Analyzing the relative importance of habitat quantity and quality for boosting pollinator populations in agricultural landscapes.

To increase pollinator populations, international policy targets minimum levels of seminatural habitat cover, but it is unknown whether improving the quality of existing habitats could bring similar benefits without the need of reducing cropland area. Using data we collected in 26 Italian agricultural landscapes during the entire flying season, we explored the relative importance of habitat quantity (seminatural habitat cover) and quality (flower availability) on pollinator densities in seminatural habitats. We obtained transect-based counts and estimated the effect of habitat quantity (proportion of seminatural habitat) and quality (flower cover and richness) on wild bee and hoverfly densities. We used the relationships revealed in the data to simulate pollinator population sizes in landscapes with varying habitat quantity and quality. Wild bee densities were only related to flower availability, whereas hoverfly densities were additionally related to seminatural habitat cover. We found that in complex agricultural landscapes (above 15% seminatural habitat cover), improving habitat quality increased pollinator populations more effectively than increasing habitat quantity. However, increasing habitat quantity was by far the most effective approach for boosting pollinator populations in simple landscapes.

Análisis de la importancia relativa de la cantidad y calidad del hábitat para incrementar las poblaciones de polinizadores en los paisajes agrícolas Resumen Las políticas internacionales buscan que existan niveles mínimos de cobertura seminatural del hábitat para incrementar las poblaciones de polinizadores y se desconoce si mejorar la calidad de los hábitats existentes podría brindar beneficios similares sin tener que reducir el área de cultivo. Usamos datos recolectados en 26 paisajes agrícolas de Italia durante la temporada de vuelo para analizar la importancia relativa de la cantidad (cobertura de hábitat seminatural) y calidad (disponibilidad de flores) del hábitat para la densidad de polinizadores en los hábitats seminaturales. Obtuvimos conteos basados en transectos y estimamos el efecto de la cantidad (proporción del hábitat seminatural) y calidad (riqueza y cobertura de flores) del hábitat sobre la densidad de las abejas silvestres y los sírfidos. Usamos la relación revelada por los datos para simular el tamaño poblacional de los polinizadores en los paisajes con diferente calidad y cantidad de hábitat. La densidad de las abejas silvestres sólo se relacionó con la disponibilidad de flores cuando la densidad de sírfidos se relacionó con la cobertura del hábitat seminatural. Descubrimos que en los paisajes agrícolas complejos (por encima del 15% de cobertura de hábitat seminatural) cuya calidad mejoraba, las poblaciones de polinizadores incrementaban de manera más eficiente que cuando se mejoraba la cantidad. Sin embargo, incrementar la cantidad del hábitat fue por mucho la estrategia más efectiva para acrecentar las poblaciones de polinizadores en paisajes simples.

Quantifying regulatory limits for multiple stressors in an open and transparent way.

Biodiversity is confronted globally by multiple stressors. Environmental policies must regulate these stressors to achieve targets, but how should that be done when the outcomes of limits on one stressor are contingent on other stressors, about which there is imperfect knowledge? Deriving regulatory frameworks that incorporate these contingencies is an emerging challenge at the science-policy interface. To be fit for implementation, these frameworks need to facilitate the inherently sociopolitical process of policy implementation and account transparently for uncertainty, such that practitioners and other stakeholders can more realistically anticipate the range of potential outcomes to policy. We developed an approach to quantify stressor limits that explicitly accounts for multistressor contingencies. Using an invertebrate data set collected over 30 years throughout New Zealand, we combined ecological and ecotoxicological models to predict biodiversity loss as a function of one stressor, treating multistressor contingencies as a form of uncertainty about the outcomes of limits on that stressor. We transparently accounted for that uncertainty by presenting regulatory limits as bands bounded between optimistic and pessimistic views that practitioners may have about the local context within which limits are applied. In addition to transparently accounting for uncertainties, our framework also leaves room for practitioners to build stakeholder consensus when refining limits to suit different local contexts. A criticism of this open, transparent approach is that it creates too much scope for choosing limits that are lenient on polluters, paralyzing on-the-ground management of multiple stressors, but we demonstrate that this is not necessarily the case.

