Climate change effects in older people's health: A scoping review.

BACKGROUND: Climate change has serious consequences for the morbidity and mortality of older adults. OBJECTIVE: To identify the effects of climate change on older people's health. METHODS: A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected. RESULTS: Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected. CONCLUSIONS: Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group. PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution.

Effectiveness of gamification in nursing degree education.

Background: Previous research in nursing has found favorable results from the use of teaching methodologies alternative to lectures. One of the complementary methodologies used for university teaching is gamification, or the inclusion of game elements, creating a dynamic learning environment that allows the acquisition of knowledge and the development of other skills necessary for nursing students. The purpose of this study was to evaluate the effect of a gamification session on student satisfaction and knowledge scores in nursing students in simulated laboratory practice. Methods: A pre-post quasi-experimental study was conducted with 122 students from the nursing degree program who participated in the research. The evaluation consisted of four sessions of three hours each. In two sessions, participants were trained through a vertical methodology, by means of theoretical training provided by teaching staff, and two hours of clinical simulation, where the students were able to practice the techniques on professional simulators. At the other two sessions, participants received an explanation of the theoretical aspects of the session, one hour of clinical simulation, and one hour of gamification, in which they had to pass tests based on the performance of practical activities on the subject of the session. At the end of the gamification session, all the participants received a certificate as winners of the "nursing game". Results: There was an improvement in the satisfaction and the knowledge level in the gamification sessions. Both were statistically significant (P < 0.001). There was an improvement in the items related to the development of critical thinking and the mobilizing concepts from theory to practice in the gamification sessions. Conclusion: The intervention was effective in improving the satisfaction of the sessions received and in knowledge development.

Variables predictoras del uso de los métodos anticonceptivos en jóvenes: una revisión sistemática / Predictor variables of contraceptive method use in young people: A systematic review

Diseño: Revisión sistemática. Fuentes de datos: Se consultaron las bases de datos PubMed, CINAHL, Scopus, Cuiden Plus, LILACS e IME. Selección de estudios: Se realizó una evaluación de la calidad de los estudios que fue revisada por dos investigadores en paralelo. Como resultado, se seleccionaron un total de cinco investigaciones primarias. Extracción de datos: Se extrajo información sobre la población seleccionada en el estudio, método anticonceptivo estudiado y las variables predictoras identificadas. Resultados: Se identificaron siete variables predictoras que explican específicamente el uso del preservativo masculino, píldora anticonceptiva o píldora anticonceptiva de emergencia. Las variables más relevantes fueron el nivel de conocimiento y las actitudes hacia el empleo de los métodos anticonceptivos, de manera que un mayor conocimiento y unas actitudes positivas incrementan la probabilidad de uso de métodos anticonceptivos. Otro resultado destacado fue la presencia de un sesgo formativo con un mayor conocimiento de las mujeres sobre las opciones anticonceptivas hormonales y actitudes más positivas. Conclusión: Los futuros programas formativos deben orientarse hacia la evaluación de cambios en el comportamiento, mediante el desarrollo de actitudes positivas hacia el uso de los métodos anticonceptivos a través de la adquisición de un conocimiento de calidad sobre las opciones contraceptivas.(AU)

Objective: To analyse predictor variables of contraceptive method use in young people. Design: Systematic review. Data sources: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. Study selection: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. Data extraction: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. Results: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with womenhaving higher knowledge of hormonal contraceptive options and more positive attitudes. Conclusion: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.(AU)

Observation of Early Social Interactions in Sibling Dyads: A Systematic Review.

Sibling relationships provide unique social experiences that can vary across the lifespan. Early sibling social interactions (ESSI) have been associated with children's own relationship and developmental outcomes, highlighting the essential role that sibling encounters play, even from a young age. Understanding how these social exchanges occur and unfold and the range of opportunities they provide can shed light on critical aspects of early childhood development and family life. However, the methodological approach used in studying ESSI can influence our understanding of these early experiences. This systematic review aims to delineate the methodological framework adopted in observational studies of ESSI. Through a systematic search of psychology and domain-general databases until March 2023, we focused on studies that addressed bidirectional naturalistic interactions in young sibling dyads (at least one child aged 0-36 months). Of the 713 articles screened, only 63 met the inclusion criteria. Findings regarding three main issues are examined, including sample characteristics, study designs and procedures, and sibling interactive behaviours targeted. Previous research has focused on a diverse range of sibling behavioral exchanges, including cues of children's social skills and relationship quality within mainly ecological contexts. However, limitations in representativeness and standardization have been identified. Future studies should incorporate sequential analyses to fully comprehend the interactive nature of early sibling social encounters.

