia media −0,18; IC 95%: −0,30 a −0,06, baja QoE); 180 menos cálculos/año/1.000 pacientes tratados (IC 95%: 300 a 60). No se informaron datos sobre síntomas urinarios. La asociación entre el uso de diuréticos y los efectos adversos graves fue incierta (RR 5,00; IC 95%: 0,60 a 41,88, muy baja QoE); 4 efectos adversos severos más/1.000 pacientes tratados (IC 95%: 0 a 39). Conclusiones: Los diuréticos añadidos a una dieta normal o modificada probablemente reducen la aparición de cálculos y pueden disminuir su tasa de formación. Es incierto si los diuréticos incrementan la ocurrencia de efectos adversos graves. No se encontraron estudios que investigaran otros outcomes o realizados en niños. (AU)

Control in patients with advanced cancer: an interpretative phenomenological study.

BACKGROUND: In the context of life-threatening illness, loss of control is argued as a source of suffering and loss of perceived dignity, whereas having control over the dying process has been seen as a way of maintaining personal independence. Little is known about the meaning of control from the patients' perspectives. Thus, the aim of this study was to explore how patients with advanced cancer understand control, in terms of underlying beliefs, attitudes, and expectations consistent with self-efficacy, in different dimensions of their life, their illness, and their healthcare. METHODS: We conducted semi-structured qualitative interviews using an interpretive phenomenological analysis approach. Patients with advanced cancer from an oncology unit and a palliative care unit from Barcelona (Spain) were recruited. The inclusion criteria were a) ≥ 18 years old; b) fluency in Spanish or Catalan; c) outpatients diagnosed with advanced cancer; d) Eastern Cooperative Oncology Group (ECOG) between 0 and 3; e) judged by their physician or nurse to be emotionally stable; f) considered to have control over their illness and circumstances according to their responsible physician; and g) signed informed consent. RESULTS: We interviewed eight participants (ages ranged from 29 to 70 years, six were female). Two themes were identified: 1) factors that influence the perception of control, with subthemes: uncertainty about future suffering, character traits underlying a need for control; sense of lack of care as a source of loss of control; and 2) perceiving control over an uncontrollable illness, explained by perceived control over subjective wellbeing and adjusting the focus of control. The data allowed us to identify strategies that promote a sense of control in these patients. CONCLUSIONS: The illness, according to the participants, was experienced as series of losses. However, attention was often focused on areas where they continued to have control. These findings selectively reflect experiences of those who see themselves able to effect outcomes in life, suggesting future research should address how both family members and healthcare professionals can help to empower all patients.

Improvement of medical students' performance in simulated patient interviews by pre-clinical communication training.

Objectives: To compare the communication skills shown by medical students during simulated patient interviews between those who received training in communication during the preclinical years and those who did not. Methods: A retrospective study was conducted to analyze the communication skills of several cohorts of fourth-year medical students from Universitat Internacional de Catalunya during simulated patient interviews. Out of a total of 477 students included in the study, 229 (48%) had received training in communication skills through a 60-hour elective course during the preclinical second year, while the remaining 248 (52%) had received none. Communication skills were assessed by an evaluation team using a numerical scale (0 to 10) that included eight categories: "verbal", "non-verbal", "empathy", "concreteness", "warmth", "message content", "assertiveness", and "respect". Scores obtained by trained and non-trained students were compared using the t-test. Results: A trend towards obtaining better results was observed among students who had received communication training (mean score: 6.98/10) versus none (6.83/10, t(1,869)=-1.95, p=0.05). Non-trained male students obtained significantly lower mean scores than non-trained females in the categories of "respect" (7.48/10 vs. 7.83/10, t(968)=-2.89, p<0.01), "verbal communication" (6.87/10 vs. 7.15/10, t(968)=-2.61, p=0.01), "warmth" (6.53/10 vs. 6.95/10, t(968)=-3.40, p<0.01), and "non-verbal communication" (6.49/10 vs. 6.79/10, t(968)=-2.48, p=0.01). Trained female and male students had similar scores. Conclusions: Training in communication skills during the preclinical years may improve fourth-year students' performance in simulated interviews with patients, particularly among males. These results demonstrate the importance of introducing specific training in communication skills early in the undergraduate medical curriculum.

