Diferencias en los resultados quirúrgicos en pacientes con anemia preoperatoria tratada con hierro o sin hierro previo a la cirugía / Differences in surgical results for patients with pre-operative anemia treated with or without iron before surgery

Objetivos: conocer las diferencias en los resultados quirúrgicos en pacientes con anemia preoperatoria tratada con hierro carboximaltosa (HC) o sin hierro previo a la cirugía.Métodos: estudio observacional retrospectivo de dos cohortes de pacientes. Grupo sin HC preoperatorio (antes de la implementación del programa de Prehabilitación Quirúrgica) y grupo con HC (posterior a la implementación del programa). Revisión de historias clínicas electrónicas. Variables de resultado: número de transfusiones de hemoderivados necesarias después de la cirugía, complicaciones posquirúrgicas y días de estancia hospitalaria. Comparación de variables de estudio mediante prueba Chi cuadrado y t de Student. Programa estadístico SPSS v.26.Resultados: se incluyeron 152 pacientes, 92 del grupo HC (2020-2022) y 56 del grupo sin HC (2019). El 60,5% (n= 92) fue mujer. Edad media (desviación estándar) de 63,91 (13) años. Las cirugías incluidas fueron: colectomía (n= 77; 64,5%), mastectomía (n= 55; 23%) e histerectomía (n= 20; 12,5%). Se encontraron resultados estadísticamente significativos entre la necesidad de transfusiones sanguíneas (p< 0,001; OR 15,91 [4,44-57,01]), las complicaciones posoperatorias (p< 0,001; OR 7,36 [3,35-16,16]), y la estancia media hospitalaria (p< 0,001), que fue de 4,14 días en el grupo HC frente a nueve días en el grupo control sin HC.Conclusiones: el tratamiento con HC reduce el número de transfusiones sanguíneas, las complicaciones posquirúrgicas y los días de estancia hospitalaria. (AU)

Objectives: to understand the differences in surgical results in patients with preoperative anemia treated with Ferric carboxymaltose (FCM) or without iron before surgery.Methods: a retrospective observational study of two patient cohorts: a Group without preoperative FCM (before the implementation of the Surgical Prehabilitation program), and a Group with FCM (after the implementation of the program). A review of electronic clinical records; the outcome variables were the number of transfusions of blood products required after surgery, postsurgical complications, and days of hospital stay. There was a comparison of study variables through Chi square and Student’s t tests; the SPSS statistical program, v. 26, was used.Results: the study included 152 patients, 92 in the FCM Group (2020-2022) and 56 in the Group without FCM (2019); 60.5% (n= 92) were female. Their mean age (standard deviation) was 63.91 (13) years. The surgical procedures included were: colectomy (n= 77; 64.5%), mastectomy (n= 55; 23%) and hysterectomy (n= 20; 12.5%). Statistically significant outcomes were found between the need for blood transfusions (p< 0.001; OR 15.91 (4.44-57.01)), postsurgical complications (p< 0.001; OR 7.36 (3.35-16.16)), and the mean hospital stay (p< 0.001), which was 4.14 days in the FCM group vs. nine days in the control group without FCM.Conclusions: treatment with FCM reduced the number of blood transfusions, postsurgical complications, and days of hospital stay. (AU)

Enfermera de práctica avanzada en Programa de Prehabilitación Quirúrgica / The Advanced Practice Nurse in a Surgical Prehabilitation Program

La rehabilitación multimodal engloba una serie de medidas y estrategias preoperatorias, intraoperatorias y posoperatorias, en la que se incluye la prehabilitación quirúrgica como parte de la fase preoperatoria del proceso quirúrgico. Entre los objetivos del Programa de Prehabillitación Quirúrgica destacan: a) mejorar el estado de salud del paciente, interviniendo sobre parámetros modificables de calidad de vida, funcionalidad y comorbilidades que le permitan afrontar la cirugía en condiciones más óptimas; b) reducir las complicaciones posoperatorias; c) disminuir estancia hospitalaria y reingresos; d) reducir costes sanitarios. Este programa está liderado por una enfermera de práctica avanzada que trabaja, de forma colaborativa e interdisciplinar con un internista, para realizar un abordaje integral del paciente, disminuyendo el número de derivaciones a otros especialistas, y consiguiendo una reducción de los tiempos de atención necesarios para su preparación quirúrgica. El Programa de Prehabilitación Quirúrgica se puso en marcha a mediados de 2019 en el Hospital Infanta Cristina (Madrid, España) con inclusión de 25 pacientes. En 2020 se atendieron 144, en 2021 fueron 276 y en 2022 480 pacientes. En estos años se han registrado resultados clínicos relevantes: mejora de la funcionalidad y calidad de vida; disminución de complicaciones, reingresos, días de estancia y necesidad de concentrados de hematíes; así como un ahorro de aproximadamente 400.000 euros.(AU)

