Knowledge, attitudes, and practices about COVID-19 pandemic: a bibliometric analysis.

Background: In order to avoid high rates of COVID-19 infection, one of the main tasks that must be performed is to improve the knowledge, attitudes, and practices (KAP) about the virus. In this sense, Health Education is an essential tool for dealing with the virus. The aim of health education is to educate individuals through educational, motivational, skill development, and awareness techniques, and an understanding of the main needs of KAP is essential for this. Many KAP studies were published during the COVID-19 pandemic, and the aim of the present study was to analyze these publications through a bibliometric study. Methods: A bibliometric analysis of the publications on KAP and COVID-19 was conducted in the Web of Science Core Collection database. The RStudio Bibliometrix and VOSviewer packages were utilized to analyze the scientific production, authors, citations, countries, publishers, journals, research areas, and keywords. Results: Of the 1,129 articles published, 777 were included in the study. The year with the most publications and citations was 2021. Three authors were underlined (all from Ethiopia), due to the number of articles published, the number of citations, and the collaboration networks established. As for the countries, most of the publications came from Saudi Arabia, while China obtained the most citations. PLOS One and Frontiers in Public Health published the most articles on the subject. The most frequent keywords were knowledge, attitudes, practices, and COVID-19. At the same time, others were identified based on the population group analyzed. Conclusion: This is the first bibliometric study on KAP and COVID-19. The significant number of publications identified on KAP and its relationship to the COVID-19 pandemic, in the span of only 3 years, indicates the increased interest in this area. The study provides relevant information to researchers who are approaching this subject for the first time. It is a useful tool that can stimulate new studies and collaborations between researchers from different countries, areas and approaches. At the methodological level, a step-by-step guide is provided for future authors who wish to perform a bibliometric analysis.

Experiences of Telenursing in Overcoming Challenges and Applaying Strategies by COVID-19 Patients in Home Isolation: Qualitative Study in Primary Care.

During the first wave of the COVID-19 pandemic, there was a significant increase in the use of telenursing to provide care for patients at home. However, the quality of the patient experience when nurses rely on technology instead of personal contact has not been thoroughly investigated. This study aimed to understand the perspectives of COVID-19 patients in home isolation who received telenursing from primary care nurses during the initial phase of the pandemic. A qualitative study was conducted that employed purposive sampling and involved semi-structured interviews via videoconference with fourteen COVID-19 patients from two primary health centers in Catalonia (Spain). Thematic analysis was used, and the study adhered to the COREQ checklist. The findings revealed three themes related to the challenges faced by COVID-19 patients in home isolation: physical symptoms, emotional and social difficulties, and a lack of information. Three themes emerged regarding the strategies patients employed to overcome these challenges and the role of nurses: self-care, emotional support, and personal commitment. The patients reported having achieved strategies to improve their physical, psychological, and situational well-being despite the unprecedented situation. The study highlights that telenursing is a valuable resource for delivering patient-centered care, which could lead to changes in organisational policies and the development of best clinical practices.

Pedagogy of death within the framework of health education: The need and why teachers and students should be trained in primary education.

The objective of the present study is to analyze the perceptions of in-service teachers about Pedagogy of Death within the framework of Health Education (HE), with respect to the training received and their teaching experience. A quantitative method was utilized, with the design of an ad hoc questionnaire with a Likert-type response scale and dichotomous questions. The results showed that while the teachers were aware of the need to educationally address death and health, they lacked or did not have initial or continuous training for doing so, and had not thought about it as a normalized aspect throughout their teaching career. We believe it is necessary to offer more training on Pedagogy of Death in the area of HE at universities and continuous education centers, so that it can ultimately be implemented in Primary Education classrooms.

Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Positive Body Image among Adolescents Scale (PBIAS) into Spanish and Catalan.

The Positive Body Image among Adolescents Scale (PBIAS) explores the factors that bolster and interfere with developing and maintaining a positive body image during adolescence. The aim of this study was to translate, adapt, and validate the PBIAS into Spanish and Catalan. A cross-sectional study was conducted for the instrument's translation, cross-cultural adaptation, and psychometric validation. A process of translation, back-translation, expert consultation, and piloting was followed. The reliability and statistical validity were evaluated. The Cronbach's alpha was 0.95 in both the Spanish and Catalan versions. Pearson's correlation coefficients were statistically significant (r > 0.087) for all items analyzed. The resulting values of the Spanish and Catalan versions indicate a good level of concordance (p < 0.001) with the original questionnaire, the comparative fit index being 0.914 and 0.913, the Tucker-Lewis index being 0.893 and 0.892, the root mean square error of approximation being 1.31 and 1.28, and the standardized root mean square residual being 0.051 and 0.060, respectively. The instrument presents a good level of internal consistency, a high level of reliability, and statistical validity compared to the original instrument. The PBIAS in Spanish and Catalan can be a useful assessment instrument for educators and health professionals in the context of adolescent mental health literacy. This work contributes to the Sustainable Development Goals (Goal 3) of the United Nations 2030 Agenda.

