Role of dry watercourses of an arid watershed in carbon and nitrogen processing along an agricultural impact gradient.

In the Mediterranean arid region such as Southeast (SE) Spain, a considerable part of the fluvial network runs permanently dry. Here, many dry watercourses are embedded in catchments where agriculture has brought changes in carbon (C) and nitrogen (N) availability due to native riparian vegetation removal and the establishment of intensive agriculture. Despite their increasing scientific recognition and vulnerability, our knowledge about dry riverbeds biogeochemistry and environmental drivers is still limited, moreover for developing proper management plans at the whole catchment scale. We examined CO2 and N2O emissions in five riverbeds in SE Spain of variable agricultural impact under dry and simulated rewetted conditions. Sediment denitrifying capacity upon rewetting was also assessed. We found that, regardless of agricultural impact, all riverbeds can emit CO2 under dry and wet conditions. Emissions of N2O were only observed in our study when a long-term rewetting driving saturated sediments was conducted. Besides, most biogeochemical capabilities were enhanced in summer, reflecting the sensitiveness of microbial activity to temperature. Biogeochemical processing variation across rivers appeared to be more controlled by availability of sediment organic C, rather than by agriculturally derived nitrate. We found that the studied dry riverbeds, agriculturally affected or not, may be active sources of CO2 and contribute to transitory N2O emissions during rewetting phenomena, potentially through denitrification. We propose that management plans aiming to support ecosystem biogeochemistry through organic C from native vegetation rather than agricultural exudates would help to reduce anthropogenic greenhouse gases emissions and excess of nutrients in the watershed and to control the nitrate inputs to coastal ecosystems.

Nitrogen availability in biochar-based fertilizers depending on activation treatment and nitrogen source.

Different activation and N-doping treatments were used to produce biochar-based fertilizers (BBFs) with increased N concentration and slow N release. Pristine biochars were produced by pyrolysis of olive tree pruning feedstock at low and high temperatures (400 and 800 °C). These biochars were activated either by ultrasonication, or oxidation with hydrogen peroxide (H2O2) or nitric acid (HNO3) to increase their N retention potential. Subsequently biochars were enriched with N with either urea or ammonium sulfate. The activation of low-temperature biochars with HNO3 was the most effective treatment leading to new surface carboxylic groups that facilitated the later enrichment with N. When treated with urea, BBFs reached 7.0 N%, whereas the H2O2 activation only allowed an increase up to 2.0 N%. The use of urea as the external N source was the most efficient for incorporating N. Urea treated biochars had a water-soluble fraction that represented up to 14.5 % of the total N. The hydrolyzable N fraction, composed by amides and simple N heterocycles originated by the N-doping treatments, and nitro groups generated from HNO3 activation, represented up to 60 % of the total N. This study relates the N chemical forms in the new BBFs to potential N availability in soil. The presence of water-soluble, hydrolyzable and non-hydrolyzable N implied that these BBFs may supply N that would be progressively available for plants, acting as slow-release fertilizers.

Limpieza de úlceras de etiología venosa. Una revisión sistemática / Cleansing venous leg ulcers. A systematic review

Objetivo: Evaluar los efectos de la limpieza, así como las soluciones y técnicas utilizadas, para el tratamiento de las úlceras de etiología venosa. Metodología: Se realizó una revisión sistemática siguiendo las últimas recomendaciones de la declaración PRISMA. La búsqueda se realizó en 3 bases de datos (PubMed, CINAHL, Cochrane), limitándose por idioma (inglés/español) y por año (de enero de 2011 a diciembre de 2021). Siguiendo el diagrama PRISMA, se realizó la depuración y evaluación de calidad de los estudios por pares, utilizando las normas de la Red EQUATOR, y seleccionando únicamente ensayos clínicos aleatorizados y revisiones sistemáticas de calidad media o alta. Resultados: Se identificaron un total de 790 artículos, de los cuales se eliminaron 58 por estar duplicados, 700 tras la revisión por título y resumen, y 25 en el cribado por texto completo. De los 7 artículos restantes, se incluyeron 5 al presentar alta calidad metodológica (cumplieron > 70% de los ítems), 3 con diseño de estudio clínico aleatorizado y 2 revisiones sistemáticas. Conclusiones: Actualmente, no se dispone de evidencias científicas sólidas que den valor a la limpieza dentro del tratamiento integral de las heridas. Se necesitan más estudios que permitan orientar a los profesionales en la toma de decisiones para realizar una práctica segura y una optimización de los recursos existentes, considerando a la persona, sus necesidades y su satisfacción en el proceso del cuidado de las lesiones (AU)

