Management of analgesia in acute pancreatitis: Results of a national survey. / Manejo de la analgesia en la pancreatitis aguda. Resultados de una encuesta nacional.

INTRODUCTION: Acute pancreatitis is one of the main reasons for digestive admissions. Adequate pain treatment is crucial in its management. However, there are hardly any descriptions of the analgesic guidelines used in our setting. METHODS: On-line survey on analgesic management in acute pancreatitis, aimed at attending physicians and residents practising in Spain. RESULTS: Two hundred and nine physicians from 88 centres responded to the survey. Ninety percent were specialists in gastrointestinal medicine and 69% worked in a tertiary centre. The majority (64.4%) do not routinely use scales to measure pain. When choosing a drug, experience in its use was the most important factor. The most commonly prescribed initial treatments are: combination of paracetamol and metamizole (53.5%), paracetamol alone (19.1%) and metamizole alone (17.4%). As rescue: meperidine (54.8%), tramadol (17.8%), morphine chloride (17.8%) and metamizole (11.5%). Continuous perfusion is used in 8.2% of initial treatments. Physicians with >10 years of service use more metamizole as monotherapy (50%), while residents and attending physicians with <10 years of service prescribe it in combination with paracetamol (85%). If progression is needed, morphine chloride and meperidine are mainly used. The speciality of the respondent, the size of the work centre and the unit/service where the patients were admitted did not influence the analgesia prescribed. Satisfaction with pain management reached 7.8/10 (SD 0.98). CONCLUSION: In our setting, metamizole and paracetamol are the most commonly used analgesics as initial pain treatment in acute pancreatitis, and meperidine is the most commonly used rescue analgesic.

Use of digital health tools in inflammatory bowel disease. / Uso de herramientas digitales en salud en enfermedad inflamatoria intestinal.

OBJECTIVE: To analyse the characteristics and use of digital health tools (DHT) in inflammatory bowel disease (IBD). METHODS: We performed a qualitative study based on a narrative literature review, a questionnaire and on the opinion of 3 expert gastroenterologists. Several searches were carried out until September 2022 through Medline to identify articles on the use of DHT in IBD by healthcare professionals. A structured questionnaire was designed to be answered by health professionals involved in the care of patients with IBD. The experts generated a set of recommendations. RESULTS: There are multiple DHT for IBD with different characteristics and contents. We received 29 questionnaires. Almost 50% of the participants were 41-50 years old, the majority were women (83%) and 90% were gastroenterologists. A total of 96% reported the use of several DHT, but 20% used them occasionally or infrequently. Web pages were found the most used (62%). DHT are mostly used to get information (80%), followed by clinical practice issues (70%) and educational purposes (62%). G-Educainflamatoria website is the best known and most used HDS (96% and 64%, respectively). The main barriers to the use of DHT in IBD were the lack of time (55%), doubts about the benefit of DHT (50%) and the excess of information (40%). CONCLUSIONS: Healthcare professionals involved in the care of patients with to IBD frequently use DHT, although actions are needed to optimize their use and to guarantee their efficient and safe use.

Public attitudes and intentions toward engaging in reintroduction of wolves to Japan.

Reintroducing apex predators is an important approach in ecosystem restoration; however, it is challenging. Wolves (Canis lupus) were exterminated in Japan around 1900, and since then, there has been a lack of top predators throughout the country. Currently, the wild ungulate population is increasing, causing agricultural and forest damage. This has triggered an ongoing debate among researchers and nongovernmental organizations on whether wolves should be reintroduced to promote self-regulating biodiverse ecosystems. We conducted a nationwide survey to examine public attitudes toward wolf reintroduction (WR) in Japan. We sent online questionnaires to 88,318 citizens across the country. Among the 12,028 respondents, excluding those with invalid or incomplete answers and unqualified respondents, we obtained and analyzed 7500 responses that were representative of Japanese citizens in terms of some key sociodemographic attributes. More respondents disagreed with WR (39.9%) than agreed (17.1%), and many respondents (43.0%) were undecided. Structural equation modeling revealed that risk perceptions affected public attitudes, implying that the greater the perceived threat of wolf attacks, the less likely people are to support WR. In contrast, attitudes toward wolves (e.g., "I like wolves.") influenced by wildlife value orientation and beliefs about the ecological role of wolves (e.g., controlling deer populations) positively affected public attitudes toward WR. Those who had a positive attitude toward WR showed intentions to engage in behaviors that support WR. Our results suggest that the dissemination of information related to the ecological role of wolves and the development of a more mutualistic mindset in people could positively influence public support for WR in Japan.