Multimodal rehabilitation encompasses a series of preoperative, intraoperative and postoperative measures and strategies, including Surgical Prehabilitation as part of the preoperative stage in the surgical process. Some of the objectives of the Surgical Prehabilitation Program stand out: a) to improve the health status of the patient, with interventions over modifiable parameters of quality of life, functionality and comorbidity, allowing them to face surgery in optimal conditions: n) to reduce postoperative complications; c) to reduce the hospital stay and re-admissions; d) to reduce healthcare costs. This program is led by an Advanced Practice Nurse, working in a collaborative and interdisciplinary way with an Internal Medicine Specialist, for a comprehensive approach to the patient, reducing the number of referrals to other specialists, and achieving a reduction in the times of care required for their surgical preparation. The Surgical Prehabilitation Program was initiated by mid-2019 at the Hospital Infanta Cristina (Madrid, Spain), and included 25 patients. In 2020, 144 patients were managed, 276 in 2021, and 480 patients in 2022. Relevant clinical results have been registered in these years: an improvement in functionality and quality of life; reduction in complications, readmissions, hospitalization days, and need for packed red blood cells; as well as savings of approximately 400,000 euros.(AU)

Evaluation of transformer models for financial targeted sentiment analysis in Spanish.

Nowadays, financial data from social media plays an important role to predict the stock market. However, the exponential growth of financial information and the different polarities of sentiment that other sectors or stakeholders may have on the same information has led to the need for new technologies that automatically collect and classify large volumes of information quickly and easily for each stakeholder. In this scenario, we conduct a targeted sentiment analysis that can automatically extract the main economic target from financial texts and obtain the polarity of a text towards such main economic target, other companies and society in general. To this end, we have compiled a novel corpus of financial tweets and news headlines in Spanish, constituting a valuable resource for the Spanish-focused research community. In addition, we have carried out a performance comparison of different Spanish-specific large language models, with MarIA and BETO achieving the best results. Our best result has an overall performance of 76.04%, 74.16%, and 68.07% in macro F1-score for the sentiment classification towards the main economic target, society, and other companies, respectively, and an accuracy of 69.74% for target detection. We have also evaluated the performance of multi-label classification models in this context and obtained a performance of 71.13%.

Mass tourism urban destinations and climate change in small islands: resilience to extreme rainfall in the Canary Islands.

The Canary Islands are one of the main destinations for mass tourism in the European context, characterized by the absence of seasonality in tourist activity. Moreover, the level of activity increases during the winters, coinciding with a greater probability of extreme rainfall events, whose danger seems to be increasing as a result of climate change. Owing to its pronounced orography, the southern coast of the island of Gran Canaria houses several tourist settlements built along ravines and steeply sloping terrain. This scenario presents considerable risk because of spatial probability of landslide occurrence. The case of San Agustín, especially, serves to test the model of tourist urbanization along the hillside, demonstrating its high fragility in the face of extreme rainfall events. Especially owing to its importance in providing assistance in emergency situations, its vulnerability has been analyzed with regard to accessibility, which is entirely dependent on road mobility. The growth model of San Agustín serves as an example of mass tourism in small islands, allowing urban planners and designers to assess corrective measures based on managing its existing road infrastructure and open spaces right from the planning stage.

Metabolomic Approach to Study the 'Purple Queen' Pomegranate Cultivar Response to Alternative Culture Media and Phenological Stages.

