Linking extinction risk to the economic and nutritional value of sharks in small-scale fisheries.

To achieve sustainable shark fisheries, it is key to understand not only the biological drivers and environmental consequences of overfishing, but also the social and economic drivers of fisher behavior. The extinction risk of sharks is highest in coastal tropical waters, where small-scale fisheries are most prevalent. Small-scale fisheries provide a critical source of economic and nutritional security to coastal communities, and these fishers are among the most vulnerable social and economic groups. We used Kenya's and Zanzibar's small-scale shark fisheries, which are illustrative of the many data-poor, small-scale shark fisheries worldwide, as case studies to explore the relationship between extinction risk and the economic and nutritional value of sharks. To achieve this, we combined existing data on shark landings, extinction risk, and nutritional value with sales data at 16 key landing sites and information from interviews with 476 fishers. Shark fisheries were an important source of economic and nutritional security, valued at >US$4 million annually and providing enough nutrition for tens of thousands of people. Economically and nutritionally, catches were dominated by threatened species (72.7% and 64.6-89.7%, respectively). The most economically valuable species were large and slow to reproduce (e.g. mobulid rays, wedgefish, and bull, silky, and mako sharks) and therefore more likely to be threatened with extinction. Given the financial incentive and intensive fishing pressure, small-scale fisheries are undoubtedly major contributors to the decline of threatened coastal shark species. In the absence of effective fisheries management and enforcement, we argue that within small-scale fisheries the conditions exist for an economically incentivized feedback loop in which vulnerable fishers are driven to persistently overfish vulnerable and declining shark species. To protect these species from extinction, this feedback loop must be broken.

Conexión entre el riesgo de extinción y el valor nutricional de los tiburones en las pesquerías a pequeña escala Resumen Para lograr la sustentabilidad de las pesquerías de tiburones se deben entender los factores ecológicos y las consecuencias ambientales de la sobrepesca, así como los factores sociales y económicos del comportamiento del pescador. El riesgo de extinción de los tiburones es mucho mayor en las aguas tropicales costeras, en donde son más frecuentes las pesquerías a pequeña escala. Las pesquerías a pequeña escala, que además se encuentran entre los grupos con mayor vulnerabilidad social y económica, proporcionan una fuente importante de seguridad económica y nutricional para las comunidades costeras. Usamos las pesquerías de Kenia y Zanzíbar, las cuales representan muy bien a muchas de las pequeñas pesquerías de tiburones con deficiencia de datos, como estudios de caso para explorar la relación entre el riesgo de extinción y el valor económico y nutricional de los tiburones. Para lograr esto, combinamos los datos ya existentes de desembarques de tiburones, riesgo de extinción y valor nutricional con la información de ventas en 16 sitios clave de desembarque e información de las entrevistas a 476 pescadores. Las pesquerías de tiburones son una fuente importante de seguridad alimentaria y económica, valorada en más de US$4 millones anuales y que proporciona suficiente alimentación para miles de personas. En cuanto a la economía y la alimentación, las capturas estuvieron dominadas por especies amenazadas (72.7% y 64.6­89.7%, respectivamente). Las especies con mayor valor económico eran aquellas de gran tamaño y lenta reproducción, y, por lo tanto, con mayor probabilidad de estar en peligro de extinción. A causa del incentivo económico y la presión intensa de pesca, las pesquerías pequeñas sin duda son uno de los principales contribuyentes a la declinación de especies amenazadas de tiburones en las costas. Ya que no hay una aplicación ni un manejo efectivos de las pesquerías, argumentamos que en las pequeñas pesquerías existen las condiciones para un bucle de retroalimentación con incentivación económica en el que los pescadores vulnerables con frecuencia necesitan sobre pescar las especies de tiburones vulnerables y en declinación. Para proteger a estas especies de la extinción, este bucle de retroalimentación debe romperse.

An assessment of future rewilding potential in the United Kingdom.

