Achieving biodiversity net gain by addressing governance gaps underpinning ecological compensation policies.

Biodiversity compensation policies have emerged around the world to address the ecological harms of infrastructure expansion, but historically compliance is weak. The Westminster government is introducing a requirement that new infrastructure developments in England demonstrate they achieve a biodiversity net gain (BNG). We sought to determine the magnitude of the effects of governance gaps and regulator capacity constraints on the policy's potential biodiversity impacts. We collated BNG information from all new major developments across six early-adopter councils from 2020 to 2022. We quantified the proportion of the biodiversity outcomes promised under BNG at risk of noncompliance, explored the variation in strategies used to meet developers' biodiversity liabilities, and quantified the occurrence of simple errors in the biodiversity metric calculations. For large developments and energy infrastructure, biodiversity liabilities frequently met within the projects' development footprint. For small developments, the purchase of offsets was most common. We estimated that 27% of all biodiversity units fell into governance gaps that exposed them to a high risk of noncompliance because they were associated with better-condition habitats delivered on-site that were unlikely to be monitored or enforced. More robust governance mechanisms (e.g., practical mechanisms for monitoring and enforcement) would help ensure the delivery of this biodiversity on-site. Alternatively, more biodiversity gains could be delivered through off-site biodiversity offsetting. For the latter case, we estimated that the demand for offsets could rise by a factor of 4; this would substantially increase the financial contributions from developers for conservation activities on private land. Twenty-one percent of development applications contained a simple recurring error in their BNG calculations. One-half of these applications were approved by councils, which may indicate under-resourcing in council development assessments. Our findings demonstrate that resourcing and governance shortfalls risk undermining the policy's effectiveness.

sObtención de la ganancia neta de biodiversidad mediante el abordaje de las lagunas en la gobernanza que apuntalan las políticas de compensación ecológica Resumen Las políticas de compensación por biodiversidad han surgido en todo el mundo para abordar los daños ecológicos de la expansión infraestructural, aunque su cumplimiento histórico es deficiente. El gobierno de Westminster está introduciendo un requerimiento para que las nuevas infraestructuras en Inglaterra demuestren que obtienen una ganancia neta de biodiversidad (GNB). Buscamos determinar la magnitud que tienen los efectos de las lagunas de gobernanza y las restricciones de la capacidad regulatoria sobre los impactos potenciales de la política en la biodiversidad. Recopilamos la información de GNB de todos los desarrollos principales en seis consejos pioneros entre 2020 y 2022. Cuantificamos la proporción de los resultados de biodiversidad prometidos bajo la GNB en riesgo de no ser cumplidos, exploramos la variación de estrategias usadas para cumplir las responsabilidades de biodiversidad de los desarrolladores y cuantificamos la incidencia de errores simples en el cálculo de las medidas de biodiversidad. En los grandes desarrollos y en la infraestructura energética, las responsabilidades de biodiversidad fueron cumplidas con frecuencia dentro de la huella de desarrollo del proyecto. En los pequeños desarrollos, la compra de compensaciones fue más común. Estimamos que el 27% de todas las unidades de biodiversidad caen dentro de las lagunas de gobernanza que las exponen a un riesgo elevado de no ser cumplidas porque se asociaban con hábitats en mejores condiciones entregados en sitios con mayor probabilidad de no ser monitoreados o implementados. Tener mecanismos de gobernanza más robustos (mecanismos prácticos para el monitoreo y la implementación) ayudaría a asegurar la entrega de esta biodiversidad en sitio. Como alternativa, una mayor ganancia de biodiversidad podría entregarse a través de las compensaciones de biodiversidad fuera de sitio. Para el último caso, estimamos que la demanda de compensaciones podría aumentar en un factor de 4; esto incrementaría sustancialmente las contribuciones económicas de los desarrolladores para las actividades de conservación en suelo privado. El 21% de las aplicaciones de desarrollo incluyeron un error simple recurrente en los cálculos de su GNB. La mitad de estas aplicaciones fueron aprobadas por consejos, lo que podría indicar una escasez de evaluaciones en los consejos. Nuestros resultados demuestran que la insuficiencia en la dotación de recursos y la de gobernanza arriesga la efectividad de las políticas.

IMPLEMENTATION AND SUSTAINABILITY OF CHILD-PARENT PSYCHOTHERAPY: THE ROLE OF REFLECTIVE CONSULTATION IN THE LEARNING COLLABORATIVE MODEL.