The increasingly evident threat of depletion of world peat bogs is encouraging the search for and study of alternative agricultural substrates that can fully or partially replace peat, guaranteeing food supply (quality and quantity). On the other hand, the identification of the potential for the reuse of waste from relevant economic activities has increased in recent years, mainly motivated by the change to a sustainable circular economy, as is the case of port sediments. Taking into account that significant volumes of dredged port sediments are generated annually so that ports can maintain their economic activity, it is necessary to find objective, sustainable and safe reuse alternatives. In this sense, the objective of this study was to study the response of the "Purple Queen" pomegranate when grown with dredged port sediment. For this, the fruit production (kg), number of fruits (fruits tree-1), fruit weight (g), and seed yield (%) aiming to verify the correct tree development were evaluated. In addition, a 1H-NMR foliar metabolomic study for the three most relevant phenological phases was performed (flowering, fruit development, and post-harvest) to identify metabolic changes in trees. In total, 29 metabolites were identified; among them, 11 were amino acids, 6 organic acids, 5 sugars, and 7 secondary metabolites. The good agronomical development of the trees and fruits indicated the potential for using the dredged sediment as an agricultural substrate. On the other hand, the results revealed that the greatest variability in the metabolomic study occurred between the phenological phases and a lower variability is explained by the substrates used.

Potential of Seed Halopriming in the Mitigation of Salinity Stress during Germination and Seedling Establishment in Durum Wheat (Triticum durum Desf.).

The salinity of soils and irrigation water is among the main factors that limit plant productivity worldwide. Several alternatives have been proposed to get around this problem. However, these alternatives have faced difficulties in their implementation. As an alternative, the adverse effects of salinity on crop yield can be minimized by selecting species and varieties better adapted to salinity and/or by finding priming agents that give plants a certain tolerance during the vegetative and reproductive stages. The latter are strictly dependent on germination and seedling establishment. For this purpose, a laboratory experiment was conducted on three Tunisian wheat cultivars (Karim, Razeg, and Maali) subjected to moderate salinity stress (MSS, 5 g L-1 NaCl), severe salinity stress (SSS, 10 g L-1 NaCl), or control (0 NaCl) after soaking the seeds in a solution of KNO3 or ZnSO4 (0.5 g L-1). Salinity stress significantly decreased germination capacity (GC) and induced osmotic stress under MSS, which declined under SSS in favor of toxic stress. Pretreatment of seeds with KNO3 or ZnSO4 alleviated the toxic effect, and seedlings recovered initial vigor and GC even under SSS. The Karim cultivar showed better tolerance to salinity and a higher ability to react to priming agents. The calculated sensitivity tolerance index (STI) based on germination capacity, seedling growth, and initial vigor decreased in all cultivars under salt stress; however, this parameter clearly discriminated the studied cultivars. Karim was the most tolerant as compared to Razeg and Maali. We conclude that halopriming provides a benefit by alleviating the harmful effects of salt toxicity and that cultivars differ in their response to priming and extent of salt stress. KNO3 and ZnSO4 effectively alleviated the inhibitory effect of salt stress on seed germination and seedling establishment while significantly improving initial vigor.

Expectations and Experiences of Spanish Primiparous Women Who Decide to Breastfeed Their Infants and Strategies for Change in 2020-A Qualitative Study.

To describe the experiences and expectations of Spanish women regarding breastfeeding and the support they receive from healthcare professionals, family, and friends during the breastfeeding journey, A qualitative study using an empirical-phenomenological approach was conducted. Primiparous women that had already given birth were interviewed using a purposive and snowball sampling. In-depth interviews were conducted between 1 January and 30 April 2020. The interviews were transcribed verbatim and analysed using Haase's adaptation of Colaizzi's phenomenological method. We recruited 14 women who had recently become mothers. Three major themes describing experiences of infant feeding by maternal lactation were identified-institutional influences, establishing breastfeeding, and cessation of breastfeeding-as well as the following 10 categories: hospital routines, lactation concerns (amount and infant nutrition), antenatal breastfeeding decision, embarrassment to breastfeed, and normalisation of breastfeeding. Prior education and support were identified as key elements in possible breastfeeding support strategies.

Does admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry.

