RESUMEN
This study aimed to investigate the variations of parasites in the feces of brown bears Ursus arctos inhabiting the Cantabrian Mountains (NW Spain). A total of 248 bear fecal samples were collected throughout one year, spanning from August 2018 to September 2019, at an approximate frequency of 20 samples per month. The results were analyzed in relation to both the season and the biological activity of the brown bears, i.e., hibernation, mating and hyperphagia. Among the examined samples, eggs of Dicrocoelium dendriticum (32.2%; 95% Confidence Interval: 26.4-38.1), Baylisascaris sp. (44.8%; 38.5-50.9), ancylostomatids (probably belonging to Uncinaria spp.) (16.5%; 11.9-21.1) and Trichuris sp. (1.2%; 0-2.6) were observed. Significant seasonal differences were noted for Baylisascaris and ancylostomatids (χ2 = 21.02, P = 0.001 and χ2 = 34.41, P = 0.001, respectively). Furthermore, the presence of helminth eggs was correlated with the activity phase of the brown bears. Dicrocoelium attained the highest prevalence during the mating phase, while Baylisascaris and ancylostomatids were more frequent during hyperphagia. Notably, the highest egg-output counts for Dicrocoelium and Baylisascaris sp. were recorded during the mating phase and hibernation, respectively, whereas ancylostomatids eggs peaked during hyperphagia. Additionally, variations in egg-output counts were significant for all helminths concerning the season, with the exception of Trichuris sp., and for Dicrocoelium and Baylisascaris sp. According to bear activity. It is concluded that infection by gastrointestinal helminths depends on the season and the biological activity of the bears from the Cantabrian Mountains, and their health status could result influenced.
RESUMEN
The integration of care between primary, secondary, tertiary health care and social care needs to be interprofessional and patient-centered. The aim of this study was to develop and validate a questionnaire for measuring patients' perception of integration across health care teams and social services. Data for psychometric assessment of our questionnaire were collected from patients who attended at eleven Primary Care Centers and one tertiary referral Hospital in Spain from March to October 2018. The questionnaire was tested in a pilot study with 40 patients before being administered in a sample of 279 patients. The questionnaires were distributed in urban Health Centers, peri-urban or rural Health Centers (67%) and a tertiary referral hospital (33%). The questionnaire included 9 items that measured patient perceived experiences about care coordination, data accessibility and delivery of clinical information. The model explained 51% of the variation in the data and Cronbach's alpha was 0.8. Two factors comprising perception of coordination and assessment of patient-centered care were identified. The overall perception for integration was low. The reliability and validation of our questionnaire showed its potential as a valuable instrument for assessing patients' perception of the integration of care and can be used within the quality metrics to assess the success of integrated health care management programs.