Benefits and barriers to accreditation of HPB center and fellowship programs in Europe: a strength-weakness-opportunity-and-threats (SWOT) analysis by an E-AHPBA-ESSO-UEMS ad hoc working committee.

BACKGROUND: Training in HPB surgery lacks uniformity across regions covered by the E-AHPBA. Accreditation has been in place for centers and fellowship programs, but with low uptake. The decision whether to continue, change or cease such accreditation is being discussed. Thus, a strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted. METHODS: A mixed-methods, cross-sectional study among stakeholders in E-AHPBA, ESSO and UEMS under the E-AHPBA executive council was founded, ensuring representation by gender and geographic distribution. RESULTS: Responses were collected from across E-AHPBA regions, with response from 15 of 24 subchapters. The most frequent and recurring themes are presented in a SWOT matrix which allows for paired evaluations of factors deemed to be helpful (Strengths and Opportunities), those that are harmful (Weaknesses and Threats). CONCLUSION: This study identified both helpful and harmful effects to an accreditation process of HPB centers or HPB fellowship training across the E-AHPBA membership region. Formal accreditation of centers is not within the scope, nor jurisdiction nor financial capacity for E-AHPBA in the current situation. A strong interest in formal HPB training should be capitalized into E-AHPBA strategic planning towards a structured accreditation system for HPB fellowship programs or HPB training tracks.

One-step electrospun scaffold of dual-sized gelatin/poly-3-hydroxybutyrate nano/microfibers for skin regeneration in diabetic wound.

This work aimed to implement an electrospinning protocol that allows simultaneous production of micro- and nanofibers in a single scaffold to mimic the extracellular matrix (ECM) combining biodegradable polymers and proteins, and to evaluate its capability to manage diabetic wounds. Poly-3-hydroxybutyrate (PHB) and gelatin (Ge) were chosen to prepare micro- and nanofibers, respectively. Electrospinning conditions were optimized testing various polymer concentrations, voltages, and flow rates. One-step dual-size fibers were obtained from 8%w/v PHB in chloroform (microfibers, 1.25 ± 0.17 µm) and 30%w/v gelatin in acetic acid (75%w/v) (nanofibers, 0.20 ± 0.04 µm), at 0.5 mL/h and 25 kV. A chemical characterization, swelling, hydrophilicity of scaffolds made of PHB-microfibers, Ge-nanofibers and their combination (Ge-PHB) were evaluated before and after crosslinking with genipin. All scaffolds showed excellent fibroblasts viability and attachment after incubation for 1, 3, and 7 days, and low levels of hemolysis. In vivo wound healing was evaluated in diabetic rats for 21 days. Ge-containing scaffolds promoted faster healing. The wounds treated with the Ge-PHB scaffolds proved to be in a late proliferative stage showing higher content of hair follicles and sweat glands and lower content in fibroblast compared with the control wounds.

The Impact of Cultural Dissonance and Acculturation Orientations on Immigrant Students' academic performance / El impacto de la disonancia cultural y las orientaciones de aculturación en el rendimiento académico de estudiantes inmigrantes

Abstract Prior research has documented meaningful differences between school performance of immigrant and native students. Multicultural education has been associated with academic failure of foreign students. The aim of this study was to examine the impact of a set of psychosocial variables on the perceived academic achievement of first generation immigrant adolescents from public secondary schools in Northern Spain. Results showed that 46% of the variability in foreign students' perceived academic performance was explained by home-school cultural dissonance. We also explored the impact of acculturation orientation to separation, perception of discrimination from teachers, school adjustment, and psychological well-being in academic performance. Any multicultural education context should take into account psychosocial adjustment, given its influence on academic performance of all students.

Resumen Se han hallado diferencias significativas entre el rendimiento académico de los inmigrantes y el de los estudiantes nativos. Sin embargo, hay una escasa evidencia acerca de los aspectos psicosociales de este fenómeno. El objetivo de este estudio fue examinar el impacto de un conjunto de variables psicosociales: disonancia cultural y orientaciones de aculturación en el rendimiento académico percibido de adolescentes inmigrantes de primera generación de centros de Educación Secundaria en el Norte de España. Los resultados mostraron que alrededor del 46% de la variabilidad en el rendimiento era explicada por la disonancia cultural entre escuela y hogar. Cualquier contexto de educación multicultural ha de tomar en consideración el ajuste psicosocial, dada su influencia en el rendimiento académico de los estudiantes.

