Integrative Clinical, Hormonal and Molecular Data associate with Invasiveness in Acromegaly: REMAH Study.

INTRODUCTION: Growth-hormone (GH)-secreting pituitary-tumors (GHomas) are the most common acromegaly cause. At diagnosis, most of them are macroadenomas, and up to 56% display cavernous sinus invasion. Biomarkers assessment associated with tumor-growth and invasion are important to optimize their management. OBJECTIVES: To identify clinical/hormonal/molecular-biomarkers associated with tumor-size and invasiveness in GHomas, and to analyze the influence of pre-treatment with somatostatin-analogs or dopamine-agonists in key molecular biomarkers expression. METHODS: Clinical/analytical/radiological-variables were evaluated in 192 patients from the REMAH-study (ambispective multicenter post-surgery study of the Spanish Society of Endocrinology and Nutrition). Expression of somatostatin/ghrelin/dopamine-systems components, and key pituitary/proliferation-markers were evaluated in GHomas after the first surgery. Univariate/multivariate regression studies were performed to identify association between variables. RESULTS: 80% of patients harbor macroadenomas (63.8% with extrasellar-growth). Associations between larger and more invasive GHomas with younger age, visual-abnormalities, higher IGF1-levels, extrasellar/suprasellar-growth and/or cavernous-sinus invasion were found. Higher GH1 and lower PRL/POMC/CGA/AVPR1B/DRD2T/DRD2L expression levels (p<0.05) were associated to tumor invasiveness. LASSO´s penalized regression identified combinations of clinical and molecular features with AUCs between 0.67-0.82. Preoperative therapy with dopamine-agonist or somatostatin-analogs did not alter the expression of any of the markers analyzed except for DRD1/AVPR1B (up-regulated with dopamine-agonist), and FSHB/CRHR1 (down-regulated with somatostatin-analogs). CONCLUSIONS: A specific combination of clinical/analytical/molecular variables was found to be associated with tumor invasiveness and growth capacity in GHomas. Pre-treatment with first-line drugs for acromegaly did not significantly modify the expression of the most relevant biomarkers in our association model. These findings provide valuable insights for risk stratification and personalized management of GHomas.

Polyphenolic Characterization and Anti-Inflammatory Effect of In Vitro Digested Extracts of Echinacea purpurea L. Plant Parts in an Inflammatory Model of Human Colon Cells.

Echinacea purpurea L. (EP) preparations are globally popular herbal supplements known for their medicinal benefits, including anti-inflammatory activities, partly related to their phenolic composition. However, regarding their use for the management of inflammation-related intestinal diseases, the knowledge about the fate of orally ingested constituents throughout the human gastrointestinal tract and the exposition of in vitro digested extracts in relevant inflammatory models are unknown. This study investigated for the first time the impact of in vitro gastrointestinal digestion (INFOGEST) on the phenolic composition and anti-inflammatory properties of EP extracts from flowers (EF), leaves (EL), and roots (ER) on IL-1ß-treated human colon-derived CCD-18Co cells. Among the seven hydroxycinnamic acids identified using HPLC-UV-MS/MS, chicoric and caftaric acids showed the highest concentrations in EL, followed by EF and ER, and all extracts exerted significant reductions in IL-6, IL-8, and PGE2 levels. After digestion, despite reducing the bioaccessibility of their phenolics, the anti-inflammatory effects were preserved for digested EL and, to a lesser extent, for EF, but not for digested ER. The lower phenolic content in digested EF and ER could explain these findings. Overall, this study emphasizes the potential of EP in alleviating intestinal inflammatory conditions and related disorders.

[Design of the evaluation of the socio-educational groups for men in primary care]. / Diseño de la evaluación de los grupos socioeducativos para hombres en atención primaria.

The Public Health System of Andalusia develops the Socio-Educational Groups Strategy (GRUSE), focused on promoting the health and emotional well-being of those who present somatic symptoms without organic cause in primary care health centers. This intervention began with groups of women and has been extended to groups of men, after verifying that the unemployment caused by the economic crisis, generated discomfort due to the loss of the "productive role". A mixed methodology research has been designed to measure the effects of GRUSE in male participants. The quantitative design has longitudinal and quasi-experimental section, in which a battery of scales are used as instruments for collecting information. The qualitative design includes semi-structured interviews and focus groups. The objective of this article is to present the design of the research, with which it is expected to collect evidence of the impact of the intervention.

