Knowledge, attitude, and practice towards COVID-19: Research to develop a measuring instrument.

OBJECTIVE: To evaluate the knowledge, attitudes, and behaviors of individuals about COVID-19 and to develop a valid and reliable scale that can measure these items about COVID-19 and other similar pandemic processes. DESIGN: Methodological scale study with a quantitative approach. SITE: Carried out at the Uludag University Family Health Center in Bursa, Turkey. PARTICIPANTS: 415 individuals in the first phase and 367 in the retest phase. INTERVENTIONS: Carried out between March 1, 2021, and April 30, 2021. MAIN MEASUREMENTS: Reliability and factor analyses were performed and validity was evaluated. In factor analysis, a scale with 4 factors and 30 questions was obtained. Confirmatory factor analysis (CFA) was applied to the factor scores of the scale. Factors were named A-General Culture, B-Mask, Distance and Cleanliness, C-Mental Status, and D-Way of Information. A 3-point Likert-type scoring system was created for the responses. RESULTS: Cronbach's alpha value was 0.894. In factor modeling, 3 of the confirmatory factor analysis fit indices were good and 4 of them were acceptable, so our model was found to be appropriate. The scale was highly reliable, according to internal and external consistency coefficients. The scale was named the Turkey COVID-19 Attitude Scale. p values<0.05 were considered statistically significant. CONCLUSIONS: The valid and reliable Turkey COVID-19 Attitude Scale, which we developed to evaluate the knowledge, attitudes, and behaviors of individuals about COVID-19, can be used to guide research during COVID-19 and future pandemics.

The importance of tangible and intangible factors in human-carnivore coexistence.

Conflict with humans is one of the major threats facing the world's remaining large carnivore populations, and understanding human attitudes is key to improving coexistence. We surveyed people living near Hwange National Park about their attitudes toward coexisting with lions. We used ordinal regression models with the results of the survey to investigate the importance of a range of tangible and intangible factors on attitudes. The variables investigated included the costs and benefits of wildlife presence, emotion, culture, religion, vulnerability, risk perception, notions of responsibility, and personal value orientations. This was for the purpose of effectively tailoring conservation efforts but also for ethical policy making. Intangible factors (e.g., fear and ecocentric values) were as important as, if not more important than, tangible factors (such as livestock losses) for understanding attitudes, based on the effect sizes of these variables. The degree to which participants' fear of lions interfered with their daily activities was the most influential variable. The degree to which benefits accrue to households from the nearby protected area was also highly influential, as was number of livestock lost, number of dependents, ecocentric value orientation, and participation in conflict mitigation programs. Contrary to what is often assumed, metrics of livestock loss did not dominate attitudes to coexistence with lions. Furthermore, we found that socioeconomic variables may appear important when studied in isolation, but their effect may disappear when controlling for variables related to beliefs, perceptions, and past experiences. This raises questions about the widespread reliance on socioeconomic variables in the field of human-wildlife conflict and coexistence. To facilitate coexistence with large carnivores, we recommend measures that reduce fear (through education and through protective measures that reduce the need to be fearful), reduction of livestock losses, and ensuring local communities benefit from conservation. Ecocentric values also emerged as influential, highlighting the need to develop conservation initiatives tailored to local values.

