Advance Care Planning in Spain.

In the last decade in Spain, an important push has been given to the development of health policies that define the framework of action in the care of people with advanced chronic diseases. Respect for the autonomy of the patient, shared decision-making processes and advance care planning (ACP) are recognized into health plans as a key aspect in chronic care, frailty, and palliative care. A few but significant number of institutions, local governments, and healthcare professionals from different regions of Spain have started a rationale and roadmap for a new twist in Spain's theoretical, ethical and policy development, promoting ACP implementation into public health care systems. In 2020, a working group founded in 2017, evolved into the "Spanish Association of Shared Care Planning" (AEPCA). The Shared Care Planning (SCP) concept grows up after the two international consensus Delphi studies in 2017 and pretends to shift from the framework of ACP programs to a person-centred care approach. In the last years, several experiences show how professionals are more sensible and interested on the ACP process, but it cannot be said, for now, that it has taken effect in the global Spanish health system. Even both ACP and SCP are being used simultaneously in Spain, each day more people and autonomous communities embrace renewed concept and foundations of SCP, supporting the work of AEPCA on spreading the value of this process into the care of people who are coping with chronic diseases, vulnerability, and frailty.

Empathy and psychological concerns among medical students in Brazil during the COVID-19 pandemic.

OBJECTIVE: Being in direct contact with COVID-19 patients for long periods increases the risk of infection among frontline workers. The purpose of this study was to identify levels of empathy and psychological concern among medical students during the COVID-19 pandemic. METHODS: An online cross-sectional study was conducted among medical interns divided into two groups: those who worked on the frontline (n = 87) and those who did not (n = 63) during the COVID pandemic. The students completed the Interpersonal Reactivity Index, Maslach Burnout Inventory, Perceived Stress Scale, and Patient Health Questionnaire. RESULTS: The majority of respondents were women (70.7%), and the mean age was 25.45 ± 3.93 years. In unadjusted analyses, those who worked with COVID-19 patients had a higher level of empathy, stress, burnout symptoms, and depressive symptoms. In the logistic regression analyses, students who worked on the frontline during the COVID-19 pandemic had a higher level of empathy (OR: 1.27; 95% CI: 1.16-1.14), higher perceived stress levels (OR: 1.21; 95% CI: 1.05-1.39), and greater burnout symptoms (OR: 1.19; 95% CI: 1.10-1.30). CONCLUSION: Medical students in the internship period who worked on the frontline during the COVID-19 pandemic had more psychological concerns and higher levels of empathy compared to those who did not work on the frontline.

Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience.

PURPOSE: The coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse. METHODS: This is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021. RESULTS: Of the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36-63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1-4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1-12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020. CONCLUSION: Heart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.

[Clinical Ethics Consultation: current European models and novel approaches in Spain]. / Consultoría en ética clínica: modelos europeos y nuevas propuestas en España.

To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospital setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been questioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, which has proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America, its implementation in Europe is still marginal. In this document we present the general characteristics of CEC services, comparing their potential advantages and risks to those of HECs. We will then share relevant European experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share our recent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise the minimum requirements that such a CEC service must meet in order to carry out its consulting activity: organisational flexibility, well-trained professionals, with sufficient clinical experience, economical support, and organisational dependency on HECs.

Emotions and mood swings of pharmacy students in the context of the coronavirus disease of 2019 pandemic.

INTRODUCTION: The coronavirus disease of 2019 pandemic has changed university routines affecting student mental health. The aims of this study were to survey aspects related to mental health of pharmaceutical course students considering previous and current contexts. METHODS: The Depression, Anxiety, and Stress Scale (DASS-21), Impact of Event Scale-Revised, and Brunel Mood Scale were used. DASS-21 was completed pre- and post-pandemic. The validity and reliability of the data were verified. The prevalence (95% CI) of mental health symptoms was estimated. The relationship between the time spent watching/reading the news and mean scales scores was evaluated (Pearson's correlation coefficient). RESULTS: The prevalence of depression symptoms in students pre-pandemic was 66.7% (95% CI = 65.3-68.1) and during the pandemic was 81% (95% CI = 79.8-82.2). More than 70% (95% CI = 69.8-72.6) of participants had some psychological impact as a result of the pandemic (mild: 16.7% [95% CI = 15.6-17.8]; moderate: 9.1% [95% CI = 8.2-10]; severe: 45.4% [95% CI = 43.9-46.9]). High values of tension, depressed mood, mental confusion, and anger were observed. There was a significant correlation between the time spent following the news of the pandemic and symptoms of anxiety (r = 0.356; P < .001), stress (r = 0.248; P = .014), hyperarousal (r = 0.322; P ≤ 0.001), and intrusion (r = 0.21; P = .039). CONCLUSIONS: Students are highly vulnerable to depressive symptoms and mood swings due to the pandemic. These findings deserve consideration mainly from mental health professionals, but also from managers and educators.