Actitudes e intenciones públicas respecto a la reintroducción de lobos en Japón Resumen La reintroducción de superdepredadores es una estrategia importante para la restauración de los ecosistemas; sin embargo, representa muchos retos. Los lobos (Canis lupus) fueron exterminados en Japón alrededor de 1900 y desde entonces no ha habido superdepredadores en el país. Hoy en día, la población silvestre de ungulados está incrementando y ocasionando daño agrícola y forestal. Esto ha detonado un debate entre los investigadores y las organizaciones no gubernamentales sobre si se debiesen reintroducir lobos para promover ecosistemas biodiversos autorregulados. Realizamos una encuesta nacional para analizar las actitudes públicas respecto a la reintroducción de lobos (RL) en Japón. Enviamos 88,318 cuestionarios virtuales a ciudadanos de todo el país. De los 12,028 respondientes, excluyendo a aquellos con respuestas inválidas o incompletas y a los respondientes no calificados, obtuvimos y analizamos 7500 respuestas representativas del ciudadano japonés en términos de algunas características sociodemográficas importantes. Hubo más respondientes en contra (39.9%) que a favor (17.1%) de la RL y todavía más respondientes (43.0%) no estaban decididos. El modelo de ecuación estructural reveló que las percepciones de riesgo impactaron sobre las actitudes públicas, lo que implica que entre mayor sea la amenaza percibida de los ataques de lobos, es menos probable que la gente apoye la RL. Como contraste, la orientación del valor de la fauna que influyó sobre las actitudes (p. ej.: "me gustan los lobos") y las creencias sobre el papel ecológico de los lobos (p. ej.: controlar las poblaciones de venados) tuvieron un impacto positivo en las actitudes respecto a la RL. Quienes tuvieron una actitud positiva respecto a la RL mostraron intenciones de apoyarla. Nuestros resultados sugieren que la divulgación de información relacionada con el papel ecológico de los lobos y el desarrollo de una mentalidad más mutualista en las personas podrían influir positivamente en el apoyo público para la RL en Japón.

International on-line questionnaire about severe lower gastrointestinal bleeding management: Do we have it clear? / Encuesta internacional on-line sobre el manejo de la hemorragia digestiva baja grave. ¿Lo tenemos claro?

BACKGROUND AND AIMS: The diagnostic and therapeutic strategy in severe lower gastrointestinal bleeding (LGIB) varies depending on the patient's clinical situation. Actual clinical practice guidelines propose different management strategies. We aim to know the attitude of the gastroenterologists from different hospitalary centers in the management of this entity. METHODS: Descriptive and observational study using an on-line questionnaire, addressed to gastroenterologists in Spain and Latin America, in December 2021. RESULTS: We included 281 anonymous questionnaires of gastroenterologists from Spain and Latin America. Diagnostic and therapeutic management of severe LGIB was heterogeneous among the participants. Regarding to the first diagnostic modalities they showed variability between performing computed tomography angiography (CTA) (44.5%), gastroscopy (33.1%), colonoscopy (20.6%) and arteriography (1.1%). The therapeutic attitude after a positive CTA mostly varied between performing arteriography (38.1%) and colonoscopy (44.1%). If negative CTA, in the majority of cases a gastroscopy was performed. If the patient needed intensive critical unit (ICU) care and to undergo colonoscopy, most participants performed an urgent colonoscopy (<24h) (31% always, 43.4% in most cases); while if the patient did not require ICU admission this percentage was lower (10% always, 33.8% in most cases). The 40.9% of the participants admitted having doubts about the management of this patients and the 98.2% considered the need for a creation of an action protocol. CONCLUSIONS: There is a high interhospitalary variability on the management of severe lower gastrointestinal bleeding among gastroenterologists. It is necessary to unify the diagnostic and therapeutic management of this pathology.

Survey on the Management of Dysplastic Nevus by Dermatologists in the Center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV). / Encuesta sobre el manejo del nevus displásico por los dermatólogos de la sección Centro de la Academia Española de Dermatología y Venereología (AEDV).

BACKGROUND AND OBJECTIVES: There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma. MATERIAL AND METHODS: We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm). RESULTS: We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists' attitudes. CONCLUSIONS: Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases.

