Importance of methodological pluralism in deriving counterfactuals for evidence-based conservation.

Most protected area impact research that uses counterfactuals draws heavily on quantitative methods, data, and knowledge types, making it valuable in producing generalizations but limited in temporal scope, historical detail, and habitat diversity and coverage of ecosystem services. We devised a methodological pluralistic approach, which supports social science qualitative methods, narratives, mixed methods, and interdisciplinarity, to fully unlock the potential of counterfactuals in ensuring a place-based and detailed understanding of the socioecological context and impacts of protected areas. We applied this approach to derive possible counterfactual conditions for the impact of a montane protected area on 40 years of vegetation change in the Cape Floristic Region-a global biodiversity hotspot and UNESCO World Heritage Site in South Africa. We incorporated diverse methods, knowledge, and information sources, drawing on before-after protected area comparisons for inside and outside the protected area. A significant increase in shrubland vegetation (17-30%) was observed and attributed primarily to a decline in frequent burning for grazing. This also occurred outside the protected area and was driven by socioeconomic drivers and not by concerns over biodiversity conservation or land degradation. Had the protected area not been established the area would have seen intensification of cultivation and increased road networks, buildings, and water storage in dams. Our approach increased historical temporal coverage of socioecological change and contextualized assumptions around causality. Protected area impact evaluation should reengage in place-based research that fully incorporates pluralism in methodologies for constructing counterfactuals in a way that builds regional and global understanding from the local level upward. We devised 10 key principles for deriving counterfactuals grounded in methodological pluralism, covering aspects of collaboration, cocreation, inter- and transdisciplinarity, diverse values and lived experiences, multiple knowledge types, multiple possible causal mechanisms, social science qualitative methods, perceptions, perspectives, and narratives.

Importancia del pluralismo metodológico en la derivación de situaciones contrafactuales para la conservación basada en evidencias Resumen La mayoría de las investigaciones sobre el impacto de las áreas protegidas que usan situaciones contrafactuales se basan en gran medida en métodos cuantitativos, datos y tipos de conocimiento, por lo que son muy valiosas para producir generalizaciones, pero limitadas en el enfoque temporal, el detalle histórico y la diversidad de hábitats y cobertura de los servicios ambientales. Diseñamos una estrategia metodológica pluralista, la cual apoya los métodos cualitativos de las ciencias sociales, narrativas, métodos mixtos e interdisciplinarios para utilizar por completo el potencial de las situaciones contrafactuales para asegurar un conocimiento detallado y basado en el lugar del contexto socio ecológico y el impacto de las áreas protegidas. Aplicamos esta estrategia para derivar las posibles condiciones contrafactuales del impacto de un área protegida montañosa sobre 40 años de cambio de vegetación en el reino florístico del Cabo ­ un punto caliente de biodiversidad y Sitio de Patrimonio Mundial de la UNESCO en Sudáfrica. Incorporamos varios métodos, conocimientos y fuentes de información a partir de las comparaciones antes­después dentro y fuera del área protegida. Observamos un incremento significativo en la vegetación del matorral (17­30%), el cual atribuimos principalmente en la disminución de la quema frecuente para el pastoreo. Esto también ocurrió fuera del área protegida y fue causado por factores socioeconómicos y no por preocupación por la conservación de la biodiversidad o por la degradación del suelo. De no haberse establecido el área protegida, la zona habría sufrido una intensificación de cultivos y un incremento de carreteras, edificios y almacenamiento de agua en presas. Nuestra estrategia incrementó la cobertura histórica temporal del cambio socio­ecológico y contextualizó las suposiciones sobre la causalidad. La evaluación del impacto del área protegida debe volver a la investigación basada en el lugar que incorpora de lleno el pluralismo en la metodología para construir situaciones contrafactuales de una forma que genere conocimiento regional y global a partir del nivel local y hacia arriba. Diseñamos diez principios clave para derivar las situaciones contrafactuales basados en el pluralismo metodológico, la cobertura de los aspectos de colaboración, creación conjunta, inter­ y transdisciplinariedad, valores diversos y experiencias vividas, varios tipos de conocimiento, diferentes mecanismos causales posibles, métodos cualitativos de las ciencias sociales, percepciones, perspectivas, historias y narrativas.

Expanding narratives of governance constraints to improve coral reef conservation.

To understand and address the failures of reef governance, it is critical to understand the perceptions of diverse policy makers and practitioners about the challenges they face in achieving their goals. Examining the discourse of policy makers and practitioners can reveal the extent to which these perceptions capture the full spectrum of potential governance challenges, including those related to management, institutional structures and processes, the values and principles underpinning governance, and the social and environmental context. We conducted semistructured interviews with 110 policy makers and practitioners across multiple sectors, scales, and contexts in Barbados, St Kitts and Nevis, Belize, and Honduras. We used thematic qualitative analysis informed by theories of interactive governance and governability to examine the challenges perceived by governance actors. Perceived governance challenges were broadly consistent across countries, but differed by sector (V = 0.819, F6,60 = 1.502, p = 0.01) and by level (community compared with national) (V = 0.194, F1,10 = 2.178, = 0.026). Management inputs and outputs, challenges relating to the socioeconomic context, issues of leadership and power, and stakeholder engagement were commonly cited challenges (>75%). Few respondents discussed challenges relating to the ecological context, governance processes, or the values and principles underpinning governance. We argue that examining perceptions can inform efforts to improve governance and assess the appropriateness of particular management tools under context-specific governance constraints. Furthermore, expanding the narratives of governance challenges to encompass the subtle values and images underpinning governance, and the scale of the challenges faced, can help identify a wider set of opportunities for change.