[Predictor variables of contraceptive method use in young people: A systematic review]. / Variables predictoras del uso de los métodos anticonceptivos en jóvenes: una revisión sistemática.

OBJECTIVE: To analyse predictor variables of contraceptive method use in young people. DESIGN: Systematic review. DATA SOURCES: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. STUDY SELECTION: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. DATA EXTRACTION: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. RESULTS: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with women having higher knowledge of hormonal contraceptive options and more positive attitudes. CONCLUSION: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.

Vitamin D deficiency and SARS­CoV­2 infection: A retrospective case-Control study with big-data analysis covering March 2020 to March 2021.

BACKGROUND: Vitamin D may have immunomodulatory functions, and might therefore play a role in the pathogenesis of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, no conclusive evidence exists regarding its impact on the prevalence of this infection, the associated course of disease, or prognosis. OBJECTIVE: To study the association between SARS-CoV-2 infection and vitamin D deficiency in patients attending a tertiary university hospital, and to examine the clinical course of infection and prognosis for these patients. METHODS: This non-interventional, retrospective study, which involved big-data analysis and employed artificial intelligence to capture data from free text in the electronic health records of patients diagnosed with SARS-CoV-2, was undertaken at a tertiary university hospital in Madrid, Spain, between March 2020 and March 2021. The variables recorded were vitamin D deficiency, sociodemographic and clinical characteristics, course of disease, and prognosis. RESULTS: Of the 143,157 patients analysed, 36,261 had SARS-CoV-2 infection (25.33%) during the study period, among whom 2,588 (7.14%) had a vitamin D deficiency. Among these latter patients, women (OR 1.45 [95%CI 1.33-1.57]), adults over 80 years of age (OR 2.63 [95%CI 2.38-2.91]), people living in nursing homes (OR 2.88 [95%CI 2.95-3.45]), and patients with walking dependence (OR 3.45 [95%CI 2.85-4.26]) appeared in higher proportion. After adjusting for confounding factors, a higher proportion of subjects with SARS-CoV-2 plus vitamin D deficiency required hospitalisation (OR 1.38 [95%CI 1.26-1.51]), and had a longer mean hospital stay (3.94 compared to 2.19 days in those with normal levels; P = 0.02). CONCLUSION: A low serum 25(OH) vitamin D concentration in patients with SARS-CoV-2 infection is significantly associated with a greater risk of hospitalisation and a longer hospital stay. Among such patients, higher proportions of institutionalised and dependent people over 80 years of age were detected.

Satisfaction of Online University Education during the COVID-19 Pandemic.

The rapid global spread of the coronavirus disease affected the education sector, which had to adapt its teaching methodology to an online scenario to curb the increase in infections. This study aimed to determine the satisfaction level of university students regarding the online education they received during the COVID-19 pandemic. A descriptive cross-sectional study was carried out with nursing degree students. Convenience sampling was used because of the accessibility of the sample, estimating 168 as the minimum sample size needed. The satisfaction level was measured using the "Questionnaire on Satisfaction of University Students with Online Training" (CUSAUF). The sample consisted of 215 participants. The overall level of satisfaction was high. Subject content and teaching methodology were the most highly rated aspects, while aspects related to lecturer-student communication and communication among students were rated the worst. The Cronbach's α for the satisfaction scale was 0.94, showing high internal consistency and reliability of the sample. Online education could be considered an alternative methodology for teaching learning modules or complementing face-to-face training in future training programs.

Young nursing and medical students' knowledge and attitudes towards sexuality and contraception in two spanish universities: an inferential study.