Recent implementation science in mental health has focused on identifying the most effective strategies to disseminate and implement evidence-based treatments (EBTs) into real-world practice settings. The learning collaborative training methodology and its use of expert trainers/consultants have become increasingly popular as one of these approaches. Moreover, there is preliminary evidence that ongoing expert consultation may increase the adoption, learning, and sustainability of EBTs by an already practicing workforce and, consequently, help trainers, practitioners, and organizations address implementation barriers. This article describes the authors' experiences in facilitating Child-Parent Psychotherapy (CPP) training and explores the role of reflective clinical consultation as an active process that supports the implementation of a rich, but complex, model that requires sophisticated knowledge and skills from practitioners. It examines the intricate range of the CPP consultant's functions, which ultimately support clinicians' reflective practice as they learn and adopt this EBT. Reflective consultation is proposed as an essential component for the integration of knowledge, experience, and emotions in practitioners and as a catalyst for organizational change. Using their voices as trainers-consultants and those of their trainees, the authors discuss the implications of reflective consultation for the effective implementation and sustainability of CPP. Reflections are offered on lessons learned.

An agenda for assessing and improving conservation impacts of sustainability standards in tropical agriculture.

Sustainability standards and certification serve to differentiate and provide market recognition to goods produced in accordance with social and environmental good practices, typically including practices to protect biodiversity. Such standards have seen rapid growth, including in tropical agricultural commodities such as cocoa, coffee, palm oil, soybeans, and tea. Given the role of sustainability standards in influencing land use in hotspots of biodiversity, deforestation, and agricultural intensification, much could be gained from efforts to evaluate and increase the conservation payoff of these schemes. To this end, we devised a systematic approach for monitoring and evaluating the conservation impacts of agricultural sustainability standards and for using the resulting evidence to improve the effectiveness of such standards over time. The approach is oriented around a set of hypotheses and corresponding research questions about how sustainability standards are predicted to deliver conservation benefits. These questions are addressed through data from multiple sources, including basic common information from certification audits; field monitoring of environmental outcomes at a sample of certified sites; and rigorous impact assessment research based on experimental or quasi-experimental methods. Integration of these sources can generate time-series data that are comparable across sites and regions and provide detailed portraits of the effects of sustainability standards. To implement this approach, we propose new collaborations between the conservation research community and the sustainability standards community to develop common indicators and monitoring protocols, foster data sharing and synthesis, and link research and practice more effectively. As the role of sustainability standards in tropical land-use governance continues to evolve, robust evidence on the factors contributing to effectiveness can help to ensure that such standards are designed and implemented to maximize benefits for biodiversity conservation.

[Yogurt as a fermented food for healthy and sustainable daily consumption. Recommendations to the population]. / El yogur como alimento fermentado de consumo diario saludable y sostenible. Recomendaciones a la población.

Introduction: Yogurt has been valued very positively for centuries, but the concern for food sustainability and the fact that it is a food of animal origin has raised doubts about the consumption that may be convenient. The objective of this work is to deepen the topic and establish recommendations for the population. From the nutritional point of view, yogurt is a valuable food, for its high content, quality and bioavailability of its nutrients, in a low energy content, its components together with probiotic microorganisms are provided in a matrix that helps achieve greater nutritional and health benefit. Regular consumption of yogurt has been linked to cardiovascular protection, against diabetes, excess weight, cancer, bone health. Thinking about environmental sustainability, yogurt production is not particularly dangerous, as the kg of CO2 eq (greenhouse gases) associated with their production are the lowest obtained compared to other animal foods and even lower than those associated with the production of some plant foods and the supply of nutrients per 1000 kcal, per 100 g, or per euro is one of the highest available. There is the possibility to further improve sustainability with improvements in animal feed, packaging, transport, etc. Considering this evidence, the daily consumption of yogurt / fermented milk should be included in the food guidelines, not only as one more milk option, but specifying a specific consumption such as a ration / day, this pattern can be useful from the nutritional point of view and for the improvement of public health.