Restoring ecosystems is an imperative for addressing biodiversity loss and climate change, and achieving the targets of the Kunming-Montreal Global Biodiversity Framework. One form of restoration, rewilding, may have particular promise but may also be precluded by requirements for other forms of land use now or in the future. This opportunity space is critical but challenging to assess. We explored the potential area available for rewilding in Great Britain until the year 2080 with a multisectoral land-use model with several distinct climatic and socioeconomic scenarios. By 2080, areas from 5000 to 7000 km2 were either unmanaged or managed in ways that could be consistent with rewilding across scenarios without conflicting with the provision of ecosystem services. Beyond these areas, another 24,000-42,000 km2 of extensive upland management could provide additional areas for rewilding if current patterns of implementation hold in the future. None of these areas, however, coincided reliably with ecosystems of priority for conservation: peatlands, ancient woodlands, or wetlands. Repeatedly, these ecosystems were found to be vulnerable to conversion. Our results are not based on an assumption of support for or benefits from rewilding and do not account for disadvantages, such as potential losses of cultural landscapes or traditional forms of management, that were beyond the modeled ecosystem services. Nevertheless, potential areas for rewilding emerge in a variety of ways, from intensification elsewhere having a substantial but inadvertent land-sparing effect, popular demand for environmental restoration, or a desire for exclusive recreation among the wealthy elite. Our findings therefore imply substantial opportunities for rewilding in the United Kingdom but also a need for interventions to shape the nature and extent of that rewilding to maintain priority conservation areas and societal objectives.

Una evaluación del potencial futuro de la resilvestración en el Reino Unido Resumen La restauración de ecosistemas es urgente para abordar la pérdida de biodiversidad y el cambio climático, así como para lograr los objetivos del Marco Mundial de Biodiversidad de Kunming­Montreal. Un método de restauración, la resilvestración, puede ser particularmente prometedor, aunque también puede ser excluido por los requerimientos para otras formas de uso de suelo actuales o en el futuro. Este espacio de oportunidad es crítico, pero también un reto para evaluar. Exploramos el área potencial disponible para el resilvestrado en Gran Bretaña hasta el año 2080 con un modelo multisectorial de uso de suelo con varios escenarios climáticos y socioeconómicos. Para este año, las áreas entre 5,000 y 7,000 km2 no estaban gestionadas o lo estaban, pero de manera que podían ser consistentes con el resilvestrado de los escenarios sin conflictuar el suministro de servicios ambientales. Más allá de estas áreas, otros 24,000­42,000 km2 de gestión extensiva tierra arriba podrían proporcionar áreas adicionales para el resilvestrado si los patrones actuales de implementación siguen en pie en el futuro. Sin embargo, ninguna de estas áreas coincidió de manera confiable con los ecosistemas de prioridad para la conservación: las turberas, bosques antiguos o humedales. Estos ecosistemas aparecieron varias veces como vulnerables a la conversión. Nuestros resultados no están basados en una suposición de apoyo para o los beneficios de la resilvestración y no consideran las desventajas, como la pérdida potencial de paisajes culturales o las maneras tradicionales de manejo, que estaban fuera del alcance de los servicios ambientales modelados. Sin embargo, las áreas potenciales para el resilvestrado emergen en una variedad de formas, desde la intensificación en otros lugares con un efecto de ahorro de tierras sustancial pero inadvertido, la demanda popular por la restauración ambiental o el deseo de una recreación exclusiva entre la elite acaudalada. Por lo tanto, nuestros descubrimientos implican una oportunidad sustancial para la resilvestración en el Reino Unido, aunque también una necesidad de intervenciones para moldear la naturaleza y la extensión de ese resilvestrado para mantener las áreas prioritarias de conservación y los objetivos sociales.

Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP): A valuable quality tool for all colonoscopies.

INTRODUCTION: The Colonoscopy Satisfaction and Safety Questionnaire based on Patient experience (CSSQP) was recently developed and validated within a Bowel Cancer Screening Program. We aimed to identify factor related to patient experience through the CSSQP, including all indications for colonoscopy. Indicators of satisfaction and perceived safety with colonoscopy were also assessed to compare the different centers. METHODS: Multicenter study in nine Spanish hospitals. Consecutive patients who had undergone a colonoscopy completed the CSSQP adding a novel item on bowel preparation. Factors related to patient experiences and data from non-respondents were analyzed. RESULTS: Of 2200 patients, 1753 filled out the questionnaire (response rate 79.7%, sample error 2%). Patients whose colonoscopy indication was a primary colorectal cancer screening (OR: 1.68, 95% CI: 1.15-2.44, p=0.007) or due to a +FIT (OR: 1.73, 95% CI: 1.18-2.53) reported higher satisfaction than patients with gastrointestinal symptoms. In addition, college-educated patients (OR: 2.11, 95% CI: 1.25-3.56) were more likely to report better overall satisfaction than patients with lower education level. Significant differences were observed in the majority of the CSSQP items between centers. Safety incidents were reported by 35 (2%) patients, and 176 (10%) patients reported that they received insufficient information. CONCLUSION: The CSSQP identifies several significant factors on satisfaction and perceived safety in patients referred for colonoscopy for any reason. The CSSQP also allows comparison of patient-identified colonoscopy quality indicators between centers.