La predicción afectiva positiva como factor de protección socio-emocional en madres transnacionales antes y después de la reagrupación familiar: relación con la satisfacción con la vida, regulación emocional, soledad social, resiliencia y estrés / Positive affective prediction as a factor of social emotional protection in transnational mothers before and after family reunification: relationship with life satisfaction, emotional regulation, social loneliness, resilience and stress

La predicción afectiva es un proceso de sobrestimación emocional previo a un acontecimiento. Suele asociarse a altas expectativas y a un coste socioemocional posterior. Para estudiar las diferencias entre las predicciones afectivas antes y después de la reagrupación familiar transnacional, se analizan a 188 madres inmigrantes residentes en España, bien expectantes por reagrupar, bien reagrupadas con sus hijos. Se hipotetiza y confirma la existencia de diferencias estadísticamente significativas entre las mujeres en situación antes y después en relación a satisfacción con la vida, control emocional, resiliencia, estrés y soledad social. Además, se, resalta la función positiva del pronóstico afectivo en el ajuste socio cognitivo de las madres transnacionales. Previamente al evento, éste media entre la satisfacción y la soledad social, y después de la reagrupación, tiene una función mediadora entre la satisfacción vital y el descontrol emocional asociado al encuentro lo que expresa su papel protector en la conciliación familiar.

Affective forecasting is an emotional process of overestimation of the future. Previous studies indicate that if these expectations are excessive and do not coincide with reality they can lead to a high socio emotional cost after the event. In order to analyze the differences in affective predictions before and after transnational reunification 188 immigrant mothers resident in Spain were divided in two groups according to whether or not they had regrouped with their children. Both groups were homogeneous in socio-demographics (age, number of children, education level, employment status, and reasons for migrating). The results confirm the existence of significant differences between emotional experience, before and after reunification. It was found that affective forecasting played a positive role before and after the event for the variables affecting socio-cognitive regulation in both groups (well-being, emotional regulation, resilience and stress), but in different manner during the process of transnational family reunification.

Improving Communication between Physicians and Their Patients through Mindfulness and Compassion-Based Strategies: A Narrative Review.

Communication between physicians and patients is a key pillar of psychosocial support for enhancing the healing process of patients and for increasing their well-being and quality of life. Physicians and other health professionals might benefit from interventions that increase their self-care, awareness, compassion, and other-focused concern, and reduce the chances of distress and burnout. There is substantial evidence for the contribution of different management strategies to achieve these aims. The goal of this article is to review the potential effect of mindfulness and compassion-based strategies for the improvement of physician-patient interactions. The acquisition of the necessary skills by physicians requires continuous education. Future research will be useful for identifying more evidence on the cost-effectiveness of this type of intervention.

Effect of a Mindfulness Training Program on the Impulsivity and Aggression Levels of Adolescents with Behavioral Problems in the Classroom.

Objective: The aim of the present study was to analyze the effects of a mindfulness training psycho-educative program on impulsivity and aggression levels in a sample of high school students. Methods: A randomized controlled trial with pre-test-post-test measurements was applied to an experimental group and a control group (waiting list). The Barratt Impulsivity Scale (BIS-11) Patton et al. (1995) and the Aggression Questionnaire (Buss and Perry, 1992) were used. Results: Statistical analyses showed a significant decrease in the levels of impulsivity and aggressiveness in the experimental group compared with the control group. These results have important implications for improving the level of academic engagement and self-efficacy of students and for reducing school failure. Conclusion: This is one of the first studies showing the effectiveness of mindfulness training at reducing impulsive and aggressive behaviors in the classroom. The efficacy of mindfulness-based programs is emphasized.

The State of the Art of Group Psychotherapy in Spain.