Cuantificación abierta y transparente de los límites regulatorios para varios estresantes Resumen La biodiversidad enfrenta a múltiples estresantes en todo el mundo. Las políticas ambientales deben regularlos para alcanzar los objetivos fijados, pero ¿cómo hacerlo cuando los resultados de la limitación de un estresante dependen de otros factores, de los que se conoce muy poco? La elaboración de marcos reguladores que incorporen estas contingencias es un reto emergente en la interfaz ciencia­política. Para aplicar estos marcos, se debe facilitar el proceso sociopolítico inherente a la aplicación de políticas y tener en cuenta de forma transparente la incertidumbre, de modo que los profesionales y otras partes interesadas puedan anticipar de forma más realista la variedad de posibles resultados de las políticas. Desarrollamos un método para cuantificar los límites de los estresantes que considera explícitamente las contingencias de múltiples factores. Usamos un conjunto de datos sobre invertebrados recolectados durante 30 años en toda Nueva Zelanda. Después combinamos modelos ecológicos y eco­toxicológicos para predecir la pérdida de biodiversidad en función de un estresante y tratamos las contingencias de múltiples estresantes como una forma de incertidumbre sobre los resultados de los límites de ese mismo estresante. Explicamos esa incertidumbre de forma transparente con los límites normativos como bandas delimitadas entre las opiniones optimistas y pesimistas que los profesionales pueden tener sobre el contexto local en el que se aplican los límites. Además de hacer lo anterior, nuestro marco también deja margen para que los profesionales lleguen a un consenso con las partes interesadas a la hora de perfeccionar los límites para adaptarlos a los distintos contextos locales. Una crítica a este enfoque abierto y transparente crea demasiado margen para elegir límites indulgentes con los contaminadores, paralizando la gestión sobre el terreno de múltiples estresantes, pero demostramos que no es necesariamente así.

Building pondscapes for amphibian metapopulations.

The success of ponds constructed to restore ecological infrastructure for pond-breeding amphibians and benefit aquatic biodiversity depends on where and how they are built. We studied effects of pond and landscape characteristics, including connectivity, on metapopulation dynamics of 12 amphibian species in Switzerland. To understand the determinants of long-term occupancy (here summarized as incidence), environmental effects on both colonization and persistence should be considered. We fitted dynamic occupancy models to 20 years of monitoring data on a pond construction program to quantify effects of pond and landscape characteristics and different connectivity metrics on colonization and persistence probabilities in constructed ponds. Connectivity to existing populations explained dynamics better than structural connectivity metrics, and simple metrics (distance to the nearest neighbor population, population density) were useful surrogates for dispersal kernel-weighted metrics commonly used in metapopulation theory. Population connectivity mediated the persistence of conservation target species in new ponds, suggesting source-sink dynamics in newly established populations. Population density captured this effect well and could be used by practitioners for site selection. Ponds created where there were 2-4 occupied ponds within a radius of ∼0.5 km had >3.5 times higher incidence of target species (median) than isolated ponds. Species had individual preferences regarding pond characteristics, but breeding sites with larger (≥100 m2) total water surface area, that temporarily dried, and that were in surroundings with maximally 50% forest benefitted multiple target species. Pond diversity will foster amphibian diversity at the landscape scale.

Construcción de estanques para meta poblaciones de anfibios Resumen El éxito de los estanques construidos para restaurar la infraestructura ecológica para los anfibios que allí se reproducen y para beneficiar la biodiversidad acuática depende de en dónde y cómo se construyen. Estudiamos los efectos de las características de los estanques y el paisaje, incluida la conectividad, sobre la dinámica de las meta poblaciones de 12 especies de anfibios en Suiza. Se deben considerar los efectos ambientales sobre la colonización y la persistencia para entender las determinantes de la ocupación a largo plazo (resumida aquí como incidencia). Ajustamos los modelos dinámicos de ocupación a datos de 20 años de monitoreo de un programa de construcción de estanques para cuantificar los efectos de las características del estanque y el paisaje y las diferentes medidas de conectividad para las probabilidades de colonización y persistencia en los estanques construidos. La conectividad con las poblaciones existentes explicó mejor la dinámica que las medidas de conectividad estructural, mientras que las medidas simples (distancia a la población vecina más cercana, densidad poblacional) fueron sustitutos útiles para las medidas de dispersión ponderadas al núcleo que se usan con frecuencia en la teoría de meta poblaciones. La conectividad poblacional medió la persistencia de las especies a conservar en los estanques nuevos, lo que sugiere que hay dinámicas fuente­sumidero en las poblaciones recién establecidas. La densidad poblacional capturó muy bien este efecto y podría usarse para que los practicantes seleccionen sitios. Los estanques construidos en un radio de ≈0.5 km de dos a cuatro estanques ocupados tuvieron >3.5 más incidencia de las especies a conservar (mediana) que los estanques aislados. Las especies tuvieron preferencias individuales con respecto a las características de los estanques, aunque los sitios de reproducción con una mayor superficie total de agua (≥100 m2), que se secaban temporalmente y que estaban rodeados con un máximo de 50% de bosque beneficiaron a muchas especies a conservar. Por esto, la diversidad de estanques promoverá la diversidad de anfibios a escala de paisaje.