Importancia de los Factores Tangibles e Intangibles en la Coexistencia Humanos-Carnívoros Resumen Los conflictos con humanos son una de las principales amenazas que enfrentan las poblaciones permanentes de grandes carnívoros del planeta y el entendimiento de las actitudes humanas es importante para mejorar la coexistencia. Preguntamos a las personas que viven cerca del Parque Nacional Hwange sobre su postura hacia la coexistencia con leones. Usamos modelos de regresión ordinal en los resultados del cuestionario para investigar la importancia de una gama de factores tangibles e intangibles para estas posturas. Las variables investigadas incluyeron el costo y beneficio de la presencia de fauna, emociones, cultura, religión, vulnerabilidad, percepción de riesgos, nociones de la responsabilidad y orientaciones de valor personal. Realizamos esto con el propósito de diseñar efectivamente los esfuerzos de conservación pero también para la generación de políticas éticas. Los factores intangibles (p. ej.: el miedo y los valores ecocéntricos) fueron tan importantes, si no es que más importantes, como los factores tangibles (como la pérdida de cabezas de ganado) para el entendimiento de las actitudes, con base en los tamaños del efecto de estas variables. El grado al que el miedo que los participantes sienten por los leones interfiere con sus actividades diarias fue la variable con mayor influencia. El grado al que los hogares del área protegida cercana devengan beneficios también tuvo una influencia alta, como lo tuvo el número de cabezas de ganado perdidas, el número de dependientes, la orientación de los valores ecocéntricos y la participación en programas de mitigación del conflicto. Contrario a lo que frecuentemente se asume, las medidas de la pérdida de cabezas de ganado no dominó sobre las actitudes por la coexistencia con leones. Más allá, encontramos que las variables socioeconómicas pueden parecer importantes cuando se estudian de manera aislada pero su efecto puede desaparecer cuando se controlan las variables relacionadas con las creencias, percepciones y experiencias pasadas. Esto genera preguntas sobre la dependencia hacia las variables socioeconómicas en el área de estudios de conflictos y coexistencia entre humanos y fauna. Para facilitar la coexistencia con carnívoros mayores recomendamos tomar medidas que reduzcan el miedo (por medio de la educación y medidas de protección que reduzcan la necesidad de vivir con miedo), la disminución de la pérdida de cabezas de ganado y garantizarles a las comunidades locales los beneficios que proporciona la conservación. Los valores ecocéntricos también surgieron como influyentes, lo que resalta la necesidad de desarrollar iniciativas de conservación adaptadas a los valores locales.

Evaluation of knowledge, attitudes and practices of health services vocational schools' students with regard to COVID-19.

INTRODUCTION: The most critical intervention to control SARS-CoV-2 infection requires appropriate knowledge and attitude towards the virus. OBJECTIVE: To determine the level of knowledge, attitudes and practices of students of a health services' vocational school with regard to COVID-19. METHODS: Cross-sectional study carried out between May and June 2020 in a university of the Turkish region. Data were collected through an online survey portal. RESULTS: Four hundred and fifty-four questionnaires were completed and returned. Students of medical laboratory techniques and first aid and emergency medicine had significantly higher knowledge scores (p < 0.001). More than 43 % of the students (n = 201) used the TV as their main source of information on COVID-19. There was a positive attitude towards preventive measures such as avoiding crowded places and maintaining hand hygiene and social distance. CONCLUSIONS: Health services vocational school students have good knowledge and positive attitude towards COVID-19. The main sources of information were the TV and social media. For this reason, more attention should be given to these issues in the curriculum in order for science-based information sources to be used.

INTRODUCCIÓN: La intervención más crítica para controlar la infección por SARS-CoV-2 requiere el conocimiento y la actitud correctos hacia el virus. OBJETIVO: Determinar el conocimiento, las actitudes y las prácticas de los estudiantes de una escuela vocacional de servicios de salud respecto a COVID-19. MÉTODOS: Estudio transversal realizado entre mayo y junio de 2020 en una universidad de la región de Turquía. Los datos se recopilaron mediante un portal de encuestas en línea. RESULTADOS: Se completaron y devolvieron 454 cuestionarios. Los estudiantes de técnicas de laboratorio médico y primeros auxilios y emergencias tuvieron puntuaciones de conocimiento significativamente más altas (p < 0.001). Más de 43 % de los estudiantes (n = 201) usaron televisores como su principal fuente de información sobre COVID-19. Se manifestó una actitud positiva hacia las aplicaciones, así como evitar lugares concurridos y mantener la higiene de las manos y la distancia social. CONCLUSIONES: Los estudiantes de la escuela vocacional de servicios de salud tienen buen conocimiento y actitud positiva hacia COVID-19. Las principales fuentes de información fueron la televisión y las redes sociales, por lo que se debe prestar más atención a estos temas en el plan de estudios para utilizar fuentes de información basadas en la ciencia.

Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería.

OBJECTIVE: Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD: A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS: A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION: There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.

OBJETIVO: Identificar, analizar y sintetizar la evidencia empírica disponible sobre conocimientos y actitudes del personal de enfermería en la prevención de lesiones por presión (LPP). MÉTODO: Se realizó una revisión sistemática de la literatura publicada entre 2008 y 2019, guiada por las directrices de la declaración PRISMA. Se consultaron bases de datos con los siguientes términos en español, portugués e inglés: actitud, conocimiento, lesión por presión, y enfermeras y enfermeros. RESULTADOS: Un total de 33 artículos con abordaje cuantitativo de tipo descriptivo trasversal cumplió con los criterios de revisión. Los hallazgos revelaron un déficit de conocimientos del personal de enfermería sobre las medidas de prevención de LPP. Las actitudes fueron consideradas positivas. Pocos estudios examinaron la relación entre conocimientos, actitudes y práctica de enfermería. CONCLUSIÓN: Se necesita mayor educación continuada en conocimientos y actitudes del personal de enfermería en la prevención de LPP, e investigación sobre alternativas en la organización del trabajo de enfermería. La lectura de guías actualizadas de manera regular y realización de cursos de entrenamiento podrían ser estrategias beneficiosas para ejecutar en la práctica.

Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería.

OBJECTIVE: Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD: A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS: A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION: There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.

OBJETIVO: Identificar, analizar y sintetizar la evidencia empírica disponible sobre conocimientos y actitudes del personal de enfermería en la prevención de lesiones por presión (LPP). MÉTODO: Se realizó una revisión sistemática de la literatura publicada entre 2008 y 2019, guiada por las directrices de la declaración PRISMA. Se consultaron bases de datos con los siguientes términos en español, portugués e inglés: actitud, conocimiento, lesión por presión, y enfermeras y enfermeros. RESULTADOS: Un total de 33 artículos con abordaje cuantitativo de tipo descriptivo trasversal cumplió con los criterios de revisión. Los hallazgos revelaron un déficit de conocimientos del personal de enfermería sobre las medidas de prevención de LPP. Las actitudes fueron consideradas positivas. Pocos estudios examinaron la relación entre conocimientos, actitudes y práctica de enfermería. CONCLUSIÓN: Se necesita mayor educación continuada en conocimientos y actitudes del personal de enfermería en la prevención de LPP, e investigación sobre alternativas en la organización del trabajo de enfermería. La lectura de guías actualizadas de manera regular y realización de cursos de entrenamiento podrían ser estrategias beneficiosas para ejecutar en la práctica.

Violence against women in Primary Health Care: Potentialities and limitations to identification.

OBJECTIVE: To determine the potential and limitations of Primary Health Care professionals to identify situations of violence against women. LOCATION: A municipality of Rio Grande do Sul, Brazil. DESIGN: Descriptive and exploratory study with a qualitative approach. PARTICIPANTS: Twenty-one health professionals of three Family Health Strategy units, as well as one Basic Health Unit. The inclusion criterion consisted of being a health worker in these services. The exclusion criterion was to be absent from work by any kind type license during the period of data production. METHOD: The technique used to produce data was individual, semi-structured, interviews in order to collect sociodemographic data and the monitoring by professionals related to the potentials and limitations to identify violence situations. The data collection was suspended based on the saturation criterion. The data were systematized and analyzed by the content analysis technique, according to the analytical categories of health care network and gender. RESULTS: The potential to identify themes were: professional experience, receptive atmosphere, bonding, and listening to the reports of women, children and/or neighbors and observing their behavior; to identify the lesions; prenatal consultations; and home visits. As to the limitations: silence, denial/non-recognition of violence, lack of complaints by women; fear and guilt; flaws and unpreparedness of the health team; and fear due to the presence of aggressor. CONCLUSIONS: It is urgent to recognize the potential of Primary Care and to promote the qualification of professionals in order to identify the situation among visible and invisible complaints, leading to the confrontation of violence.