Health literacy in childhood and adolescence. A bibliometric analysis of scientific publications and professionals' involvement.

Background: Health Literacy (HL) is a powerful tool to empower children and adolescents in their own health. School nurses are the professionals who, with their expertise in health promotion and education, can facilitate this literacy throughout the educational process. Purpose: To analyze the scientific production in HL in childhood and adolescence in the last two decades, and to determine the involvement of professionals in this field, with emphasis on nursing professionals. Methods: A bibliometric analysis of the scientific literature (from 2000 to 2021) of articles retrieved from the Web of Science database was carried out. Original articles in all languages were considered as inclusion criteria. Bibliometrix 3.1.4 package from RStudio and VOSviewer were used to analyze publications and explain main results about citations, authors, countries, keywords trends, evolution, clusters of related terms, and professionals' involvement. Results: A total of 2032 articles were included in the analysis. The results of the analysis showed that both publications and citations increased substantially since 2014. The most prolific authors in this field are not the most cited so far. The countries that published the most during the period evaluated were the United States, Australia and Canada. The keyword clusters identified in this scientometric study made it possible to determine hotspots in the study of HL in childhood and adolescence, with "mental health" being one of the main terms identified. There are different health-related professionals who are publishing in this field; in spite of this, nurses are not visible as authors in the publications. Conclusion: The scientific literature on HL in childhood and adolescence is a growing field in which different professionals are involved. Despite the increase in the number of publications, and despite the role that nurses play in schools regarding HL, their presence in scientific production is practically nonexistent.

Educational Interventions for Newly Diagnosed Patients With Inflammatory Bowel Disease: A Scoping Review.

The latest consensus standards for patients with inflammatory bowel disease published by the European Crohn's and Colitis Organisation conclude that optimizing quality of care in inflammatory bowel disease involves information and education after diagnosis. A scoping review was performed to identify educational interventions in newly diagnosed inflammatory bowel disease patients. A systematic literature search was conducted using five databases and gray literature. Inclusion criteria were studies with at least one group of patients whom were less than 2 years from their initial inflammatory bowel disease diagnosis. The review process initially identified 447 articles, resulting in four relevant studies: three randomized controlled trials and one pre-/post-test. Only one study exclusively included newly diagnosed inflammatory bowel disease patients. All studies included a multidisciplinary assessment and three were based on a group intervention, but none of them was described in enough detail to be replicated. The content was the same for all patients regardless of the time elapsed since diagnosis. Education of newly diagnosed patients does not seem to be a priority given the lack of publications meeting our criteria despite the evidence of their need. Interventions and outcomes are heterogeneous. Interventions did not consider patient needs and suggest that they centered more on the professional than on the patient. More evidence is clearly needed about this topic.

Without fear of change: the flipped classroom as a flexible model in different learning environments.

The study presented is the result of a research study conducted within a historical moment which led to the pandemic in 2020, and the unexpected situation experienced by university professors of transforming their face-to-face teaching to a virtual model. The resulting situation of confinement was utilized to explore how professors in Spain who implemented the Flipped Classroom (FC) model adapted to the change. The main goal was to verify if the FC model facilitated the transition from face-to-face to virtual teaching of university courses. A quantitative, non-experimental and descriptive approach was considered as the most adequate to reach the objective proposed, with the use of an ad-hoc Likert-type questionnaire. A total of 130 individuals completed the questionnaire, of which 48.5% were men and 51.5% women. The results showed that professors had to make very few changes to their courses. The female professors, and those who had less teaching experience with the FC model, mentioned having to make more modifications. Our findings show that the FC model facilitated the transition from a face-to-face university teaching model to a virtual one.

Evolution of Scientific Production on Health Literacy and Health Education-A Bibliometric Analysis.