Objectives: To evaluate the effects of cleansing venous ulcers on the healing, as well as wound cleansing solutions available and wound cleansing techniques used. Methodology: A systematic review has been made following the PRISMA statement recommendations. This research used 3 databases (PubMed, CINAHL, Cochrane), filtering by language (English/Spanish) and by date (from January 2011 to December 2021). Diagram PRISMA was the base for filtering and evaluating the peer review quality, using the EQUATOR Network and selecting only the randomised clinical trial (RCT) and high or medium quality systematic reviews (SR). Results: A total of 790 articles were identified, of which 58 were eliminated as duplicates, 700 after reviewing by title and abstract, and 25 after screening by full text. Of the 7 remaining articles, 5 of them were included as they were of high methodological quality (more than 70% of the items were accomplished), 3 with an RCT design and 2 SR. Conclusions: Currently, there is no solid scientific evidence that gives credence that cleansing injuries, adds value, within the comprehensive treatment of wounds. More studies are needed, to give professionals decision-making guidelines for providing safe practices and optimising existing resources, considering the state of the patient, their needs and their comfort during the process of injury care (AU)

Standardized incidence ratios and risk factors for cancer in patients with systemic sclerosis: Data from the Spanish Scleroderma Registry (RESCLE).

AIM: Patients with systemic sclerosis (SSc) are at increased risk of cancer, a growing cause of non-SSc-related death among these patients. We analyzed the increased cancer risk among Spanish patients with SSc using standardized incidence ratios (SIRs) and identified independent cancer risk factors in this population. MATERIAL AND METHODS: Spanish Scleroderma Registry data were analyzed to determine the demographic characteristics of patients with SSc, and logistic regression was used to identify cancer risk factors. SIRs with 95% confidence intervals (CIs) relative to the general Spanish population were calculated. RESULTS: Of 1930 patients with SSc, 206 had cancer, most commonly breast, lung, hematological, and colorectal cancers. Patients with SSc had increased risks of overall cancer (SIR 1.48, 95% CI 1.36-1.60; P < 0.001), and of lung (SIR 2.22, 95% CI 1.77-2.73; P < 0.001), breast (SIR 1.31, 95% CI 1.10-1.54; P = 0.003), and hematological (SIR 2.03, 95% CI 1.52-2.62; P < 0.001) cancers. Cancer was associated with older age at SSc onset (odds ratio [OR] 1.22, 95% CI 1.01-1.03; P < 0.001), the presence of primary biliary cholangitis (OR 2.35, 95% CI 1.18-4.68; P = 0.015) and forced vital capacity <70% (OR 1.8, 95% CI 1.24-2.70; P = 0.002). The presence of anticentromere antibodies lowered the risk of cancer (OR 0.66, 95% CI 0.45-0.97; P = 0.036). CONCLUSIONS: Spanish patients with SSc had an increased cancer risk compared with the general population. Some characteristics, including specific autoantibodies, may be related to this increased risk.

The incidence rate of pulmonary arterial hypertension and scleroderma renal crisis in systemic sclerosis patients with digital ulcers on endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i).