[Factors associated with caregiver burden in primary caregivers of older adults with type2 diabetes]. / Factores asociados a la sobrecarga del cuidador en cuidadores primarios de personas adultas mayores con diabetes tipo2.

OBJECTIVE: To characterize the profile of the informal primary caregiver (IPC) of adult patients with type2 diabetes (T2D) and the possible factors associated with caregiver collapse (CC). DESIGN: Observational, descriptive, cross-sectional and analytical study. SITE: Ambulatory Care Medical Unit. PARTICIPANTS: Mexican CPIs of adult patients with T2D. MAIN MEASUREMENTS: Data were collected through a prolective design using the Zarit scale and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed. RESULTS: The CPI profile is assumed by: women, people aged 36-58, daughters, people with a secondary and high school educational level, married, Catholic, with income <8,900 Mexican pesos, own home, inhabited by a maximum of 5 inhabitants, with support networks, who have dedicated >5years to the care of their patient, without training and with chronic diseases. The risk factors that increase the risk of CC are: being a woman (OR=11.03; 95%CI: 1.49-81.95), having a history of more than 5years of having assumed the role of caregiver (OR=2, 65; 95%CI: 1.07-6.55), living in one's own house (OR=3.03; 95%CI: 1.04-8.82), with 6 or more inhabitants (OR=2.41; 95%CI: 1.08-5.38). The support of other family members and/or friends was associated as a protective factor (OR=0.15; 95%CI: 0.07-0.33). CONCLUSIONS: Prevention programs are required to avoid CC and complications, as well as interventions to improve the quality of life of the CPI and patients in care, incorporating strategies to generate and/or increase their family and social support networks.

[Does recommending the dosing frequency in the electronic prescription improve its adequacy? Before and after study]. / ¿Recomendar la frecuencia de administración de medicamentos en la prescripción electrónica mejora su adecuación? Estudio antes-después.

OBJECTIVE: To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. DESIGN: Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020. LOCATION: Primary care setting. PARTICIPANTS: Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included. INTERVENTION: Recommendation of the appropriate dosing frequency in the prescription module. MAIN MEASUREMENTS: Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. RESULTS: After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. CONCLUSIONS: The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.

[Why is it increasingly difficult to "do the right thing" and to "stop doing the wrong thing"? Strategies for reversing low-value practices]. / ¿Por qué resulta cada vez más complicado "hacer lo que hay que hacer" y "dejar de hacer lo que no hay que hacer"? Estrategias para revertir las prácticas de bajo valor.

This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with "do not do" recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to "do not do" recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients' healthcare, and because most of the citizens' healthcare demands are managed and resolved at the first level of care.

Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders.

JAK inhibitors target specific inflammatory cytokines involved in various inflammatory diseases. Four molecules have been approved for dermatological use: upadacitinib, baricitinib, abrocitinib and topical ruxolitinib. Off-label prescriptions for other dermatological conditions have been reported. We conducted a narrative review of the literature to assess the long-term safety profile of currently approved JAK inhibitors in dermatology, and their off-label use in skin disorders. We performed literature searches with Pubmed and Google Scholar from January 2000 to January 2023, using the keywords "Janus kinase inhibitors", "JAK inhibitors", "off-label", "dermatology", "safety", "adverse events", "ruxolitinib", "upadacitinib", "abrocitinib" and "baricitinib". Our search yielded a total of 37 dermatological disorders with studies supporting the use of these JAK inhibitors. Preliminary studies indicate that JAK inhibitors generally have a favorable safety profile and can be considered as an option in many dermatological disorders.

Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders. / [Artículo traducido] Perfil de seguridad a largo plazo y usos fuera de indicación de los inhibidores de JAK en dermatología.