Clinical Unmet Needs and Treatment Patterns of Paediatric Psoriasis Patients: A Real-World Evidence Study in Spain.

BACKGROUND AND OBJECTIVE: Real-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines. MATERIAL AND METHOD: This retrospective analysis of a cross-sectional market research survey assessed the clinical unmet needs and treatment patterns in patients with paediatric PsO in Spain, as reported by their primary care and specialist physicians, using data collected as part of the Adelphi Real World Paediatric PsO Disease-Specific Program (DSP™) between February and October 2020. RESULTS: Survey data from 57 treating physicians were included (71.9% [N=41] dermatologists, 17.6% [N=10] general practitioners/primary care physicians, and 10.5% [N=6] paediatricians); the final analysis included 378 patients. At sampling, 84.1% (318/378) of patients had mild disease, 15.3% (58/378) had moderate disease and 0.5% (2/378) had severe disease. Retrospectively reported physician-judged severity at the time of PsO diagnosis recorded 41.8% (158/378) of patients with mild disease, 51.3% (194/378) with moderate disease and 6.9% (26/378) with severe disease. Overall, 89.3% (335/375) of patients were currently receiving topical PsO therapy, while 8.8% (33/375), 10.4% (39/375) and 14.9% (56/375) of patients were currently receiving phototherapy, conventional systemics and biologics, respectively. CONCLUSIONS: These real-world data reflect the current burden and treatment landscape of paediatric PsO in Spain. The management of patients with paediatric PsO could be improved by further educating healthcare professionals and developing regional guidelines.

Clinical Unmet Needs and Treatment Patterns of Paediatric Psoriasis Patients: A Real-World Evidence Study in Spain. / [Artículo traducido] Necesidades clínicas no satisfechas y patrones de tratamiento de los pacientes pediátricos con psoriasis: estudio de evidencia en el mundo real en España.

BACKGROUND AND OBJECTIVE: Real-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines. MATERIAL AND METHOD: This retrospective analysis of a cross-sectional market research survey assessed the clinical unmet needs and treatment patterns in patients with paediatric PsO in Spain, as reported by their primary care and specialist physicians, using data collected as part of the Adelphi Real World Paediatric PsO Disease-Specific Program (DSP™) between February and October 2020. RESULTS: Survey data from 57 treating physicians were included (71.9% [N = 41] dermatologists, 17.6% [N = 10] general practitioners/primary care physicians, and 10.5% [N = 6] paediatricians); the final analysis included 378 patients. At sampling, 84.1% (318/378) of patients had mild disease, 15.3% (58/378) had moderate disease and 0.5% (2/378) had severe disease. Retrospectively reported physician-judged severity at the time of PsO diagnosis recorded 41.8% (158/378) of patients with mild disease, 51.3% (194/378) with moderate disease and 6.9% (26/378) with severe disease. Overall, 89.3% (335/375) of patients were currently receiving topical PsO therapy, while 8.8% (33/375), 10.4% (39/375) and 14.9% (56/375) of patients were currently receiving phototherapy, conventional systemics and biologics, respectively. CONCLUSIONS: These real-world data reflect the current burden and treatment landscape of paediatric PsO in Spain. The management of patients with paediatric PsO could be improved by further educating healthcare professionals and developing regional guidelines.

A global community-sourced assessment of the state of conservation technology.

Conservation technology holds the potential to vastly increase conservationists' ability to understand and address critical environmental challenges, but systemic constraints appear to hamper its development and adoption. Understanding of these constraints and opportunities for advancement remains limited. We conducted a global online survey of 248 conservation technology users and developers to identify perceptions of existing tools' current performance and potential impact, user and developer constraints, and key opportunities for growth. We also conducted focus groups with 45 leading experts to triangulate findings. The technologies with the highest perceived potential were machine learning and computer vision, eDNA and genomics, and networked sensors. A total of 95%, 94%, and 92% respondents, respectively, rated them as very helpful or game changers. The most pressing challenges affecting the field as a whole were competition for limited funding, duplication of efforts, and inadequate capacity building. A total of 76%, 67%, and 55% respondents, respectively, identified these as primary concerns. The key opportunities for growth identified in focus groups were increasing collaboration and information sharing, improving the interoperability of tools, and enhancing capacity for data analyses at scale. Some constraints appeared to disproportionately affect marginalized groups. Respondents in countries with developing economies were more likely to report being constrained by upfront costs, maintenance costs, and development funding (p = 0.048, odds ratio [OR] = 2.78; p = 0.005, OR = 4.23; p = 0.024, OR = 4.26), and female respondents were more likely to report being constrained by development funding and perceived technical skills (p = 0.027, OR = 3.98; p = 0.048, OR = 2.33). To our knowledge, this is the first attempt to formally capture the perspectives and needs of the global conservation technology community, providing foundational data that can serve as a benchmark to measure progress. We see tremendous potential for this community to further the vision they define, in which collaboration trumps competition; solutions are open, accessible, and interoperable; and user-friendly processing tools empower the rapid translation of data into conservation action. Article impact statement: Addressing financing, coordination, and capacity-building constraints is critical to the development and adoption of conservation technology.