Cannabinoids for nausea and vomiting related to chemotherapy: Overview of systematic reviews.

Nausea and vomiting are common and distressing adverse events of chemotherapy. This review focuses on the findings and quality of systematic reviews (SRs) of cannabinoids for chemotherapy-induced nausea and vomiting (CINV). Review of SRs, a systematic literature search, was conducted in several electronic databases and included SRs evaluating cannabinoids for CINV in cancer patients. Methodological quality and quality of reporting were evaluated by AMSTAR and PRISMA, respectively. Initial search retrieved 2,206 records, and 5 SRs were included. On the basis of findings of the sole SR judged as high methodological quality, cannabinoids seem to be more effective than placebo, equal to prochlorperazine for reducing CINV, and to be preferred by patients. The response to different combinations of antiemetic agents seems to be equal to 1 antiemetic alone. The average of AMSTAR score was 5, and the average of PRISMA score was 13.2. Cannabinoids represent a valuable option for treating CINV, despite the adverse events related to treatment, such as drowsiness and cognitive impairment. There is no good quality evidence to recommend or not the use of cannabinoids for CINV. More studies are still needed to evaluate the effectiveness of cannabinoids when compared with modern antiemetics.

Educação alimentar na obesidade: adesão e resultados antropométricos / Food education for the obese: adherence and anthropometric results

OBJETIVO:O objetivo deste estudo foi avaliar a adesão de indivíduos com excesso de peso a um programa de educação alimentar e a evolução antropométrica, no período de março de 2005 a dezembro de 2007. MÉTODOS:A amostra foi composta por adultos de uma comunidade universitária pública, de ambos os sexos, na faixa etária entre 20 e 59 anos. Durante 10 semanas, em grupo, eles receberam orientação alimentar e apoio psicológico, e praticaram exercício físico adaptado. Foram coletados dados sociodemográficos, de peso e de estatura, para cálculo do índice de massa corporal, além da circunferência da cintura no início e no final da intervenção. RESULTADOS: Como resultados, 116 indivíduos com idade de 41 anos inscreveram-se no programa, a maioria do sexo feminino (73,3 por cento), casada (70,7 por cento) e com ensino médio completo (49,1 por cento). Houve adesão de 50,0 por cento deles. Os desistentes eram obesos (65,5 por cento), com índice de massa corporal médio de 33,4kg/m. Aqueles que completaram o programa apresentaram queda no índice de massa corporal (32,5 para 31,2kg/m) com perda ponderal média de 3,9 por cento; 37,9 por cento apresentaram perda maior ou igual a 5,0 por cento. A circunferência da cintura também reduziu de 102,1 para 98,6cm. CONCLUSÃO: Conclui-se que a adesão foi baixa, mas a evolução antropométrica daqueles que aderiram à estratégia foi satisfatória, sugerindo que a combinação de ações multi- e interdisciplinares podem ser eficientes para o tratamento da obesidade.

OBJECTIVE: The goal of this study was to evaluate the adherence of overweight subjects to a food education program and their anthropometric history from March, 2005 to December, 2007. METHODS: Males and females aged 20 to 59 years from a public university community were included. The group received dietary advice, psychological support and performed special physical activities over a period of 10 weeks. Sociodemographic information, weight, height and waist circumference were collected to calculate body mass index at baseline and end of the program. RESULTS: One-hundred and sixteen 41-year old subjects enrolled in the program; most of them were married (70.7 percent), had a high school diploma (49.1 percent), and were females (73.3 percent). Half the subjects (50.0 percent) adhered to the program. The defaulters (65.5 percent) were overweight, with a mean body mass index of 33.4 kg/m². The body mass index of the participants who completed the program decreased from 32.5 to 31.2kg/m², with an average weight loss of 3.9 percent of their body weight; 37.9 percent lost >5.0 percent of their body weight. Waist circumference also decreased from 102.1 to 98.6cm. CONCLUSION: Although adherence was low, the anthropometric history of those who remained in the program was satisfactory, suggesting that a combination of multi- and interdisciplinary actions can be effective for treating obesity.

[Nutritional evaluation and prevalence of not transmissible chronic disease in elderly participating in an assistance program]. / Avaliação nutricional e prevalência de doenças crônicas não transmissíveis em idosos pertencentes a um programa assistencial.