Introducción: El yogur ha sido valorado positivamente durante siglos, pero la preocupación por la sostenibilidad alimentaria y al hecho de tratarse de un alimento de origen animal han hecho dudar respecto al consumo que puede ser conveniente. El objetivo del presente trabajo es profundizar en el tema y establecer recomendaciones para la población. Desde el punto de vista nutricional, el yogur es un alimento valioso por la calidad, la biodisponibilidad y el elevado contenido de sus nutrientes, con un bajo contenido energético. Estos componentes, junto con microorganismos probióticos, aportan una matriz que ayuda a lograr un mayor beneficio nutricional y sanitario. El consumo regular de yogur se ha relacionado con protección cardiovascular, frente a la diabetes, al exceso de peso, frente al cáncer y con la salud ósea. Pensando en la sostenibilidad ambiental, la producción de yogur no es especialmente peligrosa, pues los kilogramos de CO2 equivalentes asociados a su producción son de los más bajos que se obtienen en comparación con otros alimentos de origen animal, e incluso más bajos que los asociados a la producción de algunos alimentos vegetales, y el aporte de nutrientes por 1000 kcal, por cada 100 g, o por euro, es de los más elevados que pueden obtenerse; existe la posibilidad de mejorar más la sostenibilidad con cambios en la alimentación animal, los envases, el transporte, etc. Teniendo en cuenta estas evidencias, el consumo diario de yogur o de leche fermentada debería incluirse en las guías alimentarias, no solo como una opción láctea más, sino especificando un consumo concreto, como puede ser una ración al día. Esta pauta puede ser útil desde el punto de vista nutricional y para la mejora de la salud pública.

Tackling the future in hospital pharmacy: Training as a pillar of success. / Conquistando el futuro en farmacia hospitalaria: la formación como pilar del éxito.

The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: Artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc., as well as including training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber-resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, essential. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known "burned out worker syndrome" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.

[Translated article] Conquering the future in hospital pharmacy: Training as a pillar of success.

The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc. as well as training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, inexcusable. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known "burned out worker syndrome" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.

[Food sustainability: keys for the consumer, advantages and disadvantages]. / Sostenibilidad alimentaria: claves para el consumidor, ventajas e inconvenientes.

Introduction: To meet the food and nutritional needs of a growing population and, at the same time, guarantee natural and productive resources, food systems must undergo changes in production models and consumption patterns, adopting more sustainable diets. The recommendations of different organizations and institutions are aimed at adopting a varied and balanced dietary pattern, with a greater predominance of plant-based food and a lower presence of animal food, to improve the state of health and well-being, while reducing the environmental impact. These types of diets have important health benefits, especially if diets are well planned and foods are properly combined. However, in some stages of life (schoolchildren, adolescents, elders) and in some special physiological situations (pregnancy, athletes), special attention should be paid to the increase of certain nutritional requirements that could compromise the health status if a correct dietary planning is not carried out. Therefore, well-designed strategies should be put in place to facilitate the transition to a sustainable diet, including nutrition education programs for consumers with specific instructions on the most appropriate food choices to increase the nutritional value of the diet. In addition, in specific physiological situations, where meeting nutritional requirements may be compromised, the consumption of fortified foods and/or supplementation could be considered.

Introducción: Para atender las necesidades alimentarias y nutricionales de una población creciente y garantizar los recursos naturales y productivos, los sistemas alimentarios deben experimentar cambios adoptando dietas más sostenibles. Diferentes organismos e instituciones recomiendan patrones de dieta variada y equilibrada, con predominio de alimentos de origen vegetal y menor presencia de alimentos de origen animal, para mejorar el estado de salud y bienestar y reducir el impacto medioambiental. Este tipo de dietas presentan beneficios en la salud, sobre todo si están bien planificadas y los alimentos se combinan adecuadamente. Sin embargo, en algunas etapas de la vida (escolares, adolescentes, ancianos) y en situaciones fisiológicas especiales (embarazadas, deportistas) se debe prestar atención a los requerimientos nutricionales, que podrían verse comprometidos en caso de no llevar a cabo una correcta planificación dietética, lo que podría derivar en problemas para la salud. Por ello, para facilitar la transición de los consumidores a una dieta sostenible, se deben promover estrategias bien diseñadas que incluyan programas de educación nutricional con instrucciones específicas acerca de las elecciones y combinaciones de alimentos más adecuadas para aumentar el valor nutricional de la dieta. Además, en situaciones fisiológicas específicas en las que alcanzar los requerimientos nutricionales pudiera estar comprometido, podría considerarse el consumo de alimentos enriquecidos y/o la administración de suplementos.

Green hospital pharmacy: A sustainable approach to the medication use process in a tertiary hospital. / [Artículo traducido] Farmacia hospitalaria ecológica: un enfoque sostenible del proceso de utilización de medicamentos en un hospital de tercer nivel.