Expansión de las Narrativas de los Límites de la Gobernanza para Mejorar la Conservación de los Arrecifes de Coral Resumen Es muy importante entender las percepciones que tienen los practicantes y los formuladores de políticas sobre los retos que enfrentan para alcanzar sus objetivos para poder entender y abordar los fracasos en la gobernanza de los arrecifes. El análisis del discurso de los formuladores y los practicantes puede revelar la extensión a la que estas percepciones capturan el espectro completo de los retos potenciales para la gobernanza, incluidos aquellos relacionados con el manejo, las estructuras y los procesos institucionales, los valores y principios que apuntalan la gobernanza y el contexto social y ambiental. Realizamos entrevistas semiestructuradas a 110 formuladores y practicantes de múltiples sectores, escalas y contextos en Barbados, San Cristóbal y Nieves, Belice y Honduras. Usamos un análisis cualitativo temático informado por las teorías de la gobernanza interactiva y la gobernabilidad para examinar los retos percibidos por los actores de gobernanza. A grandes rasgos, los retos percibidos en la gobernanza fueron coherentes entre los países, pero difirieron por sector (V = 0.819, F6,60 = 1.502, p = 0.01) y por nivel (comunitario comparado con nacional) (V = 0.194, F1,10 = 2.178, = 0.026). Las aportaciones y producciones del manejo, los retos relacionados con el contexto socioeconómico, los temas de liderazgo y poder y la participación de los actores fueron los retos mencionados comúnmente (>75%). Pocos respondientes discutieron los retos relacionados con el contexto ecológico, los procesos de gobernanza o los valores y principios que apuntalan la gobernanza. Alegamos que el análisis de las percepciones puede guiar a los esfuerzos para mejorar la gobernanza y evaluar cuán apropiadas son las herramientas particulares de manejo bajo los límites de gobernanza específicos al contexto. Además, expandir las narrativas de los retos de gobernanza para englobar los valores e imágenes sutiles que apuntalan la gobernanza, y la escala del reto al que se enfrenta, puede ayudar a identificar un conjunto más amplio de oportunidades de cambio.

Developing shared qualitative models for complex systems.

Understanding complex systems is essential to ensure their conservation and effective management. Models commonly support understanding of complex ecological systems and, by extension, their conservation. Modeling, however, is largely a social process constrained by individuals' mental models (i.e., a small-scale internal model of how a part of the world works based on knowledge, experience, values, beliefs, and assumptions) and system complexity. To account for both system complexity and the diversity of knowledge of complex systems, we devised a novel way to develop a shared qualitative complex system model. We disaggregated a system (carbonate coral reefs) into smaller subsystem modules that each represented a functioning unit, about which an individual is likely to have more comprehensive knowledge. This modular approach allowed us to elicit an individual mental model of a defined subsystem for which the individuals had a higher level of confidence in their knowledge of the relationships between variables. The challenge then was to bring these subsystem models together to form a complete, shared model of the entire system, which we attempted through 4 phases: develop the system framework and subsystem modules; develop the individual mental model elicitation methods; elicit the mental models; and identify and isolate differences for exploration and identify similarities to cocreate a shared qualitative model. The shared qualitative model provides opportunities to develop a quantitative model to understand and predict complex system change.

Desarrollo de Modelos Cualitativos Compartidos para Sistemas Complejos Resumen El entendimiento de los sistemas complejos es esencial para asegurar su conservación y manejo efectivo. Es común que los modelos respalden el entendimiento de los sistemas ecológicos complejos y, por extensión, su conservación. Sin embargo, el modelado es principalmente un proceso social restringido por los modelos mentales de los individuos (es decir, un modelo interno a pequeña escala de cómo funciona una parte del mundo con base en el conocimiento, las experiencias, valores, creencias y suposiciones) y la complejidad del sistema. Para considerar tanto la complejidad del sistema como la diversidad de conocimiento sobre los sistemas complejos, diseñamos un método novedoso para desarrollar un modelo cualitativo de sistemas complejos. Desglosamos un sistema (arrecifes de coral de carbonato) en módulos más pequeños o subsistemas y cada uno representó una unidad funcional, sobre la cual es más probable que un individuo tenga mayor conocimiento integral. Este enfoque modular nos permitió obtener un modelo mental individual de un subsistema definido para el cual los individuos tuvieron un nivel más alto de confianza en su conocimiento sobre las relaciones entre las variables. Entonces, el reto fue juntar estos modelos de subsistemas para formar un modelo compartido completo del sistema entero, lo cual intentamos a lo largo de cuatro fases: desarrollar el marco de trabajo para el sistema y los módulos de los subsistemas; desarrollar los métodos de obtención para los modelos mentales individuales; obtener los modelos mentales; e identificar y aislar las diferencias para la exploración, así como identificar similitudes para crear conjuntamente un modelo cualitativo compartido. El modelo cualitativo compartido proporciona oportunidades para desarrollar un modelo cuantitativo que permita entender y predecir el cambio en los sistemas complejos.