The topical application of different galenic formulations can alter the thermographic images of skin: Limitations for public thermal screening on infection control situations.

BACKGROUND: To analyze whether the application of topical formulas as cosmetics or sunscreens could affect the skin thermographic readings in terms of infection control in pandemic situations. METHODS: The temperature of the skin of the dorsal region of the back and the face of 20 volunteers was followed after the application of 6 different types of gels, sunscreens, and make-up under controlled temperature and humidity conditions. High-resolution thermographic images were analyzed to calculate the temperature of treated skin compared to skin free of topical products. RESULTS: The application of hydroalcoholic gel resulted in a mean drop of more than 2°C just after 1 minute followed by organic sunscreens until 1.7°C. Recovery was observed progressively until minute 9. Color make-up type formulas, rich in iron oxide as well as sunscreens with mineral filters had little or no effect on the skin thermal response. CONCLUSIONS: It is possible to alter the skin temperature almost immediately by using hydroalcoholic gels and sunscreen cosmetics. So, it is possible to produce false negative data in the readings of patients screened thermically.

Diseño de la evaluación de los grupos socioeducativos para hombres en atención primaria / Design of the evaluation of the socio-educational groups for men in primary care

El Sistema Sanitario Público de Andalucía desarrolla la Estrategia Grupos Socioeducativos (GRUSE), enfocada a la promoción de la salud y del bienestar emocional de quienes presentan síntomas somáticos sin causa orgánica en los centros de salud de atención primaria. Esta intervención comenzó con grupos de mujeres y se ha ampliado a grupos de hombres, tras comprobar que el desempleo provocado por la crisis económica generaba malestares por la pérdida del «rol productivo». Se ha diseñado una investigación con metodología mixta para medir los efectos de los GRUSE en los hombres participantes. El diseño cuantitativo tiene corte longitudinal y cuasiexperimental, y se usa una batería de escalas como instrumentos de recogida de la información. El diseño cualitativo contempla la realización de entrevistas semiestructuradas y grupos focales. El objetivo de este artículo es presentar el diseño de la investigación, con la que se espera recoger evidencias del impacto de la intervención. (AU)

The Public Health System of Andalusia develops the Socio-Educational Groups Strategy (GRUSE), focused on promoting the health and emotional well-being of those who present somatic symptoms without organic cause in primary care health centers. This intervention began with groups of women and has been extended to groups of men, after verifying that the unemployment caused by the economic crisis, generated discomfort due to the loss of the “productive role”. A mixed methodology research has been designed to measure the effects of GRUSE in male participants. The quantitative design has longitudinal and quasi-experimental section, in which a battery of scales are used as instruments for collecting information. The qualitative design includes semi-structured interviews and focus groups. The objective of this article is to present the design of the research, with which it is expected to collect evidence of the impact of the intervention. (AU)

(Poly)phenols: The Missing Piece in the Puzzle of Inflammation.

Despite researchers' and clinicians' exponential understanding of chronic diseases' complexity, ranging from cancer, diabetes, and neurodegenerative disorders, we still have a lot of unanswered questions on pathobiology mechanisms, wherein inflammation is central [...].

(R,S)-Equol 7-ß-D-glucuronide, but not other circulating isoflavone metabolites, modulates migration and tubulogenesis in human aortic endothelial cells targeting the VEGF pathway.

Current knowledge indicates that the consumption of isoflavone-rich foodstuffs can have a beneficial impact on cardiovascular health. To what extent these isoflavones act as the main actors of that benefit is less clear. Genistein (GEN), daidzein (DAZ), and the DAZ-derived microbial metabolite equol (Eq) exhibit antiangiogenic effects in vitro, but their low bloodstream concentrations make it difficult to rationalize the in vivo effects. Their derived phase-II metabolites (glucuronides and sulfates) are major metabolites found in plasma, but their role as antiangiogenic molecules remains unexplored. We aimed here to first assess the anti-angiogenic activities of the main circulating isoflavone metabolites (glucuronides and sulfates) and compare them with their corresponding free forms at physiological concentrations (0.1-10 µM). The effects of the conjugated vs. free forms on tubulogenesis, cell migration, and VEGF-induced signalling were investigated in primary human aortic endothelial cells (HAECs). While (R,S)-equol 7-ß-D-glucuronide (Eq 7-glur) exerted dose-dependent inhibition of tubulogenesis and endothelial migration comparable to that exerted by the free forms (GEN, DAZ, and Eq), the rest of the phase-II conjugates exhibited no significant effects. The underlying molecular mechanisms were independent of the bFGF but related to the modulation of the VEGF pathway. Besides, the observed dissimilar cellular metabolism (conjugation/deconjugation) places the phase-II metabolites as precursors of the free forms; however, the question of whether this metabolism impacts their biological activity requires additional studies. These new insights suggest that isoflavones and their circulating metabolites, including Eq 7-glur, may be involved in cardiovascular health (e.g., targeting angiogenesis).