Acetylsalicylic acid (ASA) is widely used in the treatment and prevention of cardiovascular disorders. Our objective is to evaluate its possible protective role, not only in mortality but also in other aspects such as inflammation, symptomatic thrombosis, and intensive care unit (ICU) admission in hospitalized COVID-19 patients. We realized an observational retrospective cohort study of 20,641 patients with COVID-19 pneumonia collected and followed-up from Mar 1st, 2020 to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Propensity score matching (PSM) was performed to determine whether treatment with ASA affected outcomes in COVID-19 patients. On hospital admission, 3291 (15.9%) patients were receiving ASA. After PSM, 3291 patients exposed to ASA and 2885 not-exposed patients were analyzed. In-hospital mortality was higher in the ASA group (30.4 vs. 16.9%, p < 0.001) in the global sample. After PSM, no differences were found between groups (30.4 vs. 30.3%, p = 0.938). There were no differences in inflammation, symptomatic thrombosis, or ICU admission. In conclusion, ASA intake is not associated with in-hospital mortality or any other health outcome evaluated after applying PSM analysis in a real-world large sample of hospitalized COVID-19 patients.

Experiences and Perceptions of Nursing Students during the COVID-19 Crisis in Spain.

In the early stages of the 2019 coronavirus pandemic in Spain, the Spanish health system was overwhelmed, mainly due to a lack of personnel, and many hospital centers collapsed by following avalanche of patients with COVID-19; this meant that the National System of Health called for fourth-year nursing students to come to the hospital as health care personnel. Our aim was to describe the perceptions and experiences of a sample of nursing students during the early stages of the outbreak. We conducted a qualitative study with an empirical-phenomenological approach. Twenty nursing students in their final year of study in Spain were recruited using purposive and snowball sampling. They participated in in-depth interviews between 20 April and 10 May 2020. The interviews were transcribed and then analyzed using Haase's adaptation of Colaizzi's phenomenological method. Four main themes emerged from data analysis: "social responsibility and pride as a health worker", "pressure caused by working with COVID-19 patients", "feeling defenseless and let down", and "personal growth as a health worker". These main themes were further divided into 11 theme categories. Due to an intense work day for several days in a row, the students were tired and mentally exhausted. Even so, they managed to overcome any difficulties, demonstrating their professional dedication and resilience. Greater preparatory support should be provided to safeguard the well-being of these future healthcare providers. More intensive preparatory training is necessary for health sciences students to facilitate crisis preparedness and effective crisis management. It is necessary to implement support from healthcare systems, including sufficient personal protective equipment, as well as contracts that accurately reflect the work they do. It is necessary for nursing supervisors to have effective communication in the performance of their functions with nursing students; this dialogue helps to clearly explain which are the functions that students must perform when they are carrying out their internships. There is also a need for preparatory training in managing infectious diseases such as COVID-19.

Automatic Correction of Real-Word Errors in Spanish Clinical Texts.

Real-word errors are characterized by being actual terms in the dictionary. By providing context, real-word errors are detected. Traditional methods to detect and correct such errors are mostly based on counting the frequency of short word sequences in a corpus. Then, the probability of a word being a real-word error is computed. On the other hand, state-of-the-art approaches make use of deep learning models to learn context by extracting semantic features from text. In this work, a deep learning model were implemented for correcting real-word errors in clinical text. Specifically, a Seq2seq Neural Machine Translation Model mapped erroneous sentences to correct them. For that, different types of error were generated in correct sentences by using rules. Different Seq2seq models were trained and evaluated on two corpora: the Wikicorpus and a collection of three clinical datasets. The medicine corpus was much smaller than the Wikicorpus due to privacy issues when dealing with patient information. Moreover, GloVe and Word2Vec pretrained word embeddings were used to study their performance. Despite the medicine corpus being much smaller than the Wikicorpus, Seq2seq models trained on the medicine corpus performed better than those models trained on the Wikicorpus. Nevertheless, a larger amount of clinical text is required to improve the results.

A new combined sensory-instrumental tool for pomegranate seed hardness determination.

