Blood donation attitudes and knowledge in Spanish undergraduates with roles in health-education.

BACKGROUND: Recent investigations highlight how important it is to identify the key factors involved in the design of strategies to promote blood donation among undergraduates as a public health concern. The study aims to investigate attitudes and knowledge towards blood donation in university students with health education roles and examine the way sociodemographic and educational characteristics play a part in it. MATERIALS AND METHODS: A cross-sectional and multi-center design was used. A structured questionnaire was answered by 1128 Spanish university students (Schools of Health Sciences and Education Sciences). RESULTS: The knowledge test indicated a low score (M = 4.2 out of 10), being Me = 3.00 in the case of Education Sciences and Me = 5.00 in Health Sciences students. The greatest degree of importance is found in the "external incentives" dimension (M = 3.7 out of 5). Health science students and participants with relatives who needed a donation showed fewer "fears" (p ≤ 0.001) and "pretexts" (p ≤ 0.01). CONCLUSIONS: The low knowledge score stresses the need to develop valuable health education-related strategies in the curriculum of studies related with health education; showing room for improvement particularly in Education Science students. Health education interventions aimed at increasing donors in the university environment should be designed while considering differences among undergraduates. Based on their better attitudes, health science students might play a relevant role in promoting blood donation.

Educational programs in type 2 diabetes designed for community-dwelling older adults: A systematic review.

AIMS: This systematic review aimed to assess the effectiveness of educational interventions in type 2 diabetes specifically designed for community-dwelling older adults. METHODS: In accordance with PRISMA guidelines, a systematic search of studies published between 2010 and 2021 was conducted across five electronic databases and manual sources. The study protocol was previously registered in PROSPERO (CRD42021288236). RESULTS: Twelve papers matched the inclusion criteria and were appraised using MERSQI. The features of the educational programs were heterogeneous, and none complied with the ten suggested standards for diabetes self-management education and support. Comprehensive gerontological assessment was not considered. Outcomes included biomedical, psychosocial, behavioral, and knowledge measures. HbA1c and knowledge showed improvements with a high certainty level according to GRADE. CONCLUSIONS: Structured DSME programs aimed at older adults have great potential, however there is still room to improve. Applying the principles of a comprehensive gerontological approach and the standards for DSME as continuous monitoring and support could increase their benefits.

Positive and Negative Feelings among Spanish Young-Old and Old-Old during the Lockdown of the COVID-19 First Wave.

OBJECTIVES: The COVID-19 pandemic required a population lockdown during the first wave in March 2020. Evidence has shown a circular relationship between perceived threat and the risk of developing negative mood, which might impact the affect balance of older adults. We aimed to investigate the positive and negative feelings expressed by young-old (60-70 years) and old-old (over 71 years) Spanish adults during the lockdown of the COVID-19 first wave, and the social and psychological variables associated. METHODS: Cross-sectional study conducted in 528 participants using a questionnaire composed of sociodemographic data and validated scales for resilience (Brief Resilient Coping Scale) and emotions (Scale of Positive and Negative Experience). RESULTS: We found a positive balance between positive and negative feelings with no differences between both groups. Regression analysis showed that social network and resilience, but not age, are significant predictors of both greater positive feelings and lower negative feelings. CONCLUSIONS: Our results evidence the relevance of promoting targeted support psychological and social measures that effectively help older adults to cope with such a difficult scenario as the current pandemic. CLINICAL IMPLICATIONS: Health-care providers must develop targeted care strategies aimed at providing emotional support for older adults from a holistic perspective.

Care tasks and impact of caring in primary family caregivers: A cross-sectional study from a nursing perspective.