INTRODUCTION: Endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i) are beneficial in pulmonary arterial hypertension (PAH) and digital ulcers (DU) and prevent from DU recurrences. Our study aimed to determine the difference in the incidence rate of PAH and scleroderma renal crisis (SRC) in patients with SSc and DU (SSc-DU) under ERAs/PDE5i or without treatment. METHODS: We conducted a retrospective cohort study including SSc-DU patients from the Spanish Scleroderma Registry (RESCLE). The primary outcome was the incidence rate of PAH and SRC in patients under ERAs/PDE5i or not. RESULTS: Some 544 patients out of 1817 (29.9%) in the RESCLE database had DU, 221 (40.6%) under ERAs/PDE5i and 323 (59.4%) not. The incidence rate (95% CI) difference between patients under treatment or not under did not reach statistical significance in PAH [-0.1 (-4.8, 4.69), P = 0.988] or in SRC [0.7 (-2.2, 3.7), P = 0.620]. However, the time from the first DU to the diagnosis of SRC was delayed in treated patients [mean (s.d.) 7.6 (5.8) years vs 2.9 (5.3); P = 0.021]. The dcSSc subset was more prevalent in the treatment group (36 vs 26%; P = 0.018), along with anti-topoisomerase I antibodies (34 vs 18%; P < 0.001) and tendon friction rubs (12 vs 6%; P = 0.038), whereas the lcSSc subset was more prevalent in the no-treatment group (57 vs 66%; P = 0.031) along with ACA (37 vs 46%; P = 0.031). CONCLUSION: There was no difference in the incidence rate of PAH and SRC between groups. However, treatment with ERAs and/or PDE5i appeared to delay the occurrence of SRC.

Impact of COVID-19 in spanish urology residents: Recommendations and perspective. / El impacto del COVID-19 en la residencia en urología en España: perspectivas y recomendaciones.

The COVID-19 pandemic has seriously disrupted the day-to-day running of hospitals, affecting the activity of all medical and surgical departments. It has also affected urology residents, depriving them of training at their usual workplaces and forcing them to support COVID units. This has implied not only the loss of daily activities, but also the uncertainty of job opportunities for the final year residents. In addition, the cancellation of numerous events such as congresses, exams,or courses has affected the annual planning of the specialty. A review of the current literature on the impact of the COVID-19 pandemic, as well as the de-escalation process, on resident training has been carried out using web search and PubMed. The situation of the residents has been analyzed, both through the information generated by recent literature and by the personal experience of the authors, from different areas: evaluation systems, educational and surgical aspects, as well as healthcare work. As a result of this review, the negative impact of the crisison urology resident training can be observed, especially in the surgical field, but new learning opportunities or new forms of communication with the patient can also be observed. These educational and healthcare resources invite the urology resident in particular, and the medical society in general, to reinvent themselves. The aim of this article is to analyse the training of the urology resident in the de-escalation phase. Similarly, the emerging educational resources during the pandemic are synthesized, inviting the reader, and especially the urology resident, to continue their training and learningin these times of uncertainty.

La pandemia por COVID-19 ha irrumpido gravemente en el día a día de los hospitales, afectando a la actividad de todos los servicios médicos y quirúrgicos. Del mismo modo ha afectado a los residentes de urología, privándoles a los mismos de seguir la formación en sus puestos de trabajo habituales y viéndose obligados a dar apoyo a las unidades COVID. Esto ha implicado, no solamente la pérdida de las actividades diarias, si no también la incertidumbre en oportunidades laborales de los residentes de último año. Además, la cancelación de numerosos eventos como congresos, exámenes o cursos, ha afectado a la planificación anual de la especialidad. Se ha realizado una revisión de la literatura actual sobre el impacto de la pandemia por COVID-19, así como el proceso de desescalada, en la formación de los residentes mediante búsqueda web y en PubMed. Se ha analizado la situación de los residentes, tanto através de la información generada por la reciente literatura, como por la experiencia personal de los autores, desde distintos ámbitos: sistemas de evaluación, aspectos docentes y quirúrgicos, así como labor asistencial. Como resultado de esta revisión, se observa el impacto negativo de la crisis en la formación del residente en urología, especialmente, en el ámbito quirúrgico, pero también se observan nuevas oportunidades de aprendizaje o formas de comunicación con el paciente. Estos recursos educativos y asistenciales invitan al residente de urología en concreto, y a la sociedad médica en general, a reinventarse. El objetivo del presente artículo es analizar la formación del residente en urología en la fase de desescalada. Del mismo modo, se sintetizan los recursos educativos emergentes durante la pandemia, invitando al lector y, de manera especial al residente de urología, a continuar su formación y aprendizaje ante estos tiempos de incertidumbre.

