Influence of social support and stressful life events on adherence to colorectal cancer screening using faecal occult blood test in Spanish medium risk population.

INTRODUCTION: Colorectal cancer (CRC) is the second cause of cancer-related deaths worldwide. Five-year survival rate in Spain is 57%. The most important prognostic factor is the stage of the tumor at the diagnosis. CRC can be early diagnosed, but the adherence to screening programs is low (<50%). This study aims to ascertain the influence of social support and stressful life events on the adherence to the population screening of CRC with fecal occult blood test in Spanish average risk population. METHODS: Multicenter case-control study. We conducted a simple random sampling among individuals invited to participate in the colorectal cancer screening program. We analyzed epidemiological and social variables associated with lifestyle and behavioral factors. We performed a descriptive and a bivariant analyses and a logistic regression analysis. RESULTS: Four hundred and eight patients (237 cases and 171 controls) were included. Multivariant analyses showed independent association between higher adherence to the screening program and older age (OR: 1.06; 95% CI: 1.01-1.10), stable partner (OR: 1.77, 95% CI: 1.08-2.89) and wide social network (OR: 1.68; 95% CI: 1.07-2.66). Otherwise, lower adherence was associated to perceiving barriers to participate in the program (OR: 0.92; 95% CI: 0.88-0.96). We find a statistically significant association between lower adherence and high impact stressful life events in the bivariant analyses, and the tendency was maintained (OR: 0.63, 95% CI: 0.37-1.08) in the multivariant. CONCLUSION: Social variables decisively influence the adherence to colorectal cancer screening. The implementation of social interventions that improve social support, reduce impact of stressful life events and the design of screening programs that decrease the perceived barriers, will contribute to increase the participation on these programs. Secondary, the colorectal cancer diagnosis will be made in early-stages with the consequent mortality reduction.

Health self-perception is associated with life-styles and comorbidities and its effect on mortality is confounded by age. A population based study.

Background: Health self-perception (HSP) is the individual and subjective concept that a person has of their state of health. Despite its simplicity, HSP is considered a valid and relevant indicator employed in epidemiological research and in professional practice as an overall measure of health. Objectives: (1) To describe and analyze the associations between HSP and demographic variables, lifestyle and diseases prevalent in a population and (2) to investigate the relationship between HSP and mortality. Materials and methods: In a primary care setting, we conducted a longitudinal study of a random populational sample of a Galician municipality, stratified by decade of life. A total of 1,516 adults older than 18 years, recruited by the 2013-2015 AEGIS study, were followed-up for more than 5 years. During the clinical interview, data were collected on lifestyle and prevalent diseases. The HSP was grouped into 2 categories (good/poor). The statistical analysis consisted of a logistic regression, Kaplan-Meier curves and Cox regression. Results: A total of 540 (35.6%) participants reported poor HSP. At the end of the follow-up, 78 participants had died (5.1%). The participants with increased age and body mass index and chronic diseases (anxiety, depression, ischemic heart disease, diabetes, and cancer) presented a poorer subjective health. A high level of physical activity and moderate alcohol consumption were associated with better HSP. A poorer HSP was associated with increased mortality, an association that disappeared after adjusting for the rest of the covariates (HR, 0.82; 95% CI 0.50-1.33). Conclusion: (1) Health self-perception is associated with age, lifestyle, and certain prevalent diseases. (2) A poorer HSP is associated with increased mortality, but this predictive capacity disappeared after adjusting for potential confounders such as age, lifestyle, and prevalent diseases.

[Analysis of ageism during the pandemic, a global elder abuse]. / Análisis del edadismo durante la pandemia, un maltrato global hacia las personas mayores.

Ageism is a form of abuse which has negative influence on elderly people. Although COVID-19 affects people of all ages, it has increased ageism effects, reducing the access of the elderly to different resources, including health system. Ageism is associated to cost overruns, poorer health and early mortality. From «GdT atención al mayor de semFYC¼ we make a series of proposals to decrease it based on community activities that favour intergenerational relationships and ageing education allowing a correct integration of the elderly on society.

Effectiveness and safety of tetanus vaccine administration by intramuscular vs. subcutaneous route in anticoagulated patients: Randomized clinical trial in primary care.