Physicians and the pharmaceutical industry: impact on prescription attitudes and habits.

INTRODUCTION: The physician-pharmaceutical industry relationship has been identified as an ethical problem, due to conflicts of interest motivated by the benefits that doctors receive and that can affect their clinical judgment. OBJECTIVE: To identify the frequency of physicians participation in activities financed by the pharmaceutical industry (PI), their attitudes towards PI representatives (PIRs), their prescriptive behavior and the association between their characteristics and their workplace with their participation in activities financed by the PI. METHOD: Cross-sectional survey to internists and cardiologists. The questionnaire included characteristics of the doctors and their workplace, participation in activities financed by the PI, attitudes towards PIRs, and prescription behavior. RESULTS: 455 questionnaires were analyzed; 78.5 % of surveyed subjects were aware of the physician-PI relationship, the majority acknowledged meeting with PIRs, 30 % indicated having received financial subsidies and 10 % considered that gifts affect their prescription. Having prior knowledge of the physician-PI relationship was associated with less participation in PI-financed educational activities. CONCLUSION: Practices and preferences towards the PI show the need to design strategies to avoid inappropriate prescription. INTRODUCCIÓN: La relación médico-industria farmacéutica (IF) se ha identificado como un problema ético por favorecer conflictos de interés derivados de los beneficios que reciben los médicos y que pueden afectar su juicio clínico. OBJETIVO: Identificar la frecuencia de participación de médicos en actividades financiadas por la IF, las actitudes de estos profesionales hacia los representantes de la IF, su conducta prescriptiva y la asociación de sus características y del trabajo con la participación en actividades financiadas por la IF. MÉTODO: Encuesta transversal a médicos internistas y cardiólogos. El cuestionario incluyó características de los médicos y centro de trabajo, participación en actividades financiadas por la IF, actitudes hacia los representantes y conducta de prescripción. RESULTADOS: Se analizaron 455 cuestionarios, 78.5 % de los encuestados tuvo conocimiento de la relación médico-IF, la mayoría respondió reunirse con representantes de la IF, 30 % indicó haber recibido subsidios financieros y 10 % consideró que los obsequios afectan su prescripción. Tener conocimiento previo de la relación médico-IF se asoció con menor participación en actividades educativas financiadas por por la IF. CONCLUSIÓN: Las prácticas y preferencias hacia la IF muestran la necesidad de diseñar estrategias para evitar la prescripción inapropiada.

[Sexist attitudes and recognition of abuse in young couples]. / Actitudes sexistas y reconocimiento del maltrato en parejas jóvenes.

AIM: To explore the association between gender-role attitudes and the recognition of abuse among adolescents and young adults during dating relationships. DESIGN: Cross-correlation study. LOCATION: 57 schools of secondary education, vocational education and university in five provinces of Spain (Huelva, Seville, A Coruña, Pontevedra and Asturias). PARTICIPANTS: 4,337 students aged between 15 and 26 years (40.6% males and 59.4% female) who had a dating relationship that lasted more than a month. MAIN MEASUREMENTS: The Gender Role Attitudes Scale was used, which consists of 20 indicators of egalitarian or sexism attitudes at the family, social and occupational level. The students also reported whether they suffered from recognized abuse (RA), unperceived abuse (UPA), or not abused (NA). RESULTS: In the whole sample, 68.6% declared themselves NA, 26.4% were under a situation of UPA, and 5.0% were RA. The RA group was more frequent among the females (6.3%), ≥18 years (6.4%) and university students (6.9%). UPA was more common in males (30.2%). The most sexist attitudes were found in the occupational dimension and especially in men and adolescents (15-17 years). Less sexist attitudes were associated with a lower probability of experiencing UPA (odds ratio=.71; P-trend<.001). CONCLUSIONS: Sexism seems to hinder the recognition of abuse. Achieving gender equity in adolescence and youth is imperative. Public health efforts should focus on men, as they constitute the group with more sexist attitudes and with higher prevalence of UPA.