La tecnología de conservación tiene el potencial para incrementar considerablemente la habilidad de los conservacionistas para entender y lidiar con los retos ambientales más importantes, pero las restricciones sistémicas parecen dificultar su desarrollo y adopción. La comprensión de estas restricciones y las oportunidades para el avance todavía son limitadas. Encuestamos en línea a 248 usuarios y programadores mundiales de tecnología de conservación para identificar las percepciones existentes del desempeño e impacto potencial de las herramientas actuales, restricciones para los usuarios y programadores y oportunidades clave para el crecimiento. También realizamos grupos de discusión con 45 expertos destacados para triangular los hallazgos. Las tecnologías con el potencial percibido más alto fueron el aprendizaje mecánico y la visión por computadora, la genómica y el eADN y los sensores en red. El 95%, 94% y 92% de los respondientes, respectivamente, clasificó estas tecnologías como muy útiles o como puntos de inflexión. Los retos más apremiantes que afectaron al área como conjunto fueron la competencia por el financiamiento limitado, la duplicación de esfuerzos y el desarrollo inadecuado de capacidades. El 76%, 67% y 55% de los respondientes, respectivamente, identificaron estos retos como de interés primario. Las oportunidades clave para el crecimiento que se identificaron en los grupos de diálogo fueron el incremento de la colaboración y la distribución de información, la mejoría de la operatividad entre herramientas y la potenciación de la capacidad de análisis de datos a escala. Algunas restricciones parecieron afectar desproporcionadamente a grupos marginalizados. Los respondientes de países con economías en desarrollo tuvieron mayor probabilidad de reportar la restricción por los costos iniciales, costos de mantenimiento y la financiación del desarrollo (p = 0.048, tasa de probabilidad [OR] = 2.78; p = 0.005, OR = 4.23; p = 0.024, OR = 4.26), y las mujeres respondientes tuvieron una mayor probabilidad de reportar restricciones por la financiación del desarrollo y habilidades técnicas percibidas (p = 0.027, OR = 3.98; p = 0.048, OR = 2.33). A nuestro entendimiento, este es el primero intento por capturar formalmente las perspectivas y necesidades de la comunidad mundial de la tecnología de conservación, proporcionando datos fundamentales que pueden servir como referencia para medir el progreso. Vemos un potencial tremendo para que esta comunidad amplíe la visión que definen, en la cual la colaboración se sobrepone a la competencia; las soluciones son abierta, accesibles e interoperativas; y las herramientas intuitivas de procesamiento capacitan la traducción veloz de datos a acciones de conservación.

Changes in the management of IBD patients since the onset of COVID-19 pandemic. A path toward the implementation of telemedicine in Spain?

BACKGROUND: COVID-19 pandemic increased medical services demand aside from interrupting daily clinical practice for other diseases such as inflammatory bowel disease (IBD). Here we present the results of a survey to gain the perception of IBD specialists in their patient-management using telemedicine in their daily practice. METHODS: This was an observational survey study among physicians focused on IBD (gastroenterologist, surgeons, and pediatricians) members of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU), the Spanish Association of Gastroenterology (AEG), and the Spanish Association of Coloproctology (AECP), regarding changes of management of IBD patients. RESULTS: We received a total of 269 responses to the survey (from May to June 2020). Before the pandemic, nearly all the respondents reported performing very frequently their visits face-to-face (n=251, 93.3%) while, during the pandemic, the telephone visits were the most frequent visits performed (n=138, 51.3%). Regarding communication difficulties, 157 (58.4%) respondents reported the impossibility of performing a proper examination as the most relevant issue. Also, 114 (42.4%) respondents considered remote visits more time-consuming than face-to-face visits. Most gastroenterologists (n=188, 83.2%) considered patients with active perianal disease in special need of face-to-face consultation and more than half of the surgeons (n=35, 50.7%) reported having performed an immediate postoperative follow-up remotely. CONCLUSIONS: Most IBD units have implemented remote visits during the pandemic, but most professionals found them more time-consuming and unsuitable for some disease profiles. Therefore, there is a need for the development of better telemedicine systems that can meet professionals' and patients' requirements.