COVID-19: Making the Best out of a Forced Transition to Online Medical Teaching-a Mixed Methods Study.

Introduction: The first wave of the COVID-19 pandemic resulted in a decreed confinement in Spain from March until the end of term in June 2020, forcing an abrupt transition to exclusive distance learning in universities. We aimed to describe and analyze the perceptions and experiences of undergraduate medical students and faculty members as a consequence of this educational shift so as to identify the key elements for successful online medical learning. Methods: A convergent mixed methods design was employed, using both quantitative and qualitative data collected successively through Phase 1: Online teaching follow-up program; Phase 2: Discussion groups (two focus groups and a nominal group with students and faculty, respectively) and a survey of students from first to fifth year; and Phase 3: Triangulation of qualitative and quantitative data. Results: Thirteen strongly interconnected categories were identified. Four of them played an organizational role: course planning, coordination, communication, and pedagogical coherence. The remaining nine categories were learning outcomes, teaching methodology, online resources, evaluation, time management, workload, student motivation, participation, and teacher-student relationship. Among the key aspects of learning were those that promoted rapport between faculty and students, such as synchronous sessions, especially those based on clinical cases. Conclusions: Promoting student motivation and participation at all levels were the main lessons learned for enhancing online learning and teaching experiences in undergraduate medical education. Key elements to reach this goal are, among others, planning, coordination, communication, and pedagogical coherence. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01518-9.

Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children's functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017-2018, n = 1380) and another during COVID-19 pandemic (March-May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child's sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively. CONCLUSION: Home confinement generally affected infant's and toddler's sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns. WHAT IS KNOWN: • Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning. • Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak. WHAT IS NEW: • Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants' and toddlers' sleep latency by >30 min during confinement. • Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children's sleep based on the BISQ criteria.

Pharmacological interventions for preventing complications in patients with idiopathic hypercalciuria: A systematic review.

OBJECTIVE: To assess the effects of pharmacological interventions in patients with idiopathic hypercalciuria. METHODS: We performed a search of multiple databases, trial registries, grey literature and conference proceedings up to October 2019. We included randomized and quasi-randomized controlled trials that examined any pharmacological intervention for preventing complications of idiopathic hypercalciuria (given for at least four months and six of follow-up). The primary outcomes were stone-free patients, urinary symptoms and severe adverse events. RESULTS: We included five RCTs (n=446 patients, all adults, 4 in individuals with kidney stones and 1 in postmenopausal women with osteoporosis). Diuretics were likely to increase the number of stone-free patients (RR 1.61, 95% CI 1.33-1.96, moderate quality of evidence (QoE)); 274 more stone-free patients/1000 patients treated (95% CI: 148-432) and produced a slight decrease in the stone formation rate (mean difference -0.18, 95% CI -0.30 to -0.06, low QoE); 180 fewer stones/year/1000 patients treated (95% CI: 300 r to 60). No data on urinary symptoms were reported. The association between diuretic use and severe adverse events was uncertain (RR 5.00, 95% CI 0.60-41.88, very low QoE); 4 more severe adverse events/1000 patients treated (95% CI: 0 fewer to 39 more). CONCLUSIONS: The addition of diuretics to a normal or modified diet probably reduces the number of stone recurrences and may decrease the stone formation rate. It is uncertain whether diuretics increase the occurrence of severe adverse events. There were no studies investigating other outcomes or in children.

Pharmacological interventions for preventing complications in patients with idiopathic hypercalciuria: A systematic review.