Attitude of the medical personnel of a pediatrics department towards patient death. / Actitud del personal médico de un servicio de pediatría ante la muerte de los pacientes.

Introduction: Tertiary care hospitals' physicians require high emotional competence, since they are faced with the demands of terminally ill patients and their families. Objective: to assess the attitude of physicians of a pediatrics department towards patient death. Method: Pediatrics staff and resident physicians anonymously answered the Attitudes Towards Death (ATD) questionnaire. Absolute frequencies, percentages, means, standard deviations, Student's t-test and the chi-square test were used. Statistical significance was considered with p < 0.05. Results: The questionnaire was answered by 38 physicians, 26 (68.4%) were residents and 12 (37.6%) staff physicians; 15 (39.4%) were males and 23 (60.6%) females. Four residents (15.4%) had a positive attitude versus 2 staff physicians (16.7%) (p = 0.920). Statistical significance was found in items 1 (69.2% of residents versus 100% of staff physicians, p = 0.03), 16 (23% of residents versus 100% of staff physicians, p = 0.001) and 19 (92.3% of residents versus 58.3% of staff physicians, p = 0.01), corresponding to the avoidance, acceptance and professional perspective dimensions. Conclusion: Less than 20% of pediatric physicians have a positive attitude towards death. Most didn't value death as a passage or transition to a better life, or as a solution to life's problems.

Introducción: Los médicos de hospitales de tercer nivel requie-ren alta competencia emocional, ya que enfrentan las de-mandas de enfermos terminales y sus fami-liares. Objetivo: Evaluar la actitud de médicos de un servicio de pediatría ante la muerte de los pacientes. Método: Médicos adscritos y residentes de pediatría contestaron anónimamente el Cuestionario de Actitudes ante la Muerte (CAM). Se utilizaron frecuencias absolutas, porcentajes, medias, desviaciones estándar, t de Student y chi cuadrado. Se consideró significación estadística con p < 0.05. Resultados: Contestaron el cuestionario 38 médicos, 26 (68.4 %) residentes y 12 (37.6 %) adscritos; 15 (39.4 %) hombres y 23 (60.6 %) mujeres. Cuatro residentes (15.4 %) tuvieron actitud positiva versus dos médicos adscritos (16.7 %) (p = 0.920). Se encontró significación estadística en los ítems 1 (69.2 % de residentes versus 100 % de adscritos, p = 0.03), 16 (23 % de residentes versus 100 % de adscritos, p = 0.001) y 19 (92.3 % de residentes versus 58.3 % de adscritos, p = 0.01), correspondientes a las dimensiones evitación, aceptación y perspectiva profesional. Conclusión: Menos de 20 % de los médicos de pediatría tiene una actitud positiva ante la muerte. La mayoría no valoró la muerte como un pasaje o tránsito hacia una vida mejor, ni como una salida a los problemas de la vida.

THE QUALITY OF FATHER-CHILD ROUGH-AND-TUMBLE PLAY AND TODDLERS' AGGRESSIVE BEHAVIOR IN CHINA.