BACKGROUND: Sustainable management of healthcare waste has a positive impact on the global environment. In order to reduce it, the sustainable practice of the pharmacotherapeutic process in all its stages is essential. OBJECTIVE: To analyse the sustainability strategies proposed by the pharmacy service to reduce drug waste derived from the pharmacotherapeutic process. SECONDARY OBJECTIVES: To analyse the stage of the pharmacotherapeutic process and the number and type of drugs involved. METHODS: The study was carried out in a tertiary-level hospital. To coordinate the proposals, a referent pharmacist from every pharmacy department area was selected. Four stages of the process were evaluated (management, validation, dispensing and compounding), patients concerned were classified as outpatients or inpatients, and drugs potentially involved were analysed by the administration route: Into oral or parenteral. RESULTS: Twenty eight ideas were proposed, which could affect more than 1200 drugs. 39.3% would affect the validation process, 17.9% the procurement management, 17.9% dispensing, and 7.1% the compounding. Implementation feasibility and acceptability of these proposals were evaluated. Those with the greatest potential were: Limiting the duration of treatments when possible, favouring the implementation of computer prescription order entry, favouring the use of the oral route over the parenteral route, and implementing computers in the preparation areas to avoid the use of paper guides. DISCUSION: In our study, many ideas have been proposed by hospital pharmacists to improve the sustainability of the medication use process. When assessing these proposals by impact and feasibility, according to our results, shorten as much as possible the duration of treatments, computerization of the medication use process, and oral administration over intravenous should be prioritized in order to reduce environmental impact.

Green hospital pharmacy: A sustainable approach to the medication use process in a tertiary hospital.

BACKGROUND: Sustainable management of healthcare waste has a positive impact on the global environment. In order to reduce it, the sustainable practice of the pharmacotherapeutic process in all its stages is essential. OBJECTIVE: To analyze the sustainability strategies proposed by the pharmacy service to reduce drug waste derived from the pharmacotherapeutic process. SECONDARY OBJECTIVES: to analyze the stage of the pharmacotherapeutic process and the number and type of drugs involved. METHODS: The study was carried out in a tertiary level hospital. To coordinate the proposals, a referent pharmacist from every pharmacy department area was selected. Four stages of the process were evaluated (procurement, validation, dispensing and compounding), patients concerned were classified as outpatients or inpatients, and drugs potentially involved were analyzed by the administration route: into oral or parenteral. RESULTS: 28 ideas were proposed, which could affect more than 1200 drugs. 39.3% would affect the validation process, 17.9% the procurement management, 17.9% dispensing and 7.1% the compounding. Implementation feasibility and acceptability of these proposals were evaluated. Those with the greatest potential were: limiting the duration of treatments when possible, favoring the implementation of computer prescription order entry, favoring the use of the oral route over the parenteral route, and implementing computers in the preparation areas to avoid the use of paper guides. DISCUSSION: In our study, many ideas have been proposed by hospital pharmacists to improve the sustainability of the medication use process. When assessing these proposals by impact and feasibility, according to our results, shorten as much as possible the duration of treatments, computerization of the medication use process and oral administration over intravenous should be prioritized in order to reduce environmental impact.

The carbon footprint of cataract surgery in Spain.

BACKGROUND AND PURPOSE: Climate change is one of the most important threats to human health nowadays. The healthcare industry produces a significant part of greenhouse gases (GHG) emissions. The aim of this study is to assess direct and indirect GHG emissions due to cataract surgery in Spain to identify opportunities for improving. METHODS: This observational case series study estimates and analyses the carbon footprint of a single cataract surgery using phacoemulsification in Ávila Hospital. ISO standard 14064 was applied. RESULTS: The carbon footprint of a single cataract surgery in Ávila Hospital was 86.62kg CO2eq. Medical and pharmaceutical equipment were responsible for 85% of GHG emissions. CONCLUSIONS: Collaboration between pharmaceuticals and ophthalmologists is important to improve the environmental impact of cataract surgery. Future research is needed to introduce changes that do not compromise patient and surgeon safety. Green surgery models could play an encouraging role in the new global health scene.

[The role of cereals in nutrition and health for a sustainable diet]. / El papel de los cereales en la nutrición y en la salud en el marco de una alimentación sostenible.