BACKGROUND: Scanning electron microscopy was assayed and linked with previous data with respect to obtaining a new combined sensory-instrumental tool for pomegranate seed hardness determination. The present study aimed to develop an effective tool for the prediction of sensory properties via instrumental determinations. RESULTS: Simple regression analysis determined a high correlation within descriptive seed hardness and thickness of the wall, as well as descriptive wood perception and thickness of the wall, with values of 0.71 in both cases. Multiple regression analysis improved correlations when (i) descriptive seed hardness correlated with instrumental seed hardness and wood index (0.94); (ii) descriptive wood perception correlated with instrumental seed hardness and wood index (0.79); (iii) descriptive seed hardness correlated with instrumental seed hardness and thickness of the seed wall (0.96); and (iv) descriptive wood perception correlated with instrumental seed hardness and thickness of the seed wall (0.82). The same trend was found when (i) seed hardness satisfaction degree correlated with instrumental seed hardness and wood index (0.92); (ii) wood perception satisfaction degree correlated with instrumental seed hardness and wood index (0.82); (iii) seed hardness satisfaction degree correlated with instrumental seed hardness and thickness of the wall (0.99); and (iv) wood perception satisfaction degree correlated with instrumental seed hardness and thickness of the wall (0.99). CONCLUSION: Regarding mechanical properties, the results of the present study confirm that texture analysis and scanning electron microscopy are an effective tool for obtaining reliable information. This research led to establish an objective tool allowing prediction of the consumer acceptance of pomegranate cultivars worldwide. © 2020 Society of Chemical Industry.

Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study.

BACKGROUND: For many nursing students, clinical training represents a stressful experience. The levels of stress and anxiety may vary during students' educational training, depending on their ability to adopt behavioral strategies for coping with stress, and other factors. This study aimed to investigate the relationship between anxiety, perceived stress, and the coping strategies used by nursing students during their clinical training. METHODS: A cross-sectional correlational descriptive study. The sample consisted of 190 nursing students enrolled in the Nursing Faculty of Ciudad Real University in Spain. Participants provided data on background characteristics and completed the following instruments: the Perceived Stress Scale; the State-Trait Anxiety Inventory and the Coping Behavior Inventory. Relationships between scores were examined using Spearman's rho. RESULTS: The mean age of participants was 20.71 ± 3.89 years (range 18-46 years). Approximately half of the students (47.92%) indicated a moderate level of stress with a mean Perceived Stress Scale score of 22.78 (±8.54). Senior nursing students perceived higher levels of stress than novice students. The results showed a significant correlation for perceived stress and state anxiety (r = 0.463, p < .000) and also for trait anxiety (r = 0.718, p < .000). There was also a significant relationship between the total amount of perceived stress and the following domains of the coping behavior inventory: problem solving (r = -.452, p < .01), self-criticism (r = .408 p < .01), wishful thinking (r = .459, p < .01), social support(r = -.220, p < .01), cognitive restructuring (r = -.375, p < .01), and social withdrawal (r = .388, p < .01). In the current study, the coping strategy most frequently used by students was problem-solving, followed by social support and cognitive restructuring. CONCLUSIONS: Nursing students in our study presented a moderate level of stress, in addition there was a significant correlation with anxiety. Nursing teachers and clinical preceptors/mentors should be encouraged to develop programs to help prepare nursing students to cope with the challenges they are about to face during their clinical placements.

Atención Temprana, prácticas centradas en la familia y logopedia / Early intervention: progress and challenges

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Reflexiones y estrategias de acompañamiento familiar en Atención Temprana / Reflections and strategies of family accompaniment in Early Intervention

El logopeda, en su condición de profesional experto en comunicación y lenguaje, es un miembro clave e indispensable en los equipos de Atención Temprana. Las prácticas recomendadas en los países con larga tradición en servicios de intervención a la primera infancia destacan la importancia del logopeda en el acompañamiento y la capacitación de la familia, además del apoyo que este profesional brinda a los otros miembros del equipo. Los profesionales que intervienen en Atención Temprana se enfrentan día a día al reto de establecer relaciones de colaboración con padres y cuidadores, situaciones para las que en muchas ocasiones no están preparados. Este trabajo describe las estrategias necesarias, con las que el logopeda puede dar un apoyo efectivo durante ese acompañamiento, describe de forma general las actuaciones claves, con el fin de lograr la capacitación del cuidador principal, y presenta los principios andragógicos en que debemos basarnos, con el fin de lograr una mayor eficacia de actuación. En la última sección presentamos algunos supuestos prácticos, con el fin de visualizar aquellas situaciones habituales, en las que el profesional puede encontrarse en sus consultas colaborativas con la familia, y se plantean las posibles soluciones y acciones a emprender