JAK inhibitors target specific inflammatory cytokines involved in various inflammatory diseases. Four molecules have been approved for dermatological use: upadacitinib, baricitinib, abrocitinib and topical ruxolitinib. Off-label prescriptions for other dermatological conditions have been reported. We conducted a narrative review of the literature to assess the long-term safety profile of currently approved JAK inhibitors in dermatology, and their off-label use in skin disorders. We performed literature searches with PubMed and Google Scholar from January 2000 to January 2023, using the keywords "Janus kinase inhibitors", "JAK inhibitors","off-label", "dermatology", "safety", "adverse events", "ruxolitinib", "upadacitinib","abrocitinib" and "baricitinib". Our search yielded a total of 37 dermatological disorders with studies supporting the use of these JAK inhibitors. Preliminary studies indicate that JAK inhibitors generally have a favorable safety profile and can be considered as an option in many dermatological disorders.

[Medication safety during the COVID-19 pandemic in primary care nurses]. / Seguridad de medicamentos durante la pandemia COVID-19 en las enfermeras de atención primaria.

OBJECTIVE: To know the perception of nurses about the factors that influence the safe administration of medications during the COVID-19 period, in the work context in a primary care health department of the Spanish national health system. DESIGN: This is a qualitative phenomenological study. SITE: Carried out in the Department of Health 21 (Alicante, Spain) between the months of September 2021 and November 2021. PARTICIPANTS: Fifteen nurses chosen by intentional sampling. METHODS: A semi-structured interview lasting between 30 and 60min was used, recorded and transcribed verbatim by the research team. A main category called "know" is established, which encompasses all the reflections about the nurse's performance during the medication administration process. RESULTS: The participants expressed concern about the performance of medication administration procedures, which made it possible to perceive safety as the greatest concern in the study unit. From this main category, the following subcategories are developed: work overload, insufficient training, distractions and communication and information failures. CONCLUSION: Knowing the perception of nurses about the factors that influence the safe administration of medications could facilitate the use of instruments to standardize and reduce variability in the safe administration of medications. As well as improving conditions in work environments at the community level, and not favoring social, personal and professional stigmatization due to care error.

[Perception of the safe administration of medications in primary care]. / Percepción de la administración segura de medicamentos en atención primaria.

The purpose of this study was to know the perception of nurses about safety in the preparation and administration of medications in a primary care health department of the Spanish national health system. Cross-sectional descriptive study. Carried out in the Health Department 21 (Alicante, Spain) in the months of September to November 2021. 66 nurses, with a predominance of women (88.9%). A semi-structured interview with ten questions was used. The inclusion criterion took into account nurses with more than two years of experience working in the health center. The perception of nurses about the degree of safety in the preparation and administration of medications was evaluated. 81.9% of the sample did not report adverse events. The steps for secure administration were varied. A significant association was observed in the correct time of medication (p < 0.031) and antisepsis (p < 0.026) according to the number of nurses in the basic health areas. Our results indicate the perceptions of nurses about improvements in the degree of implementation of standards or tools for the safe administration of medications, with special attention to lack of knowledge, care overload (high patient/nurse ratio) and associated dilemmas with the notification.

Illegal fisheries, environmental crime, and the conservation of marine resources.

The illegal harvest of marine species within exclusive economic zones can have a strong impact on the function of local ecosystems and livelihoods of coastal communities. The complexity of these problems is often overlooked in the development of solutions, leading to ineffective and sometimes harmful social and environmental outcomes. One-dimensional, oversimplified perspectives can lead to conservation prescriptions that exacerbate social stressors. This is particularly critical in the case of international illegal trade of endangered, high-value species, which generate a value chain in which artisanal fishers are the first operational and often the weakest link of an intricate web. We examined 2 illegal fisheries, totoaba (Totoaba macdonaldi) and sea cucumber (Isostichopus badionotus and Holothuria floridana), in Mexico. Although these are 2 separate and independent fisheries, important ecological (resource condition, fishery impacts at the ecosystem level) and social (governance, markets) similarities improve understanding of their complexity. Our findings are relevant globally and show the need for interdisciplinary decision-making groups, community engagement, and the development of demand reduction measures.