Introduction: Over the last years, the impact of food systems on human and planetary health has been appointed. The transition towards more sustainable and healthier diets is postulated as an urgent measure to address the increasing environmental and health concerns related to the current food production and consumption systems. This work reviews recent developments to integrate sustainability into dietary recommendations and food-based dietary guidelines, recognising the role of cereals as the basis for healthy sustainable dietary patterns. It is worth noting that a change in current eating patterns, to achieve greater adherence to existing official dietary guidelines, is proposed as a more realistic and feasible goal to improve the environmental and health impact of food systems. In this context, cereals play a key role as fundamental pillar of healthy and sustainable dietary patterns, due to their energy and nutrient contribution to human diet worldwide, and the different health benefits associated with an adequate intake of grain fibre and wholegrains.

Introducción: En los últimos años se ha puesto en evidencia el impacto de los sistemas alimentarios en la salud humana y en la del planeta. La transición hacia dietas más saludables y sostenibles se postula como una medida necesaria para abordar las crecientes preocupaciones medioambientales y de salud relacionadas con los sistemas actuales de producción y de consumo de los alimentos. Este trabajo revisa los avances recientes para integrar la sostenibilidad en las recomendaciones dietéticas y en las guías alimentarias poniendo en valor el papel de los cereales como la base de patrones dietéticos saludables y sostenibles. Como particularmente importante se analiza un enfoque que propone un mayor apego a las guías alimentarias existentes como un objetivo más realista y factible para mejorar el impacto medioambiental y de salud de los sistemas alimentarios. En este contexto, los cereales tienen un papel clave al ser un pilar fundamental de los patrones dietéticos saludables y sostenibles por su aporte de energía y de nutrientes a nivel global, así como por los diferentes beneficios para la salud que se asocian con un consumo adecuado de cereales integrales y fibra de cereales.

[The role of ferments in food sustainability]. / El rol de los fermentos en la sostenibilidad alimentaria.

Introduction: Food fermentation is one of the oldest conservation techniques and has evolved over the centuries. This study contributes to the understanding of the impact of fermentation and consequently of fermented products in the evolution of humanity and its influence on sustainability and food use. The production of fermented dairy products is the second industry after alcoholic beverages; thus, yogurt is one of the main fermented products consumed worldwide. Considering fermentation as a technology, this brings us different benefits such as sustainability, since in Spain each person wastes 77 kilos of food per year in their homes and we know that 9% of food waste in our country corresponds to dairy products. For this reason, we have worked with different ferments to select those that allow us to extend the useful life of the product, making it more flexible in its distribution and conservation. Also considering food safety due to the change in pH and the production of certain substances that will protect against pathogens and undesirable bacteria, guaranteeing the highest quality standards.

Introducción: La fermentación de los alimentos constituye una de las técnicas de conservación más antiguas, que ha ido evolucionando a lo largo de los siglos. Este estudio contribuye a la comprensión del impacto de la fermentación y, en consecuencia, de los productos fermentados en la evolución de la humanidad y su influencia en la sostenibilidad y en el aprovechamiento alimentario. La elaboración de productos lácteos fermentados es la segunda industria después de la de bebidas alcohólicas, así pues, el yogur es uno de los principales productos fermentados consumidos en todo el mundo. Considerando la fermentación como una tecnología, esta nos aporta distintos beneficios como la sostenibilidad, ya que en España cada persona desperdicia 77 kilos de alimentos al año en sus hogares y sabemos que el 9 % del desperdicio alimentario en nuestro país corresponde a los lácteos. Por esta razón, se ha trabajado con diferentes fermentos para seleccionar aquellos que permitan alargar la vida útil del producto y hacerlo más flexible en su distribución y conservación, teniendo en cuenta también la seguridad alimentaria debido al cambio de pH y a la producción de determinadas sustancias que protegen frente a patógenos y bacterias indeseables, garantizando los máximos estándares de calidad.

The future of diet: what will be eating? / El futuro de la dieta: ¿cómo nos alimentaremos en el futuro?

Food habits and preferences of our population are continuously changing throughout the world, especially in the wealthier countries. One of the consequences in our environment is the abandonment of the Mediterranean Diet, in accordance with an increased consumption of processed and ultraprocessed food, with negative effects on our health by the progressive increase of obesity and its multiple metabolic consequences. On the other hand, foods production is one of the most important reasons for the global warming of the planet, triggered by an increased demand of foods, caused by the grow up of the world population and by the introduction of technologies no respectful with the planet. Fortunately, every day the population is more and more awareness of the need for changing the alimentary model and the news technologies, looking for minimizing such deleterious consequence, always thinking in the health of the people and the planet. This concept, looking for a global welfare for the present and for the future, is discussed in this manuscript.

Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study.

OBJECTIVE: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. MATERIALS AND METHODS: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents. In the survey, Online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. RESULTS: Over 70% of urology residents agreed or were neutral to the statement that Online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. CONCLUSIONS: An overwhelming majority of urology residents in the United States believe Online education models should continue to be adopted once the pandemic is over.

[Role of dairy and alternative plant products in a healthy and sustainable diet]. / Rol de los lácteos y de las alternativas vegetales en una alimentación saludable y sostenible.

INTRODUCTION: Dairy products and plant alternatives are two food groups that are part of the Spanish population's diet. Both have a very different nutritional composition - unlike plant products, the high nutritional density of dairy products makes it easier to meet nutrient requirements at different stages of life. Although the environmental impact of dairy production is greater than that of plant-based products, it falls below that of other food groups such as red meat, including pork and beef. Dairy and plant alternatives meet critical points of the sustainable diet definition, and several food guides from countries around the world are including them within healthy and sustainable eating patterns. For this reason, it is necessary to clarify that both products can be part of a healthy and sustainable diet, although they belong to different food groups, which are not interchangeable and should not be used alternatively.

INTRODUCCIÓN: Los productos lácteos y las alternativas vegetales son dos grupos de alimentos que forman parte de la dieta de la población española. Estos alimentos tienen una composición nutricional muy diferente: a diferencia de los productos vegetales, la elevada densidad nutricional de los productos lácteos hace que sea más fácil cubrir los requerimientos de nutrientes en las diferentes etapas de la vida. Por otro lado, a pesar de que el impacto sobre el medioambiente de la producción de los lácteos es mayor que el de los productos de origen vegetal, queda por debajo del de otros grupos de alimentos como la carne roja, el cerdo o el vacuno. Por ese motivo, ambos grupos de alimentos cumplen con varios puntos críticos de la definición de alimentos sostenibles y cada vez son más las guías alimentarias de países de todo el mundo que los incluyen dentro de los patrones de alimentación saludable y sostenible. Por este motivo, es necesario clarificar que ambos productos pueden formar parte de una alimentación correcta, saludable y sostenible, aunque pertenecen a grupos de alimentos distintos, que no son intercambiables y no deben utilizarse de manera alternativa.

School lunch menus in Spain. A review on recommendations and policy.

INTRODUCTION: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community. MATERIAL AND METHODS: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered. RESULTS: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules. CONCLUSIONS: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations.

Gestión para la sostenibilidad del claustro en la Universidad de Ciencias Médicas de Matanzas

La atención priorizada y el seguimiento sistemático a los procesos de categorización docente constituyen aspectos imprescindibles para cada institución. Se realizó este trabajo para determinar los fundamentos de la gestión para la sostenibilidad de las categorías docentes del claustro. El enfoque histórico-lógico y la sistematización realizada, permitieron identificar los principales cambios y retos de la sostenibilidad del claustro, entre los que se encuentra uno de carácter prioritario y decisivo para el logro prospectivo del mismo: desarrollar un adecuado proceso de gestión de las categorías docentes en las universidades.

Prioritized attention and systematic follow-up of teaching categorization processes are essential aspect for each institution. This work was carried out to determine the foundations of management for the sustainability of the staff's teaching categories. The historical-logical approach and the systematization carried out allowed the authors to identify the main changes and challenges of the sustainability of the teaching staff, among which is one of a priority and decisive nature for its prospective achievement, consisting of developing an adequate process of management of teaching categories in universities.

Una odontología sustentable para Chile: revisión narrativa desde una perspectiva ecológica y sustentable