In the last few years, there has been an emphasis on the importance of health literacy (HL) and health education (HE) as basic tools to empower individuals and the community. The increasing interest in HL and HE has been observed through the evolution of publications and the nature of the main trends in the last few years. Knowing how HL and HE have evolved in scientific publications can help us to identify trends and set work priorities in this scope. Based on this, a bibliometric analysis (from 2000 to 2021) was conducted in two phases: first, an analysis was performed on the publications included in the Web of Science (WOS); second, a more specific analysis was conducted on the Core Collection from WOS. The data were analyzed with two software programs, the and Bibliometrix package for RStudio, and VOSviewer to analyze number of publications, citations, authors, collaborations, keywords trends, keywords evolutions and clusters of related terms. A total of 1799 articles were found in the first phase, and 727 in the second. The results from both analyses showed that the publications increased unequally until 2020, and considerably decreased in 2021; however, in spite of this, the number of citations remained constant. Likewise, five word clusters related with HL and HE were identified. D. Nutbeam stood out as the most prolific author on the subject, the USA as the country with the most publications, and the International Journal of Environmental Research and Public Health as having the most articles on the subject. This analysis may be a useful and helpful tool for future studies on the subject.

Influence of Gender, Age and Field of Study on Hand Hygiene in Young Adults: A Cross-Sectional Study in the COVID-19 Pandemic Context.

The effectiveness of hand hygiene (HH) on reducing the transmission of contagious diseases is widely known, although its use has been commonly associated with the area of healthcare. During the COVID-19 pandemic, HH was one of the main measures established to contain the transmission of this virus. The identification of the main barriers and facilitators of HH in young adults (aged 18-29 years old) will contribute to the better planning of HH training and its posterior success. A total of 716 young adults participated in the study by completing the ad hoc online questionnaire (#YesWeHand), which analyzed, among other aspects, the age range, gender and field of study that they belonged to. From the total participants, 81.3% indicated knowing how to perform HH correctly, while 49.4% affirmed having received training. The main reason for performing HH was concern for their own safety and that of others (75.8%), while forgetfulness (36.5%) was the main reason for not performing HH. In the group of young adults, being female, aged between 22 and 25 years old, and having studied in the area of Health Sciences, had a positive influence on correct HH. It is deemed necessary to maintain HH beyond the primary education stages, and to adapt it to different fields of education, ages, and genders, in order to maximize its success. Given the overrepresentation of participants from the healthcare field, it would be desirable to conduct more studies to ensure a better representation of the different educational levels and fields of study of the participants, in order to identify, in a more reliable way, the variables that influence HH.

Basic Body Awareness Therapy in patients suffering from fibromyalgia: A randomized clinical trial.

Introduction: The aim of this study is to assess whether Basic Body Awareness Therapy (BBAT) improves musculoskeletal pain, movement quality, psychological function, and quality of life. Methods: The effects of BBAT in addition to treatment as usual (TAU) were studied in a randomized controlled trial. Forty-one patients were randomly assigned to a control group (n = 21) and an intervention group (n = 20). Both groups received TAU including pharmacological therapy. The intervention group took part in 10 BBAT sessions. Outcome variables were measured regarding pain, movement quality, psychological function, and quality of life. Outcome measures were assessed before intervention, in posttest, and in follow-ups at 12 and 24 weeks. Results: The BBAT group showed significant improvement in 'pain' at posttest (p = 0.037) and in 'movement quality' from baseline to 24 weeks (p = 0.000). Intragroup analysis showed significant improvements in the SF-36 body pain subscale at 12 and 24 weeks (p = 0.001, p = 0.014), Hospital Anxiety Depression scale in anxiety subscale at 12 weeks (p = 0.019), State-Trait Anxiety Inventory anxiety questionnaire at 12 and 24 weeks (p = 0.012, p = 0.002), and STAI state at 12 and 24 weeks (p = 0.042, p = 0.004). Conclusion: This study showed that BBAT might be an effective intervention in patients suffering from fibromyalgia in relation to pain, movement quality, and anxiety.

Cadmium exposure during pregnancy and lactation: materno-fetal and newborn repercussions of Cd(ii), and Cd-metallothionein complexes.