Trends in habitat quality and habitat degradation in terrestrial protected areas.

Protected areas are typically considered a cornerstone of conservation programs and play a fundamental role in protecting natural areas and biodiversity. Human-driven land-use and land-cover (LULC) changes lead to habitat loss and biodiversity loss inside protected areas, impairing their effectiveness. However, the global dynamics of habitat quality and habitat degradation in protected areas remain unclear. We used the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model based on global annual remotely sensed data to examine the spatial and temporal trends in habitat quality and degradation in global terrestrial protected areas. Habitat quality represented the ability of habitats to provide suitable conditions for the persistence of individuals and populations, and habitat degradation represented the impacts on habitats from human-driven LULC changes in the surrounding landscape. Based on a linear mixed-effects modeling method, we also explored the relationship between habitat degradation trends and protected area characteristics, biophysical factors, and socioeconomic factors. Habitat quality declined by 0.005 (0.6%) and habitat degradation increased by 0.002 (11%) from 1992 to 2020 globally, and similar trends occurred even in remote or restrictively managed protected areas. Habitat degradation was attributed primarily to nonirrigated cropland (62%) and urbanization (27%) in 2020. Increases in elevation, gross domestic production per capita, and human population density and decreases in agricultural suitability were associated with accelerated habitat degradation. Our results suggest that human-induced LULC changes have expanded from already-exploited areas into relatively undisturbed areas, and that in wealthy countries in particular, degradation is related to rapid urbanization and increasing demand for agricultural products.

Tendencias en la calidad y degradación del hábitat en áreas protegidas terrestres Resumen Las áreas protegidas suelen considerarse la piedra angular de los programas de conservación y desempeñan un papel fundamental en la protección de los espacios naturales y la biodiversidad. Los cambios en el uso y la cobertura del suelo (CUCS) provocados por el hombre conducen a la pérdida de hábitats y de biodiversidad dentro de las áreas protegidas, lo que merma su eficacia. Sin embargo, la dinámica global de la calidad y la degradación del hábitat en las áreas protegidas sigue sin estar clara. Utilizamos el modelo de valoración integrada de servicios ambientales y compensaciones (InVEST), basado en datos anuales mundiales obtenidos por teledetección, para examinar las tendencias espaciales y temporales de la calidad y degradación del hábitat en las áreas terrestres protegidas de todo el mundo. La calidad del hábitat representó su capacidad para proporcionar condiciones adecuadas para la persistencia de individuos y poblaciones, y la degradación del hábitat representó los impactos sobre los hábitats de los cambios CUCS provocados por el hombre en el paisaje circundante. Con base en un método de modelo lineal de efectos mixtos, también exploramos la relación entre las tendencias de degradación del hábitat y las características de las áreas protegidas, los factores biofísicos y los factores socioeconómicos. La calidad del hábitat disminuyó en un 0.005 (0,6%) y la degradación del hábitat aumentó en un 0.002 (11%) entre 1992 y 2020 a nivel mundial, y se produjeron tendencias similares incluso en áreas protegidas remotas o gestionadas de forma restrictiva. La degradación del hábitat se atribuyó principalmente a las tierras de cultivo sin irrigación (62%) y a la urbanización (27%) en 2020. El aumento de la altitud, del producto interno bruto per cápita y de la densidad de población humana, así como la disminución de la idoneidad agrícola, se asociaron a una aceleración de la degradación del hábitat. Nuestros resultados sugieren que los cambios en el CUCS inducidos por el hombre se han extendido desde zonas ya explotadas a zonas relativamente inalteradas, y que, en particular en los países ricos, la degradación está relacionada con la rápida urbanización y la creciente demanda de productos agrícolas.

Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy.

BACKGROUND AND OBJECTIVES: There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS: We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS: In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS: The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.

Assessment of the quality of life of patients with inflammatory bowel disease. / Evaluación de la calidad de vida de los pacientes con enfermedad inflamatoria intestinal.

INTRODUCTION: Ulcerative colitis (UC) and Crohn's disease (CD) are diseases that cause a significant impact on patients' quality of life. The aim of this study is to assess the impact of inflammatory bowel disease (IBD) on health-related quality of life (HRQoL). MATERIAL AND METHODS: Observational, descriptive, cross-sectional study, carried out at Torrecárdenas Hospital (Almería). Patients over 14 years of age diagnosed with CD or UC were included. For the assessment of HRQoL, the reduced 9-item IBDQ-9 questionnaire was used. RESULTS: 106 patients with a mean age of 44 years were included, with a female predominance. Forty-five percent of the patients in the sample had UC compared to 55% with CD. Of the patients, 69.8% were in clinical remission. The median questionnaire score was 60.8 points out of 100. Statistically significant differences were observed between sexes, with worse HRQoL for females. No differences were observed between patients with UC and CD. Differences were also detected between patients who underwent surgery and those who did not. A negative association was observed between the number of flares and the questionnaire score. CONCLUSIONS: In our study population, there is an acceptable HRQoL, with no differences observed between CD and UC. Female sex, absence of clinical remission, number of previous outbreaks, and surgery have a negative association with HRQoL.