Public views about editing genes in wildlife for conservation.

Developments in CRISPR-based gene-editing technologies have generated a growing number of proposals to edit genes in wildlife to meet conservation goals. As these proposals have attracted greater attention, controversies have emerged among scientists and stakeholder groups over potential consequences and ethical implications of gene editing. Responsible governance cannot occur without consulting broader publics, yet little effort has been made to systematically assess public understandings and beliefs in relation to this new area of applied genetic engineering. We analyzed data from a survey of U.S. adults (n = 1600), collected by YouGov, and that examined respondents' concerns about gene editing in animal and plant wildlife and how those concerns are shaped by cultural dispositions toward science and beliefs about the appropriateness of intervening in nature at the genetic level. On average, respondents perceived more risk than benefit in using these tools. Over 70% agreed that gene editing in wildlife could be "easily used for the wrong purposes." When evaluating the moral acceptability of gene editing in wildlife, respondents evaluated applications to improve survival in endangered wildlife as more morally acceptable than applications to decrease abundance in a population or eliminate a population. Belief in the authority of scientific knowledge was positively related to favorable views of the benefits, risks, and moral acceptability of editing genes in wildlife. The belief that editing genes in wildlife inappropriately intervenes in nature predicted relatively more concern about risks and moral acceptability and skepticism about benefits. Given high levels of concern and skepticism about gene editing in wildlife for conservation among the U.S. public, a take-it-slow approach to making decisions about when or whether to use these tools is advisable. Early opinions, including those uncovered in this study, are likely to be provisional. Thus, consulting the public should be an ongoing process.

Opinión Pública sobre la Edición de Genes en la Conservación de Fauna Resumen El desarrollo de tecnologías de edición de genes basada en CRISPR ha generado un número creciente de propuestas para editar los genes de especies silvestres y así lograr los objetivos de conservación. Conforme estas propuestas han atraído la atención, han surgido controversias entre los grupos de científicos y accionistas sobre las consecuencias potenciales y las implicaciones éticas de la edición de genes. La gobernanza responsable no puede ocurrir sin consultar a una audiencia más amplia, y aun así se han realizado muy pocos esfuerzos por evaluar sistemáticamente las creencias y el entendimiento público relacionados con esta nueva etapa de ingeniería genética aplicada. Analizamos los resultados de una encuesta en línea realizado por YouGov entre adultos de los Estados Unidos (n = 1,600), la cual examinaba las preocupaciones de los respondientes sobre la edición genética en animales y plantas y cómo estas preocupaciones están moldeadas por la disposición cultural hacia la ciencia y las creencias sobre lo correcto que es intervenir en la naturaleza a nivel genético. En promedio, los respondientes percibieron más un riesgo que un beneficio al usar estas herramientas. Más del 70% estuvo de acuerdo en que la edición genética de especies silvestres podría "usarse fácilmente para los propósitos equivocados". Cuando evaluamos la aceptación moral de la edición genética de la fauna, los respondientes calificaron a las aplicaciones para incrementar la supervivencia de las especies amenazadas como más aceptables moralmente que las aplicaciones para disminuir la abundancia de una población o eliminarla totalmente. La creencia en la autoridad del conocimiento científico estuvo relacionada positivamente con la opinión favorable sobre los beneficios, riesgos y la aceptación moral de la edición genética de especies silvestres. La creencia de que la edición genética de especies silvestres interviene inapropiadamente con la naturaleza predijo relativamente una mayor preocupación por los riesgos y la aceptación moral y mayor escepticismo sobre los beneficios de la edición genética. Debido a los altos niveles de preocupación y escepticismo sobre la edición genética de especies silvestres para la conservación mostrados por el público estadunidense, se recomienda utilizar una estrategia de hazlo-con-calma para decidir cuándo o si usar estas herramientas. Es probable que las primeras opiniones, incluyendo las descubiertas con este estudio, sean provisionales. Por lo tanto, consultar al público debe ser un proceso continuo.

Underaddressed animal-welfare issues in conservation.

Much progress has been made toward assessing and improving animal welfare in conservation. However, several glaring knowledge gaps remain where animal-welfare concerns exist but animal-welfare studies have not been performed in politically sensitive contexts. Based on contemporary issues in Australia, we identified 4 topics that require more research: animal-welfare oversight for operations designated as management (as opposed to research); animal-welfare impacts of biological agents used to control invasive animals; welfare of animals hunted recreationally; and animal-welfare impacts associated with indigenous wildlife use. Animal-welfare science may be applied to these sensitive topics through simple quantitative studies (e.g., quantifying the frequency of adverse animal-welfare events). Several such studies have effectively addressed animal-welfare concerns in similarly contentious contexts, including feral camel (Camelus dromedarius) culling in Australia, recreational hunting in Scandinavia, and indigenous whale hunting in the United States. For discussions of animal welfare in conservation to be evidence-based, courageous research is required in the 4 key areas we identified.