The purpose of this study was to explore the influence of the quality of early father-child rough-and-tumble play (RTP) on toddler aggressive behaviors and more fully understand how child, mother, and father characteristics were associated with higher quality father-child RTP among contemporary urban Chinese families. Participants included 42 families in Changsha, China. Play observations of fathers and their children were coded for RTP quality. The specific RTP quality of father-child reciprocity of dominance was associated with fewer toddler aggressive behaviors, as rated by both fathers and mothers. Mothers' democratic parenting attitudes were associated with higher quality father-child RTP. These findings suggest that higher quality father-child RTP may be one way in which some fathers influence children's expression of aggressive behaviors, and the quality of father-child RTP may be influenced by the broader family, social, and cultural contexts.

A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death. / Estudio cualitativo sobre las experiencias y emociones de los técnicos y enfermeras de emergencias extrahospitalarias tras la realización de maniobras de reanimación cardiopulmonar con resultado de muerte.

OBJECTIVE: To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. METHOD: An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. MAIN RESULTS: After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. CONCLUSIONS: Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals.

[Attitudes to insomnia by Primary Care physicians of Majorca (Spain)]. / Actitudes ante el insomnio de los médicos de AP de Mallorca.

OBJECTIVES: To describe the current clinical management of insomnia by family physicians. DESIGN: Cross-sectional study. SETTING: Majorca Health Area, 2011-2012. PARTICIPANTS: Family physicians (FP). Paediatricians, resident physicians and emergency physicians were excluded. MEASUREMENTS: Using a self-administered questionnaire, the following variables were collected: social, demographic, professional, training in insomnia, prescription preferences, and its clinical management. RESULTS: A total of 322 of 435 physicians answered (74%), of whom 55% were female. The mean age was 48 years with a mean of 21 years in the profession. Most of them consider insomnia as a major health problem, and refer to asking patients about sleep habits and its impact on daily life. About one third have been trained in insomnia in the last 5 years. Very few (0.6%) refers patients to a psychiatrist, and 1.9% to a psychologist. The most prescribed drugs are benzodiazepines (33.4%) and Z drugs (25.7%), with 69.4% of them claiming to have checked the treatment after month of onset. Most refer to advice about sleep hygiene measures (85.1%), 15.1% prescribe herbal remedies, and 14.2% behavioural cognitive therapy (CBT). Seven out of ten physicians consider CBT as effective and applicable by both physicians and nurses. The older FPs prescribe benzodiazepines with less frequency, while female FPs prescribe more sleep hygiene measures and herbal remedies. CONCLUSIONS: Most FPs consider insomnia as a major health problem, in which they usually get involved. The most commonly used treatments are sleep hygiene advice, followed by benzodiazepines and Z drugs. The CBT is considered effective but not widely used.

Women's perceptions of the quality of emergency obstetric care in a referral hospital in rural Tanzania.

OBJECTIVES: To assess perceptions of the quality of obstetric care of women who delivered in a rural Tanzanian referral hospital. METHODS: A descriptive-exploratory qualitative study, using semistructured in-depth interviews and participatory observation. Nineteen recently delivered women and 3 health workers were interviewed. RESULTS: Although most women held positive views about the care they received in hospital, several participants expressed major concerns about negative attitudes of healthcare workers. Lack of medical communication given by care providers constituted a major complaint. CONCLUSIONS: A more positive attitude by health workers and the provision of adequate medical information may promote a more positive hospital experience of women in need of obstetric care and enhance attendance.

[Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]. / Estudio multicéntrico hospitalario en España, México y Cuba de actitud hacia la donación de vivo hepática.

INTRODUCTION: Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE: To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD: Ten hospitals were selected from the «International Donor Collaborative Project¼: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS: Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001). CONCLUSIONS: Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY.

Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self- reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions--wanting to comfort, wanting to turn away, and feelings of anxiety--using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63-10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09-0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.

FACTORS ASSOCIATED WITH INDISCRIMINATE FRIENDLINESS IN HIGH-RISK CHILDREN.