The purpose of this study was to evaluate the nutritional state and the prevalence of not transmissible chronic disease in elderly, who were participating in an assistance program of the Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil. Socio-economical, anthropometric and biochemical variables, as well as systemic blood pressure were collected from 82 individuals between 60 and 87 years of age, 90,2 % of them female. According to the body mass index (BMI) 52,4% of the studied sample were overweight, 28,0% eutrophic and 19,5% underweight; 37,8% presented high body fat percentage (BF%). With regard to the relation BMI/BF%, 63,4% of the elderly with overweight, 12,5% of the eutrophic and 11,8% of the underweight presented high BF%. The waist-to-hip ratio revealed 40,2% at high risk and 12,2% at very high risk of developing cardiovascular disease. In addition, 22,0% had high blood pressure. The biochemical tests revealed that 39,3%, 39,3% and 3,3% presented higher plasma cholesterol, triglyceride and glucose levels respectively. There is a need for continuous nutritional education programs and monitoring of the nutritional and health status for improving the quality of life of the studied individuals.

Avaliação nutricional e prevalência de doenças crônicas não transmissíveis em idosos pertencentes a um programa assistencial / Nutritional evaluation and prevalence of not transmissible chronic disease in elderly participating in an assistance program

Objetivou-se avaliar o estado nutricional e a prevalência de doenças crônicas não transmissíveis em idosos que participavam de um programa assistencial da Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brasil. Foram coletadas variáveis socioeconômicas, antropométricas, bioquímicas e pressão arterial sistêmica de 82 indivíduos de 60 a 87 anos, sendo 90,2 por cento do sexo feminino. Encontrou-se 52,4 por cento de sobrepeso, 28,0 por cento de eutrofia e 19,5 por cento de baixo peso pelo IMC e 37,8 por cento apresentaram percentual de gordura corpórea ( por centoGC) elevada. Relacionando-se Índice de Massa Corpórea (IMC) com por centoGC, 63,4 por cento dos idosos com sobrepeso, 12,5 por cento dos eutróficos e 11,8 por cento dos com baixo peso apresentavam por centoGC elevado. A razão da circunferência da cintura e do quadril (RCQ) revelou 40,2 por cento em risco alto e 12,2 por cento em risco muito alto para o desenvolvimento de doenças cardiovasculares. Quanto à pressão arterial, 22,0 por cento eram hipertensos. Em relação aos exames bioquímicos, observou-se que 39,3 por cento, 39,3 por cento e 3,3 por cento dos idosos apresentavam valores plasmáticos elevados de colesterol, triglicerídeos e glicose, respectivamente. Programas de educação nutricional continuada e de monitoramento do estado nutricional e de saúde são necessários para melhoria da qualidade de vida destes indivíduos estudados.

The purpose of this study was to evaluate the nutritional state and the prevalence of not transmissible chronic disease in elderly, who were participating in an assistance program of the Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil. Socio-economical, anthropometric and biochemical variables, as well as systemic blood pressure were collected from 82 individuals between 60 and 87 years of age, 90,2 percent of them female. According to the body mass index (BMI) 52,4 percent of the studied sample were overweight, 28,0 percent eutrophic and 19,5 percent underweight; 37,8 percent presented high body fat percentage (BF percent). With regard to the relation BMI/BF percent, 63,4 percent of the elderly with overweight, 12,5 percent of the eutrophic and 11,8 percent of the underweight presented high BF percent. The waist-to-hip ratio revealed 40,2 percent at high risk and 12,2 percent at very high risk of developing cardiovascular disease. In addition, 22,0 percent had high blood pressure. The biochemical tests revealed that 39,3 percent, 39,3 percent and 3,3 percent presented higher plasma cholesterol, triglyceride and glucose levels respectively. There is a need for continuous nutritional education programs and monitoring of the nutritional and health status for improving the quality of life of the studied individuals.

Avaliação da qualidade microbiológica do leite pasteurizado tipo “C” comercializado na cidade de Alfenas, MG / Evaluation of the microbiological quality of pasteurized milk commercialized type

Este trabalho avaliou a qualidade microbiológica de leites pasteurizados tipo C, de três diferentes marcas, comercializadas em Alfenas – MG. A pesquisa envolveu a determinação da densidade, a determinação do NMP de coliformes fecais, contagem de aeróbios mesófilos e pesquisa de Salmonella sp. Uma das marcas analisadas apresentou um lote com resultados em desacordo com a legislação brasileira, estando, portanto, inadequado para o consumo.