Social comfort zones for transformative conservation decisions in a changing climate.

Novel management interventions intended to mitigate the impacts of climate change on biodiversity are increasingly being considered by scientists and practitioners. However, resistance to more transformative interventions remains common across both specialist and lay communities and is generally assumed to be strongly entrenched. We used a decision-pathways survey of the public in Canada and the United States (n = 1490) to test two propositions relating to climate-motivated interventions for conservation: most public groups are uncomfortable with interventionist options for conserving biodiversity and given the strong values basis for preferences regarding biodiversity and natural systems more broadly, people are unlikely to change their minds. Our pathways design tested and retested levels of comfort with interventions for forest ecosystems at three different points in the survey. Comfort was reexamined given different nudges (including new information from trusted experts) and in reference to a particular species (bristlecone pine [Pinus longaeva]). In contrast with expectations of public unease, baseline levels of public comfort with climate interventions in forests was moderately high (46% comfortable) and increased further when respondents were given new information and the opportunity to change their choice after consideration of a particular species. People who were initially comfortable with interventions tended to remain so (79%), whereas 42% of those who were initially uncomfortable and 40% of those who were uncertain shifted to comfortable by the end of the survey. In short and across questions, comfort levels with interventions were high, and where discomfort or uncertainty existed, such positions did not appear to be strongly held. We argue that a new decision logic, one based on anthropogenic responsibility, is beginning to replace a default reluctance to intervene with nature.

Zonas de Comodidad Social ante las Decisiones de Conservación Transformadoras en un Clima Cambiante Resumen Los científicos y los practicantes de la conservación cada vez consideran más a las intervenciones novedosas de manejo con la intención de mitigar los impactos del cambio climático sobre la biodiversidad. Sin embargo, la resistencia a las intervenciones más transformadoras es común en especialistas y no profesionales y generalmente se asume que está fuertemente arraigada. Usamos una encuesta sobre toma de decisiones del público en Canadá y en los Estados Unidos (n = 1490) para evaluar dos propuestas relacionadas a intervenciones de conservación motivadas por el clima: la mayoría de los grupos de público están incómodos con las opciones intervencionistas para conservar la biodiversidad y dada la sólida base de valores para las preferencias con respecto a la biodiversidad y a los sistemas naturales en general, es poco probable que las personas cambien de opinión. Nuestro diseño de encuesta analizó y reanalizó los niveles de comodidad con respecto a las intervenciones para los ecosistemas boscosos en tres puntos distintos dentro del estudio. La comodidad fue reexaminada con diferentes impulsos (incluyendo información nueva proveniente de expertos confiables) y en referencia a una especie particular (Pinus longaeva). Contrario a las expectativas de malestar del público, los niveles de línea base de la comodidad del público frente a las intervenciones climáticas en los bosques fueron moderadamente altos (46% de comodidad) e incrementaron cuando a los respondientes se les proporcionó información nueva y la oportunidad de cambiar su elección después de considerar a una especie particular. Las personas que al inicio estaban cómodas con las intervenciones tendieron a permanecer así (79%), mientras que el 42% de aquellos que estuvieron incómodos inicialmente y el 40% de aquellos que estuvieron inseguros cambiaron a estar cómodos para el final del estudio. En resumen, los niveles de comodidad frente a las intervenciones fueron elevados, y cuando existieron malestar o incertidumbre, dichas posiciones no parecieron mantenerse con fuerza. Argumentamos que una lógica de decisión basada en la responsabilidad antropogénica está comenzando a reemplazar una renuencia predeterminada a intervenir en la naturaleza.

Ultra-processed foods drive to unhealthy diets: evidence from Chile.