BACKGROUND: Family caregivers of persons with dementia often experience a negative impact on their health. More studies based on nursing theories are needed to improve the provision of care. AIMS: To describe the care provided by family caregivers of persons with dementia and the impact on their health, as well as to analyse how personal variables of caregivers are related to care tasks and their health impact. METHODS: Multi-centric cross-sectional prospective study conducted on a sample of 423 primary family caregivers of persons with dementia from Spain. Data were collected through ICUB97-R questionnaire (January-April 2019), based on the fourteen needs of Virginia Henderson's Nursing Model. Data was analysed through one-way analysis of variance and Student's t-test. RESULTS: The caregiver profile was a middle-aged married woman without higher education living with the cared person, predominantly her mother. The most frequently provided care corresponded to "nutrition" and "movement" needs. Lack of free time, modifications on leisure activities, reduced sleep or rest and disruption of family life emerged as the greatest repercussions on the caregiver's health. The age of the caregiver and time caring showed differences on impact of care and care tasks, respectively. CONCLUSION: The identification of the types of care provided, the health impact of caring and the variables affecting the family caregiver's vulnerability is essential to develop effective individualised nursing care plans, including health education interventions to improve the quality of life of both caregivers and persons cared for.

Systemic Effects Induced by Hyperoxia in a Preclinical Model of Intra-abdominal Sepsis.

Supplemental oxygen is a supportive treatment in patients with sepsis to balance tissue oxygen delivery and demand in the tissues. However, hyperoxia may induce some pathological effects. We sought to assess organ damage associated with hyperoxia and its correlation with the production of reactive oxygen species (ROS) in a preclinical model of intra-abdominal sepsis. For this purpose, sepsis was induced in male, Sprague-Dawley rats by cecal ligation and puncture (CLP). We randomly assigned experimental animals to three groups: control (healthy animals), septic (CLP), and sham-septic (surgical intervention without CLP). At 18 h after CLP, septic (n = 39), sham-septic (n = 16), and healthy (n = 24) animals were placed within a sealed Plexiglas cage and randomly distributed into four groups for continuous treatment with 21%, 40%, 60%, or 100% oxygen for 24 h. At the end of the experimental period, we evaluated serum levels of cytokines, organ damage biomarkers, histological examination of brain and lung tissue, and ROS production in each surviving animal. We found that high oxygen concentrations increased IL-6 and biomarkers of organ damage levels in septic animals, although no relevant histopathological lung or brain damage was observed. Healthy rats had an increase in IL-6 and aspartate aminotransferase at high oxygen concentration. IL-6 levels, but not ROS levels, are correlated with markers of organ damage. In our study, the use of high oxygen concentrations in a clinically relevant model of intra-abdominal sepsis was associated with enhanced inflammation and organ damage. These findings were unrelated to ROS release into circulation. Hyperoxia could exacerbate sepsis-induced inflammation, and it could be by itself detrimental. Our study highlights the need of developing safer thresholds for oxygen therapy.

Effects of sevoflurane postconditioning on cell death, inflammation and TLR expression in human endothelial cells exposed to LPS.

BACKGROUND: Sevoflurane is an anesthetic agent which also participates in protective mechanisms in sepsis, likely due to anti-inflammatory properties. A key tissue in sepsis is the endothelium, which expresses TLR2 and TLR4 receptors, known regulators of inflammatory mechanisms and potential therapeutic targets for this pathology. In this context, we explored the effect of sevoflurane postconditioning in an in vitro sepsis model. METHODS: Primary cultures of human umbilical vein endothelial cells were used for two different experiments. In the first set, cultures were placed in an airtight incubation chamber and exposed to different concentrations of sevoflurane (0,1,3 or 7% vol,) for 1 hour. In the second set, lipopolysaccharide from Escherichia coli 0111:B4 (1 µg/mL) was added to culture medium for 3 hours and cells were subsequently exposed to sevoflurane (0,1,3 or 7% vol,) for 1 hour as explained before. In both cases, cell viability was measured by MTT and Trypan blue assays, TLR2 and TLR4 expression were analyzed by flow cytometry, and TNFα and IL-6 levels were quantified in cell culture media by an immunoassay immediately after exposure, at 6 and 24 hours. RESULTS: Exposure to 3% sevoflurane decreased TLR2 at 24 hours and TLR4 at 6 and 24 hours (both p<0.05), whereas exposure to 7% decreased TLR4 expression at 6 hours (p<0.05). Both 3 and 7% sevoflurane decreased TNF-α and IL-6 levels at 24 hours (both p<0.05). In LPS-stimulated cultures, exposure to 3% sevoflurane was cytoprotective at 6 and 24 hours (p<0.05) compared with control, and decreased TLR2 and TLR4 expression at 24 hours (p<0.05); whereas 7% decreased TLR4 expression at 24 hours (p<0.05). Both 3% and 7% sevoflurane decreased TNF-α and IL-6 levels at 24 hours (both p<0.05). CONCLUSIONS: Postconditioning with the halogenated anesthetic agent sevoflurane after LPS stimulation shows a cytoprotective effect in an in vitro model, decreasing cell death and reducing TLR2 and TLR4 expression as well as levels of the inflammatory mediators TNF-α and IL-6 in human endothelial cells.