El impacto del COVID-19 en la residencia en urología en España: perspectivas y recomendaciones / No disponible

La pandemia por COVID-19 ha irrumpido gravemente en el día a día de los hospitales, afectando a la actividad de todos los servicios médicos y quirúrgicos. Del mismo modo ha afectado a los residentes de urología, privándoles a los mismos de seguir la formación en sus puestos de trabajo habituales y viéndose obligados a dar apoyo a las unidades COVID. Esto ha implicado, no solamente la pérdida de las actividades diarias, si no también la incertidumbre en oportunidades laborales de los residentes de último año. Además, la cancelación de numerosos eventos como congresos, exámenes o cursos, ha afectado a la planificación anual de la especialidad. Se ha realizado una revisión de la literatura actual sobre el impacto de la pandemia por COVID-19, así como el proceso de desescalada, en la formación de los residentes mediante búsqueda web y en PubMed. Se ha analizado la situación de los residentes, tanto a través de la información generada por la reciente literatura, como por la experiencia personal de los autores, desde distintos ámbitos: sistemas de evaluación, aspectos docentes y quirúrgicos, así como labor asistencial. Como resultado de esta revisión, se observa el impacto negativo de la crisis en la formación del residente en urología, especialmente, en el ámbito quirúrgico, pero también se observan nuevas oportunidades de aprendizaje o formas de comunicación con el paciente. Estos recursos educativos y asistenciales invitan al residente de urología en concreto, y a la sociedad médica en general, a reinventarse. El objetivo del presente artículo es analizar la formación del residente en urología en la fase de desescalada. Del mismo modo, se sintetizan los recursos educativos emergentes durante la pandemia, invitando al lector y, de manera especial al residente de urología, a continuar su formación y aprendizaje ante estos tiempos de incertidumbre

The COVID-19 pandemic has seriously disrupted the day-to-day running of hospitals, affecting the activity of all medical and surgical departments. It has also affected urology residents, depriving them of training at their usual workplaces and forcing them to support COVID units. This has implied not only the loss of daily activities, but also the uncertainty of job opportunities for the final year residents. In addition, the cancellation of numerous events such as congresses, exams, or courses has affected the annual planning of the specialty. A review of the current literature on the impact of the COVID-19 pandemic, as well as the de-escalation process, on resident training has been carried out using web search and PubMed. The situation of the residents has been analyzed, both through the information generated by recent literature and by the personal experience of the authors, from different areas: evaluation systems, educational and surgical aspects, as well as healthcare work. As a result of this review, the negative impact of the crisis on urology resident training can be observed, especially in the surgical field, but new learning opportunities or new forms of communication with the patient can also be observed. These educational and healthcare resources invite the urology resident in particular, and the medical society in general, to reinvent themselves. The aim of this article is to analyse the training of the urology resident in the de-escalation phase. Similarly, the emerging educational resources during the pandemic are synthesized, inviting the reader, and especially the urology resident, to continue their training and learning in these times of uncertainty

Spanish scleroderma risk score (RESCLESCORE) to predict 15-year all-cause mortality in scleroderma patients at the time of diagnosis based on the RESCLE cohort: Derivation and internal validation.