Pesquerías Ilegales, Crímenes Ambientales y la Conservación de los Recursos Marinos Resumen La cosecha ilegal de especies marinas dentro de las zonas económicas exclusivas puede tener un impacto serio sobre la función de los ecosistemas locales y el economia de las comunidades costeras. La complejidad de estos problemas generalmente se ignora durante el desarrollo de soluciones, lo que conlleva a resultados ambientales y sociales poco efectivos y algunas veces dañinos. Las perspectivas unidimensionales y sobresimplificadas pueden derivar en prescripciones de conservación que empeoran las condiciones sociales sociales. Lo anterior es particularmente crítico para el caso del mercado ilegal de especies en peligro y de alto valor, lo que genera una cadena de valores en la que los pescadores tradicionales son el primer eslabón operativo y con frecuencia el más débil de una red intrincada. Examinamos dos pesquerías ilegales, la de la totoaba (Totoaba macdonaldi) y la del pepino de mar (Isostichopus badionotus y Holothuria floridana), en México. Aunque estas dos pesquerías son diferentes e independientes, las importantes similitudes ecológicas (estado del recurso, impactos de la pesquería a nivel de ecosistema) y sociales (governancia, mercados) mejoran el conocimiento de su complejidad. Nuestros hallazgos son relevantes a escala global y muestran la necesidad de tener grupos interdisciplinarios para tomar decisiones, la participación de la comunidad y el desarrollo de medidas para reducir la demanda por el producto pesquero.

Pharmacology and safety of tofacitinib in ulcerative colitis. / Farmacología y seguridad de tofacitinib en colitis ulcerosa.

The use of Janus kinase (JAK) inhibitors is a new approach in the therapy of inflammatory diseases with immune base. Tofacitinib is one of these inhibitors targeting JAK1 and JAK3, and its efficacy has been demonstrated in the treatment of moderate to severe ulcerative colitis (UC). It is a small synthetic molecule administered orally, with a fast bioavailability and elimination rate, predictable pharmacokinetics and lack of immunogenicity, which are convenient characteristics for both efficacy and safety. This article reviews the pharmacological characteristics of tofacitinib and its safety profile.

Parent and practitioner perspectives on Circle of Security Parenting (COS-P): A qualitative study.

Circle of Security Parenting (COS-P) is an attachment-theory-informed program for parents of infants and young children. Designed for scalability, COS-P has been widely adopted internationally. Evidence for the program's effectiveness is limited, however, restricting capacity to make informed decisions about program allocation, and threatening ongoing program funding. To help address this evidence gap, this qualitative study explored the experiences and perceptions of 20 COS-P facilitators and 14 parent recipients in Australia, where COS-P uptake has been particularly widespread. Thematic analysis of combined interview and focus group data revealed a perception that COS-P primarily changes the lens through which parents view (a) their child, (b) themselves in the parenting role, and (c) the parent-child relationship, and that this was a pathway to increased empathy, compassion, and parenting confidence. Participants identified four components that underpinned program impact: key content, skills practice, group processes, and facilitator support. Although COS-P was considered suitable for broad application, limitations were noted. Findings can guide clinical application of COS-P and inform empirical research.

El Círculo de Seguridad - Crianza (COS-P) es un programa basado en la teoría de la afectividad para progenitores de infantes y niños pequeños. Diseñado con un enfoque de escala, COS-P ha sido ampliamente adoptado internacionalmente. La evidencia de su eficacia es limitada, sin embargo, lo cual restringe la capacidad de tomar decisiones fundamentadas acerca de la distribución de fondos y amenaza el continuo apoyo económico del programa. Este estudio cualitativo explora las experiencias y percepciones de 20 mediadores que facilitaban el programa COS-P y 14 progenitores que lo recibían en Australia, donde la aceptación de COS-P ha sido particularmente extensa. Los análisis temáticos de entrevistas combinadas y datos de grupos de enfoques revelaron una percepción de que COS-P cambia el lente a través del cual los progenitores ven (a) a su niño, (b) a sí mismos en el papel de crianza, y (c) la relación progenitor-niño, y que este era una trayectoria para incrementar la empatía, la compasión, así como la confianza en la crianza. Los participantes identificaron cuatro componentes que respaldan el impacto del programa: contenido clave, práctica de habilidades, procesos de grupo y apoyo del mediador. Aunque COS-P se consideró apropiado para una aplicación más amplia, se indicaron las limitaciones. Los resultados pueden guiar la aplicación clínica de COS-P y sustentar la investigación empírica.