A Novel Chitosan Composite Biomaterial with Drug Eluting Capacity for Maxillary Bone Regeneration.

Bone grafting is one of the most commonly performed treatments for bone healing or repair. Autografts, grafts from the same patient, are the most frequently used bone grafts because they can provide osteogenic cells and growth factors at the site of the implant with reduced risk of rejection or transfer of diseases. Nevertheless, this type of graft presents some drawbacks, such as pain, risk of infection, and limited availability. For this reason, synthetic bone grafts are among the main proposals in regenerative medicine. This branch of medicine is based on the development of new biomaterials with the goal of increasing bone healing capacity and, more specifically in dentistry, they aim at simultaneously preventing or eliminating bacterial infections. The use of fibers made of chitosan (CS) and hydroxyapatite (HA) loaded with an antibiotic (doxycycline, DX) and fabricated with the help of an injection pump is presented as a new strategy for improving maxillary bone regeneration. In vitro characterization of the DX controlled released from the fibers was quantified after mixing different amounts of HA (10-75%). The 1% CS concentration was stable, easy to manipulate and exhibited adequate cuttability and pH parameters. The hydroxyapatite concentration dictated the combined fast and controlled release profile of CSHA50DX. Our findings demonstrate that the CS-HA-DX complex may be a promising candidate graft material for enhancing bone tissue regeneration in dental clinical practice.

Online (versus face-to-face) augmented reality experience on nursing students' leg ulcer competency: Two quasi-experimental studies.

AIM: The aim of this study was two-fold. Firstly, to describe the influence of an augmented reality (AR)-based online educational experience on the academic performance and learning determinants of nursing students related to the study of leg ulcer care. We also set out to compare these online results with those obtained in the same experience developed a year before but in a face-to-face design. BACKGROUND: Undergraduate education in nursing aims to train students towards an acceptable level of competence for professional practice. Sometimes, some essential clinical areas of knowledge are particularly challenging for both students and nurse educators. One of these is the care of chronic wounds, particularly in leg ulcers where nurses play a key role. Currently face-to-face teaching methods are evolving to more active contexts and alternative means such as online learning and AR are becoming widely used, garnering encouraging results. DESIGN: A quasi-experimental design was used. Two experiments were carried out to meet the aims of the study, the first one was a pre-test post-test design in one group and the second one a post-test two experimental groups design. METHODS: Participants were undergraduate nursing students from the School of Nursing of the University of Santiago de Compostela (Spain). The two experimental groups received the same training but in different environments: online during 2019/2020 (n = 111) and onsite during 2018/2019 (n = 72). The instruments selected were a knowledge and skills test and two validated questionnaires. RESULTS: Regarding academic performance, the study demonstrated significant differences towards learning after the AR-based online experience (Z = -9.074; p ≤ 0.001). The participants also showed good results in relation to the learning determinants studied. Compared with students receiving AR-based face-to-face teaching, the students with the online learning approach scored better in the dimensions Autonomous Learning (U=3104.5; p = 0.020) and 3D Comprehension (U=3167.0; p = 0.035). However, the participants in the onsite experience scored higher in the Attention dimension (U=3163.0; p = 0.035). CONCLUSIONS: AR positively influences academic performance and diverse educational variables when this experience is carried out online. Since both the online and face-to-face experience show statistically significant benefits in different dimensions of the learning determinants, the need to improve the AR learning experience through blended-learning environments should be promoted.

Identifying engagement and associated factors in nursing students: An exploratory study.