Indiscriminate friendliness (IF) refers to a lack of reticence with strangers and is well-documented in neglected children. This risky behavior is distinct from attachment insecurity, and persists when parenting/caregiving improves. A previous review has suggested that caregiving quality is not associated with IF. This review aimed to explore factors associated with IF and whether quality of caregiving is important. Ten articles were reviewed using the S.H. Downs and N. Black (1998) Checklist for randomized and nonrandomized studies. Overall quality was high. Results showed that IF is present in fostered populations and postinstitutionalized children. Attachment security was not associated with IF. Length of time in institution and inhibitory control were associated with IF. Inhibitory control moderated the association between IF and number of caregivers. Genetic factors predispose children to IF and may impact on persistence. Quality of caregiving was associated with IF. Emotional availability (i.e., the degree to which carer and child are able to respond to each other's emotional signals) predicted IF. Limitations across studies included heterogeneity in IF measurement and unreliable measures of preadoptive care. Parenting may be a useful target for intervention. Future research should focus on developing a standardized measure of IF as well as evaluating a parental intervention.

[Theory of action on patient relationships. A different way of representing and understanding the behaviour of the family doctor in the clinic]. / Teoría en la acción sobre la relación con el paciente. Una perspectiva diferente de representar y entender el comportamiento del médico de familia en la consulta.

OBJECTIVE: To identify the «theory in the action¼, according to the concept of Argyris and Schon, in a group of Family Doctors and to examine whether this «theory¼ seems to be a valid representation of their behaviour, as well as a comparison with results of other studies. DESIGN: Descriptive, cross-sectional study. SETTING: Primary Care. PARTICIPANTS: Ten Family Doctors with a minimum of 10 years experience in Health Centres of a city and its surrounding area. METHOD: Intentional sampling was used to select the participants, according to age, sex, characteristics of the Health Centre, and style of practice style. Data was collected from recordings and transcription of self-recordings, as well as from observations in the consulting room. Inductive formulation and grouping of the propositions was performed from the identification of the behaviours in the consulting room and as well as their context following the proposals of Argyris and Schon. A comparison was also made of the propositions of the participants of this study and with those in the literature. RESULTS AND DISCUSSION: The 84 propositions from the interviews were grouped into 9 topical categories, which in order of weight were: confidence / interest, prescribing medications, subjective dimension, direction, negotiation, distance, and information. The propositions of the first two topics are basically similar, while differences appear in the «theory in action¼ of various doctors. The propositions were comparable with the results of other studies. CONCLUSION: It is possible to formulate the theory in action of Family Doctors that appears to be an overall and coherent representation of their behaviour in the consulting room.

[Access and use of new information and telecommunication technologies among teenagers at high school, health implications. JOITIC Study]. / Acceso y uso de nuevas tecnologías entre los jóvenes de educación secundaria, implicaciones en salud. Estudio JOITIC.

OBJECTIVE: To determine ICT accessibility and use among the adolescents attending High School and to analyse related factors. DESIGN: Cross-sectional multicentric study. SETTING: High Schools participating in the Community Health «Salut i Escola¼ Programme. PARTICIPANTS: 5,538 students from first to fourth degree at 28 centres in the area of Barcelona. MAIN MEASUREMENTS: Self administered questionnaire including sociodemographic information, ICT use and accessibility. RESULTS: Missing answers were below 1% in all items except in school performance (3,13%); 48,6% were female, mean age 14years (range 11-20); 15,5% foreigners; 23% reported low school performance; 75,2% took extracurricular activities; 88,9% refers a good relationship with their parents. ICT access is homogeneously massive: 98% had a computer at home, 44,8% used it for two or more hours daily. 98,6% could access Internet, 47,2% without parental control. 90% owned a mobile phone (83% in first grade, 95% in fourth); 45,6% owned one before 12years old. Girls use it for social relationships and boys for playing. 68,4% played videogames, 36,5% for three or more hours a week and 66,8% without parental control. Their use decreases with age. The ICT parental control is associated with better school performance. CONCLUSIONS: Our high scholars gain access to the ICT at younger ages and they use them in almost every aspect of their lives. There have been detected some gender differences in their use, as well as in the age of the users and between the type of school.