OBJECTIVE: To assess the effects of pharmacological interventions in patients with idiopathic hypercalciuria. METHODS: We performed a search of multiple databases, trial registries, grey literature and conference proceedings up to October 2019. We included randomized and quasi-randomized controlled trials that examined any pharmacological intervention for preventing complications of idiopathic hypercalciuria (given for at least four months and six of follow-up). The primary outcomes were stone-free patients, urinary symptoms and severe adverse events. RESULTS: We included five RCTs (n=446 patients, all adults, 4 in individuals with kidney stones and 1 in postmenopausal women with osteoporosis). Diuretics were likely to increase the number of stone-free patients (RR 1.61, 95% CI 1.33-1.96, moderate quality of evidence (QoE)); 274 more stone-free patients/1000 patients treated (95% CI: 148-432) and produced a slight decrease in the stone formation rate (mean difference -0.18, 95% CI -0.30 to -0.06, low QoE); 180 fewer stones/year/1000 patients treated (95% CI: 300 r to 60). No data on urinary symptoms were reported. The association between diuretic use and severe adverse events was uncertain (RR 5.00, 95% CI 0.60-41.88, very low QoE); 4 more severe adverse events/1000 patients treated (95% CI: 0 fewer to 39 more). CONCLUSIONS: The addition of diuretics to a normal or modified diet probably reduces the number of stone recurrences and may decrease the stone formation rate. It is uncertain whether diuretics increase the occurrence of severe adverse events. There were no studies investigating other outcomes or in children.

What defines the comprehensive assessment of needs in palliative care? An integrative systematic review.

BACKGROUND: The comprehensive assessment of needs in palliative care identifies where patients most want attention to guide clinical decisions that tailor care provision from their first encounters. AIM: To define how and what needs are identified by the comprehensive assessment of needs in the original peer-reviewed articles in the field of palliative care. DESIGN: An integrative systematic review as outlined by Whittemore and Knafl. Quality appraisal performed using the Mixed Methods Appraisal Tool. DATA SOURCES: PubMed, CINAHL, PsycINFO, Web of Science databases searched through May 2019 and updated in July 2020. RESULTS: Forty-nine articles met inclusion criteria for original articles in English or Spanish reporting comprehensive assessment of needs of adult patients receiving palliative care. The majority (41/49) of studies were moderate to high quality. Two themes were identified: (1) How a comprehensive assessment of needs should be carried out in palliative care, which reflected a preference to develop structured tools for assessment; (2) What needs of patients should be assessed in the comprehensive assessment of needs in palliative care, which conveyed a trend to assess beyond core domains - physical, psychological, social, spiritual - with information and practical most prevalent, but with substantial variation in specifying and classifying needs into domains. CONCLUSIONS: The assessment of needs in palliative care is comprehensive but lacks consensus on the needs and domains that should be assessed by the palliative care team. Future studies should better define what needs can be standardized into the assessment to improve process of care and patient satisfaction.

Smartphone and Tablet Usage during COVID-19 Pandemic Confinement in Children under 48 Months in Barcelona (Spain).

BACKGROUND: Total lockdown due to COVID-19 pandemic might have potentially increased screen time in children. This study aims to describe the smartphone and tablets usage in children under 48 months living in Barcelona during the COVID-19 confinement. METHODS: Cross-sectional study using a non-probabilistic sample of parents with children under 48 months living in Barcelona (Spain) during COVID-19 confinement (n = 313). We calculated percentages of exposure to smartphones and tablets. Moreover, for those children were exposed, we calculated unadjusted and adjusted Geometric Mean Ratios (GMR) of daily smartphones and tablets usage and their 95% confidence intervals (95% CI) trough Generalized Linear Models with Gamma family and link log. Associations were adjusted for potential confounders. RESULTS: During COVID-19 confinement, 67.5% of children under 48 months were daily exposed to smartphones and tablets. Further, those children who were exposed during meals, as well as before going to bed, spend longer durations using them, aGMR = 2.38 (95% CI 1.73, 3.34) and aGMR = 1.95 (95% CI 1.34, 2.91) respectively. CONCLUSION: Two out of three children under 48 months living in Barcelona were daily exposed to smartphones and tablets during total lockdown due to COVID-19. Taking this findings into account cohort studies are needed to assess any change in the screen time patterns due to total confinement in order to allow the Government help families, particularly those more vulnerable, in a possible pandemic resurgence.