BACKGROUND: Living safely sexuality and without risk to one's health is an international priority. The youth age group has specific characteristics that make it a particularly vulnerable group for adverse consequences such as unwanted pregnancies or sexually transmitted infections. Health professionals are an important group to address this issue; however, to achieve a good result, sufficient knowledge is required to solve all the issues. This study aimed to assess the level of knowledge of young university students studying a nursing or a medical degree. METHODS: A descriptive cross-sectional study of young medical and nursing students was conducted. The selection of participants was made by convenience. The Sexuality and Contraceptive Knowledge Instrument scale was used to measure knowledge level. A bivariate analysis was conducted using the Mann-Whitney U test or the Kruskal-Wallis H test, depending on the number of categories of the independent variable. Finally, a multivariate analysis was conducted using a multiple linear regression model, establishing the level of knowledge as the dependent variable and all variables that obtained statistical significance in the bivariate analysis as predictors. Data collection was carried out from October 2020 to March 2021. RESULTS: The sample comprised 657 health university students. Participants had a good level of knowledge, with 77.9% answering 50% of the questions correctly. Before training, 34.15% of the participants did not pass 50% of the questions asked. This percentage decreased to 12.87% after receiving sexuality training during their university degrees. The main training gaps were found for the items on hormonal contraceptive methods. The bivariate analysis showed that female participants had significantly higher knowledge scores, as did those who had used a hormonal contraceptive method during the most recent intercourse or were aware of family planning centers. These variables maintained their significant effect at the multivariate level, obtaining two models with good explanatory power for participants of both university degrees. CONCLUSION: The general level of knowledge of the healthcare students was high and sufficient after receiving training during the university degree (87.13% of the participants obtain more than 50% of items correct). The main training gap was found for items on hormonal contraceptive methods, which should be emphasized in future training programs.

Mindfulness for adults with autism spectrum disorder and intellectual disability: A pilot study.

The present study aims to examine the effects of the MindfulTEA program, an Mindfulness-based Interventions (MBIs) specifically designed for adults with Autism Spectrum Disorder (ASD) and Intellectual Disability, to reduce behavioural problems. MBIs are effective in improving well-being in people with high-functioning ASD, but little is known about the impact of the MBIs on people with ASD and intellectual disability associated. Fourteen adults (age 18 to 44) with ASD and intellectual disability participated in the program. Results showed a significant decrease in self-injurious and aggressive/destructive behaviours after the MBI. Stereotyped behaviour did not show significant change. Results suggest that the MindfulTEA program could effectively reduce some types of behaviour problems in people with ASD and intellectual disability. MBIs could be a useful alternative to traditional behaviour management interventions for reducing behaviour problems in this population.

Perceptions and concerns about sustainable healthcare of nursing students trained in sustainability and health: A cohort study.

AIM: To describe nursing students' perceptions of sustainable health education in the nursing curriculum and their concerns about sustainable healthcare and the impact of climate change on nursing. BACKGROUND: Sustainable health education involves education on the impact of climate change on health and the impact of healthcare on the environment. The effectiveness of sustainable health education in improving attitudes, knowledge and skills in sustainable healthcare has been demonstrated. However, there is a need to study students' perceptions of this and their concerns about achieving sustainable healthcare from the use and disposal of healthcare resources. DESIGN: A cohort study with an inductive content analysis of open-ended questions included in a survey. METHODS: The study was carried out with undergraduate nursing students throughout their four-year undergraduate academic program using scenario-based learning and augmented reality related to sustainability, climate change and health. As students were exposed to three educational interventions, they completed a survey of open-ended questions about their perceptions of their environmental sustainability training in the nursing curriculum, their concerns about the resources' used in healthcare and their perceptions of the impact of climate change on the nursing profession. RESULTS: Students identified content in the nursing degree program on climate change and health and hospital waste segregation. They also demanded more content on 'low environmental impact nursing care' when their clinical practice training increased. Students were concerned about the excessive and unnecessary use of materials in healthcare, especially in the post-pandemic period, the lack of environmental awareness of healthcare professionals and the lack of power to change the situation. They recognised the lack of proper waste segregation in healthcare settings, no recycling bins and little reuse of materials. They were also concerned about the polluting disposal of material. They perceived important impacts of climate change on nursing, such as patient care due to increased pollution-related diseases, including foetal malformations and new health care needs arising from weather conditions. Finally, students were concerned about the impact this will have on nursing care work and require 'nursing leadership in environmental awareness'. CONCLUSIONS: Students demand more training in low environmental impact healthcare and innovative educational practices are effective in this regard. Appropriate Sustainable Healthcare Education can make future health professionals more environmentally aware and enable them to lead the shift towards climate-smart care. TWEETABLE ABSTRACT: Students demand more training in low environmental impact healthcare and perceive significant impacts of climate change on nursing.

Effectiveness of scenario-based learning and augmented reality for nursing students' attitudes and awareness toward climate change and sustainability.