Design: Prospective, double-blind clinical trial comparing tetanus-diphtheria vaccine administration routes, intramuscular (IM) vs. subcutaneous (SC) injection, in patients with oral anticoagulants. ISRCTN69942081. Study population: Patients treated with oral anticoagulants, 15 health centers, Vigo (Spain). Sample size, 117 in each group. Outcome variables: Safety analysis: systemic reactions and, at the vaccine administration site, erythematic, swelling, hematoma, granuloma, pain.Effectiveness analysis: differences in tetanus toxoid antibody titers.Independent variables: route, sex, age, baseline serology, number of doses administered. Analysis: Following the CONSORT guidelines, we performed an intention-to-treat analysis. We conducted a descriptive study of the variables included in both groups (117 in each group) and a bivariate analysis. Fewer than 5% of missing values. Imputation in baseline and final serology with the median was performed. Lost values were assumed to be values missing at random. We conducted a descriptive study of the variables and compared routes. For safety, multivariate logistic regression was applied, with each safety criterion as outcome and the independent variables. Odds ratios (ORs) were calculated. For effectiveness, a generalized additive mixed model, with the difference between final and initial antibody titers as outcome. Due to the bimodal distribution of the outcome, the normal mixture fitting with gamlssMX was used. All statistical analyses were performed with the gamlss.mx and texreg packages of the R free software environment. Results: A previously published protocol was used across the 6-year study period. The breakdown by sex and route showed: 102 women and 132 men; and 117 IM and 117 SC, with one dose administered in over 80% of participants. There were no differences between groups in any independent variable. The second and third doses administered were not analyzed, due to the low number of cases. In terms of safety, there were no severe general reactions. Locally, significant adjusted differences were observed: in pain, by sex (male, OR: 0.39) and route (SC, OR: 0.55); in erythema, by sex (male, OR: 0.34) and route (SC, OR: 5.21); and in swelling, by sex (male, OR: 0.37) and route (SC, OR: 2.75). In terms of effectiveness, the model selected was the one adjusted for baseline serology.

Reflexiones en torno al papel de enfermería en los comités de bioética

Propósito/Contexto. En este artículo expondremos los diferentes tipos de comités de bioética y realizaremos un recorrido por su historia para luego adentrarnos en el rol de enfermería dentro de estos espacios. Metodología/Enfoque. Los comités de bioética son organismos que abordan aspectos dilemáticos de orden moral que se presentan en las ciencias de la salud, las ciencias biológicas y las políticas de salud innovadoras. Si bien la conformación debería ser multidisciplinar, con el objetivo de tener un enfoque amplio frente a las situaciones que se presentan, en la práctica no siempre sucede esto. Nos enfocaremos en analizar cómo es la experiencia de estos profesionales dentro de los comités y cuáles son las barreras que se encuentran al querer formar parte de estos equipos. Resultados/Hallazgos. Entre los hallazgos se encuentran las dificultades para la participación de los enfermeros en los comités por falta de tiempo, reconocimiento y apoyo institucional, de los compañeros y de los superiores, falta de formación específica y confusión entre problemas éticos y legales. También se encontró dispersión en la legislación argentina sobre el tema. Discusión/Conclusiones/Contribuciones. Es necesario ganar un mayor reconocimiento y apoyo por parte de las instituciones y de los colegas y superiores para que la participación de los profesionales en enfermería pueda ser efectiva.

Purpose/Context. This article presents different types of bioethics committees, looks through their history, and delves into the role of nursing in these settings. Methodology/Approach. Bioethics committees deal with moral dilemmas arising in health sciences, biological sciences, and innovative health policies. While their structure should be multidisciplinary for a broad approach to emerging situations, it does not always happen in practice. We will focus on analyzing what nurses' experience is like within committees and the barriers they face when joining these teams. Results/Findings. We found difficulties in the participation of nurses in committees due to a lack of time, recognition, and support by institutions, colleagues, and superiors, no specific training, and confusion between ethical and legal issues. A dispersion was also detected in Argentine legislation on the subject. Discussion/Conclusions/Contributions. Greater recognition and support from institutions, colleagues, and superiors is necessary for the participation of nursing professionals to be effective.