A few scores predicting the short-term risk of mortality in Systemic sclerosis (SSc) have been reported to date. Our study aimed to create a predictive 15-year all-cause mortality score at the time of the diagnosis of SSc. The study was based on the Spanish Scleroderma Registry (RESCLE). The cohort was split up in derivation (DC) and validation cohort (VC). A multivariate analysis to detect variables related to all-cause mortality within the first 15 years from SSc diagnosis was performed, assigning points to the rounded beta values to create the score (RESCLESCORE). 1935 SSc patients were included. The variables in the final model were as follows: age at diagnosis (+2 points > 65 years-old), male gender (+1 point), lcSSc subset (-1 point), mode of onset other than Raynaud's (+1 point), cancer (+1 point) and visceral involvement, such as ILD (+1 point), PAH (+1 point), heart (+1 point) and renal involvement (+2 points). Autoantibodies did not achieve statistical significance in the multivariate analysis. The 3 categories of risk to predict 15-year all-cause mortality at the time of diagnosis were as follows: low risk (5% vs. 7%, p = .189), intermediate risk (26.5% vs. 25.5%, p = .911) and high risk (47.8% vs. 59%, p = .316). The AUC was 0.799 (DC) vs. 0.778 (VC) (p = .530). In conclusion, the RESCLESCORE demonstrated an excellent ability to categorize SSc patients at the time of diagnosis in separate 15-year all-cause mortality risk strata at the time of diagnosis.

An historical ecological assessment of land-use evolution and observed landscape change in an arid aeolian sedimentary system.

Coastal areas worldwide are undergoing major changes and degradation due to a set of combined natural and anthropogenic stressors. In arid aeolian sedimentary systems these changes can be even more acute given their sensitivity to perturbances in landscape dynamics. While in many such areas recent (20 year) observations have been made regarding measurable differences in dune coverage and stability, few studies have assessed and quantified the long-term relationships of transitioning exploitation and land-use changes in order to fully evaluate their importance. Land management, therefore, does not always benefit from the more holistic picture that a combined deeper time historical ecology and geographical approach provides and can contribute to decision making. The Jandía isthmus, in Fuerteventura (Canary Islands, Spain) presented an ideal field laboratory in which to assess these phenomena in actual conditions and test a combined methodology using historical and current sources (historical documents, aerial photographs, orthophotos, LiDAR data, field work and oral sources). By doing so, different phases of land exploitation associated with changing land ownership were identified and the consequences of each on the dune system assessed. It is concluded that the transition from traditional land uses (livestock and fuel extraction) to more recent ones (aggregate extraction, construction of new roads and urban-touristic resorts, and some recreational uses) has altered aeolian sedimentary transport, inducing stabilization of the landforms, as well as producing significant changes in the vegetation. The wider application of this type of study can benefit the many other areas worldwide that are facing similar pressures.

Development of a Scale Based on Nursing Outcome Classification "Dignified Life Closure" (1307) to Assess End-of-Life Dignity of Patients in Care Homes for the Elderly.

PURPOSE: To develop and pilot the DD-14 scale, a 14-indicator scale based on the Nursing Outcome Classification "Dignified life closure" (1307). METHODS: Sixteen experts selected 14 indicators for Spanish populations. Six care home nurses piloted the scale in 50 terminal patients without cognitive impairment. Factorial and reliability analyses were performed and correlations were determined with dependency, symptomatology, and palliative care quality. FINDINGS: DD-14 demonstrated high reliability (α = 0.916) and a stable factorial structure. It was not influenced by sex, age, or disease and correlated positively with the Barthel index (r = .622; p = .00) and negatively with the Palliative Outcome Scale (r = -.542;p = .00). CONCLUSIONS: DD-14 is a useful scale for evaluating end-of-life dignity. IMPLICATIONS FOR NURSING PRACTICE: This instrument could be useful in planning nursing interventions.

Emotional and behavioral difficulties in adolescence: Relationship with emotional well-being, affect, and academic performance / Dificultades emocionales y comportamentales en la adolescencia: relación con bienestar emocional, afecto y rendimiento académico

The main purpose of this study was to examine difficulties in behavioral and emotional adjustment and their relationship to subjective well-being, positive and negative affect, and academic performance in a representative sample of nonclinical adolescents. The sample consisted of a total of 1,664 participants (M = 16.12 years, SD = 1.36, range 14-19 years), selected through stratified cluster sampling. The instruments used were the Strengths and Difficulties Questionnaire (SDQ), the Positive and Negative Affect Schedule for Children (PANAS-C), the Personal Wellbeing Index-School Children (PWI-SC), the ad hoc academic performance questionnaire, and the Oviedo Scale of Response Infrequency. In all, 7.7% of the adolescents showed a possible mental health risk. Emotional and behavioral difficulties were negatively correlated with emotional wellbeing and Positive Affect, and positively associated with Negative Affect. In addition, students with poorer academic performance reported greater emotional and behavioral difficulties. These results are consistent with those found in previous studies. They have clear implications, in both health and education, for improving the promotion of emotional wellbeing and the prevention of psychological problems in this population sector