BACKGROUND: Burnout and engagement in health students surpass work life. Although levels of burnout in Nursing students are high, academic engagement is an understudied topic in Nursing, which has shown benefits. The aims were to know the level of engagement of Nursing students and to identify factors that prompt higher levels of engagement. METHODS: An exploratory study was conducted during 2019 in three Universities in Spain. The UWES-S-17 questionnaire was used. RESULTS: The sample consisted of 808 Nursing students. An average level of engagement was found. Engagement differed significantly by gender and age, with females and older students showing greater attitudes. Participants in the second year showed lower scores in the willingness to dedicate effort and persistence than those in the first and third year (p < 0.05). CONCLUSIONS: The identification of the level of engagement and factors involved are an opportunity to probe into this approach by reinforcing positive attitudes in Nursing students. These findings show the need to seek strategies through specific educational interventions and policies. Engagement should be upheld throughout the degree and once they enter the job market to ensure the well-being during academic and future work life, a high-quality nursing care and patient safety.

Relevant Aspects of Titanium Topography for Osteoblastic Adhesion and Inhibition of Bacterial Colonization.

The influence of the surface topography of dental implants has been studied to optimize titanium surfaces in order to improve osseointegration. Different techniques can be used to obtain rough titanium, however, their effect on wettability, surface energy, as well as bacterial and cell adhesion and differentiation has not been studied deeply. Two-hundred disks made of grade 4 titanium were subjected to different treatments: machined titanium (MACH), acid-attacked titanium (AE), titanium sprayed with abrasive alumina particles under pressure (GBLAST), and titanium that has been treated with GBLAST and then subjected to AE (GBLAST + AE). The roughness of the different treatments was determined by confocal microscopy, and the wettability was determined by the sessile drop technique; then, the surface energy of each treatment was calculated. Osteoblast-like cells (SaOs-2) were cultured, and alkaline phosphatase was determined using a colorimetric test. Likewise, bacterial strains S. gordonii, S. oralis, A. viscosus, and E. faecalis were cultured, and proliferation on the different surfaces was determined. It could be observed that the roughness of the GBLAST and GBLAS + AE was higher, at 1.99 and 2.13 µm of Ra, with respect to the AE and MACH samples, which were 0.35 and 0.20 µm, respectively. The abrasive treated surfaces showed lower hydrophilicity but lower surface energy. Significant differences could be seen at 21 days between SaOS-2 osteoblastic cell adhesion for the blasted ones and higher osteocalcin levels. However, no significant differences in terms of bacterial proliferation were observed between the four surfaces studied, demonstrating the insensitivity of bacteria to topography. These results may help in the search for the best topographies for osteoblast behavior and for the inhibition of bacterial colonization.

Effectiveness of augmented reality in learning about leg ulcer care: A quasi-experimental study in nursing students.

BACKGROUND: Chronic wounds are a serious public health problem worldwide. Providing optimal treatment to patients suffering from leg ulcers is a priority for nursing. Therefore, nursing students need to acquire the necessary competencies to provide evidence-based care. Augmented Reality (AR) is an emerging technology in health science education which can help nursing students achieve these skills if it is promoted by both institutions and educationalists. OBJECTIVES: To test the effectiveness of an AR-based methodology for teaching-learning aspects of the nursing curriculum (leg ulcer care), as well as to describe how AR influences different learning determinants of nursing students. DESIGN: A quasi-experimental study was carried out. PARTICIPANTS/SETTINGS: The participants of the study were 137 s-year nursing students from the School of Nursing of the University of Santiago de Compostela (Spain) (average age = 21.59 years, 80.29 % females). Of them, 65 comprised the control group (Non-AR-based teaching) and 72 comprised the experimental group (AR-based teaching). METHODS: Pre-post tests were used to measure knowledge and skills about leg ulcer care in both groups. Additionally, two validated questionnaires were selected to identify the influence of AR on learning determinants in the experimental group. The study took place during the 2018/2019 academic year. RESULTS: Significantly higher scores (7.68 vs. 6.14) were found in the knowledge post-test in the experimental group (p ≤ 0.001), while the pre-test did not show differences between groups (4.43 vs. 4.32). Also, nursing students indicated high scores in attention, autonomous learning, understanding and motivation to carry out learning objectives using AR. CONCLUSIONS: AR is a tool that improves performance related to the specific aspects of the nursing academic curriculum (leg ulcer care), while encouraging positive attitudes towards the teaching-learning process. These findings reinforce the need to include innovative methodologies in nursing classrooms.