Summer and spring elbow rashes is a variant of polymorphous light eruption: confirmation by photoprovocation and histopathology in a series of five cases.

Background: Summer and spring eruptions on the elbows are a variant of polymorphous light eruption described on clinical and histopathological grounds; however, to our knowledge, they have not been confirmed by photobiological studies. Objective: Based on photobiological studies, this study aimed to demonstrate the involvement of ultraviolet-A (UVA) radiation in this variant of polymorphous light eruption occurring exclusively on the elbows. Methods: A series of five patients with polymorphous light eruption lesions on the elbows were included in our study. All patients underwent phototesting and photoprovocation of the skin lesions after exposure to a UVA light source [Philips UVA HPA lamp (400 W)]. All patients underwent punch biopsy and histopathological and immunohistochemical studies with anti-CD123. Results: In all the cases, UVA irradiation caused the appearance of skin lesions on the elbows with characteristic polymorphous light eruption. Histological data showed edema in the superficial dermis and a perivascular lymphocytic infiltrate compatible with polymorphous light eruption. Immunohistochemical staining for CD1-23 showed negative results. Conclusions: For the first time, photobiological photoprovocation studies demonstrated that repeated exposure to UVA radiation leads to the generation of skin lesions on the elbows, which are clinically and histologically consistent with summer and spring eruptions, confirming that elbow rash is a variant of polymorphous light eruption.

Elemental distribution and source analysis of atmospheric aerosols from Meycauayan, Bulacan, Philippines.

One of the industrialized cities in the Philippines is Meycauayan, Bulacan. This study reports the elemental distribution and source apportionment in eight varying land cover-land use type sampling points located along the Marilao-Meycauayan- Obando Rivers System. Elemental analysis was conducted using a scanning electron microscope coupled with energy dispersive x-ray. Cu, Pb, Zn, Cr, Mn, As, Cd, Co, Fe, Ni, Ti, and V concentrations were determined using Inductively Coupled Plasma Mass Spectrometry, and Hg concentrations by Mercury analyzer. Principal component analysis (PCA), hierarchical cluster analysis (HCA), and Pearson's r correlation were used to analyze different sources of heavy metals and its corresponding land use-land cover type. The aerosol samples showed the presence of heavy metals Pb and Hg, elements that were also detected in trace amounts in the water measurements. Concentrations of heavy metals such as Cu, Fe, Pb, Zn, V, Ni, and As found in the atmospheric aerosols and urban dusts were attributed to anthropogenic sources such as residential, commercial and industrial wastes. Other source of aerosols in the area were traffic and crustal emissions in Meycauayan. Using HCA, there are 3 clusters observed based on the similar sets of heavy metals: (1) AQS1 (Caingin), AQS2 (Banga), and AQS8 (Malhacan); (2) AQS3(Calvario), AQS4 (Camalig), and AQS5(Langka); (3) AQS1(Sto Nino-Perez), and (AQS7) (Sterling). These groups are related based on different land use setting such as residential/commercial, agricultural, and commercial/industrial areas. Our study recommends the need to address heavy metal pollution in Meycauayan in support to the ongoing implementation of laws and regulations by the local and private sectors.

Physiological Mechanisms Inherent to Diabetes Involved in the Development of Dementia: Alzheimer's Disease.