El propósito de este estudio fue examinar las dificultades en el ajuste emocional comportamental y su relación con el bienestar emocional, el afecto positivo y negativo y el rendimiento académico en una muestra representativa de adolescentes no clínicos. La muestra la conformaron un total 1.664 de participantes (M = 16.12 años; DT = 1.36, rango 14-19 años), seleccionados mediante muestreo estratificado por conglomerados. Los instrumentos empleados fueron el Strengths and Difficulties Questionnarie (SDQ), el Positive and Negative Affect Schedule for Children (PANAS-C), el Personal Wellbeing Index-School Children (PWI-SC), un cuestionario ad hoc de rendimiento académico y la Escala Oviedo de Infrecuencia de Respuesta. Los resultados mostraron que el 7,7% de los adolescentes manifestaron posible riesgo de mala salud mental. Las dificultades emocionales y comportamentales correlacionaron de forma negativa con el bienestar emocional subjetivo y Afecto Positivo y de forma positiva Afecto Negativo. Además, los alumnos con un peor rendimiento académico informaron de mayores dificultades en ajuste emocional y comportamental. Estos resultados son convergentes con los encontrados en trabajos previos y tienen claras implicaciones, tanto a nivel sanitario como educativo, de cara a mejorar la promoción del bienestar emocional y prevención de los problemas psicológicos en este sector de la población

Perfiles motivacionales de elección de estudios en estudiantes universitarios de nuevo ingreso / Career Choice Motivational Profiles in First Year University Students

Resumen Este trabajo tuvo como propósito analizar los motivos de elección de estudios y establecer perfiles motivacionales diferenciados en estudiantes universitarios de nuevo ingreso en la Universidad Católica Argentina (UCA). Para ello se diseñó y validó un cuestionario ad hoc, estructurado en tres escalas de motivación: (1) Motivos de superación profesional y altruismo; (2) Búsqueda de prestigio y solvencia económica y (3) Motivos de evitación. El cuestionario se aplicó a la totalidad de los estudiantes de nuevo acceso a la UCA en el curso académico 2013-2014 (1 156 estudiantes de diferentes disciplinas). Los resultados permitieron establecer la existencia de grupos diferenciados de estudiantes y obtener un modelo predictivo de clasificación destinado al diseño de acciones de orientación que tengan en cuenta sus motivaciones y necesidades en un contexto determinado.

Abstract This study examines the career choice motivations of first year students in the Catholic University of Argentina (UCA) and describes a classification of the student characteristics that are associated with these motivations. A questionnaire was designed and validated for this purpose. The factor analysis renders three motivational dimensions: (1) Self-fulfilment and altruism; (2) Search for prestige and economic welfare; and (3) Avoidance motivation. The instrument has been applied to the first year cohort at UCA in the academic year 2013/14 (a total of 1156 students from different disciplines). The existence of differentiated student groups resulting from scores in the motivational scales has been demonstrated. The resulting predictive model can be purposed to guide interventions that are mindful of students' motivations and needs in a particular context.

End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale.

Quality end-of-life care is a central issue in nursing homes, requiring the assessment of individual and family needs by health professionals. Although previous instruments have been developed, they usually rely on family reports and have been adapted from other clinical contexts (hospital or primary care). It is important to consider how health care professionals working in nursing homes perceive what is necessary to achieve quality end-of-life care. In this study, the objective was to develop an instrument to assess quality of end-of-life care in the context of Spanish care homes. A 24 item scale Nursing Home End of Life Care Scale (NHEOLC) was developed through a systematic evaluation of existing tools combined with an iterative process of consultation with group experts in end of life care in long term care settings. A total of 307 health care professionals agreed to participate in the study and completed the scale. The scale was grouped in six dimensions: physical, psychological aspects and spiritual aspects of care, family care, bereavement, and patient/family preferences management. The results suggest an adequate factorial structure of the scale and good internal consistency for the total score and the subscales. In addition, the results showed significant differences depending on the size of the nursing home, the category of health professionals, and their own perceptions of his work regarding end-of-life care.

Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales / Facilitators and barriers regarding end of life care at nursing homes: A focus group study

OBJETIVO: Identificar las dificultades y factores favorables experimentados por los profesionales, relacionados con el final de la vida en las residencias de ancianos. DISEÑO: Estudio cualitativo descriptivo, desde una perspectiva fenomenológica mediante análisis del contenido. Emplazamiento: Residencias de ancianos del Distrito de Atención Primaria Granada (España). PARTICIPANTES: Quince profesionales asistenciales con un mínimo de 6 meses de experiencia en residencias y sin formación específica en cuidados paliativos. MÉTODOS: Se realizaron 3 grupos focales con profesionales de diferentes disciplinas y residencias. Las conversaciones fueron grabadas y transcritas literalmente. Se realizó una codificación abierta y axial para identificar las categorías más relevantes. RESULTADOS: Los profesionales identifican dificultades en la comunicación con las familias, relacionadas con sentimientos de culpa de los familiares, dificultad para comprender el deterioro, y un abordaje tardío del tema de la muerte. En cuanto a la toma de decisiones, los profesionales reconocen que no fomentan la participación de los pacientes. Las voluntades anticipadas son valoradas como una herramienta necesaria, pero no contemplan su implementación de manera sistemática. Otras dificultades que los profesionales destacan son la falta de coordinación con otros profesionales, relacionada con la falta de comprensión de las necesidades de los pacientes, así como la falta de formación y de recursos materiales y humanos. Como factor favorable, destacan las relaciones con los equipos de atención primaria. CONCLUSIÓN: Es necesario mejorar la comunicación entre los profesionales, las familias, los pacientes y otros trabajadores de la salud

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. Placement: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers

[Facilitators and barriers regarding end of life care at nursing homes: A focus group study]. / Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales.

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. PLACEMENT: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.

Necesidades de orientación profesional de usuarios de servicios públicos de empleo en España / Necessidades de orientação profissional dos usuários de serviços públicos de emprego na Espanha / Career counseling needs of employment public services users in Spain

Este artículo explora las necesidades de orientación profesional de 1816 usuarios de servicios públicos de empleo, en relación con las competencias requeridas para la planificación del proyecto vital y profesional. Pretende identificar diferencias entre la población general y los grupos de atención prioritaria (mujeres, jóvenes, personas con baja cualificación, parados mayores de 45, población rural). La recogida de información se realizó a través de un cuestionario diseñado ad-hoc. Los resultados permiten identificar tres dimensiones en el conjunto de necesidades de orientación profesional: 1. las relativas a la gestión de la carrera profesional, a 2. la planificación de metas realistas y a 3. la búsqueda de empleo, en las que se encuentran diferencias significativas en función de alguna o varias de las variables consideradas.

Este artigo aborda as necessidades de orientação profissional de 1816 usuários dos serviços públicos de emprego, em relação às competências requeridas para o planejamento dos projetos de vida e profissional. Como objetivo, pretende identificar as diferenças entre a população geral de usuários e os grupos de atenção prioritárias (mulheres, jovens, pessoas com baixa qualificação profissional, desempregados com mais de 45 anos, população rural). A coleta de informação foi realizada através de um questionário ad-hoc. Os resultados permitem identificar três dimensões nas necessidades de orientação vocacional: 1. as relativas à gestão de carreiras profissionais, 2. o planejamento de metas realistas e 3. a procura por emprego, nas quais se encontrou diferenças significativas com base em uma ou mais variáveis sócio-demográficas consideradas na pesquisa.