Temas de Bienestar Animal Sin Tratar en la Conservación Resumen En la conservación se ha progresado mucho en la evaluación y el mejoramiento del bienestar animal. Sin embargo, todavía permanecen varios vacíos evidentes en donde existe preocupación por el bienestar animal, pero los estudios sobre este bienestar no se han realizado en contextos políticamente sensibles. Con base en temas contemporáneos en Australia, identificamos cuatro temas que requieren de más investigación: omisión del bienestar animal por operaciones designadas como manejo (en lugar de investigación); impactos de los agentes biológicos usados para controlar a animales invasores sobre el bienestar animal; bienestar de los animales cazados por recreación; e impactos sobre el bienestar animal asociados con el uso de la fauna nativa. La ciencia del bienestar animal puede aplicarse a estos temas sensibles por medio de estudios cuantitativos (p. ej.: cuantificación de la frecuencia de eventos adversos para el bienestar animal). Varios de estos estudios han tratado efectivamente las preocupaciones por el bienestar animal en contextos similarmente polémicos, incluyendo el sacrificio de camellos ferales (Camelus dromedarius) en Australia, la cacería recreativa en Escandinavia, y la caza de ballenas por aborígenes en los Estados Unidos. Para que las discusiones sobre el bienestar animal en la conservación estén basadas en evidencias, se requiere de investigaciones atrevidas en las cuatro áreas clave que identificamos.

Expert judgment and uncertainty regarding the protection of imperiled species.

Decisions concerning the appropriate listing status of species under the U.S. Endangered Species Act (ESA) can be controversial even among conservationists. These decisions may determine whether a species persists in the near term and have long-lasting social and political ramifications. Given the ESA's mandate that such decisions be based on the best available science, it is important to examine what factors contribute to experts' judgments concerning the listing of species. We examined how a variety of factors (such as risk perception, value orientations, and norms) influenced experts' judgments concerning the appropriate listing status of the grizzly bear (Ursus arctos horribilis) population in the Greater Yellowstone Ecosystem. Experts were invited to complete an online survey examining their perceptions of the threats grizzly bears face and their listing recommendation. Although experts' assessments of the threats to this species were strongly correlated with their recommendations for listing status, this relationship did not exist when other cognitive factors were included in the model. Specifically, values related to human use of wildlife and norms (i.e., a respondent's expectation of peers' assessments) were most influential in listing status recommendations. These results suggest that experts' decisions about listing, like all human decisions, are subject to the use of heuristics (i.e., decision shortcuts). An understanding of how heuristics and related biases affect decisions under uncertainty can help inform decision making about threatened and endangered species and may be useful in designing effective processes for protection of imperiled species.

Understanding public perceptions of risk regarding outdoor pet cats to inform conservation action.

Free-ranging domestic cats (Felis catus) incur and impose risks on ecosystems and represent a complex issue of critical importance to biodiversity conservation and cat and human health globally. Prior social science research on this topic is limited and has emphasized feral cats even though owned cats often comprise a large proportion of the outdoor cat population, particularly in urban areas. To address this gap, we examined public risk perceptions and attitudes toward outdoor pet cats across varying levels of urbanization, including along the wildland-urban interface, in Colorado (U.S.A.), through a mail survey of 1397 residents. Residents did not view all types of risks uniformly. They viewed risks of cat predation on wildlife and carnivore predation on cats as more likely than disease-related risks. Additionally, risk perceptions were related to attitudes, prior experiences with cats and cat-wildlife interactions, and cat-owner behavior. Our findings suggest that changes in risk perceptions may result in behavior change. Therefore, knowledge of cat-related risk perceptions and attitudes could be used to develop communication programs aimed at promoting risk-aversive behaviors among cat owners and cat-management strategies that are acceptable to the public and that directly advance the conservation of native species.

Narrative Solutions: Using Preferred View of Self to Motivate Individual and Family Change.

This article describes refinements of the Narrative Solutions approach to individual and family therapy we first presented in Family Process 22 years ago. The centerpiece of this integrative (narrative-strategic) model is "preferred view of self," or the constellation of qualities people would like to see in themselves and have others see in them. We assume that problems generally involve one or more people mismanaging discrepancies or "gaps" between preferred views of self and either their actual behavior or how they see others seeing them and their behavior. Because clients are motivated to resolve such discrepancies, we use specifiable conversational strategies to help people (a) be clear about their preferred view of self, (b) notice gaps or discrepancies, and (c) summon resources to manage these gaps more effectively. Positive clinical effects of these strategic conversations can be rapid and dramatic. Case examples highlight applications to child and family problems, and we discuss some challenges and future directions for the Narrative Solutions approach.

SUPPORTING PRETERM INFANT ATTACHMENT AND SOCIOEMOTIONAL DEVELOPMENT IN THE NEONATAL INTENSIVE CARE UNIT: STAFF PERCEPTIONS.