Le Parentage Cercle de Sécurité (en anglais Circle of Security Parenting, soit COS-P) est un programme basé sur la théorie de l'attachement pour les parents de nourrissons et de jeunes enfants. Conçu pour son extensibilité le COS-P a été largement adopté au niveau international. Les preuves d'efficacité sont cependant limitées, ce qui restreint la capacité à prendre des décisions informées sur les allocations au programme et menaçant le financement continu du programme. Cette étude qualitative a exploré les expériences et les perceptions de 20 facilitateurs COS-P et 14 récipiendaires parents en Australie, ou l'adoption du COS-P est particulièrement répandue. Une analyse thématique consistant en une combinaison d'entretien et de données de groupes de discussion a révélé une perception que le COS-P change principalement le prisme au travers duquel les parents voient (a) leur enfant, (b) eux-mêmes dans le rôle de parentage, et (c) la relation parent-enfant, et que cela crée un chemin d'empathie, de compassion et de confiance de parentage accrue. Les participants ont identifié quatre composantes qui étaient l'impact du programme: un contenu clé, la pratique des compétences, les processus de groupe et le soutien au facilitateur. Bien que le COS-P soit considéré comme étant adapté à une application générale des limites ont été notées. Les résultats peuvent guider l'application clinique du COS-P et éclairer la recherche empirique.

[Adequacy of the safety of metamizole and agranulocytosis]. / Adecuación de la seguridad del metamizol y agranulocitosis.

OBJECTIVE: To analyze whether the drug safety update issued by the Spanish Agency of Medicines and Healthcare Products (AEMPS), dated October 30, 2018, on agranulocytosis and metamizole contains accurate and necessary information to protect patients from the presentation of this adverse reaction (AR) and if the official documentation of medicines containing metamizole for doctors, pharmacists and the general population conforms to the guidelines of the AEMPS to reduce this risk. SETTING AND PARTICIPANTS: Drug safety update, bibliographic search, information at the European Medicines Agency on metamizole drugs marketed in Spain, technical datasheets, leaflets, Bot PLUS Health Information Database and Catalog of Pharmaceutical Specialties. Notification of 4cases of agranulocytosis due to metamizole after the drug safety update was issued. MAIN INTERVENTIONS AND MEASUREMENTS: Comparison of the key points of the drug safety update and official documents on metamizole with the bibliography. Description of the 4cases of agranulocytosis due to metamizole and application of the causality and severity algorithm. RESULTS: The drug safety update contains omissions and contradiction in respect to the bibliography and the actual use of metamizole in healthcare practice. The official documents show a lack of updating, unapproved indications and doses higher than those recommended. The drug safety update has not stopped the presentation of cases of agranulocytosis due to metamizole. CONCLUSIONS: The AEMPS drug safety update can be improved and it is necessary to update the official information documents on metamizole for health professionals and patients in order to decrease the risk of agranulocytosis.

[Patient safety incidents reported before and after the start of the COVID-19 pandemic in Primary Care in Tarragona]. / Incidentes de seguridad del paciente notificados antes y después del inicio de la pandemia de COVID-19 en atención primaria en Tarragona.

OBJECTIVE: To analyse and compare the epidemiology of patient safety incidents reported in Primary Health Care, before and after the start of the COVID-19 pandemic. DESIGN AND SETTING: Analytical descriptive study comparing reported incidents from March 1st 2019 to February 28th 2020, and from March 1st 2020 to February 28th 2021, notified through the TPSC Cloud™ platform accessible from the Intranet corporative in 25 Primary Health Care centres from Tarragona district, in Catalonia (Spain). MEASUREMENTS: Data obtained from voluntary notifications, through electronic, standardized and anonymized forms. VARIABLES: Centre, professional, incident type, risk matrix, causal factors and contributing factors, and avoidability. STATISTICAL ANALYSIS: Every notification was included in descriptive analysis, and another one specifically for adverse events, comparing both periods. RESULTS: 2231 incidents were reported. Comparing both periods, during the pandemic a reduction in the number of reported incidents was observed (only represented 20% of the total). However, the percentage of reported notifications from health care professionals and adverse events that required observation were increased. Causal factors related to attendance and diagnosis were incremented whereas the causal factors related to medication were decreased. In addition, an increase in contributing factors related to the professional was observed. Avoidability was high (>95%) in both periods. CONCLUSIONS: During the pandemic, fewer patient safety incidents have been reported, but proportionally more adverse events, most of which are preventable. The professional himself becomes the main contributing factor.