Screening for the Desire to Die in the First Palliative Care Encounter: A Proof-of-Concept Study.

Context: There is a lack of consensus about the appropriate moment to assess a potential wish to hasten death (WTHD) in patients with life-threatening illness, despite evidence of its positive appraisal among patients. Objectives: To evaluate the practical potential and acceptability of questions about the WTHD in the first palliative care (PC) clinical encounter. Design: A proof-of-concept single-arm unmasked trial. Subjects: We enrolled 30 advanced cancer patients, 16 inpatients and 14 outpatients in their first PC clinical encounter. Measurements: We assessed the WTHD using a semistructured interview guide, the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) embedded in a multidimensional needs assessment carried out during the first PC encounter. Information about practical potential [patients consider the assessment (a) important and (b) helpful] and acceptability [patients (a) understand and (b) are not bothered by the questions] was obtained. Results: Thirty-two patients were approached and 30 (94%) agreed to participate. The WTHD was present in two outpatients and eight inpatients. The question to assess WTHD were well understood by 94% of patients and was considered not bothersome by 87% and quite or very helpful by 80%, regardless of whether they had WTHD. Conclusions: The results support that clinicians can integrate screening for the WTHD in usual clinical practice within a multidimensional needs assessment. Patient acceptability suggests that this as a part of patient-centered care including in the first PC clinical encounter. Further studies are needed to confirm efficacy and safety in larger and different populations.

How do infants and toddlers sleep in Spain? A cross-sectional study.

There is limited information on sleep patterns among infants and toddlers in Spain. The aim of this study was to assess sleep patterns in children three to 36 months of age in Spain. A cross-sectional study was conducted between February 2017 and February 2018. Sociodemographic data and sleep variables were collected using an expanded version of the validated Spanish version of the brief infant sleep questionnaire. A total of 1,404 parental reports on children (725 males; 679 females) with a mean age of 18.8 ± 9.5 months were collected. Parents who perceived their child's sleep as problematic (39% of our sample) reported fewer sleep hours (median 9 versus 10 h), more night awakenings (median 2 versus 1), and longer periods of nocturnal awakenings (median 0.5 versus 0.08 min) (p < 0.001). Parental presence at the time of sleep onset and later and irregular bedtime routines were significantly associated with a reduction in total sleep time, longer sleep latency, and disruptive night awakenings (p < 0.001). These findings highlight the need for further studies to assess how to improve sleep patterns as a relevant modifiable lifestyle factor.Conclusion: A substantial percentage of the population perceived that their children slept poorly, which was evident in a variety of sleep patterns, including sleep duration and sleep quality. What is known: • Previous research has established that sleep difficulties among pediatric population affect up to 30% of all children and up to 20-30% of infants and toddlers. • A positive relationship between less parental bedtime involvement and sleep consolidation in infants and toddlers has been established. What is new: • More than a third of Spanish parents perceived their infants and toddlers sleep as problematic and their children reportedly have shorter night sleep hours, more night awakenings, and longer periods of nocturnal awakenings. • Later and irregular parental bedtime routines were associated with worst infants and toddlers sleep.

Older Age: A Protective Factor Against Perceived Dignity-Related Distress in Patients With Advanced Cancer?

CONTEXT: Most older adults will face threats to loss of health and social support, which can affect their perceived dignity. Although problems with perceived dignity increase in the context of cancer, the specific experience for those older compared with younger patients with advanced cancer has not been described despite its contributions to the wish to hasten death (WTHD). OBJECTIVES: To understand the influence of age group to the perception of dignity, considering changes in quality of life and the WTHD in patients with advanced cancer. METHODS: The Patient Dignity Inventory was administered to 194 patients with advanced cancer. The data were analyzed by separating the sample into age groups younger than 65 years (N = 106) or 65 years and older (N = 88). Linear regression models were adjusted with the explanatory variables of WTHD, quality of life, as well as functional status, physical dependence, depression, anxiety, and sociodemographic variables. RESULTS: Older patients showed a 2.6% decrease in the total scores of perceived dignity-related distress compared to younger patients. CONCLUSION: Older age could be a protective factor against the perception of loss of dignity in patients with advanced cancer, a more positive perspective of the aging experience.