Objetivo/contexto. Neste artigo exporemos os diferentes tipos de comitês de bioética e realizaremos um percurso por sua história para logo adentrar-nos no rol de enfermagem dentro destes espaços. Metodologia/Abordagem. Os comitês de bioética são organismos que abordam aspectos dilemáticos de ordem moral que se apresentam nas ciências da saúde, nas ciências biológicas e nas políticas de saúde inovadoras. Embora a conformação deveria ser multidisciplinar, com o objetivo de ter uma abordagem ampla diante das situações que se apresentam, na prática nem sempre isso acontece. Vamos nos concentrar em analisar como é a experiência destes profissionais dentro dos comitês e quais são as barreiras diante das que se encontram ao querer fazer parte destas equipes. Resultados/Descobertas. Entre as descobertas encontram-se as dificuldades para a participação dos enfermeiros nos comitês por falta de tempo, reconhecimento e apoio institucional, dos companheiros e dos superiores, falta de formação específica e confusão entre problemas éticos e legais. Também encontrou se dispersão na legislação argentina sobre o tema. Discussão/Conclusões/Contribuições. É necessário ganhar um maior reconhecimento e apoio por parte das instituições e dos colegas e superiores para que a participação dos profissionais de enfermagem possa ser efetiva.

An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study.

BACKGROUND: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. OBJECTIVE: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). METHODS: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. RESULTS: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). CONCLUSIONS: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic.

[Making balances between the risks and benefits of pharmacological treatment in dementia, chronic pain and anticoagulation in elderly persons]. / Haciendo equilibrios entre los riesgos y beneficios del tratamiento farmacológico en demencia, dolor crónico y anticoagulación en personas mayores.

In dementia, specific drugs and psychotropic drugs used for psychotic and behavioral symptoms have limited efficacy. Adverse effects may be important given the age and comorbidity of the patients. It is necessary, frequently, its withdrawal, planned together with the family, monitoring the response and offering non-pharmacological treatment alternatives. Chronic pain is suffered by 25-76% of the elderly who live in a community and is more frequent in women. The treatment is multidisciplinary, establishing realistic objectives, individualizing it, starting with lower doses of drugs and continuously reevaluating to control side effects and to get the correct level of analgesia. The prevalence of atrial fibrillation increases with age and is underdiagnosed. ACO is recommended with dicoumarin or direct oral anticoagulants not antagonists of vitamin K, in patients with AF older than 65 years unless contraindicated, to reduce embolic risk, confirming subgroup analyzes similar efficacy in prevention of stroke.

Patient safety and nursing implication: Survey in Catalan hospitals. / Seguridad del paciente e implicación de las enfermeras: encuesta en los hospitales de Cataluña.

OBJECTIVE: This study aims to describe the implementation of the patient safety (PS) programs in catalan hospitals and to analyze the level of nursing involvement. METHOD: Multicenter cross-sectional study. To obtain the data two questionnaires were developed; one addressed to the hospital direction and another to the nurse executive in PS. The survey was distributed during 2013 to the 65 acute care hospitals in Catalonia. RESULTS: The questionnaire was answered by 43 nursing directors and 40 nurse executive in PS. 93% of the hospitals responded that they had a PS Program and 81.4% used a specific scoreboard with PS indicators. The referent of the hospital in PS was a nurse in 55.8% of the centres. 92.5% had a system of notification of adverse effects with an annual average of 190.3 notifications. In 86% of the centres had a nurse involved in the PS program but only in the 16% of the centres the nurse dedication was at full-time. The nurse respondents evaluate the degree of implementation of the PBS program with a note of approved and they propound as improvement increase the staff dedicated to the PS and specific academic training in PS. CONCLUSIONS: The degree of implementation of programs for patient safety is high in Catalan acute hospitals, while the organizational structure is highly diverse. In more than half of the hospitals the PS referent was a nurse, confirming the nurse involvement in the PS programs.

Microalgae as a safe food source for animals: nutritional characteristics of the acidophilic microalga Coccomyxa onubensis.