OBJECTIVES: To assess the consumption of ultra-processed foods and its association with the overall dietary content of nutrients related to non-communicable diseases (NCD) in the Chilean diet and to estimate the population attributable fraction of ultra-processed food consumption on the unhealthy nutrient content. DESIGN: Cross-sectional analysis of dietary data collected through a national survey (2010). SETTING: Chile. PARTICIPANTS: Chilean population aged ≥2 years (n 4920). RESULTS: In Chile, ultra-processed foods represented 28·6 % of the total energy intake. A significant positive association was found between the dietary share of ultra-processed foods and NCD-promoting nutrients such as dietary energy density (standardised regression coefficient (ß) = 0·22), content of free sugars (ß = 0·45), total fats (ß = 0·26), saturated fats (ß = 0·19), trans fats (ß = 0·09) and Na:K ratio (ß = 0·04), while a significant negative association was found with the content of NCD-protective nutrients such as K (ß = -0·19) and fibre (ß = -0·31). The content of Na (ß = 0·02) presented no significant association. Except for Na, the prevalence of inadequate intake of all nutrients (WHO recommendations) increased across quintiles of the dietary share of ultra-processed foods. With the reduction of ultra-processed foods consumption to the level seen among the 20 % lowest consumers (3·8 % (0-9·3 %) of the total energy from ultra-processed foods), the prevalence of nutrient inadequacy would be reduced in almost three-fourths for trans fats; in half for energy density (foods); in around one-third for saturated fats, energy density (beverages), free sugars and total fats; in near 20 % for fibre and Na:K ratio and in 13 % for K. CONCLUSIONS: In Chile, decreasing the consumption of ultra-processed foods is a potentially effective way to achieve the WHO nutrient goals for the prevention of diet-related NCD.

Survey of adherence to treatment in inflammatory bowel disease. ENADEII study. / Encuesta de adherencia al tratamiento en enfermedad inflamatoria intestinal. Estudio ENADEII.

The rate of non-adherence to medical treatment in inflammatory bowel disease (IBD) is around 50%, with the consequent negative impact on treatment results, morbidity and cost. OBJECTIVES: To determine through an online survey among gastroenterologists with special dedication to IBD, their knowledge about the adherence to treatment of their patients and the methods used to improve it. METHODS: An email was sent to gastroenterologists from the technical office of the Crohn's disease and ulcerative colitis Spanish working group (GETECCU), with a link to the online survey. RESULTS: 760 physicians were invited. One hundred eighty-four surveys were obtained (28.5%). A total of 68% of respondents had indexed IBD publications, 13% of which were on adherence. Although almost 99% considered adherence as very important/important, 25% of physicians did not assess it. Even though 100% considered that improving adherence would imply a better prognosis, 47% did not use any system to improve it. The factors associated with the assessment and improvement of adherence were: university hospital (81.4%), combined treatment with thiopurines and biological drugs (44.6%), physician gender (female) (63.1%), dedicating≥6hours weekly to IBD (71.6%), previous published indexed papers on IBD (68.5%) and on adherence in IBD (12.5%), and considering adherence as important/very important (98.9%). CONCLUSIONS: Although knowledge about the relevance of adherence to medical treatment in IBD is widespread, among the gastroenterologists with special dedication to IBD who were surveyed, almost half do not use any objective system to quantify it. An effort must be made to quantify and improve adherence to the treatment of these patients.

Management of acute severe ulcerative colitis in Spain: A nationwide clinical practice survey. / Manejo de la colitis ulcerosa aguda grave en España: Resultados de una encuesta sobre práctica clínica.

INTRODUCTION: Ulcerative colitis (UC) is a chronic disease of the digestive tract and up to 20-30% of UC patients may suffer a severe flare-up during the course of the disease. Although there are national and international recommendations about its clinical management, there is not enough information about the treatment of acute severe UC in clinical practice. METHODS: An electronic and anonymous survey with 51 multiple-choice questions was performed among all the members of the Spanish Crohn's Disease and Ulcerative Colitis Working Group (GETECCU). RESULTS: Out of the 164 responders (20%), most were gastroenterologists (95%), with 59% from tertiary hospitals treating a median of 5 patients per year (IQR: 3-8) with a severe flare-up of ulcerative colitis. An endoscopic examination was routinely performed in 86% of patients (62% at admission). The most commonly used corticosteroid was methylprednisolone, usually at a dose of 60mg/day, and its response was assessed after a median of 3days (IQR: 3-5). Both in thiopurine-naïve and thiopurine-refractory patients, infliximab was the drug most frequently prescribed as rescue therapy. Half of responders (55%) had ever prescribed a first dose of infliximab higher than 5 mg/kg, and a higher proportion (73%) had ever prescribed an earlier dose of infliximab in the second or third infusion. CONCLUSIONS: Acute severe UC is generally managed according to current treatment guidelines in our setting. The rescue therapy most commonly prescribed is infliximab, and the use of intensified or accelerated regimens with this biological drug is not unusual.