Aging of glucose profiles in an adult population without diabetes.

AIMS: This study aimed to determine the effect of aging on glucose profiles in a population without diabetes. METHODS: We investigated the evolution of glucose profiles in an adult population without diabetes using continuous glucose monitoring (CGM) in two periods separated by 5 years. Anthropometrics, laboratory tests (HbA1c, fasting blood glucose) and CGM data (mean glycemia level, coefficient of variation, time in range) were measured in both periods to study the change in values over time. RESULTS: 125 participants (68% women) mean age 43.1 ± 12.4 years and classified as normoglycemic at baseline were included. Of the total population 15.2% had worsened glycemic status after 5 years, age and baseline glucose values (HbA1c and percentage of values above 175 mg/dL) were the variables related with this change. Related to CGM, we found that after 5 years there was a decrease in the percentage of values between 70 and 99 mg/dl (45.0% to 38.7%, p = 0.002) and an increase in the 100-139 mg/dL range (52.9% to 57.5% p = 0.016). CONCLUSIONS: Our results indicate that in an adult population without diabetes there are changes in glucose profiles with aging highlighting the reduction of blood glucose values below 100 mg/dL.

Toll-like receptors 7 and 8 expression is associated with poor outcome and greater inflammatory response in acute ischemic stroke.

Toll-like receptors are innate immunity receptors that activate inflammation and adaptive immunity. Our objectives were to analyze the association between TLR3, 7, 8 and 9 expressions and clinical outcome in patients with ischemic stroke and the expression of inflammatory molecules. One hundred-ten patients with ischemic stroke were included within 12h of symptoms onset. Stroke severity was evaluated by the NIHSS, and functional outcome was assessed at 3 months by the modified Rankin Scale. Infarct volume at 4-7 days was measured on Computed Tomography imaging. TLR7 and TLR8 at different time points were independently associated with poor outcome. TLR8 was also correlated with infarct volumes. Furthermore, TLR7 and TLR8 on admission were correlated with levels of IL6 and IL1ß at 24h, 72 h and 7 days. In conclusion, TLR 7 and TLR8 expressions are associated with poor outcome and greater inflammatory response in acute ischemic stroke.

Association between neuroserpin and molecular markers of brain damage in patients with acute ischemic stroke.

BACKGROUND: Neuroserpin has shown neuroprotective effects in animal models of cerebral ischemia and has been associated with functional outcome after ischemic stroke. Our aim was to study whether neuroserpin serum levels could be associated to biomarkers of excitotoxicity, inflammation and blood brain barrier disruption. METHODS: We prospectively included 129 patients with ischemic stroke (58.1% male; mean age, 72.4 ± 9.6 years) not treated with tPA within 12 hours (h) of symptoms onset (mean time, 4.7 ± 2.1 h). Poor functional outcome at 3 months was considered as a modified Rankin scale score >2. Serum levels of neuroserpin, Interleukin 6 (IL-6), Intercellular adhesion molecule-1 (ICAM-1), active Matrix metalloproteinase 9 (MMP-9), and cellular fibronectin (cFn) (determined by ELISA) and glutamate (determined by HPLC) were measured on admission, 24 and 72 h. The main variable was considered the decrease of neuroserpin levels within the first 24 h. ROC analysis was used to select the best predictive value for neuroserpin to predict poor functional outcome due to a lack of linearity. RESULTS: The decrease of neuroserpin levels within the first 24 h was negatively correlated with serum levels at 24 hours of glutamate (r = -0.642), IL-6 (r = -0.678), ICAM-1 (r = -0.345), MMP-9 (r = -0.554) and cFn (r = -0.703) (all P < 0.0001). In the multivariate analysis, serum levels of glutamate (OR, 1.04; CI95%, 1.01-1.06, p = 0.001); IL-6 (OR, 1.4; CI95%, 1.1-1.7, p = 0.001); and cFn (OR, 1.3; CI95%, 1.1-1.6, p = 0.002) were independently associated with a decrease of neuroserpin levels <70 ng/mL at 24 h after adjusting for confounding factors. CONCLUSIONS: These findings suggest that neuroprotective properties of neuroserpin may be related to the inhibition of excitotoxicity, inflammation, as well as blood brain barrier disruption that occur after acute ischemic stroke.