The infant-parent relationship has been shown to be of particular significance to preterm infant socioemotional development. Supporting parents and infants in this process of developing their relationships is an integral part of neonatal intensive care; however, there is limited knowledge of NICU staff perceptions about this aspect of care. To explore NICU staff perceptions about attachment and socioemotional development of preterm infants, experience of training in this area and the emotional impact of their work. A cross-sectional questionnaire survey of staff perceptions of the emotional experiences of parents and the developing parent-infant relationship in an NICU was conducted in a Level III NICU, after pilot testing, revision, and ethical approval. Fifty-seven (68%) of NICU staff responded to the survey. Respondents identified parents' emotional experiences such as "anxiety," "shock," "loss of control," and "lack of feelings of competence as parents" as highly prevalent. Infant cues of "responding to parent's voice" and "quieting-alerting" were ranked most highly; "crying" and "physiological changes" were ranked lowest. Preterm infant medical risk, maternal emotional state, and mental health are perceived to impact most highly on the developing relationship, as compared with infant state or behavior and socioeconomic factors. Fifty-three (93%) respondents felt confident, and 50 (87.8%) felt competent discussing their emotional experiences with parents. Fifty-four (95%) responded that attending to these areas was an integral part of their role; however, staff had seldom received education in this area. Respondents also perceived that specific psychological support for parents was lacking both during and after the infant's discharge. While all staff surveyed perceived the nature of their work to be emotionally stressful, there were differences among NICU staff disciplines and with years of experience in the NICU in terms of their perceptions about education in this area, the place of supervision for staff, and in relation to opportunities to discuss the emotional impact of the work on staff. NICU staff perceive their role as integral to supporting the developing parent-infant relationship and preterm infant socioemotional development; however, education in this area and provision of specific psychological support are lacking. Opportunities for staff to discuss and reflect on this aspect of their work should be developed and evaluated given the essential, but emotionally challenging, nature of their work with preterm babies and their parents.

[Informed consent process in clinical trials: Insights of researchers, patients and general practitioners]. / Ensayos clínicos y consentimiento informado: visión de investigadores, pacientes y médicos de familia.

OBJECTIVE: Adequate information for patients and respect for their autonomy are mandatory in research. This article examined insights of researchers, patients and general practitioners (GPs) on the informed consent process in clinical trials, and the role of the GP. DESIGN: A cross-sectional study using three questionnaires, informed consent reviews, medical records, and hospital discharge reports. SETTING: GPs, researchers and patients involved in clinical trials. PARTICIPANTS: Included, 504 GPs, 108 researchers, and 71 patients. RESULTS: Consulting the GP was recommended in 50% of the informed consents. Participation in clinical trials was shown in 33% of the medical records and 3% of the hospital discharge reports. GPs scored 3.54 points (on a 1-10 scale) on the assessment of the information received by the principal investigator. The readability of the informed consent sheet was rated 8.03 points by researchers, and the understanding was rated 7.68 points by patients. Patient satisfaction was positively associated with more time for reflection. CONCLUSIONS: GPs were not satisfied with the information received on the participation of patients under their in clinical trials. Researchers were satisfied with the information they offered to patients, and were aware of the need to improve the information GPs received. Patients collaborated greatly towards biomedical research, expressed satisfaction with the overall process, and minimised the difficulties associated with participation.

Virtual garden computer program for use in exploring the elements of biodiversity people want in cities.

Urban ecology is emerging as an integrative science that explores the interactions of people and biodiversity in cities. Interdisciplinary research requires the creation of new tools that allow the investigation of relations between people and biodiversity. It has been established that access to green spaces or nature benefits city dwellers, but the role of species diversity in providing psychological benefits remains poorly studied. We developed a user-friendly 3-dimensional computer program (Virtual Garden [www.tinyurl.com/3DVirtualGarden]) that allows people to design their own public or private green spaces with 95 biotic and abiotic features. Virtual Garden allows researchers to explore what elements of biodiversity people would like to have in their nearby green spaces while accounting for other functions that people value in urban green spaces. In 2011, 732 participants used our Virtual Garden program to design their ideal small public garden. On average gardens contained 5 different animals, 8 flowers, and 5 woody plant species. Although the mathematical distribution of flower and woody plant richness (i.e., number of species per garden) appeared to be similar to what would be expected by random selection of features, 30% of participants did not place any animal species in their gardens. Among those who placed animals in their gardens, 94% selected colorful species (e.g., ladybug [Coccinella septempunctata], Great Tit [Parus major], and goldfish), 53% selected herptiles or large mammals, and 67% selected non-native species. Older participants with a higher level of education and participants with a greater concern for nature designed gardens with relatively higher species richness and more native species. If cities are to be planned for the mutual benefit of people and biodiversity and to provide people meaningful experiences with urban nature, it is important to investigate people's relations with biodiversity further. Virtual Garden offers a standardized tool with which to explore these relations in different environments, cultures, and countries. It can also be used by stakeholders (e.g., city planners) to consider people's opinions of local design.

[Towards good governance for health: incorporating the diversity of perceptions around urban health]. / Hacia el buen gobierno por la salud: incorporación de la diversidad de percepciones en salud urbana.

OBJECTIVE: To analyse the similarities and differences in the discourse surrounding the conceptualisation of health and the perceived health assets and needs in the neighborhoods and city of Bilbao in a participatory process. METHOD: Participatory workshops were held with professionals, neighbors and associated citizens. The differences in perceptions of the three content blocks were analysed on the basis of the health model referred, as well as the typologies -of a more individual or structural nature- of identified health needs and assets. RESULTS: The conceptualisation of health from a biopsychosocial perspective was clearer among professionals, although both profiles pointed to the importance of its social determinants. The formulation of needs and assets in health by the neighbors was made from the impact on their daily life and from a position of users with respect to a service provider administration. Among the associated citizens and professionals, intermediate and structural determinants were more frequently mentioned, as well as issues related to the administration's scope of action. CONCLUSIONS: The inclusion of the multiplicity and diversity of perceptions in planning is key to good local government for health. To address their contradictions, a commitment by governments to effectively incorporate citizen participation is needed.