[Sociodemographic profile of the homeopathy user in Spain]. / Perfil sociodemográfico del usuario de la homeopatía en España.

OBJECTIVE: To identify the sociodemographic profile of the homeopathy user in Spain. DESIGN: Quantitative study. LOCATION: Spain. CORPUS: The Centre for Sociological Research database (Study 3205, February 2018), with a total of 2,486 interviews, and the sub-sample that includes all patients who have claimed to use homeopathy in Spain in the last 12 months (n=124). MAIN MEASUREMENTS: The percentages, means and/or standard deviation of the factors were calculated, as well as the significance of the changes in the different variables analysed in the general population, and the specific users of homeopathy in Spain. This was determined by the variance analysis or Pearson's χ2 test, depending on the nature of the variable in the study. RESULTS: The homeopathy user-type profile in Spain is a woman, of middle/high social status, with higher university studies, and with a progressive political ideology. CONCLUSIONS: The Spanish profile is similar to that in other international studies.

Prospects for stakeholder coordination by protected-area managers in Europe.

Growing resource demands by humans, invasive species, natural hazards, and a changing climate have created broad-scale impacts and the need for broader-extent conservation activities that span ownerships and even political borders. Implementing regional-scale conservation brings great challenges, and learning how to overcome these challenges is essential for maintaining biodiversity (i.e., richness and evenness of biological communities) and ecosystem functions and services across scales and borders in the face of system change. We administered an online survey to examine factors potentially driving perspectives of protected-area (PA) managers regarding coordination with neighboring PAs and other stakeholders (i.e., stakeholder coordination) for conserving biodiversity and ecosystem services during the next decade within diverse regions across Europe. Although >70% (n = 58) of responding PA managers indicated that climate change and invasive species are relevant for their PAs, they gave <50% probability that these threats could be mitigated through stakeholder coordination. They thought there was a >60% probability (n = 85) that stakeholder coordination would take place with the aim to improve conservation outcomes. Consistent with the foundation on which many European PAs were established, managers viewed maintaining or enhancing biodiversity as the most important (>70%; n = 61) expected benefit. Other benefits included maintaining or enhancing human resources and environmental education (range of Bayesian credibility intervals [CIs] 57-93%). They thought the main barriers to stakeholder coordination were the lack of human and economic resources (CI 59-67% chance of hindering; n = 64) followed by communication and interstakeholder differences in political structures and laws (CI 51-64% probability of hindering). European policies and strategies that address these hindering factors could be particularly effective means of enabling implementation of green infrastructure networks in which PAs are the nodes.

State of endoscopic ultrasonography in Spain in 2017. / Estado de la ecoendoscopia en España en 2017.

AIM: To understand the current state of endoscopic ultrasonography (EUS) in Spain. METHODS: Descriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists. RESULTS: Sixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7,446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2-8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6months (0.5-36). CONCLUSIONS: EUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training program since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.

Comparison of administrative and survey data for estimating vitamin A supplementation and deworming coverage of children under five years of age in Sub-Saharan Africa.

OBJECTIVE: To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries. METHODS: Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6- to 11-month and 12- to 59-month age group. RESULTS: For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean ± SD differences in coverage between administrative and survey data were 12.2% ± 22.5% for the door-to-door delivery strategy and 25.9% ± 24.7% for the fixed-site model (P = 0.06). For deworming, mean ± SD differences in coverage between data sources were 28.1% ± 43.5% and 33.1% ± 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6- to 11-month age group and 45 of 48 (94%) comparisons for the 12- to 59-month age group. CONCLUSION: Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods.

Encuesta sobre la higiene de las heridas: conocimiento, implementación, obstáculos y resultados.