Multiple Ion Scaffold-Based Delivery Platform for Potential Application in Early Stages of Bone Regeneration.

Bone has the intrinsic capacity to regenerate itself, as long as the damage is small, through the sequential stimulation of specific phases, such as angiogenesis followed by osteogenesis. However, when the damage is extensive it is unable to regenerate and bone tissue engineering is used as an alternative. In this study, we developed a platform to allow the triple ion delivery with sequential delivery capacity to potentially stimulate antibacterial, angiogenic and osteogenic processes. The scaffold-based platform consisted of alginate/hydroxyapatite (HA) microparticles embedded in alginate fibers. Firstly, microparticles were developed using different ratios of alginate:HA using the spraying method, resulting in a high reproducibility of the technique. Microparticle size between 100-300 µm and ratio 1:40 resulted in a more spherical morphology and were selected for their incorporation into alginate fiber. Different amounts of copper and cobalt were added with the microparticles and alginate fiber, respectively, were used as model ions which could eventually modulate and mimic antimicrobial and angiogenic processes. Moreover, calcium ion was also incorporated in both, in order to provide the system with potential osteogenic properties together with HA. The multiple delivery of copper, cobalt and calcium released were in the therapeutic range as measured by induced coupled plasma (ICP), providing a promising delivery strategy for tissue engineering.

Attitudes and knowledge in blood donation among nursing students: A cross-sectional study in Spain and Portugal.

BACKGROUND: Blood donors are key in meeting the ever-increasing blood requirements worldwide. The Spanish and Portuguese donation systems are based on altruism and voluntariness. However, nursing students may not be fully aware of the importance of this social responsibility and their professional skills in this field. OBJECTIVES: This study aimed to identify differences regarding attitudes towards and knowledge about blood donation among Spanish and Portuguese undergraduate Nursing students (1st to 8th semester), as well as to analyse how different variables account for them. DESIGN: A multicentre cross-sectional study was carried out. PARTICIPANTS/SETTINGS: The participants of the study were 1038 nursing students from four Schools of Nursing in two countries, Spain and Portugal. METHODS: The web-based CADS-19 questionnaire to measure attitudes and knowledge was used during the academic years 2018-2019 and 2019-2020. Additionally, sociodemographic data were collected. RESULTS: The mean knowledge score was 3.079 out of 10 (SD = 1.429). The level of knowledge differed significantly by gender, where females scored higher, along with older students and previous donors. The highest mean attitude score corresponded to the "external incentives" dimension, significant differences were found between countries. In barriers and incentives, some differences were found depending on gender or sexual orientation, among others, with slightly better attitudes in Spanish participants. CONCLUSIONS: The level of knowledge was lower than expected, considering participants were nursing students. The attitude's comparative analysis between both countries showed significant differences, especially in the pretext dimension. As for greater donation rates found in Spanish students, nurse-led international partnerships could be designed to enhance health literacy and sensitivity among nursing undergraduates. Interventions should focus on specific theoretical and practical training programs and educative actions should contribute to a greater awareness, motivation, and sensitise students to blood donation.

Assessing the potential role of copper and cobalt in stimulating angiogenesis for tissue regeneration.

The use of copper (Cu2+) and cobalt (Co2+) has been described to stimulate blood vessel formation, a key process for the success of tissue regeneration. However, understanding how different concentrations of these ions affect cellular response is important to design scaffolds for their delivery to better fine tune the angiogenic response. On the one hand, gene expression analysis and the assessment of tubular formation structures with human umbilical vein endothelial cells (HUVEC) revealed that high concentrations (10µM) of Cu2+ in early times and lower concentrations (0.1 and 1µM) at later times (day 7) enhanced angiogenic response. On the other hand, higher concentrations (25µM) of Co2+ during all time course increased the angiogenic gene expression and 0.5, 5 and 25µM enhanced the ability to form tubular structures. To further explore synergistic effects combining both ions, the non-toxic concentrations were used simultaneously, although results showed an increased cell toxicity and no improvement of angiogenic response. These results provide useful information for the design of Cu2+ or Co2+ delivery scaffolds in order to release the appropriate concentration during time course for blood vessel stimulation.