Type 2 diabetes mellitus (T2D) is a metabolic disease reaching pandemic levels worldwide. In parallel, Alzheimer's disease (AD) and vascular dementia (VaD) are the two leading causes of dementia in an increasingly long-living Western society. Numerous epidemiological studies support the role of T2D as a risk factor for the development of dementia. However, few basic science studies have focused on the possible mechanisms involved in this relationship. On the other hand, this review of the literature also aims to explore the relationship between T2D, AD and VaD. The data found show that there are several alterations in the central nervous system that may be promoting the development of T2D. In addition, there are some mechanisms by which T2D may contribute to the development of neurodegenerative diseases such as AD or VaD.

Costunolide and parthenolide: Novel blood-brain barrier permeable sesquiterpene lactones to improve barrier tightness.

Sesquiterpene lactones - such as those found in chicory - are considered promising bioactive compounds. These small molecules have shown several health benefits for various diseases, including brain disorders. However, it is unknown whether these compounds can cross the blood-brain barrier (BBB), and which could be the effects on brain microvascular endothelial cells. We show that six sesquiterpene lactones evaluated in an in vitro model of the BBB have different capacities to be transported through the barrier. Costunolide presented more than 20 % of transport while lactucin, 11ß-13-dihydrolactucin, 11ß-13-dihydrolactucopicrin, and parthenolide presented between 10 % and 20 %, whilst almost no transport was detected for lactucopicrin. Furthermore, costunolide and parthenolide reduced P-gp ABC transporter expression alongside an increase in caveolin-1, the main protein of caveolae. Remarkably, these two compounds improved barrier tightness by increasing the expression of both tight and adherens junctions. These findings open a new avenue to explore costunolide and parthenolide as promising compounds for brain therapies.

Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural / Teleophthalmology-based diabetic retinopathy screening in a rural health basic area

Objetivo: Conocer la prevalencia de retinopatía diabética en una zona básica de salud rural, clasificándola según tipo y grado de severidad y conocer su relación con la presencia de otros factores de riesgo cardiovascular y con el sexo. Diseño: Estudio descriptivo transversal o de prevalencia. Emplazamiento: Zona básica de salud rural en España. Nivel de atención primaria. Participantes: Quinientos pacientes diabéticos mayores de 18 años. Mediciones principales: Estudio de la retina mediante retinografía bajo midriasis, según protocolo de la Joslin Vision Network, incorporando un centro de lectura para diagnóstico. Correlación de la existencia y gravedad de la retinopatía con los factores de riesgo cardiovascular –tabaquismo, hipertensión e hiperlipemia– y las características de la diabetes –tipo, tiempo de evolución, tratamiento, control metabólico y función renal–Resultados: Prevalencia encontrada del 16,4%, sin diferencias significativas entre sexos. Las variables tabaquismo e hipertensión estaban relacionadas con la existencia de retinopatía y la variable años de evolución de la diabetes con su existencia y su gravedad. El 9,6% de las personas afectadas fueron derivadas a oftalmología con carácter preferente, por retinopatía amenazante para la visión y el 6,8% de las personas estudiadas fueron derivadas por otras patologías oftalmológicas. Conclusiones: Es posible el seguimiento oftalmológico del 82% de la población diabética en atención primaria, implicando a sus profesionales y trabajando en equipo con el servicio de oftalmología. Es fundamental considerar esta enfermedad en el contexto global de la persona con diabetes, relacionándola con las otras complicaciones microvasculares y la enfermedad cardiovascular.(AU)

Objective: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. Design: Cross-sectional or prevalence descriptive study. Location: Rural health basic area in Spain. Primary health care level. Participants: 500 patients over 18 years old with diabetes. Main measurements: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors –smoking, hypertension and hyperlipidemia– and the characteristics of the diabetes –type, evolution time, treatment, metabolic control and renal function–.Results: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. Conclusions: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.(AU)

Comparison of two handgrip dynamometers in older adults before elective surgery.