Descriptive observational study on the use of virtual reality in patients with inflammatory bowel disease undergoing biological treatment.

BACKGROUND: Virtual reality (VR) is a neurosensory experience in which simulated spaces a person has the sensation of being able to function within them. Some patients with inflammatory bowel disease (IBD) receive intravenous biological treatments in an Adult Day Hospital (ADH) regime. VR has been used in some fields of medicine, demonstrating its usefulness in reducing negative symptoms. However, we do not have any literature showing the applicability in real clinical practice of VR in IBD. METHODS: Descriptive observational pilot study based on an initial cohort of 87 patients that were obtained from the ADH of the IBD Unit. Satisfaction and acceptance of VR through the use of 3D glasses and the reduction of negative symptoms during intravenous biological treatment in patients with IBD in ADH have been assessed. RESULTS: 43 patients (52.4%) used VR and completed the study. In the comparative analysis of the results of the questionnaires before and after the use of VR, a statistically significant improvement was observed in the patients' view on the ability of VR to achieve a reduction in stress (65% patients improve; p: 0.0021) and pain (VAS, 54% p. improve; p<0.05) during treatment. Likewise, with the applicability of VR in other areas of medicine (53%; p: 0.05) and with the possibility of improving well-being during the stay in the ADH (56%; p: 0.0014). No side effects were reported with the use of the 3D glasses. CONCLUSIONS: VR is a useful complementary tool to improve the stay of patients with IBD on ADH during intravenous treatment.

Profiling the patient with inflammatory bowel disease in the relationship between physical activity and partner/social network status: A post hoc patient-tailored analysis of the "BE-FIT-IBD" study.

INTRODUCTION: Normal quality of life is an ultimate target in the therapeutic approach to inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC) in the context of which regular physical activity (PA) is often a chimeric parameter that is not standardized in terms of quality/quantity. The study aimed to profile a sample of IBD patients about the relationship between PA-partner status and social network support. PATIENTS AND METHODS: A post hoc analysis of the "BE-FIT-IBD" study was set up by stratifying the data of PA with that of partner status and the support that the patient's social network (i.e., relatives, friends) provided in inciting the patient to practice regular PA. RESULTS: In the 219 patients included, there was a greater tendency for patients with stable partners to view the risk of reactivation/worsening of IBD as a barrier to conducting regular PA (p<0.0001). Single patients considered PA more as a protective factor (p=0.045). Patients without a PA-supporting social network retained IBD-related treatment as a PA barrier (p=0.016) and PA as a risk for IBD complications (p=0.01), with less confidence that PA could improve the course of IBD (p<0.001). Rectal syndrome was an IBD-related barrier more represented in patients with PA-deterring social network (p<0.0001). CONCLUSIONS: These factors are potential targets for recovering the IBD patient's adherence to regular PA.

Pancreas units within gastroenterology departments. Organizational and operational standards for a patient-centered service. / Las unidades de páncreas en los servicios de aparato digestivo. Estándares de organización y funcionamiento para un servicio centrado en el paciente.

The Asociación Española de Pancreatología (AESPANC), Asociación Española de Gastroenterología (AEG), and Sociedad Española de Patología Digestiva (SEPD) have developed a consensus document on the standards and recommendations they consider essential for the organization of pancreas units (PUs) within gastroenterology services (GSs) in order to conduct their activities in an efficient, high-quality manner. The consensus document defines PUs and lays down standards relating to their organization, structure, service portfolio, processes, and teaching and research activities. Standards have been categorized as mandatory (requirements to be met to qualify for certification by the scientific societies responsible for the standards) or recommendations. Standards should be updated at most within five years based on the experience gained in Spanish PUs and the advance of knowledge regarding pancreas disease. Development of health outcome indicators, including patient-reported outcome measures (PROMs), is considered a relevant challenge, as is evidence on the association of PU structure and activity standards with health outcomes.

Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on sexuality and inflammatory bowel disease. / Documento de posicionamiento. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa sobre sexualidad y enfermedad inflamatoria intestinal.

It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.

Assessment of the quality, diagnosis, and therapeutic recommendations of clinical practice guidelines on patients with Helicobacter pylori infection: A systematic review.