Gender impact of caring on the health of caregivers of persons with dementia.

BACKGROUND: Dementia is a brain syndrome that affects a growing number of persons worldwide and generates a strong and progressive demand for care from a family caregiver, usually females. OBJECTIVE: We aimed to describe the care provided by family caregivers of persons with dementia as well as the impact on their health and its interrelation with gender. PATIENT INVOLVEMENT: This study was carried out in collaboration with the 13 associations of family caregivers of persons with dementia that are part of a Regional Federation. This partnership worked towards bettering patient care and proposing improvements to the public health system. METHODS: A multi-institutional cross-sectional study. A total of 462 primary family caregivers of persons with dementia from north-west Spain were included. Data were collected between January and April 2019 with an anonymous self-administered validated questionnaire (ICUB-97) based on Virginia Henderson's nursing care model. RESULTS: The most affected needs in family caregivers are those related to "recreational activities", "communication" and "rest and sleep". Statistically significant differences between male and female participants' pattern of care and health-related impacts were found, especially in issues related to work and family reconciliation. DISCUSSION: Care plans should be developed taking gender perspective into account. From a nurse model point of view, more research is necessary to reduce health disparities. This study provides an assessment of gender differences in care and the impact on caregivers' health. PRACTICAL VALUE: Regarding the specific health conditions of female caregivers and from a holistic point of view, these findings could provide novel and interesting data that might help to implement gender perspective in nursing care plans, generally invisible in routine clinical practice.

A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education.

The objective of this study was to investigate the usability of the augmented reality (AR) in higher education in the area of health sciences to describe what type of interventions have been developed, their impact on various psychopedagogical aspects of the students as well as the main advantages, disadvantages and challenges in incorporating AR in the teaching-learning process. A systematic review was carried out in the CINAHL, PsycINFO, MEDLINE, Web of Science databases and the Google Scholar search engine. The search was limited to original research articles written in English, Spanish or Portuguese since 2014. The quality of the selected articles (n = 19) was assessed using the Mixed Methods Appraisal Tool (MMAT). The applications and electronic devices used and the measurement instruments used were described. The use of AR made it easier for students to acquire skills, especially in courses with a high component of three-dimensional visualization, and positively influenced various aspects of the learning process such as motivation, satisfaction or autonomous learning. As an educational technological tool applied to higher education in health sciences, AR improves the teaching-learning process by influencing it in a multidimensional way.

Proteomic analysis of the tear film in patients with keratoconus.

PURPOSE: To identify proteins differentially expressed between the tear film of keratoconus (KC) patients and control subjects using two dimensional electrophoresis (2-DE) and mass spectrometry-based techniques. METHODS: Twenty two patients (44 eyes) diagnosed with bilateral KC and 22 control subjects (44 eyes) were studied in a prospective case-control study. Keratoconus screening programs and Orbscan II topographies were performed on all participants. Tear samples were collected by the Schirmer I method using filter paper. Proteins were extracted from the Schirmer strips and separated by 2-DE. Comparison of protein patterns was performed using PDQuest Software and protein differences were identified by mass spectrometry. Finally, results were validated by western-blot. RESULTS: Four spots were identified to be differentially expressed between KC patients and control subjects. Three of them were more expressed in healthy subjects and they were identified as zinc-α2-glycoprotein (ZAG), lactoferrin, and IGKC (immunoglobulin kappa chain). The other spot was more expressed in KC patients and it was identified as ZAG. Differences in ZAG seem controversial in two different spots because different posttranslational modifications, however, analysis of both spots revealed that globally, ZAG is overexpressed in healthy subjects. Founded differences in ZAG, lactoferrin, and IGKC expression were subsequently validated by western blot. CONCLUSIONS: IGKC protein, ZAG, and lactoferrin are under-expressed in the tears of patients diagnosed with bilateral KC compared with healthy subjects. These differences could contribute to the knowledge of the pathophysiology of this disease.