Cadmium (Cd) is a non-physiological heavy metal that can be harmful at low concentrations. Increasing anthropogenic activities are incrementing the risk of accumulation of this heavy metal in different organs and tissues of the body. In the case of pregnant women, the threat is more serious due to the implications affecting not only their own health but also fetal development as well. Metallothioneins (MTs), small cysteine-rich proteins, are involved in zinc (Zn) and copper homeostasis in mammals but can, however, also bind with Cd if present. The accumulation of Cd in maternal tissues (e.g. placenta, maternal blood, and mammary glands) induces the synthesis of MTs, preferably MT2, in an attempt to sequester the metal to avoid toxicity. The formed Cd-MT complexes will avoid the Cd transport from the placenta to the fetus and end up accumulating in the maternal kidneys. At the same time, high concentrations of MTs will increase the formation of Zn-MT complexes, therefore decreasing the amount of Zn ions available to be transported to the fetus by means of Zn transporters such as ZnT2, ZIP14 and DMT1. Although MTs cannot transport Cd from the mother to the fetus, the divalent DMT1 transporter is suggested to carry the metal to the fetus. As a consequence, the low levels of Zn(ii) in the fetus, together with the presence of Cd(ii) coming from the mother either via the placenta and cord blood or via breast milk induce changes in the fetal development including fetal growth retardation, and low weight or height of the newborn. Likewise, the concentrations of Cd(ii) in the newborn can cause alterations such as cognitive disabilities. In summary, the presence of Cd(ii) in the maternal tissues will induce MT synthesis in an attempt to detoxify these tissues and reduce the possible toxicity of Cd in fetal and newborn tissues.

Are the classic signs of infection in concordance with results from percutaneous aspiration to diagnose infection in pressure injuries?

AIM: To explore the concordance between the presence of classic signs of infection and the positive diagnosis identified by the microbiological culture of fluid collected by percutaneous aspiration. BACKGROUND: The classic signs of infection are commonly applied in some contexts to confirm infection in pressure injuries, but its accuracy has been questioned in chronic wounds. Little is known about the concordance of this method with others, such as the deep fluid culture from pressure injuries collected by percutaneous aspiration. DESIGN: Multicentre, cross-sectional observational study. METHODS: Pressure injuries of patients from four health centres were analysed. Three types of data were recorded between February 2011 and March 2012: i) socio-demographic and clinical data, ii) number and type of infection signs and iii) microbiological results of deep fluid culture from injuries. The concordance was calculated with the kappa index to find a possible concordance between both methods. RESULTS: On 40·2% (n = 47) of injuries, two or more classic signs of infection or purulent exudate as unique sign were present, while the total positive results in the microbiological cultures were 50·4% (n = 59). The disparity of positive results, depending on the location and the stage of the pressure injury and the method applied, suggested a poor concordance between methods. The -0·092 kappa index confirmed the non-concordance of the analysed methods. CONCLUSIONS: The tandem strategy is not useful to indicate an infection in pressure injuries. We advocate exploring other signs of infection and the adoption of other more reliable signs together with the classic signs of infection.

Understanding the 7-Cys module amplification of C. neoformans metallothioneins: how high capacity Cu-binding polypeptides are built to neutralize host nutritional immunity.

Cryptococcus neoformans metallothioneins (MTs), CnMT1 and CnMT2, have been identified as essential infectivity and virulence factors of this pathogen. Both MTs are unusually long Cu-thioneins, exhibiting protein architecture and metal-binding abilities compatible with the hypothesis of resulting from three and five tandem repetitions of 7-Cys motives, respectively, each of them folding into Cu5-clusters. Through the study of the Zn(II)- and Cu(I)-binding capabilities of several CnMT1 truncated mutants, we show that a 7-Cys segment of CnMT1 folds into Cu5-species, of additive capacity when joined in tandem. All the obtained Cu-complexes share practically similar architectural features, if judging by their almost equivalent CD fingerprints, and they also share their capacity to restore copper tolerance in MT-devoid yeast cells. Besides the analysis of the modular composition of these long fungal MTs, we evaluate the features of the Cys-rich stretch spacer and flanking sequences that allow the construction of stable metal clusters by adjacent union of binding modules. Overall, our data support a mechanism by which some microbial MTs may have evolved to enlarge their original metal co-ordination capacity under the specific selective pressure of counteracting the Cu-based immunity mechanisms evolved by the infected hosts.

Hints for metal-preference protein sequence determinants: different metal binding features of the five tetrahymena thermophila metallothioneins.