BACKGROUND: Handgrip strength is a useful measurement of muscle strength and has been proposed as a single predictor of postoperative outcomes in older adults. The aim of this study was to assess the correlation and concordance of Camry digital hand grip dynamometer (EH101) with gold standard Jamar® hydraulic handgrip dynamometer in older adults previous to elective surgery. METHODS: A cross-sectional study was conducted on patients ≥ 65 years old admitted to a Chilean private hospital for elective surgery between March 2018 and February 2019. Handgrip strength was assessed 2 times with each hand prior to surgery, using both the Jamar® dynamometer and the Camry digital dynamometer. The highest value of each dynamometer was used for analysis. RESULTS: We included a total of 220 patients (mean age 73.1 years old ± 6.3). Maximal handgrip strength averaged 26.9 kg ± 9.6 with the Camry dynamometer and 26.9 kg ± 9.7 with the Jamar® dynamometer in the right hand and 25.5 kg ± 9.5 with the Camry dynamometer and 25.7 kg ± 9.2 with the Jamar® dynamometer with the left hand. The difference between both measures did not differ significantly from 0, with Pearson correlation index of 0.95 and Lin's concordance index of 0.95 (p < 0001). The Bland-Altman graphics show that 90% of the measures were inside the confidence limits, without systematic bias. CONCLUSION: Camry digital dynamometer is an inexpensive and valid device to measure handgrip strength in older adults previous to elective surgery, compared to the gold standard Jamar® hydraulic handgrip dynamometer.

Magnetic resonance imaging as a predictor of therapeutic response to pasireotide in acromegaly.

OBJECTIVE: Hyperintensity signal in T2-weighted magnetic resonance imaging (MRI) has been related to better therapeutic response during pasireotide treatment in acromegaly. The aim of the study was to evaluate T2 MRI signal intensity and its relation with pasireotide therapeutic effectiveness in real-life clinical practice. DESIGN, PATIENTS AND MEASUREMENTS: Retrospective multicentre study including acromegaly patients treated with pasireotide. Adenoma T2-weighted MRI signal at diagnosis was qualitatively classified as iso-hyperintense or hypointense. Insulin-like growth factor (IGF-I), growth hormone (GH) and tumour volume reduction were assessed after 6 and 12 months of treatment and its effectiveness evaluated according to baseline MRI signal. Hormonal response was considered 'complete' when normalization of IGF-I levels was achieved. Significant tumour shrinkage was defined as a volume reduction of ≥25% from baseline. RESULTS: Eighty-one patients were included (48% women, 50 ± 1.5 years); 93% had previously received somatostatin receptor ligands (SRLs) treatment. MRI signal was hypointense in 25 (31%) and hyperintense in 56 (69%) cases. At 12 months of follow-up, 42/73 cases (58%) showed normalization of IGF-I and 37% both GH and IGF-I. MRI signal intensity was not associated with hormonal control. 19/51 cases (37%) presented a significant tumour volume shrinkage, 16 (41%) from the hyperintense group and 3 (25%) from the hypointense. CONCLUSIONS: T2-signal hyperintensity was more frequently observed in pasireotide treated patients. Almost 60% of SRLs resistant patients showed a complete normalization of IGF-I after 1 year of pasireotide treatment, regardless of the MRI signal. There was also no difference in the percentage tumour shrinkage over basal residual volume between the two groups.

Analysis of University Student Motivation in Cross-Border Contexts.

The development of the personality of university students can determine their affinities for certain disciplines; therefore, it is important to know their specific socio-demographic and motivational profile, what motivates them to start a certain university degree and what encourages them to continue with it, which can help to adapt the teaching methodology. A total of 292 university students from the University of Granada (Ceuta and Melilla campuses) participated in this quantitative study with a descriptive, cross-sectional design, in which motivation and social skills were analysed. Among the results, it can be highlighted that the student population is mainly female, with a higher level of motivation. Sociability, communication, thinking (optimistic or pessimistic), empathy and self-confidence are skills that affect university students' motivation levels. This study highlights the importance and impact of students' motivation on their learning and the development of their social competence, so it is essential to carry out educational interventions that promote these types of skills, especially in cross-border contexts, which can be demotivating environments.

Evaluation of Lactobacillus Coryniformis K8 Consumption by Health Care Workers Exposed to COVID-19 (LactoCor2 Project): Protocol for a Randomized Controlled Trial.