Management of prediabetes from the perspective of Spanish physicians and community pharmacists: Detecta2 study.

INTRODUCTION: Prediabetes is a high-risk state for diabetes. The study aims to describe routine clinical practice and the views of physicians and pharmacists on prediabetes management. MATERIALS AND METHODS: An observational, descriptive, cross-sectional study was conducted using a structured questionnaire. RESULTS: A total of 410 physicians and 393 pharmacists completed the questionnaire. Self-adherence to clinical practice guidelines (CPGs) was reported by 51.5% and 23.2% of physicians and pharmacists, respectively. Less than 60% of participants defined prediabetes according to main CPG. Regarding the use of screening strategies to detect prediabetes (physicians: 96%; pharmacists: 42.1%), reports indicate the opportunistic strategy is widely employed (≥75%) whereas systematic screening is unusual (<20%). Changes in lifestyle were deemed essential by almost all participants (≥95%), but in clinical practice only 58.3% of healthcare centers and 28.0% of pharmacies were found to provide awareness-raising/instruction. The role of pharmacists in the prevention of prediabetes/diabetes was judged useful by most participants. CONCLUSIONS: Use of CPG, systematic prediabetes screening strategies, and specific strategies for patient education are scarce. The support of community pharmacists in prediabetes management was well valued. Therefore, it is crucial that the lines of action followed by both physicians and pharmacists align with each other and with the CPG.

Management of prediabetes from the perspective of Spanish physicians and community pharmacists: Detecta2 study.

INTRODUCTION: Prediabetes is a high-risk state for diabetes. The study aims to describe routine clinical practice and the views of physicians and pharmacists on prediabetes management. MATERIALS AND METHODS: An observational, descriptive, cross-sectional study was conducted using a structured questionnaire. RESULTS: A total of 410 physicians and 393 pharmacists completed the questionnaire. Self-adherence to clinical practice guidelines (CPGs) was reported by 51.5% and 23.2% of physicians and pharmacists, respectively. Less than 60% of participants defined prediabetes according to main CPG. Regarding the use of screening strategies to detect prediabetes (physicians: 96%; pharmacists: 42.1%), reports indicate the opportunistic strategy is widely employed (≥75%) whereas systematic screening is unusual (<20%). Changes in lifestyle were deemed essential by almost all participants (≥95%), but in clinical practice only 58.3% of healthcare centers and 28.0% of pharmacies were found to provide awareness-raising/instruction. The role of pharmacists in the prevention of prediabetes/diabetes was judged useful by most participants. CONCLUSIONS: Use of CPG, systematic prediabetes screening strategies, and specific strategies for patient education are scarce. The support of community pharmacists in prediabetes management was well valued. Therefore, it is crucial that the lines of action followed by both physicians and pharmacists align with each other and with the CPG.

[Perceptions of intensive care professionals about hand hygiene compared with observational studies]. / Percepciones de los profesionales de cuidados intensivos sobre la higiene de manos en comparación con estudios observacionales.

OBJETIVE: To identify perceptions and knowledge about the adherence to hand hygiene of the healthcare staff of an intensive care unit, correlating them with compliance data on adherence to hand hygiene through observational studies MATERIAL AND METHOD: A quantitative methodology has been combined, based on the completion of a personal survey, and a qualitative methodology based on direct observation. Units of Intensive Care of Adults (A-ICU) and Pediatrics (P-ICU) of a tertiary hospital. There were 187 health professionals. Personal and work data of the professionals were collected, as well as questions related to their knowledge and perceptions about the hand hygiene. RESULTS: Those 187 professionals, 75,9% from A-ICU, represented more than 80% of the study population, and 91.4% had received previous training on hand hygiene. Regarding knowledge, 35% of the A-ICU professionals and almost 50% from the P-ICU consider that hand washing is more effective than hand friction with alcohol-based solutions for the elimination of microorganisms. They have a better perception that they correctly perform the hand washing (89.32% ICU-P and 82.93% ICU-A), than when we compare them to the adherence rates obtained by direct observation (ICU-P 73.8% and ICU-A 51.4%, P=0.0001). CONCLUSIONS: Despite having previous training on hand hygiene, they have incomplete knowledge and, although they overestimate the problem of the healthcare-associated infections, they have a perception that does not fit with reality.

Barreras para una alimentación saludable: un análisis cualitativo de las semánticas emergentes en las comunidades escolares de Ciudad Sur

La literatura ha hecho hincapié en la centralidad que cumplen los entornos alimentarios en las elecciones alimentarias y en el estado nutricional de la población. Objetivo: identificar las percepciones de padres, madres y apoderados, profesionales de establecimientos educacionales, funcionarios municipales, y feriantes pertenecientes a la zona sur de Santiago de Chile, respecto a las barreras y limitaciones de la puesta en práctica de una alimentación saludable en el ambiente alimentario escolar. Método: se realizaron seis grupos focales agrupando a 50 actores claves vinculados a los establecimientos educacionales de Ciudad Sur utilizando una muestra no probabilística. Se aplicó un análisis de contenido mediante la técnica de codificación temática buscando relevar los universos semánticos emergentes. Resultados: se identificaron nueve barreras, o semánticas, que caracterizan limitantes a la realización de la alimentación saludable en los entornos escolares desde la perspectiva de los participantes: la familia, kioscos escolares, la salida de los establecimientos escolares, gusto, determinantes socioeconómicos, política pública, falta de conocimiento, publicidad y disponibilidad de productos sin sellos. Conclusiones: las limitaciones asociadas al ambiente alimentario doméstico tienen una representación significativamente alta (47,9%) y contienen un carácter de responsabilización individual en su enunciación. Esta cultura explicativa es opuesta a la evidencia científica y académica respecto al funcionamiento de la conducta alimentaria, y a la centralidad de los ambientes alimentarios respecto a la facilitación u obstaculización del consumo de alimentos saludables o adecuados.