BACKGROUND: Edible microalgae are marine or fresh water mesophilic species. Although the harvesting of microalgae offers an abundance of opportunities to the food and pharmaceutical industries, the possibility to use extremophilic microalgae as a food source for animals is not well-documented. OBJECTIVE: We studied the effects of dietary supplementation of a powdered form of the acidophilic microalga Coccomyxa onubensis on growth and health parameters of laboratory rats. METHOD: Four randomly organized groups of rats (n=6) were fed a standard diet (Diet 1, control) or with a diet in which 0.4% (Diet 2), 1.25% (Diet 3), or 6.25% (Diet 4) (w/w) of the standard diet weight was substituted with dried microalgae powder, respectively. The four groups of animals were provided ad libitum access to feed for 45 days. RESULTS: C. onubensis biomass is rich in protein (44.60% of dry weight) and dietary fiber (15.73%), and has a moderate carbohydrate content (24.8%) and a low lipid content (5.4%) in which polyunsaturated fatty acids represent 65% of the total fatty acid. Nucleic acids are present at 4.8%. No significant difference was found in growth rates or feed efficiency ratios of the four groups of rats. Histological studies of liver and kidney tissue revealed healthy organs in control and C. onubensis-fed animals, while plasma hematological and biochemical parameters were within healthy ranges for all animals. Furthermore, animals fed a microalgae-enriched diet exhibited a statistically significant decrease in both blood cholesterol and triglyceride levels. The blood triglyceride content and very low density lipoprotein-cholesterol levels decreased by about 50% in rats fed Diet 4. CONCLUSIONS: These data suggest that C. onubensis may be useful as a food supplement for laboratory animals and may also serve as a nutraceutical in functional foods. In addition, microalgae powder-supplemented diets exerted a significant hypocholesterolemic and hypotriglyceridemic effect in animals.

Endocarditis infecciosa nosocomial sobre válvula nativa mitral por Staphylococcus lugdunensis / Nosocomial mitral valve endocarditis caused by S. lugdunensis

Se presenta el caso clínico de un paciente de 53 años que tras una intervención neuroquirúrgica (laminectomía) presentó cuadro séptico. Se identificó la presencia de S. lugdunensis en la herida operatoria. El ecocardiograma transesofágico demostró rotura valvular mitral, vegetaciones e insuficiencia mitral masiva. El paciente se recuperó satisfactoriamente tras reemplazo valvular por prótesis mecánica.

A 53 year old man developed sepsis following laminectomy for spinal disease. S lugdunensis was identified from the surgical wound. Trans esophageal echocardiography demonstrated mitral valve rupture, vegetations and severe mitral regurgitation. The patient successfully recovered following mitral valve replacement with a mechanical prosthesis.

Color, phenolics, and antioxidant activity of blackberry (Rubus glaucus Benth.), blueberry (Vaccinium floribundum Kunth.), and apple wines from Ecuador.

Seventy wines were produced in Ecuador under different processing conditions with local fruits: Andean blackberries (Rubus glaucus Benth.) and blueberries (Vaccinium floribundum Kunth.) and Golden Reinette apples. Wines were evaluated for antioxidant activity (AA) using the radical scavenging capacity (DPPH) method, total phenolic content (TPC) using the Folin-Ciocalteu method, total monomeric anthocyanins (TMAs) using the pH differential test, and color parameters using VIS-spectrophotometry. For blackberry wines, ellagitannins and anthocyanins were also analyzed using high-performance liquid chromatography with diode-array detection (HPLC-DAD). Apples wines (n = 40) had the lowest TPC (608 ± 86 mg/L) and AA (2.1 ± 0.3 mM Trolox). Blueberry wines (n = 12) had high TPC (1086 ± 194 mg/L) and moderate AA (5.4 ± 0.8 mM) but very low TMA (8 ± 3 mg/L), with a color evolved toward yellow and blue shades. Blackberry wines (n = 10) had the highest TPC (1265 ± 91 mg/L) and AA (12 ± 1 mM). Ellagitannins were the major phenolics (1172 ± 115 mg/L) and correlated well with AA (r = 0.88). Within anthocyanins (TMA 73 ± 16 mg/L), cyanidin-3-rutinoside (62%) and cyanidin-3-glucoside (15%) were predominant. Wines obtained by cofermentation of apples and blackberries (n = 8) showed intermediate characteristics (TPC 999 ± 83 mg/L, AA 6.2 ± 0.7 mM, TMA 35 ± 22 mg/L) between the blackberry and blueberry wines. The results suggest that the Andean berries, particularly R. glaucus, are suitable raw materials to produce wines with an in vitro antioxidant capacity that is comparable to red grape wines.