(1) What is the history and the theoretical orientation of group therapy in Spain? (2) How is training organized? (3) What role does group psychotherapy play in the health system in Spain? (4) What is the relationship between group psychotherapy research and clinical practice in Spain? (5) What topics can be identified as unique to therapy groups in Spain? (6) How are group-related issues important within the social background of Spain? and (7) What does group work hold for the future? Although not even a century has passed since the birth of this discipline, there have already been many events associated with the management of power and knowledge, the development of a sense of community, and the evolution of the political and social life of our country. Group therapy training is still evolving and is properly supported and accredited by prestigious institutions. In the 2013 Symposium of the Spanish Society of Group Psychotherapy and Group Techniques (SEPTG), the need for joint group theories and techniques within the profession's activities was clearly highlighted. Further, the enthusiasm of group psychotherapists to open themselves to specific social perspectives (health, education, community prevention, organizations) is a way of encouraging society to untangle conscious and unconscious knots that are created in social interaction.

Enhancing relaxation states and positive emotions in physicians through a mindfulness training program: A one-year study.

Previous research on mindfulness has focused mainly on stress-related negative symptoms and short-term effects. In contrast, the present article focuses on the impact of a mindfulness-based stress reduction (MBSR) program on improving well-being (i.e. relaxation states and related positive emotions) in a longitudinal study for a period of one year. A randomized controlled trial in a sample of 42 physicians was used. The intervention group participated in an 8-week MBSR program, with an additional 10-month maintenance period and completed measures of mindfulness and relaxation at pre-intervention, post-intervention and after 10 months. Heart rate measures were also obtained. Significant improvements in favor of the experimental group compared with the control group on the levels of mindfulness and relaxation (including positive emotional states, such as at ease/peace, renewal, energy, optimism, happiness, acceptance, and even transcendence) were obtained after eight weeks. Remarkably, change magnitudes (effect size) significantly increased at the end of the maintenance period after a year, especially for mindfulness and positive energy. Additionally, heart rate significantly decreased for the intervention group and maintained a year after the beginning of the treatment. Results are relevant in terms of practical consequences for improving health and well-being in this population and also in terms of cost-efficiency.

Acceptability and Effectiveness of a Long-Term Educational Intervention to Reduce Physicians' Stress-Related Conditions.

INTRODUCTION: This study aimed to test the acceptability and effectiveness of a two-phase mindfulness-based stress reduction program (8-week initial treatment plus a 10-month maintenance phase) in alleviating work stress-related symptoms (i.e., burnout, heart rate [HR], and blood pressure [BP]) in a sample of 42 physicians. METHODS: A randomized controlled trial and a simple pre-post design were used, respectively, for each of the two phases of the study. Outcome measures included the Five Facets of Mindfulness Questionnaire and the Maslach Burnout Questionnaire. HR and BP measures were also obtained in the experimental group by means of a digital monitor. RESULTS: After the initial 8 weeks of treatment, significant improvements for the experimental group in mindfulness levels and reductions in emotional exhaustion, HR, and BP were obtained. Effect sizes (Cohen d) significantly increased over the 10-month maintenance period, especially for mindfulness and systolic BP. Acceptance was notably high (low attrition rate and high compliance with program activities). DISCUSSION: Outcomes are significant in terms of practical consequences for reducing and controlling risks of developing burnout and cardiovascular disease in this population and enhancing well-being in life.

Evaluation of marine algae Undaria pinnatifida and Porphyra purpurea as a food supplement: composition, nutritional value and effect of intake on intestinal, hepatic and renal enzyme activities in rats.

BACKGROUND: There is a long tradition in Eastern countries of consuming seaweeds, although demand for these organisms has also increased in Western countries. However, knowledge of the effects of consumption of algae is limited. In this study the proximate composition and amino acid profile of Undaria pinnatifida (Harvey) Suringar (wakame) and Porphyra purpurea (Olivi) De Toni (nori) were determined. The effects of feeding diets containing 100 g kg(-1) of wakami or nori for 4 weeks on food intake, growth, protein efficiency ratio, diet conversion ratio and some organ weights in growing rats were evaluated. The effects on intestinal, hepatic and renal enzyme activities were also studied. RESULTS: Both algae are a good source of protein, particularly nori, and contain essential amino acids. There was no effect of alga consumption on trophic balance. Intestinal disaccharidase and hepatic and renal γ-glutamyl transpeptidase activities were lower in alga-fed rats than in the control group, while intestinal leucine aminopeptidase activity was higher in rats fed algae. CONCLUSION: Both seaweeds are a good source of protein and carbohydrates and contain all essential amino acids. The effects of the two algae on enzyme activities were similar. The inhibition of intestinal disaccharidase activity by seaweed ingestion could be interesting in patients with altered glucose homeostasis.