Literature has emphasized on food environments centrality in food choices and nutritional status. Objective: identify social perceptions of fathers, mothers and guardians, professionals from educational establishments, municipal officials, and stallholders belonging to the southern area of Santiago de Chile, regarding limitations of healthy diet implementation on school environments. Method: six focus groups were carried out grouping 50 key actors linked to educational establishments using a non-probabilistic sample. A content analysis was applied through thematic coding technique seeking to reveal emerging semantic universes. Results: Nine barriers, or semantics, were identified characterizing limitations to healthy eating habits in school environments: family, school kiosks, leaving school establishments, taste, socioeconomic determinants, public policy, lack of knowledge, publicity, and availability of products without seals. Conclusions: limitations associated with domestic food environment have a significantly high representation (47,9%) and contain an individualized responsibility feature. This explanatory culture is opposed to scientific and academic evidence regarding the functioning of eating behavior, and the centrality of food environments facilitating or hindering healthy food consumption.

[Multiple sclerosis, loss of functionality and gender]. / Esclerosis múltiple, pérdida de funcionalidad y género.

OBJECTIVE: To identify the type of support and assistance that patients with multiple sclerosis need in order to cope with the loss of functionality, and to show how gender affects the perception of these needs. METHOD: Interpretative-phenomenological qualitative study. LOCATION: Granada (Spain). Year: 2014. Intentional sample: 30 patients and 20 family caregivers. Data were gathered from 26 interviews and 4 focus groups. The data were coded and analysed with the NVivo programme. RESULTS: The multiple sclerosis patients and family caregivers had different perceptions of the loss of capacity to undertake activities of daily living. Being able to self care was considered the last vestige of autonomy. The women with multiple sclerosis tried to take on the responsibility of housework, but the male caregivers became gradually involved in these tasks. Gender roles were redefined with respect to housekeeping. The multiple sclerosis patients showed a need for emotional support. Some of the men had abandoned the stereotype of the strong male as a result of the decline in their health. Adaptations in the home took place without planning them in advance. The use of mobility devices started on an occasional basis. A fear of stigma was an obstacle for regular use of assistive technology. CONCLUSIONS: Health care for people with multiple sclerosis should include family caregivers. Gender influences the perception that caregivers and patients have of the assistance they require to maximise their quality of life. This flags up several intervention areas for the follow-up and long-term care of these patients by the healthcare system.

Redes sociales de apoyo formales e informales para la reducción de pobreza del adulto mayor y su familia

Introducción: El aumento en la esperanza de vida se ha convertido en una realidad, en una problemática y en un reto para los países en desarrollo como Colombia, marcado por determinantes sociales dentro de los cuales la población adulta mayor se ve ampliamente afectada. Objetivo: Describir la percepción del adulto mayor y su familia acerca de las redes sociales de apoyo formales e informales, que contribuyen en la reducción de la pobreza. Materiales y métodos: Se realizó un estudio cualitativo con enfoque fenomenológico. Participaron 22 adultos mayores, 3 hombres y 19 mujeres entre los 60 y 89 años, dos cuidadores y un empleado administrativo de la institución en Neiva (Huila). Resultados: Los hallazgos se enmarcaron bajo tres cuatro categorías instauradas previa revisión teórica: precepción de envejecimiento, estructura de las redes sociales de apoyo, dinámica familiar y percepción de redes sociales de apoyo; además, se obtuvieron durante el estudio emergieron tres categorías emergentes: la pobreza más allá del concepto económico, entre lo espiritual y emocional como red de apoyo y la resignificación del trabajo en el adulto mayor como una opción. Conclusiones: Los adultos mayores perciben las redes sociales de apoyo formales e informales como necesarias para su bienestar físico, espiritual y emocional, además, identifican la resignificación del trabajo como una opción de vida desde sus capacidades instrumentales, junto con la espiritualidad, la cual se fortalece a lo largo de sus vidas y al interior de sus familias.

Introduction: The increase in life expectancy has become a reality, a problem, and a challenge for developing countries such as Colombia, marked by social determinants in which the elderly population is largely affected. Objective: Describe the perception of older adults and their families regarding formal and informal social support networks that contribute to poverty reduction. Materials and methods: A qualitative study using a phenomenological approach was conducted. Twenty-two older adults, three men and 19 women, between 60 and 89 years old; two caregivers, and an administrative employee at the institution in Neiva (Huila) participated. Results: The findings were framed under four categories established after a theoretical review: perception of aging, structure of social support networks, family dynamics, and perception of social support networks. Three categories emerged during the study: Poverty beyond the economic concept, between the spiritual and emotional as a support network, and the resignification of work in the elderly as an option. Conclusions: Older adults perceive formal and informal social support networks as something necessary for their physical, spiritual, and emotional well-being. In addition, they identify the resignification of work as a life option based on their instrumental capabilities, along with spirituality, which is strengthened throughout their lives and within their families.