The speech therapist, as a professional expert in communication and language, is a key and indispensable member of Early Intervention teams. Recommended practice in countries with a long tradition in early childhood intervention services, highlights the importance of the speech therapist in the accompaniment and capacity-building of the family, in addition to their support to other team members. The professionals involved in Early Intervention, face the challenge of establishing collaborative relationships with parents and caregivers, situations for which they are often not prepared. This paper describes the strategies required for the speech therapist to provide effective support during this accompaniment. It describes in a general way key actions in training the main caregiver, and presents the andragogical principles we must use to achieve greater performance efficiency. In the last section we present some practical assumptions, in order to visualise the routine situations faced by the professional in their collaborative consultations with the family, and consider possible solutions and actions to be undertaken

Multiple stresses occurring with boron toxicity and deficiency in plants.

Boron (B), an essential nutrient for plants, participates in many physiological processes, with emphasis its role in the formation of the plant's cell wall. In soil, the range between deficiency and toxicity of B is very narrow as compared to other nutrients, which makes its management in agriculture very difficult, as it depends on the soil and environmental conditions. B stress simultaneously acts with others (extreme temperatures, excess of light, high concentration of CO2, drought, salinity or heavy metal contamination, etc.). The effects of these other stresses could increase the sensitivity of plants to B toxicity or deficiency. The simultaneous combination (B stress × other abiotic stresses) is a complex interaction that should be analyzed in detail if the resistance of crops to climate change is needed. This article reviews the response of plants when facing a combination of B stress with other stresses, and compares this response with the individual stresses. Also, in the last few years, the role of B has been described in multiple plant functions that can improve its resilience to specific stresses. Thus, this article also analyses in what conditions the application of B can be efficient for the improvement of the plant's response to other stresses.

Physiological, Nutritional and Metabolomic Responses of Tomato Plants After the Foliar Application of Amino Acids Aspartic Acid, Glutamic Acid and Alanine.

Agriculture is facing a great number of different pressures due to the increase in population and the greater amount of food it demands, the environmental impact due to the excessive use of conventional fertilizers, and climate change, which subjects the crops to extreme environmental conditions. One of the solutions to these problems could be the use of biostimulant products that are rich in amino acids (AAs), which substitute and/or complement conventional fertilizers and help plants adapt to climate change. To formulate these products, it is first necessary to understand the role of the application of AAs (individually or as a mixture) in the physiological and metabolic processes of crops. For this, research was conducted to assess the effects of the application of different amino acids (Aspartic acid (Asp), Glutamic acid (Glu), L-Alanine (Ala) and their mixtures Asp + Glu and Asp + Glu + Ala on tomato seedlings (Solanum lycopersicum L.). To understand the effect of these treatments, morphological, physiological, ionomic and metabolomic studies were performed. The results showed that the application of Asp + Glu increased the growth of the plants, while those plants that received Ala had a decreased dry biomass of the shoots. The greatest increase in the growth of the plants with Asp + Glu was related with the increase in the net CO2 assimilation, the increase of proline, isoleucine and glucose with respect to the rest of the treatments. These data allow us to conclude that there is a synergistic effect between Aspartic acid and Glutamic acid, and the amino acid Alanine produces phytotoxicity when applied at 15 mM. The application of this amino acid altered the synthesis of proline and the pentose-phosphate route, and increased GABA and trigonelline.

Barriers and facilitators for caregiver involvement in the home care of people with pressure injuries: A qualitative study.