We conducted this study to systematically review and assess the current clinical practice guidelines (CPGs) related to the diagnosis and treatment of Helicobacter pylori (H. pylori) infection. The aim was to evaluate the quality of these included CPGs and provide clinicians with a convenient and comprehensive reference for updating their own CPGs. We searched four databases to identify eligible CPGs focusing on H. pylori diagnosis and treatment recommendations. The results were presented using evidence mappings. Quality and clinical applicability were assessed comprehensively using AGREE-II and AGREE-REX. Statistical tests, specifically Bonferroni tests, were employed to compare the quality between evidence-based guidelines and consensus. A total of 30 eligible CPGs were included, comprising 17 consensuses and 13 guidelines. The quality showed no statistical significance between consensuses and guidelines, mainly within the moderate to low range. Notably, recommendations across CPGs exhibited inconsistency. Nevertheless, concerning diagnosis, the urea breath test emerged as the most frequently recommended method for testing H. pylori. Regarding treatment, bismuth quadruple therapy stood out as the predominantly recommended eradication strategy, with high-dose dual therapy being a newly recommended option. Our findings suggest the need for specific organizations to update their CPGs on H. pylori or refer to recently published CPGs. Specifically, CPGs for pediatric cases require improvement and updating, while a notable absence of CPGs for the elderly was observed. Furthermore, there is a pressing need to improve the overall quality of CPGs related to H. pylori. Regarding recommendations, additional evidence is essential to elucidate the relationship between H. pylori infection and other diseases and refine test indications. Clinicians are encouraged to consider bismuth quadruple or high-dose dual therapy, incorporating locally sensitive antibiotics, as empirical radical therapy. .

How do maternal and child health nurses incorporate infant mental health promotion into their clinical practice? Experiences of an Australian municipality.

The field of infant mental health (IMH) has offered valuable insights into the critical importance of social-emotional development, including the enduring influence of early experiences throughout life. Maternal and Child Health (MCH) nurses are ideally placed to facilitate knowledge sharing with parents. This Australian-based qualitative exploratory descriptive study explored how MCH nurses incorporate IMH in their clinical practice, and how they share this information with caregivers. Ten community-based MCH nurses participated in voluntary, semi-structured interviews which were transcribed verbatim and analyzed thematically. Findings identified five themes that characterized how MCH nurses incorporated IMH concepts into their practice. These themes were: prioritizing physical health promotion activities, highlighting infant communications, variations in knowledge and application of IMH concepts, workplace time schedules, and the relational nature of the work. Recommendations include encouraging IMH as a health promotion activity, facilitating IMH assessment, further education, reflective supervision, and extension of predetermined appointment times to enable knowledge and skill sharing. Further research is also recommended to provide additional insights into how nurses with IMH training promote and share IMH concepts with caregivers. Adoption of these recommendations would further enhance the care given to families and the role of the MCH nurses.

El campo de la salud mental infantil (IMH) ha ofrecido perspectivas valiosas sobre la suma importancia del desarrollo socioemocional en los primeros años para el desarrollo social y emocional posterior. Las enfermeras de la salud materno-infantil (MCH) se encuentran en posición ideal para facilitar el proceso de compartir conocimiento con los progenitores. Este estudio cualitativo, exploratorio y descriptivo, llevado a cabo en Australia, exploró cómo las enfermeras MCH incorporan IMH en sus prácticas clínicas y cómo ellas comparten esta información con los cuidadores. Un grupo de enfermeras MCH de base comunitaria participó en entrevistas voluntarias semiestructuradas. Las entrevistas se transcribieron palabra por palabra y se analizaron temáticamente. Los resultados identificaron cinco temas que caracterizaban cómo incorporaron los conceptos de IMH en su práctica. Estos temas fueron: actividades para promover el darle prioridad a la salud física, enfatizar las comunicaciones del infante, variaciones en el conocimiento y la aplicación de conceptos de IMH, tablas de horarios del lugar de trabajo y la naturaleza relacional del trabajo. Entre las recomendaciones se incluyen el fomentar IMH como una actividad de promoción de la salud, facilitar la evaluación de IMH, más educación, supervisión con reflexión, así como extensión del horario de citas predeterminado para permitir el proceso de compartir conocimiento y habilidades. También se recomienda más investigación para ofrecer perspectivas adicionales de cómo las enfermeras con entrenamiento de IMH promueven y comparten los conceptos de IMH con los cuidadores. La adopción de estas recomendaciones mejoraría más el cuidado que se ofrece a familias y el papel de las enfermeras MCH.