OBJETIVO: Se ha desarrollado una encuesta para comprender el conocimiento y la implementación actual del concepto de higiene de las heridas un año después de su difusión. También se analizaron los obstáculos para su implementación y los resultados. MÉTODO: La revista Journal of Wound Care (JWC), con la colaboración de ConvaTec, desarrolló una encuesta de 26 preguntas, compuesta por respuestas de opción múltiple y texto libre, que distribuyó globalmente por correo electrónico y en línea; la encuesta estuvo abierta unas 12 semanas. Debido a la naturaleza exploratoria de la investigación, se utilizó una técnica de muestreo no probabilístico. Los autores analizaron los resultados de la encuesta para sacar conclusiones de los datos. RESULTADOS: Un total de 1478 participantes dio su consentimiento para el uso de sus datos combinados anonimizados. Casi el 90% era de Estados Unidos o el Reino Unido. La mayoría se desempeñaba como especialista en el cuidado de las heridas y estaba distribuido equitativamente entre centros de atención primaria y hospitales de agudos. El 66,6% había trabajado en el área de cuidado de las heridas durante más de 8 años. Los encuestados trabajaban con una amplia variedad de tipos de heridas. Más de la mitad (57,4%) había oído hablar del concepto de higiene de las heridas, y entre ellos, el 75,3% la había implementado; el 78,7% respondió que la aplicaba "siempre", mientras que el 20,8% lo hacía "a veces". Los tres principales obstáculos para su adopción fueron la confianza (39,0%), el deseo de que haya más estudios sobre la higiene de las heridas (25,7%) y la competencia (24,8%). En general, tras la implementación de la higiene de las heridas, el 80,3% informó que las tasas de cicatrización de sus pacientes habían mejorado. CONCLUSIÓN: Los encuestados estuvieron totalmente de acuerdo en que la implementación de la higiene de las heridas es un método exitoso para el tratamiento del biofilm y un componente fundamental para mejorar las tasas de cicatrización en heridas de difícil cicatrización. Sin embargo, los obstáculos para su adopción e implementación demuestran que se necesitan cursos integrales de educación y capacitación, apoyo institucional para los cambios de política, protocolos, y más estudios clínicos para promover la higiene de las heridas.

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use.

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N = 63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.e., patient maintained abstinence for 30 days prior to treatment termination or had more than one heavy drinking day in the same period). Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech, derived from a videotaped pretreatment interaction task and three subsequent therapy sessions. Spouse we-talk during the intervention (accounting for pretreatment we-talk), as an index of communal orientation, uniquely predicted successful treatment outcomes. In contrast, both patient and spouse I-talk during the intervention (accounting for pretreatment I-talk), as a marker of individualistic orientation, uniquely predicted unsuccessful outcomes, especially when distinguishing active and passive (I vs. me/my) pronoun forms. Results strengthen evidence for the prognostic significance of spouse behavior for patient health outcomes and for communal coping (indexed via pronoun use) as a potential mechanism of change in couple-focused interventions for health problems.

[Organisation of care and initial management of severe head injury in Spain: Results of a national survey]. / Organización de la asistencia y manejo inicial del traumatismo craneoencefálico grave en España: resultados de una encuesta nacional.

OBJECTIVE: The main objective of the study is to obtain knowledge about the organisation of care for severe head trauma as well as the initial management of these patients in Neurosurgical Departments in Spain. MATERIAL AND METHOD: A 22-item questionnaire was designed and sent to 59 Neurosurgical Departments. The aim of the questionnaire was to collect data regarding the general profile of the patients with a severe head injury, the general characteristics of the hospitals, the initial care of these patients, the monitoring techniques used, and the measures used to control Intracranial pressure (ICP). RESULTS: Of the 59 Neurosurgical Departments identified, 29 (49.2%) completed the questionnaire. There was a wide variability in the number of patients treated per year between the different departments. The leadership of care often fell (58.6%) on the intensive care specialist. Many (69%) of the departments did not have a neurosurgeon specially dedicated to the management and monitoring of these patients. The initial care in the Emergency department usually fell (51.7%) on the general medicine practitioner. The availability of computed tomography (CT) was universal. The use of telemedicine was highly variable. ICP monitoring was performed on more than 75% of patients in most (89.7%) of departments, but there was limited use of other monitoring techniques. Most Departments followed the recommendations of the Brain Trauma Foundation (BTF) guidelines for the control of ICP. CONCLUSIONS: The organisation of care and the initial management of severe head trauma in Spain is very similar to its neighbouring countries. However, there are shortcomings, such as low participation by a neurosurgeon in the initial management of these patients, insufficient use of telemedicine, and the low implementation of certain brain monitoring techniques (SjO2, PtiO2, and Doppler).