Introducción: la gestión inadecuada de residuos en el sector de la salud, especialmente en odontología, conlleva riesgos para la salud y el medio ambiente. En Chile, el reglamento sobre manejo de residuos de establecimientos de atención de salud (REAS) clasifica los residuos según su riesgo. La odontología sostenible, mediante prácticas como las 3 R y un modelo ampliado de 5 R, reduce impactos ambientales y costos, atrayendo a pacientes ecoconscientes. Objetivos: identificar el impacto ambiental de residuos en odontología y, utilizando el modelo de 5R, proponer acciones ecológicas basadas en evidencia, que se puedan aplicar en Chile. Materiales y Métodos: se realizó una revisión narrativa sobre el manejo de residuos generados en servicios dentales y prácticas sustentables durante la atención. Se utilizaron 30 artículos para lograr los objetivos. Resultados: los residuos odontológicos, en especial los quirúrgicos, provocan un impacto desmesurado en el medio ambiente. La generación y gestión de estos residuos dependen directamente de los profesionales. La odontología ecológica se centra en la adopción de prácticas sustentables y diferentes tecnologías e innovaciones para reducir el consumo de energía y la generación de residuos. Se presentan alternativas basadas en las 5R (reducir, reutilizar, reciclar, reflexionar e investigar) para disminuir la huella ambiental en la odontología. Conclusión: abordar el impacto ambiental de la odontología es crucial. La odontología sostenible requiere un enfoque interdisciplinario, prácticas más ecoamigables y políticas públicas adecuadas. La educación continua, la investigación y la concienciación ambiental son esenciales para este cambio. El método de las 5R es clave para fomentar la sostenibilidad en la odontología.

Introduction: Inadequate waste management in the healthcare sector, especially in dentistry, poses risks to health and the environment. In Chile, regulations on waste management from health care facilities (REAS) classify waste according to its risk level. Sustainable dentistry, through practices such as the 3 Rs and an expanded model of the 5 Rs, reduces environmental impacts and costs, appealing to eco-conscious patients. Materials and Methods: A review of the literature was performed on the management of waste generated in dental services and sustainable practices during care. Thirty articles were used to achieve the objectives. Results: Dental waste, especially surgical waste, has a disproportionate impact on the environment. The generation and management of these wastes depend directly on professionals. Ecological dentistry focuses on adopting sustainable practices and different technologies and innovations to reduce energy consumption and waste generation. Alternatives based on the 4 Rs (reduce, reuse, recycle, and reflect) are presented to reduce the environmental footprint in dentistry. Alternatives based on the 5Rs (reduce, reuse, recycle, rethink, and research) are presented to reduce the environmental footprint in dentistry. Conclusion: Addressing the environmental impact of dentistry is crucial. Sustainable dentistry requires an interdisciplinary approach, eco-friendly practices, and appropriate public policies. Continuous education, research, and environmental awareness are essential for this change. The 5R method is key to promoting sustainability in dentistry.

Estudio del switch de adalimumab por su biosimilar en un hospital de tercer nivel / Study of adalimumab switch for its biosimilar in a tertiary hospital

Objetivos: Debido al aumento en el consumo de los medicamentos biológicos y al impacto que esto supone en el gasto hospitalario, los objetivos de este estudio son: calcular el ahorro económico anual generado por el switch a adalimumab biosimilar y analizar el porcentaje de pacientes que mantienen dicho tratamiento en un hospital de tercer nivel. Material y métodos: Estudio descriptivo, observacional, longitudinal, retrospectivo en el que se incluyeron un grupo de pacientes a los que se les realizó switch de adalimumab por su biosimilar cuando en la Comisión Asesora Técnica de medicamentos de la comunidad se autorizó dicho cambio. Resultados: De los 218 pacientes, nueve tuvieron que volver al medicamento original (4,13%). La motivación fue: pérdida de eficacia en cinco, reacción alérgica en tres y otro, un paciente pediátrico con dolor tras la inyección del medicamento biosimilar. El coste de adquisición en nuestro hospital de una unidad del medicamento original es de 195,6 €, mientras que del biosimilar es de 75 €. Si consideramos una posología cada dos semanas, ya que es la más frecuente en nuestros pacientes, el coste anual por paciente con el original sería de 5.085 € y con el biosimilar de 1.950 €. Por lo tanto, el ahorro anual que supone el cambio del medicamento original al biosimilar es de 683.560 €. Conclusiones: El switch de adalimumab original al biosimilar supone un importante ahorro económico sin que se reduzca la efectividad en el proceso de su enfermedad. Lo que contribuye a la eficiencia y sostenibilidad del sistema sanitario. En nuestra población, el 4,13% tuvo que volver al medicamento original. Sería conveniente realizar estudios en un número superior de pacientes y continuar su seguimiento a largo plazo para obtener conclusiones más firmes. (AU)