Le domaine de la santé mentale du nourrisson (IMH en anglais) a permis de mieux comprendre l'importance critique du développement socio-émotionnel dans les premières années pour le développement social et émotionnel ultérieur. Les infirmiers et infirmières de la Santé Maternelle et de l'Enfant (MCH en anglais) sont idéalement situées pour faciliter le partage des connaissances avec les parents. Cette étude Qualitative Exploratoire Descriptive, en Australie, a exploré comment les infirmier/infirmières MCH incorporent l'IMH dans leur pratique clinique et comment ils/elles partagent cette information avec les personnes prenant soin des enfants. Une cohorte de 10 infirmiers/infirmières MCH basées dans leur communauté ont participé à des entretiens volontaires semi-structurés. Les entretiens ont été transcrits verbatim et analysé de manière thématique. Les résultats ont identifié cinq thèmes qui ont caractérisé les concepts IMH dans leur pratique. Ces thèmes étaient: donner la priorité à la promotion d'activités de santé physique, la mise en évidence des communications du nourrisson, les variations dans les connaissances et l'application des concepts IMH, les emplois du temps du lieu de travail et la nature relationnelle du travail. Les recommandations incluent la nécessité d'encourager l'IMH en tant qu'activité de promotion de la santé, la facilitation de l'évaluation IMH, une formation supplémentaire, une supervision de réflexion et l'extension de rendez-vous pour développer les connaissances et partager les compétences. De plus amples recherches sont recommandées afin d'éclairer la manière dont les infirmiers/infirmières formées en IMH promeuvent et partagent les concepts IMH avec les personnes prenant soin des enfants. L'adoption de ces recommandations pour améliorer davantage le soin offert aux familles et les rôles des infirmiers/infirmières MCH.

[Systematic review of the primary care quality assessment instruments used in the last 10 years]. / Revisión sistemática de los instrumentos de evaluación de la calidad de Atención Primaria utilizados en los últimos 10 años.

OBJECTIVE: There are numerous instruments in the scientific literature for the evaluation of the quality of Primary Care (PC) and to know which of them are the most used and in which countries provides more information to make a well-founded decision. The aim is to determine which, between 2013 and 2023, have been the instruments used to assess the international quality of PC, its evolution and geographical distribution. DESIGN: Systematic review. DATA SOURCES: PubMed and Embase. From March to December 2023. INCLUSION CRITERIA: 1) Validation studies of specific assessment instruments to measure the quality of PC and/or the satisfaction of patients, providers or managers. 2) carried out in the field of PC and 3) published between 1/01/2013 and 01/02/2023. 83 full-text articles were included. DATA EXTRACTION: From each publication, an instrument used to evaluate the quality of the PC, attributes of the PC it evaluates, recipient of the evaluation, user, provider or manager, year, and country. RESULTS: Fifteen PC assessment instruments were found. The most widely used is the Primary Care Assessing Tool (PCAT), with wide geographical distribution, versions in several languages, is more limited in Europe, except in Spain, and is mostly used in the Primary Care Assessing Tool (PCAT). CONCLUSIONS: The PCAT, due to its cultural adaptability, availability in several languages, its ability to evaluate the fundamental principles of PC enunciated by the World Health Organization and to contemplate the perspectives of all health agents, is a complete, versatile, and consistent questionnaire for the evaluation of the quality of PC.

[Improving quality of life in older adults with the decline syndrome: The role of occupational therapy in primary care]. / Mejorando la calidad de vida en personas mayores con el síndrome del declive: el rol de la terapia ocupacional en Atención Primaria.

OBJECTIVE: To evaluate the effect of an occupational therapy intervention in users recently diagnosed with the decline syndrome, who have experienced a decrease in the Barthel and/or Lawton index in the last month and susceptible to improvement based on medical opinion. DESIGN: Non-controlled, quasi-experimental longitudinal study. A pre-post intervention. LOCATION: Sant Hipòlit de Voltregà health centre. Osona, Barcelona. PARTICIPANTS: Patients referred by the centre's primary care nursing, social work or medical staff with a recent diagnosis of decline syndrome who may benefit from the intervention of an occupational therapy professional. INTERVENTION: Following the initial assessment visit, four training sessions were conducted to improve functional independence, mobility and adaptation of the home environment, providing training to primary caregivers. MAIN MEASUREMENTS: Patient autonomy was assessed using the Barthel and Lawton scales, quality of life using the EuroQol questionnaire (EQ-5D) and home suitability using the home suitability assessment questionnaire. RESULTS: Improvements were observed in autonomy in activities of daily living (p=0.003), mobility (p=0.001) and housing adaptation (p<0.001). The level of anxiety/depression was reduced (p=0.028), and the mean health status score increased markedly (p<0.001). CONCLUSIONS: This study highlights the improvement in the quality of life and autonomy in the basic activities of daily living for individuals receiving occupational therapy, emphasizing the need for home adaptation and family support.