The metal binding preference of metallothioneins (MTs) groups them in two extreme subsets, the Zn/Cd- and the Cu-thioneins. Ciliates harbor the largest MT gene/protein family reported so far, including 5 paralogs that exhibit relatively low sequence similarity, excepting MTT2 and MTT4. In Tetrahymena thermophila, three MTs (MTT1, MTT3 and MTT5) were considered Cd-thioneins and two (MTT2 and MTT4) Cu-thioneins, according to gene expression inducibility and phylogenetic analysis. In this study, the metal-binding abilities of the five MTT proteins were characterized, to obtain information about the folding and stability of their cognate- and non-cognate metal complexes, and to characterize the T. thermophila MT system at protein level. Hence, the five MTTs were recombinantly synthesized as Zn(2+)-, Cd(2+)- or Cu(+)-complexes, which were analyzed by electrospray mass spectrometry (ESI-MS), circular dichroism (CD), and UV-vis spectrophotometry. Among the Cd-thioneins, MTT1 and MTT5 were optimal for Cd(2+) coordination, yielding unique Cd17- and Cd8- complexes, respectively. When binding Zn(2+), they rendered a mixture of Zn-species. Only MTT5 was capable to coordinate Cu(+), although yielding heteronuclear Zn-, Cu-species or highly unstable Cu-homometallic species. MTT3 exhibited poor binding abilities both for Cd(2+) and for Cu(+), and although not optimally, it yielded the best result when coordinating Zn(2+). The two Cu-thioneins, MTT2 and MTT4 isoforms formed homometallic Cu-complexes (major Cu20-MTT) upon synthesis in Cu-supplemented hosts. Contrarily, they were unable to fold into stable Cd-complexes, while Zn-MTT species were only recovered for MTT4 (major Zn10-MTT4). Thus, the metal binding preferences of the five T. thermophila MTs correlate well with their previous classification as Cd- and Cu-thioneins, and globally, they can be classified from Zn/Cd- to Cu-thioneins according to the gradation: MTT1>MTT5>MTT3>MTT4>MTT2. The main mechanisms underlying the evolution and specialization of the MTT metal binding preferences may have been internal tandem duplications, presence of doublet and triplet Cys patterns in Zn/Cd-thioneins, and optimization of site specific amino acid determinants (Lys for Zn/Cd- and Asn for Cu-coordination).

Full characterization of the Cu-, Zn-, and Cd-binding properties of CnMT1 and CnMT2, two metallothioneins of the pathogenic fungus Cryptococcus neoformans acting as virulence factors.

We report here the full characterization of the metal binding abilities of CnMT1 and CnMT2, two Cryptococcus neoformans proteins recently identified as metallothioneins (MTs), which have been shown to play a crucial role in the virulence and pathogenicity of this human-infecting fungus. In this work, we first performed a thorough in silico study of the CnMT1 and CnMT2 genes, cDNAs and corresponding encoded products. Subsequently, the Zn(II)-, Cd(II)- and Cu(I) binding abilities of both proteins were fully determined through the analysis of the metal-to-protein stoichiometries and the structural features (determined by ESI-MS, CD, ICP-AES and UV-vis spectroscopies) of the corresponding recombinant Zn-, Cd- and Cu-MT preparations synthesized in metal-enriched media. Finally, the analysis of the Zn/Cd and Zn/Cu replacement processes of the respective Zn-MT complexes when allowed to react with Cd(II) or Cu(I) aqueous solutions was performed. Comprehensive consideration of all gathered results allows us to consider both isoforms as genuine copper-thioneins, and led to the identification of unprecedented Cu5-core clusters in MTs. CnMT1 and CnMT2 polypeptides appear to be evolutionarily related to the small fungal MTs, probably by ancient tandem-duplication events responding to a highly selective pressure to chelate copper, and far from the properties of Zn- and Cd-thioneins. Finally, we propose a modular structure of the Cu-CnMT1 and Cu-CnMT2 complexes on the basis of Cu5 clusters, concordantly with the modular structure of the sequence of CnMT1 and CnMT2, constituted by three and five Cys-rich units, respectively.

Cryptococcus neoformans copper detoxification machinery is critical for fungal virulence.

Copper (Cu) is an essential metal that is toxic at high concentrations. Thus, pathogens often rely on host Cu for growth, but host cells can hyperaccumulate Cu to exert antimicrobial effects. The human fungal pathogen Cryptococcus neoformans encodes many Cu-responsive genes, but their role in infection is unclear. We determined that pulmonary C. neoformans infection results in Cu-specific induction of genes encoding the Cu-detoxifying metallothionein (Cmt) proteins. Mutant strains lacking CMTs or expressing Cmt variants defective in Cu-coordination exhibit severely attenuated virulence and reduced pulmonary colonization. Consistent with the upregulation of Cmt proteins, C. neoformans pulmonary infection results in increased serum Cu concentrations and increases and decreases alveolar macrophage expression of the Cu importer (Ctr1) and ATP7A, a transporter implicated in phagosomal Cu compartmentalization, respectively. These studies indicate that the host mobilizes Cu as an innate antifungal defense but C. neoformans senses and neutralizes toxic Cu to promote infection.