¿Aprender Medicina a distancia?: percepción de estudiantes confinados por la pandemia COVID-19

Background: The suspension of face-to-face teaching activity due to the COVID-19 pandemic forced an abrupt transition to distance learning in Spanish universities. Aim: To know how medical students value distance learning in the context of COVID-19 pandemic. Material and Methods: Undergraduate medical students from first to fifth year in Barcelona (Spain) were invited to answer an anonymous online survey about their perceptions and level of satisfaction with virtual learning. Results: Of 483 students invited to the survey, 244 (50.5%) answered it. Respondents from the first and second year rated distance learning as acceptable (mean 3.1) on a Likert scale from 1 to 5. Those from third to fifth years rated distance learning as unsatisfactory (mean 2.7). The best evaluated aspects were synchronous lectures (3.9) and lectures based on cases (3.4). The worst evaluated issues were motivation (2.3), interaction with faculty (2.1), and additional workload (0.7). Conclusions: The perceptions expressed by these students reinforce the importance of facilitating communication, motivation and participation of students in distance learning in Medicine.

Health-related quality of life in patients with advanced cancer who express a wish to hasten death: A comparative study.

BACKGROUND: Some evidence suggests the wish to hasten death is related to poor health-related quality of life. Deficits in perceived dignity and self-efficacy are risk factors for wish to hasten death that also impact health-related quality of life. AIM: To compare perceived health-related quality of life, dignity and self-efficacy in patients with advanced cancer who either do (case group) or do not (control group) express a wish to hasten death. Cases and controls were matched on sociodemographic and functional characteristics. DESIGN: A comparative cross-sectional study. PARTICIPANTS: A total of 153 adult patients with advanced cancer were assessed for wish to hasten death using the Desire for Death Rating Scale. Scores ⩾1 indicate some degree of wish to hasten death (case group, n = 51), and score = 0 implies no wish to hasten death (control group, n = 102). Assessments included health-related quality of life using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 15-Item Palliative Questionnaire, perceived loss of dignity using the Patient Dignity Inventory and self-efficacy using the General Self-Efficacy Scale. RESULTS: Patients with a wish to hasten death had worse emotional functioning (p < 0.001), greater perceived loss of dignity (p < 0.001) and lower self-efficacy (p = 0.001). There was no difference in most physical symptoms. Perceived overall health-related quality of life was significantly worse for those with a clinically relevant wish to hasten death (p = 0.023) and marginally worse for the case group than the control group (p = 0.052). CONCLUSION: Patients with wish to hasten death showed lower perceived dignity, self-efficacy and emotional quality of life than patients without wish to hasten death without necessarily perceiving worse physical symptoms.

Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol.

INTRODUCTION: The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. METHODS AND ANALYSIS: To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.

[Perceptions of students confined by the COVID-19 pandemic on distance learning in medicine]. / ¿Aprender Medicina a distancia?: percepción de estudiantes confinados por la pandemia COVID-19.

BACKGROUND: The suspension of face-to-face teaching activity due to the COVID-19 pandemic forced an abrupt transition to distance learning in Spanish universities. AIM: To know how medical students value distance learning in the context of COVID-19 pandemic. MATERIAL AND METHODS: Undergraduate medical students from first to fifth year in Barcelona (Spain) were invited to answer an anonymous online survey about their perceptions and level of satisfaction with virtual learning. RESULTS: Of 483 students invited to the survey, 244 (50.5%) answered it. Respondents from the first and second year rated distance learning as acceptable (mean 3.1) on a Likert scale from 1 to 5. Those from third to fifth years rated distance learning as unsatisfactory (mean 2.7). The best evaluated aspects were synchronous lectures (3.9) and lectures based on cases (3.4). The worst evaluated issues were motivation (2.3), interaction with faculty (2.1), and additional workload (0.7). CONCLUSIONS: The perceptions expressed by these students reinforce the importance of facilitating communication, motivation and participation of students in distance learning in Medicine.