This article explores the career counseling needs of 1816 users of employment public services, in relation to the competencies required for the planning of the vital and professional project. It aims to identify differences between the general population and the priority attention groups (women, young people, people with low skills, unemployed over 45, rural population). The collection of information was done through an ad-hoc designed questionnaire. The results allow to identify three dimensions in the set of career counseling needs: 1. those related to career management, 2. realistic goal planning and 3. job search, in which are found significant differences depending on one or several of the variables considered.

Paciente con placas céreas en el dorso de la nariz / A patient with waxy plaques on the nose

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Fin de vida en residencia de ancianos desde la perspectiva de los residentes: revisión bibliográfica / End-of-life in nursing home from the perspective of residents: Literature review

Objetivos: Describir cómo se desarrollan los procesos de fin de vida en las residencias de ancianos desde la perspectiva de los residentes. Metodología: Revisión bibliográfica en distintas bases de datos, en los últimos 10 años. Las bases de datos consultadas fueron Cuiden, IME, Elsevier, PubMed y CINALH. Se excluyeron aquellos artículos que no estudiaban las experiencias u opiniones de los residentes. Resultados: De los 305 artículos encontrados, se eliminaron los que no cumplían con los criterios de inclusión y exclusión. Finalmente se seleccionaron13 artículos. Algunos de los temas que se abordan son las necesidades que los residentes consideran más importantes, aspectos indicativos de buena muerte y la relación del dolor con la calidad de los procesos de fin de vida. Conclusión: Los resultados de este estudio demuestran lo poco que se sabe sobre los procesos de fin de vida en las residencias de ancianos de nuestro país. La falta de evidencia en este sentido no nos permite asegurar que las residencias sean un lugar adecuado para el desarrollo de los procesos de fin de vida

Objectives: Describe the development of end of life of older people in nursing home from the point of view of the residents. Methodology: Bibliographic review in different databases over the last ten years. The consulted database were Cuiden, IME, Elsevier, PubMed and CINALH. The articles which did not study the experiences and opinions of the residents were excluded. Results: Out of the 305 articles that were found those which did not satisfy the inclusion an exclusion criteria were removed, in the end 13 articles were selected. Some of the topics approached are the needs that are considered most important by the residents, indicative aspects of good death and the relation between pain and the quality of end of life processes. Conclusion: The results of this study demonstrate the little that is known about the processes of life in the nursing homes in our country. The lack of evidence toward this topic, does not allow us to assure that homes are adequateplace for the development of end of life processes

Patterns of drug therapy in newly diagnosed Spanish patients with systemic lupus erythematosus.

OBJECTIVES: This is the first Spanish multicentric inception lupus cohort, formed by SLE patients attending Spanish Internal Medicine Services since January 2009. We aimed to analyse drug therapy during the first year of follow-up according to disease severity. METHODS: 223 patients who had at least one year of follow-up were enrolled upon diagnosis of SLE. Therapy with prednisone, pulse methyl-prednisolone, hydroxychloroquine, immunosuppressives and calcium/vitamin D was analysed. RESULTS: Prednisone was given to 65% patients, at a mean (SD) daily dose of 11 (10) mg/d. 38% patients received average doses >7.5 mg/d during the first year. Patients with nephritis and with a SLEDAI ≥6 were treated with higher doses of prednisone. 81% of patients were treated with hydroxychloroquine, with higher frequency among those with a SLEDAI ≥6 (88% vs. 68%, p<0.001). The use of immunosuppressive drugs and methyl-prednisolone pulses was higher in patients with a baseline SLEDAI ≥6, however, differences were no longer significant when patients with lupus nephritis were excluded. The use of calcium/vitamin D increased with the dose of prednisone, however, 43% of patients on medium-high doses of prednisone did not take any calcium or vitamin D. CONCLUSIONS: This study gives a real-world view of the current therapeutic approach to early lupus in Spain. The generalised use of hydroxychloroquine is well consolidated. There is still a tendency to use prednisone at medium to high doses. Pulse methyl-prednisolone and immunosuppressive drugs were used in more severe cases, but not as steroid sparing agents. Vitamin D use was suboptimal.