[Primary care organization in pandemic times]. / Organización de la Atención Primaria en tiempos de pandemia.

The COVID-19 pandemic has forced the adoption of drastic changes in primary care, modifying the organization and work dynamics previously established. From one day to the next, professionals had to adapt to the new situation to be able to attend cases and contacts tracing, to avoid contagion and to maintain attention to other health problems. At the beginning of the pandemic, professionals had to establish new practices and care circuits in primary care in an improvised way, due to lack of updated guidelines, without adequate means of protection, evaluating their risks and benefits on the fly. We present the main organizational changes in the first level of care and describe, from the point of view of patient safety and the consequences for patients and professionals of the priority care for COVID-19. Finally, we consider how to incorporate the knowledge acquired during the pandemic, analyzing the advantages and disadvantages of the adopted measures to maintain as much as possible a safe, accessible and quality primary care.

[The Global Patient Safety Action Plan 2021-2030: Identifying actions for safer primary health care]. / El Plan de acción mundial para la seguridad del paciente 2021-2030: identificando acciones para una atención primaria más segura.

The 74th World Health Assembly adopted in May 2021 the "Global Patient Safety Action Plan: 2021-2030" to enhance patient safety as an essential component in the design, procedures and performance evaluation of health systems worldwide. It is a strategic plan that guides country governments, health sector entities, health organisations and the World Health Organisation secretariat on how to implement the assembly's patient safety resolution. Deployment of the plan will strengthen the quality and safety of health systems worldwide by spanning the entire continuum of people's health care from diagnosis to treatment and care, reducing the likelihood of harm in the course of care. The Declaration on Primary Health Care during the Global Conference on Primary Health Care in Astana, 2018, urged countries to strengthen their primary health care systems as an essential step towards achieving universal health coverage and providing access to safe, quality care without financial loss. The deployment of the Global Patient Safety Action Plan in primary care is therefore a high-priority health policy action. The Action Plan is structured into 6 strategic objectives with 35 strategic actions. We present an analysis of the strategic actions regarding healthcare organizations and the challenges ahead for their particular deployment in primary health care settings.

[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

[Diagnostic error and overdiagnosis in Primary Care. Proposals for the improvement of clinical practice family medicine]. / El error diagnóstico y sobrediagnóstico en Atención Primaria. Propuestas para la mejora de la práctica clínica en medicina de familia.

Family doctors see a wide range of patients, with a wide range of complexity, in a short time and with few diagnostic resources. This situation makes primary care professionals more vulnerable to diagnostic errors. For this reason, an adequate clinical reasoning process is the most powerful tool family doctors have to safely guide the patient care process. Considering these errors as missed opportunities for a correct diagnosis, which may cause harm to the patient, leads us as professionals to review how to improve this process. The review includes, among other aspects, identifying cognitive biases, analysing the ways in which work is organised in primary care teams, and situations in the care context that may contribute to such errors. In this article we describe the most frequent diagnostic errors and their causal factors in primary care, the impact of cognitive process failures, situations of overdiagnosis and the diagnostic and therapeutic cascades associated with them. Finally, we propose a set of tools to improve decision-making in the diagnostic process in primary care.

[Patient safety training and a safe teaching in primary care]. / La formación en seguridad del paciente y una docencia segura en atención primaria.

This narrative review manuscript aims to raise the difficulties and opportunities for patient safety in specialised healthcare training considering undergraduate, postgraduate, specialist and continuing education, even during the COVID-19 pandemic. It also suggests some proposals for carrying it out. It very briefly discusses this specific training and its current situation in primary care. Highlighting that patient safety is a need, an area of competence and a training opportunity for residents. It establishes the general framework of patient safety in primary care in the document "7 steps for Patient Safety in Primary Care", stating the need for a systemic approach. It highlights the elaboration and presentation of cases on clinical errors as the most frequent training strategy. The real-life clinical scenarios relate to difficult patients, critical incidents and bioethics issues in professional practice. These scenarios have as common characteristics, the fact to produce difficulties and suffering for all the actors involved. Several instruments for training in patient safety are also included. The medium-term goal is to consolidate clinical safety in specialised healthcare training. Finally, an analysis is made of the impact of the pandemic on patient safety training, particularly on specialised healthcare training and some proposals are recommended on how to carry out safe teaching in the times of the COVID-19 pandemic.