BACKGROUND: Mainstreaming sustainable healthcare into the curricula of health professions is a key action to raise awareness and change attitudes. Therefore, the present study aimed to assess the contribution of scenario-based learning and augmented reality to the environmental awareness and attitudes toward climate change and sustainability among undergraduate nursing students. METHODS: This study was designed as a time-series analysis. Undergraduate nursing students in their 3 years were introduced to sustainability and climate change in the context of healthcare through scenario-based learning sessions. Questionnaires were used to collect data on participants' attitudes towards sustainability and climate change, the usefulness of the educational sessions and the extent to which students changed their clinical practice. A data summary, related sample Friedman and Wilcoxon signed-rank tests were used to test for differences in survey scores. RESULTS: Attitudes and environmental awareness toward climate change and sustainability increased significantly as students received the learning sessions over the 3 years. After their first clinical training period, students already showed a high awareness of unsustainable practices in their working environment; however, they still struggled to apply sustainability and address unsustainable practices in healthcare settings. Most students felt that the scenarios helped them to make links between climate change, resources, and health. CONCLUSIONS: The scenario-based learning and augmented reality increase environmental awareness and attitudes toward climate change and sustainability among nursing students. Students are very aware of unsustainable practices in their work environment, but more work needs to be done on the application of sustainability principles to nursing practice.

Knowledge of Sexuality and Contraception in Students at a Spanish University: A Descriptive Study.

Youth is a period characterized by impulsiveness and risk-taking. This population often feels invulnerable and has a strong motivation to seek out their identity. These characteristics make it a risky age period for an unwanted pregnancy. This study aimed to investigate the level of knowledge about sexuality and contraception among nursing students at the University of Jaen. The students completed a 16-item questionnaire assessing their knowledge level about sexuality and contraception. A bivariate analysis was performed using the Kruskal-Wallis H and Mann-Whitney U tests. Later, an ordinal logistic regression model was generated. The sample consisted of 130 participants, with an average age of 20.36 years. The level of knowledge about sexuality and contraception was moderately high, 10.38 points out of 16. The factors associated with the probability of accordingly presenting a high level of knowledge were being a woman, having studied in a public institution, not having used any contraceptive method in the first sexual experience, and wishing to use a contraceptive pill in future sexual relations. In conclusion, the knowledge level about sexuality and contraception is high, although it is necessary to assess whether this level of high knowledge translates to the use of contraceptive methods in future sexual experiences.

Mother-infant co-regulation from 0 to 2 years: The role of copy behaviors. A systematic review.

The purpose of this review was twofold: (1) to examine how copy behaviors (CB) have been studied in mother-infant natural interactions from 0 to 24 months, and (2) to determine to what extent they can be considered co-regulation processes between both members of the dyad. To do this, 36 studies published between 1975 and 2021 were systematically examined, classified and discussed. The analyzed evidence showed that CB in spontaneous mother-infant interactions have been examined under different perspectives, that such behaviors might be differentially classified as distinct modes of copying according to their traits and, lastly, that CB operate as social facilitators that foster the co-regulation of both affects and behaviors and direct mothers and infants, most of the times, towards a mutual sense of interpersonal matching that adds quality to their interactions.

Effects of climate change in the elderly's health: a scoping review protocol.

INTRODUCTION: Climate change is a global problem that affects human health, especially the most vulnerable groups, including the elderly. However, no scope review includes the perspective of institutions specialised in climate change and health and whose reports are the basis for policies orientated on the environmental health. Therefore, this study aims to identify these effects on older people health. The results will allow health professionals to have valuable information enabling them to provide quality care in meeting the demand that this situation is producing. METHODS AND ANALYSIS: A scoping review of the relevant literature will be performed from 2008 to 2021. The Joanna Briggs Institute guidelines and the PRISMA-Scoping Review Extension checklist will be used. A peer-reviewed search will be conducted using the electronic databases Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PsycINFO and Cuiden Plus between October and December 2021. Original quantitative studies and reports from official agencies on the effects of climate change on the elderly health in any health and geographical context will be included. Literature selection will be made by two reviewers. The table format used for data extraction will be reviewed by the review team and tested by two reviewers. ETHICS AND DISSEMINATION: This study does not require approval by an ethics committee to be conducted. This article will result in the mapping of the direct and indirect effects of climate change on the health of the elderly. The results will be published in scientific journals to be accessible to health professionals in the creation of care plans for the elderly at climate risk.

Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study.

BACKGROUND: Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness. OBJECTIVES: This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014. DESIGN: A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. SETTINGS: Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia). PARTICIPANTS: A convenience sample of first-year undergraduate nursing students. METHODS: The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020. RESULTS: Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1-6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the 'inclusion of climate change and sustainability in the nursing curricula'. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland). CONCLUSIONS: Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.

Educational program on sexuality and contraceptive methods in nursing degree students.

BACKGROUND: Previous educational programs about sexuality and contraceptive methods are delivered through vertical teaching methodology and use an increase in knowledge level as an indicator of effectiveness; however, attitudes towards contraceptive use are not addressed. OBJECTIVES: This study aimed to evaluate the effect of a peer-educational intervention to improve knowledge level and attitudes regarding contraceptive methods in university students. DESIGN: A pre-post quasi-experimental study. SETTINGS: Young university students from a Spanish university. PARTICIPANTS: 131 students in their second year of the Nursing degree program. METHODS: An intervention consisting of two 3-hour sessions was conducted. The first session introduced the main aspects of contraceptive methods and was conducted by the teacher. The second session began with student presentations about contraceptive methods, followed by clinical simulations of a family planning service that the students had to implement and solve. RESULTS: There was a 71.43% improvement in the knowledge level scale score and a 2.17% improvement in the attitudes towards the use of contraceptive methods; both were statistically significant (p < 0.001). For 11 of the 15 items in the knowledge scale, a significantly higher proportion of success was found after the intervention. CONCLUSION: Peer-educational intervention was effective in improving knowledge level and attitudes about contraceptive methods.

Nutritional control of postembryonic development progression and arrest in Caenorhabditis elegans.

Developmental programs are under strict genetic control that favors robustness of the process. In order to guarantee the same outcome in different environmental situations, development is modulated by input pathways, which inform about external conditions. In the nematode Caenorhabditis elegans, the process of postembryonic development involves a series of stereotypic cell divisions, the progression of which is controlled by the nutritional status of the animal. C. elegans can arrest development at different larval stages, leading to cell arrest of the relevant divisions of the stage. This means that studying the nutritional control of development in C. elegans we can learn about the mechanisms controlling cell division in an in vivo model. In this work, we reviewed the current knowledge about the nutrient sensing pathways that control the progression or arrest of development in response to nutrient availability, with a special focus on the arrest at the L1 stage.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

Long-Term Survival After Implantable Cardiac Defibrillator Therapy According to Sex: A Propensity Matched Study.

Background: Whether the sex factor influences the benefit of the implantable cardioverter-defibrillator (ICD) for the prevention of sudden death remains a subject of debate. Using a prospective registry, we sought to analyze the survival and time to first ICD therapy according to sex. Materials and Methods: Retrospective analysis of a prospective cohort of patients undergoing an ICD implant from 2008 to 2019. Data about time to first appropriate therapy, type of therapy administered, and incidence and causes of mortality were collected. Results: Among 756 ICD patients, 150 (19.8%) were women. Women were younger (51 ± 15 years vs. 61 ± 14 years; p < 0.001) and showed a lower rate of ischemic cardiomyopathy (23% vs. 54%; p < 0.001) and atrial fibrillation (12% vs. 19%; p = 0.05). Women had higher left ventricular ejection fraction (39% ± 17% vs. 35% ± 13%) and showed more frequently left bundle branch block (39% vs. 28%, p = 0.027). The rate of primary prevention (68% vs. 59.6%; p = 0.058) and cardiac resynchronization therapy (27% vs. 19%, p = 0.02) were higher in women. After a median follow-up of 46 months (3382 patient-years), the incidence of both the primary combined endpoint of mortality/transplant (20% vs. 29%; logrank = 0.031) and ICD therapies (27% vs. 34%; p = 0.138) were lower in women. According to the propensity score-matching analysis, no differences were observed between both sexes with respect to the incidence of mortality/transplant (24.8% vs. 28.6%; logrank = 0.88), ICD therapies (28% vs. 27%; logrank = 0.17), and main cause of death (heart failure [HF]). Conclusions: The clinical characteristics at the moment of ICD implant are different between sexes. After adjusting them, both sexes equally benefit from the ICD. HF is the main cause of mortality both in men and women.