AIM: To explore the barriers and facilitators perceived by home caregivers regarding their involvement in the home care of people with pressure injuries. BACKGROUND: Although home caregivers are key in the process of caring for people with pressure injuries, little is known about their perceptions regarding their involvement in the same. METHODS: A qualitative study based on grounded theory involving a theoretical sample of 15 home caregivers of people with pressure injuries within the health district of Puertollano, Spain. RESULTS: This study identified three barriers (feminization of care, necessary life adaptations as a home caregiver, and the organization of health services) and three facilitators (the perceived family duty for caring, willingness to provide care, and satisfaction with the care received on behalf of primary care services) associated with caregiver involvement in the home care of pressure injuries. CONCLUSIONS: The care of a person with pressure injuries is perceived as a duty and requires important adaptations affecting the home caregiver's personal, social and work life. The emotional closeness and trust that develops between a patient and the primary care staff equals an involvement which, in turn, also has positive results for both the home caregiver and the patient.

Patients' and Caregivers' Conceptualisations of Pressure Ulcers and the Process of Decision-Making in the Context of Home Care.

Background: Although the addition of patients in the process of shared decision-making can improve their recovery, there is a lack of knowledge about patients' and caregivers' perceptions on the management of pressure ulcers at home. Objectives: To explore the conceptualisations of patients with pressure ulcers and their caregivers on the barriers and facilitators for their involvement in home care and in the process of shared decision-making regarding the care provided. Methods: A qualitative study based on grounded theory in a theoretical sample of 10 patients with pressure ulcers and 15 main caregivers from the health district of Puertollano (Spain). The data were based on semi-structured interviews, analysed using a coding process and the constant comparative method. Results: According to the participants, personal motivation and the involvement of primary care professionals facilitated their participation in the process of shared decision-making and generated feelings of positivity. In contrast, older age, having disabling pathologies, a low educational level or health paternalism were perceived as barriers for their involvement. Conclusions: A non-paternalistic care model and personal motivation facilitate the process of shared decision-making in the care of people with pressure ulcers. Further studies are required to deepen the understanding of this phenomenon and examine the barriers and facilitators for the involvement of patients and caregivers in the management of these injuries in other contexts.

Cost-benefit analysis of tomato in soilless culture systems with saline water under greenhouse conditions.

BACKGROUND: The current need to produce food for a growing population, from diminishing natural resources, such as water and energy, and with minimum environmental degradation, demands the optimization of production. We compare the economic feasibility of tomato production in an open system with a perlite substrate, a closed system with the nutrient film technique (NFT), and a hydroponic crop (deep flow technique, DFT) using three levels of salinity that are found within the normal range for irrigation water quality in southeastern Spain. RESULTS: Production with DFT resulted in an increase in the cost of phytosanitary treatments and the cost of maintenance. Production with perlite resulted in an increase in the cost of irrigation water and fertilization, and the use of NFT resulted in an increase in energy costs. The point of price equilibrium was exceeded in the three soilless systems when using low salinity water, and in perlite, with intermediate salinity water. CONCLUSION: Profitability was reduced in the following order: perlite > NFT > DFT. There were positive results when using irrigation water with low salinity, and in the case of perlite, with intermediate salinity. In every case, salinity reduced the profitability of the operation, and this was greater when NFT was employed. The analysis of these soilless systems should be continued to determine the possibility of reducing cultivation costs. © 2019 Society of Chemical Industry.

Agricultural and Physiological Responses of Tomato Plants Grown in Different Soilless Culture Systems with Saline Water under Greenhouse Conditions.

Tomato is the most important horticultural crop in the world. The yields for this crop are highest in Southeastern Spain. In this work we studied a commercial variety of tomato, with different soilless culture systems (deep flow technique, nutrient film technique, and the perlite substrate) and three levels of salinity (2.2, 6.3, and 10.2 dS·m-1) typical of Southeastern Spain. The irrigation management was carried out for optimizing the water use efficiency. Alterations in the water status of the plants, Cl- and Na+ toxicity, and nutritional imbalances altered the vegetative growth and physiology of the plants. The marketable yield was affected by both soilless culture system and salinity. Regarding the soilles culture system, yield decreased in the order: deep flow technique > perlite > nutrient film technique. The salinity treatments improved the fruits quality by increasing the total soluble solids and titratable acidity. Plants cultivated with the nutrient film technique had the highest concentrations of Cl- and Na+ and the highest Na+/K+ ratio. The concentrations of Cl- and Na+ in the plants were not related directly to the yield loss. Therefore, the influence of the toxicity, osmotic effect, and nutritional imbalance seems to have been responsible for the yield loss.