Spanish-Latin American multicenter study of attitudes toward organ donation among personnel from hospital healthcare centers.

INTRODUCTION: Hospital personnel are a group which has an influence on the opinion of the rest of the population about healthcare matters. Any unfavorable attitude of this group would be an obstacle to an increase in organ donation. OBJECTIVE: To analyze the attitude of hospital workers toward the donation of one's own organs in Spanish and Latin American hospitals and to determine the factors affecting this attitude. MATERIAL AND METHOD: Eleven hospitals from the "International Collaborative Donor Project" were selected, 3 in Spain, 5 in Mexico, 2 in Cuba and one in Costa Rica. A random sample was stratified by the type of service and job category. Attitude toward donation and transplantation was assessed using a validated survey. The questionnaire was completed anonymously and was self-administered. STATISTICAL ANALYSIS: Student's t-test, the χ2 test and logistic regression analysis. RESULTS: Of the 2,785 workers surveyed, 822 were from Spain, 1,595 from Mexico, 202 from Cuba and 166 from Costa Rica and 79% (n=2,191) were in favor of deceased organ donation. According to country, 94% (n=189) of Cubans were in favor, compared to 82% (n=1,313) of the Mexicans, 73% (n=121) of the Costa Ricans and 69% (n=568) of the Spanish (P<.001). In the multivariate analysis, the following variables had the most specific weight: 1) originating from Cuba (odds ratio=8.196; P<.001); 2) being a physician (OR= 2.544; P<.001); 3) performing a job related to transplantation (OR = 1.610; P=.005); 4) having discussed the subject of donation and transplantation within the family (OR= 3.690; P<.001); 5) having a partner with a favorable attitude toward donation and transplantation (OR= 3.289; P<.001); 6) a respondent's belief that his or her religion is in favor of donation and transplantation (OR= 3.021; P=.001); 7) not being concerned about the possible mutilation of the body after donation (OR= 2.994; P<.001); 8) the preference for other options apart from burial for treating the body after death (OR= 2.770; P<.001); and 9) acceptance of carrying out an autopsy if one were needed (OR= 2.808; P<.001). CONCLUSIONS: Hospital personnel in Spanish and Latin American healthcare centers had a favorable attitude toward donation, although 21% of respondents were not in favor of donating. This attitude was more favorable among Latin American workers and was very much conditioned by job-related and psychosocial factors.

Health personnel perception about central sensitivity syndrome-fibromyalgia patients.

BACKGROUND AND OBJECTIVES: Fibromyalgia is characterized by musculoskeletal pain and asthenia of chronic course. Fibromyalgia patients are often a challenge for the health care community as a whole. Existing studies are often limited to the opinion of rheumatologists or family physicians. With this study we seek to know what are the actions, perceptions and knowledge of health professionals as a whole when caring for patients with this disease. MATERIALS AND METHODS: Descriptive cross-sectional study, by means of a self-administered and anonymous survey. Distributed mainly in hospital wards and primary care centers. Statistical analysis of the variables collected was performed (p < 0.05). RESULTS: 200 surveys were collected, most of them physicians 63.5% (n = 127) or nurses 25.5% (n = 51). 71% of physicians reported using the WHO analgesic scale. 53% (n = 59) use NSAIDs or Paracetamol. Antidepressants are the third drug of choice. Most believe that the referral specialists should be rheumatologists or primary care physicians, a similar percentage, that management should be multidisciplinary. 52% feel discouraged or annoyed when dealing with these patients. Physicians have more negative connotations and believe that the care that the patient receives is mostly influenced by the diagnosis of fibromyalgia, compared to nurses and other professionals. CONCLUSIONS: Our study shows that the lack of knowledge and therapeutic tools generates, to a large extent, frustration and discomfort in health personnel. It is important to develop new approaches to this entity.