[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.

Usefulness of mindfulness for the management of anxiety, stress, and quality of life in infertile women. A clinical exploratory study.

BACKGROUND: Infertility increases stress and affects life quality. Mindfulness reduces stress and improves life quality, but its role in infertility remains unclear. OBJECTIVE: To evaluate the effect of mindfulness on stress and quality of life of women with infertility. MATERIAL AND METHODS: An exploratory clinical study was conducted in women under infertility treatment, together with an 8-week mindfulness intervention (MND) or only infertility treatment (CTRL). Anxiety and quality of life were assessed at baseline and at the end of intervention with IDARE and FertiQoL questionnaires respectively, as well as salivary alpha-amylase and cortisol concentrations. Non-parametric statistics was used for analysis using an alpha value of 0.10. RESULTS: 14 MND and 15 CTRL completed follow-up. At baseline, CTRL patients exhibited better quality of life than MND; anxiety scores correlated negatively with quality of life. At the end of intervention, cortisol concentrations (p = 0.097), and the increments of amylase (p = 0.039), were higher in CTRL than in MND. Increases in quality of life were associated with basal anxiety score (p = 0.002), improvements in tolerability (p < 0.001), and mindfulness intervention (p = 0.014). CONCLUSION: Our results suggest that mindfulness reduces stress and improves quality of life in women under infertility treatment.

ANTECEDENTES: La infertilidad incrementa el estrés y afecta la calidad de vida. OBJETIVO: Evaluar el efecto de mindfulness (atención plena) sobre la ansiedad, estrés y calidad de vida de mujeres infértiles. MATERIAL Y MÉTODOS: Estudio exploratorio en pacientes tratadas por infertilidad más una intervención de ocho semanas con mindfulness (grupo MND) o solo tratamiento de la infertilidad (grupo de control). Al inicio y después de ocho semanas se evaluaron la ansiedad (Inventario de Ansiedad Rasgo-Estado), la calidad de vida (FertiQoL), y las concentraciones salivales de α-amilasa y cortisol. Se utilizó estadística no paramétrica, con α = 0.10. RESULTADOS: 14 mujeres del grupo MND y 15 del grupo de control completaron el seguimiento. Al inicio, las pacientes del grupo de control mostraron mejor calidad de vida; las puntuaciones de ansiedad correlacionaron negativamente con la calidad de vida. Al final, el incremento de cortisol (p = 0.097) y amilasa (p = 0.039) fueron mayores en el grupo de control. Los incrementos en la calidad de vida se asociaron a ansiedad basal (p = 0.002), incremento en la subescala tolerabilidad (p < 0.001) y mindfulness (p = 0.014). CONCLUSIÓN: Los resultados sugieren que mindfulness disminuye el estrés y mejora la calidad de vida de pacientes bajo tratamiento de la infertilidad.

Cultural context and self-care impact on medical students' quality of life. A mixed-methods approach.

BACKGROUND: Medical education can make it difficult for students to take actions to improve their health. OBJECTIVE: To evaluate the influence of the university context on self-care behaviors and quality of life. MATERIAL AND METHODS: A mixed-methods approach was used, with surveys being combined to assess self-care and quality of life, with in-depth interviews to explore cultural influences and perceptions. Statistical analysis and qualitative data coding were carried out, with methods being integrated through network analysis. RESULTS: Self-care scores exceeded 50 points, and quality of life scores exceeded 60 points. Medical students' context is shaped by motivations, expectations, skills, and goals that influence identity formation and contribute to the medical profession. CONCLUSIONS: There is a positive connection between self-care practices and quality of life. However, academic stress can potentially disrupt self-care routines. Furthermore, an association between obesity and a decrease in quality of life stands out, which emphasizes the need for health promotion actions.

ANTECEDENTES: La educación médica puede dificultar que los estudiantes realicen acciones para mejorar su salud. OBJETIVO: Evaluar la influencia del contexto universitario en los comportamientos de autocuidado y la calidad de vida. ­. MATERIAL Y MÉTODOS: Se empleó un enfoque de métodos mixtos, combinando encuestas para evaluar el autocuidado y la calidad de vida, con entrevistas en profundidad para explorar influencias culturales y percepciones. Se llevaron a cabo análisis estadísticos y codificación de datos cualitativos; los métodos se integraron a través del análisis de redes. RESULTADOS: Las puntuaciones de autocuidado superaron los 50 puntos y las de calidad de vida, los 60 puntos. El contexto de los estudiantes de medicina está moldeado por motivaciones, expectativas, habilidades y metas que influyen en la formación de la identidad y contribuyen a la profesión médica. CONCLUSIONES: Existe una conexión positiva entre prácticas de autocuidado y la calidad de vida; sin embargo, el estrés académico pueden interrumpir potencialmente las rutinas de autocuidado. Además, se destaca la asociación entre la obesidad y la afectación en la calidad de vida, lo que enfatiza la necesidad de acciones de promoción de la salud.