BACKGROUND: Lactobacillus coryniformis K8 CECT5711 has immune-modulating properties, enhances the immune response to viral antigens leading to the production of specific antibodies, and has anti-inflammatory activity, which may help to prevent uncontrolled inflammatory processes leading to respiratory and other organ failures. OBJECTIVE: The purpose of this study is to evaluate the effect of the consumption of a probiotic strain on the incidence and severity of COVID-19 in health personnel who carry out their professional work among patients with infection or suspected infection by SARS-CoV-2. METHODS: This is a double-blind randomized clinical trial in which the experimental group will receive a capsule of L coryniformis K8 per day (3×109 colony former units/day), and the control group will receive a daily placebo capsule consisting of maltodextrin. A sample size of 314 volunteers was calculated. Volunteers must meet the following inclusion criteria: older than 20 years and active health personnel caring for patients with COVID-19, including all professionals such as medical doctors, nurses, and caretakers at the 2 referral hospitals that treat patients with COVID-19. The main outcome of the clinical trial will be the incidence of symptomatic infection by SARS-CoV-2 in personnel who care for patients with suspected or confirmed COVID-19. RESULTS: The study had to be extended to the 2 referral hospitals that treat patients with COVID-19 in the province of Granada (Andalusia, Spain); Hospital San Cecilio and Hospital Virgen de las Nieves. A total of 255 individuals met the inclusion criteria and were randomly assigned to one of the 2 groups. CONCLUSIONS: The results of this randomized controlled trial will provide valuable information regarding the administration of L coryniformis K8 against COVID-19, including whether there are fewer infectious processes due to this virus or, in case of occurrence, whether the disease is milder in participants taking the probiotic strain. TRIAL REGISTRATION: ClinicalTrials.gov NCT04366180; http://www.clinicaltrials.gov/ct2/show/NCT04366180. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/37857.

[Teleophthalmology-based diabetic retinopathy screening in a rural health basic area]. / Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural.

OBJECTIVE: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. DESIGN: Cross-sectional or prevalence descriptive study. LOCATION: Rural health basic area in Spain. Primary health care level. PARTICIPANTS: 500 patients over 18 years old with diabetes. MAIN MEASUREMENTS: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors -smoking, hypertension and hyperlipidemia- and the characteristics of the diabetes -type, evolution time, treatment, metabolic control and renal function-. RESULTS: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. CONCLUSIONS: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.

Type of Sex Education in Childhood and Adolescence: Influence on Young People's Sexual Experimentation, Risk and Satisfaction: The Necessity of Establishing School Nursing as a Pillar.

The aim is to identify the source of sexuality education used during childhood and adolescence and to analyse whether this education influences their sexual attitudes, their ability to cope with unwanted situations they experience and their satisfaction with their sexual lives. This is a non-experimental, quantitative, ex post facto, cross-sectional study. The sample is formed of 675 young people, with 50% of the ages included being between 20 (Quartile 1) and 22 (Quartile 3) years. The data collection was done by means of an online questionnaire, including sociodemographic and Likert questions about their sex life. Fisher "Independence Contrasts"and correlations were used to see and quantify the relationship among the variables. The main source of education was pornography (29.3%) and the internet (12.4%). The source of education has a significant relationship with whether the use of contraceptives is accepted or not (p < 0.001), refusal to use contraceptives (p < 0.001), engaging in risky sexual practices (p < 0.001), facing unwanted sexual situations (p < 0.001) and dissatisfaction with their sex life (p < 0.001). It is necessary that children and adolescents have sex education in safe environments, such as in a home or school setting, and the school nurse plays a vital part in this education. This would reduce the need for adolescents and young people to use the internet and pornography as a source of education. School nurses should be the educational axis to offer children and adolescents a reliable point of information about sex education. A joint work with teachers, nurses, students and parents would contribute positively to reduce the number of risky situations young people are facing, and it would promote and improve healthy attitudes towards sex and interpersonal relationships.

Coping Strategies during Childbirth Related to Cultural Identity: Companionship, Choice of Analgesia and Maternal Satisfaction.

Childbirth is a biological process and how it is experienced and managed is influenced by numerous factors, among them, socio-cultural or health care received. OBJECTIVE: The objective of this study is to ascertain whether cultural factors influence the way in which women deal with childbirth through the treatment of pain, companionship and maternal satisfaction. METHODS: This study is a non-experimental, quantitative, ex post facto, cross-sectional study of women who gave birth in a border town in southern Spain. The sample consisted of 249 women. RESULTS: No relationship was found between cultural factors and the choice of epidural analgesia, alternative methods to alleviate pain, being accompanied nor maternal satisfaction. There was a significant relationship between the type of companionship and with maternal satisfaction. CONCLUSIONS: Cultural factors did not influence how women dealt with dilation and childbirth. Results found that the person accompanying the mother was important for increasing maternal satisfaction. The intercultural training of healthcare professionals is necessary.