Objectives: Due to the increase in the consumption of biologic drugs and the impact this has on hospital spending, the objectives of this study are: to calculate the economic savings generated by switching to biosimilar adalimumab and to analyze the percentage of patients who maintain this treatment in a tertiary level hospital. Material and methods: Descriptive, observational, longitudinal, retrospective study that included a group of patients who were switched from adalimumab to its biosimilar, when the Technical Advisory Committee for Medicines of the community authorized the change. Results: Of the 218 patients, nine had to return to the original drug (4.13%). The motivation was: loss of efficacy in five, allergic reaction in three and the other was a pediatric patient with pain after injection of the biosimilar drug. The acquisition cost in our hospital of an unit of the original drug is €195.6, while that of the biosimilar is €75. If we consider a dosage every two weeks, since this is the most frequent in our patients, the annual cost per patient with the original drug would be €5,085 and with the biosimilar €1,950. Therefore, the annual savings from switching from the original drug to the biosimilar is €683,560. Conclusions: Switching from the original adalimumab to the biosimilar means significant economic savings without reducing the effectiveness of the disease process. This contributes to the efficiency and sustainability of the halthcare system. In our population, 4.13% had to return to the original drug. It would be advisable to carry out the study in a larger number of patients and to continue its long-term follow-up to obtain firmer conclusions. (AU)

Sustainability disclosure in the Ecuadorian banking sector: channels used, determining factors and type of information revealed

This study aimed to provide evidence on sustainability disclosure in the banking sector of Ecuador Using a descriptive-correlational approach, three key areas were examined: the most common reports for the disclosure of sustainability information, factors influencing banks' willingness to disclose, and the type of sustainability information being disclosed. Fisher's test and mean difference tests were employed to identify factors influencing banks' willingness to disclose sustainability information. Additionally, a content analysis was conducted to identify the main themes disclosed by banks regarding sustainability An index incorporating environmental, social, economic, and governance aspects was utilized for this analysis. The findings revealed low levels of disclosure, a higher prevalence of specialized reports, a positive association between willingness to disclose and organizational visibility, and a predominance of social dimension disclosure practices. These findings underscore the need to enhance disclosure standards and strengthen communication with stakeholders in Ecuador's banking sector. JEL CLASSIFICATION MI0, MI4; G2I

Este estudio buscó proporcionar evidencia sobre la divulgación de sostenibilidad en el sector bancario de Ecuador Mediante un enfoque descriptivo-correlacional se abordaron tres temáticas: los medios más utilizados para divulgar información de sostenibilidad, los factores que influyen en la disposición de los bancos a divulgar y el tipo de información sobre sostenibilidad que divulgan. Se utilizaron las pruebas de Fisher y de diferencia de medias para identificar los factores que influyen en la disposición de los bancos a divulgar información de sostenibilidad. De igual forma, se realizó un análisis de contenido para identificar los temas principales que divulgan los bancos sobre sostenibilidad. Para ello, se usó un índice que identificó aspectos ambientales, sociales, económicos y de gobernanza. Los resultados revelaron niveles bajos de divulgación, un mayor uso de informes especializados, una asociación positiva entre la disposición a divulgar y la visibilidad de la organización, y una predominancia de la divulgación de prácticas en la dimensión social. Estos hallazgos resaltan la necesidad de mejorar los estándares de divulgación y fortalecer la comunicación con los grupos de interés en el sector bancario de Ecuador. CLASIFICACIÓN JEL M10, M14; G21

Este estudo buscou fornecer evidências sobre a divulgação da sustentabilidade no setor bancário do Ecuador. Usando uma abordagem descritiva-correlacional, foram abordadas três questões: os meios mais comuns usados para divulgar informações sobre sustentabilidade, os fatores que influenciam a disposição dos bancos em divulgar e o tipo de informações sobre sustentabilidade que eles divulgam. O teste de Fisher e os testes de diferença de médias foram usados para identificar os fatores que influenciam a disposição dos bancos em divulgar informações sobre sustentabilidade. Da mesma forma, foi realizada uma análise de conteúdo para identificar os principais tópicos que os bancos divulgam sobre sustentabilidade. Isso foi feito por meio de um índice que identificou questões ambientais, sociais, econômicas e de governança. Os resultados revelaram baixos níveis de divulgação, um maior uso de relatórios especializados, uma associação positiva entre a disposição de divulgar e a visibilidade organizacional, e uma predominância de divulgação de práticas na dimensão social. Essas conclusões destacam a necessidade de melhorar os padrões de divulgação e fortalecer a comunicação com as partes interessadas no setor bancário do Ecuador. CLASSIFICAÇÃO JEL M10, M14; G21