Dried human amniotic membrane as an antiadherent layer for intraperitoneal placing of polypropylene mesh in rats.

BACKGROUND: Intraabdominal peritoneal onlay polypropylene (PP) mesh repair of incisional hernia has the potential risk of adhesions, bowel obstructions, and intestinal fistulae. Fresh or cryopreserved human amniotic membrane (HAM) has been tested as an antiadherent layer in animals, with excellent outcomes. However, it has disadvantages: it is difficult to handle, and it is expensive to store. Another processing method is available: drying in a laminar flow hood and gamma irradiation. Because this method impairs the membrane's cell viability, it may affect its antiadherent properties. However, such properties may also result from the collagen matrix and its basement membrane, which remain after drying. The aim of the present study was to asses dried irradiated HAM in adhesion prophylaxis in rats. METHODS: Twenty-four female rats were randomized into two groups. In the first group (control group), PP meshes were placed in the intraabdominal space, and in the second group (treatment group), PP meshes coated with HAM were used. Animals were killed on day 30 after surgery. Adhesions and parietal prosthetic incorporation were assessed macroscopically and expressed as the average percentage of the covered area. The portion of the abdominal wall was then resected for histological testing. RESULTS: The treatment group had a significantly higher percentage of adhesions and parietal incorporation compared with the control group (p = 0.003). Histological testing showed a higher inflammatory response in the treatment group, with an intense foreign body reaction. CONCLUSIONS: Dried irradiated HAM does not prevent adhesion formation in intraabdominal peritoneal onlay PP mesh repair in rats. Any use of this biomaterial in adhesion prophylaxis must be undertaken respecting graft cell viability as much as possible.

Structural characteristics of phosphoramide derivatives as urease inhibitors. Requirements for activity.

Taking as a reference the structural characteristics of a set of compounds that act as jack bean ( Canavalia ensiformis) urease inhibitors, namely, phenylphosphorodiamidate (PPD), N- n-butylthiophosphorictriamide (NBPT), and N- n-butylphosphorictriamide (NBPTO), we have studied the structure-activity relationships of a series of phosphoramide derivatives for which the activity as urease inhibitors in both in vitro and in vivo assays is known. Molecular modeling studies were carried out, and the results highlighted the relevance of characteristics such as the presence of intramolecular hydrogen bonds, the volume of the fragment involved in the enzyme interaction, and the degree of conformational freedom as well as the HOMO orbital and atomic orbital contributions to the HOMO orbital, electron density, and PEM distributions on the activity of these compounds as urease inhibitors. These data, along with the preliminary docking study carried out, allow us to propose a union mode to the active site of the enzyme for these compounds.

Gastric rupture from blunt abdominal trauma.

Gastric rupture following blunt abdominal trauma is rare, with a reported incidence of 0.02-1.7%. Road traffic accidents remain the most frequent cause. The factors most often implicated in the genesis of this entity are: a history of a recent meal, trauma to the left side of the body and an inappropriate use of seat belts. Splenic injury is generally the most common associated injury. The high morbidity and mortality are directly related to the number of associated injuries, delays in diagnosis and the development of intraabdominal sepsis. We performed a retrospective study of 1300 patients with blunt trauma to the abdomen from 1973 to 2001. Seven patients sustained a gastric rupture (five men and two women). The following associated characteristics were analysed: mechanism of injury, clinical presentation, possible associated injuries and postoperative complications, diagnosis methods and surgical treatment. We found an incidence of gastric rupture of 0.5%. We emphasise an early diagnosis and aggressive surgical treatment as a key to decreasing the mortality and morbidity from this injury. However, in our series, the morbidity is mainly from associated injuries.