Stimuli-responsive networks grafted onto polypropylene for the sustained delivery of NSAIDs.

Co-polymers of N-isopropyl acrylamide (NIPAAm) and N-(3-aminopropyl) methacrylamide hydrochloride (APMA) were grafted on polypropylene (PP) films by means of a γ-ray pre-irradiation method, with the aim of developing medical devices able to load non-steroidal anti-inflammatory drugs (NSAIDs) and to control their release under physiological conditions. The NIPAAm/APMA molar ratios in the grafts, estimated by Fourier transform infrared attenuated total reflection spectroscopy and X-ray photoelectron spectroscopy analysis, were 4.76 and 1.23 for PP-g-(1M NIPAAm-r-0.5M APMA) and PP-g-(1M NIPAAm-r-1M APMA), respectively. By varying the reaction time, different degrees of grafting were achieved, while the monomer ratio was kept constant. PP-g-(NIPAAm-r-APMA) films showed temperature-responsive swelling, smaller friction coefficients, hemolysis and thrombogenicity and higher cell compatibility, did not elicit secretion of cytokines, and took up remarkable amounts of diclofenac and ibuprofen and sustained delivery for several hours in phosphate buffer, pH 7.4. Coating with carboxymethyl dextran of diclofenac-loaded PP-g-(NIPAAm-r-APMA) films caused a minor discharge of the drug but did not alter the drug release rate.

Evaluation of the marine alga Ulva rigida as a food supplement: effect of intake on intestinal, hepatic, and renal enzyme activities in rats.

The use of seaweeds as a food is more widespread in Eastern than in Western countries, although demand for these plants has increased in the West because their possible usefulness as dietary supplements. However, very little is known about the effects of regular consumption of algae. The aim of the present study was to determine the composition of Ulva rigida and to evaluate the effects of dietary supplementation of the diet with 10% alga for 4 weeks on dietary intake, growth, protein efficiency ratio, diet conversion ratio, and some organ weights in growing male rats. We also studied the effect of inclusion of the alga in the diet on intestinal, hepatic, and renal enzymatic activities. U. rigida was found to be a good source of protein and carbohydrates. Food intake was higher in the U. rigida group than in the control group, but ingestion of alga did not have any effect on the other trophic parameters. The intestinal disaccharidase and leucine aminopeptidase activities were lower in rats fed with alga than in control rats, but γ-glutamyl transpeptidase activity was higher in the kidneys of alga-fed rats than in control rats. U. rigida contains high amounts of protein, carbohydrates, vitamins, and minerals and low amounts of lipids. Analysis of the amino acid composition revealed good-quality protein. The addition of alga to the diet inhibited disaccharidase activities, which suggested that alga consumption could be useful in some chronic disorders associated with pertubations of glucose homeostasis caused by carbohydrate absorption.

Composition, nutritional aspects and effect on serum parameters of marine algae Ulva rigida.

BACKGROUND: Algae are commonly consumed in Asia and have also gained popularity in Europe. However, data on the bioavailability of their components are limited. The present study was designed to determine the composition of Ulva rigida and the effects of inclusion of 10% of the algae in a standard diet for 4 weeks on nutritive value and serum parameters in order to consider the usefulness of Ulva as a dietary supplement. RESULTS: Ulva rigida is rich in protein, carbohydrates, fibre, vitamins and minerals and has a low lipid content. Analysis of the amino acid composition revealed good-quality protein. The algae were well accepted by experimental animals and did not significantly change nutritional parameters but reduced LDL cholesterol. CONCLUSIONS: Ulva rigida is an excellent source of nutrients and could improve a balanced diet. Further studies are required to research the potential of the seaweed as a natural source of bioactive compounds.

[Leiomyomatosis peritonealis disseminata]. / Leiomiomatosis peritoneal diseminada.

Leiomyomatosis peritonealis disseminata is an uncommon condition characterized by subperitoneal proliferation of benign nodules mainly composed of benign smooth muscle cells. This entity generally appears in premenopausal women and hormonal influences may play a role in its pathogenesis. The macroscopic appearance mimics peritoneal carcinomatosis. The characteristic clinical course is asymptomatic and diagnosis is only feasible after microscopic examination. To date, less than 100 cases have been reported in the literature. We report the case of a 40-year-old woman who underwent surgery in our department.