Quality of Professional Life Among Dermatologists: Impact of the COVID-19 Pandemic and Suggestions for Improvement. / Calidad de vida profesional en dermatología: impacto de la pandemia y propuestas de mejora.

BACKGROUND AND OBJECTIVE: Quality of professional life (QPL) is defined as a sense of well-being derived from a balance between the challenges of work and the resources available to deal with them. Impaired QPL can contribute to burnout. The aim of this study was to evaluate QPL in Spanish dermatologists using a validated questionnaire. MATERIAL AND METHODS: We designed a cross-sectional study in which Spanish dermatologists were invited to complete an online questionnaire sent out by messaging applications. The dermatologists were asked to provide sociodemographic information, answer 3 open questions, and complete the 35-item Spanish QPL questionnaire (Spanish abbreviation, CVP-35). RESULTS: We analyzed the information submitted by 106 dermatologists (62 women, 58%) with a mean age of 41 years (95% CI, 43.3-38.8 years). Women and department heads scored significantly higher in the workload domain of the questionnaire (P=.02 and P=.005, respectively). A heavy caseload was mentioned as the main factor contributing to impaired QPL and the main change in the wake of the COVID-19 pandemic. CONCLUSIONS: Female dermatologists reported heavier workloads. Heavy caseloads and more remote work were the main changes identified after the COVID-19 pandemic. Heavy caseloads have a significant impact on the QPL of dermatologists in Spain. Reducing caseloads would improve general job satisfaction and quality of care provision.

Burnout Syndrome, Anxiety, and Depression in Dermatology Residents: A Cross-Sectional Study. / Síndrome de burnout, ansiedad y depresión en residentes de dermatología: un estudio transversal.

BACKGROUND AND OBJECTIVE: Burnout syndrome is a mental health disorder due to chronic occupational stress. Both burnout and associated comorbidities are prevalent among health care professionals, being medical residents a vulnerable group. Despite this, the scientific medical literature currently available on this issue in dermatology residents is scarce. The aim of this study was to analyze the prevalence of the burnout syndrome, anxiety, and depression in dermatology residents, and the associated risk factors. MATERIAL AND METHOD: This was a cross-sectional trial designed to include dermatology residents from Spain (from December 2022 through June 2023). A self-administered form was sent via online messaging applications, including validated scales to study professional quality of life, burnout syndrome, anxiety, and depression. RESULTS: A total of 48 dermatology residents were included in the study, 50% of whom (24/48) were women, with a mean age of 27 years (1.25). A total of 58.33% (28/48) of the residents had some degree of anxiety, 22.9% (11/48) some degree of depression, and 23.4% a moderate risk of burnout (11/48). Workload was the main risk factor associated with the 3 disorders studied, while managerial support or intrinsic motivation seem to play a protective role. CONCLUSIONS: Burnout syndrome and its comorbidities are both prevalent in dermatology residents in Spain and closely related to each other.

Síndrome de burnout, ansiedad y depresión en residentes de dermatología: un estudio transversal.

BACKGROUND AND OBJECTIVE: Burnout syndrome is a mental health disorder due to chronic occupational stress. Both burnout and associated comorbidities are prevalent among health care professionals, being medical residents a vulnerable group. Despite this, the scientific medical literature currently available on this issue in dermatology residents is scarce. The aim of this study was to analyze the prevalence of the burnout syndrome, anxiety, and depression in dermatology residents, and the associated risk factors. METHODS: This was a cross-sectional trial designed to include dermatology residents from Spain from December 2022 through June 2023. A self-administered form was sent via online messaging applications, including validated scales to study professional quality of life, burnout syndrome, anxiety, and depression. RESULTS: A total of 48 dermatology residents were included in the study, 50% of whom (24/48) were women, with a mean age of 27 years (1.25). A total of 58.33% (28/48) of the residents had some degree of anxiety, 22.9% (11/48) some degree of depression, and 23.4% a moderate risk of burnout (11/48). Workload was the main risk factor associated with the 3 disorders studied, while managerial support or intrinsic motivation seem to play a protective role. CONCLUSIONS: Burnout syndrome and its comorbidities are both prevalent in dermatology residents in Spain and closely related to each other.