Perceptions and Challenges for Nursing Students related to Online Learning during COVID-19 in Guyana. Mixed Method Study / Percepciones y desafíos para los estudiantes de enfermería en relación con el aprendizaje en línea durante COVID-19 en Guyana. Un estudio de método mixto / Percepções e desafios dos estudantes de enfermagem relacionados ao aprendizado on-line durante a COVID-19 na Guiana. Um estudo de método misto

Objective: Exploring nursing students' perceptions and experiences of online learning during the COVID-19 Pandemic with a mixed method. Methods: A mixed method was used and obtained ethical approval from IRB. Quantitatively 419 nursing students' perceptions were assessed using a valid and reliable Likert scale of 37 items with a Google Forms survey. Qualitatively 5 focus group discussions (6 to 8 students each) of 60 to 90 minutes from 5 respective Nursing Schools were conducted via zoom and recorded. Codes were generated using MAXQDA analytics Pro 2022 version 22.2.1. Results: 276 (65.87 %) students agreed self-discipline is necessary for online learning. 267 (63.72 %) students strongly agree that online classes reduce travel expenses. Gender had no influence on perception. Younger students showed more positive perception than older students. Senior BSN students showed positive perception compared to RN students, and associations are statistically significant at <0.001. Thematic analysis led to the following themes. Some preferred online learning due to its "flexibility" "convenience" and "access to recorded sessions". Others preferred face to face: online learning is "good for theory only", but for practical sessions face to face interactions is necessary, "sense of isolation", "no student interaction", "less student- faculty interaction". Barriers identified were "internet connectivity issues", "electricity issues" and "technological issues". Facilitators were "convenience", "reduced cost in transportation", "saves time" and opportunity to become "tech savvy". Conclusion: Online classes are suitable for theoretical aspects but require face to face interaction for practical components.

Objetivo: explorar las percepciones y experiencias de los estudiantes de enfermería sobre el aprendizaje en línea durante la pandemia por COVID-19 con una metodología mixta. Método: se utilizó un método mixto y se obtuvo la aprobación ética del IRB. Cuantitativamente se evaluaron las percepciones de 419 estudiantes de enfermería utilizando una escala de Likert válida y fiable con 37 ítems a través de una encuesta en Google Forms. Desde el punto de vista cualitativo, se llevaron a cabo y se grabaron 5 debates de grupos focales (de 6 a 8 estudiantes cada uno) con una duración de 60 a 90 minutos en las 5 escuelas de enfermería respectivas. Los códigos se generaron utilizando MAXQDA analytics Pro 2022 versión 22.2.1. Resultados: 276 (65,87 %) estudiantes están de acuerdo en que la autodisciplina es necesaria para el aprendizaje en línea. 267 (63,72 %) estudiantes están totalmente de acuerdo en que las clases en línea reducen los gastos de desplazamiento. El género no influyó en la percepción. Los estudiantes más jóvenes mostraron una percepción más positiva que los de más edad, los estudiantes BSN senior mostraron una percepción positiva en comparación con los estudiantes RN; las asociaciones son estadísticamente significativas a <0,001. El análisis temático dio lugar a los siguientes temas. Algunos prefirieron el aprendizaje en línea por su "flexibilidad", "comodidad" y "acceso a sesiones grabadas". Otros prefirieron el aprendizaje presencial: el aprendizaje en línea es "bueno solo para la teoría", pero para las sesiones prácticas es necesaria la interacción presencial, "sensación de aislamiento", "no hay interacción entre estudiantes", "hay menos interacción entre estudiantes y profesores". Los obstáculos identificados fueron "problemas de conectividad a Internet", "problemas de electricidad" y "problemas tecnológicos". Los facilitadores fueron la "comodidad", el "menor coste de transporte", el "ahorro de tiempo" y la oportunidad de adquirir "conocimientos tecnológicos". Conclusiones: Las clases en línea son adecuadas para los aspectos teóricos, pero requieren interacción presencial para los componentes prácticos.

Objetivo: explorar as percepções e experiências dos alunos de enfermagem sobre o aprendizado on-line durante a pandemia da COVID-19 - um método misto. Métodos: foi usado um método misto e obteve-se aprovação ética do IRB. Quantitativamente, as percepções de 419 estudantes de enfermagem foram avaliadas usando uma escala Likert válida e confiável com 37 itens por meio de uma pesquisa no Google Forms. Qualitativamente, 5 discussões de grupos focais (6 a 8 alunos cada) com duração de 60 a 90 minutos das respectivas 5 escolas de enfermagem foram conduzidas via zoom e gravadas. Os códigos foram gerados usando o MAXQDA analytics Pro 2022 versão 22.2.1. Resultados: 276 (65,87 %) alunos concordaram que a autodisciplina é necessária para o aprendizado on-line. 267 (63,72 %) alunos concordam fortemente que as aulas on-line reduzem as despesas de viagem. O gênero não influenciou a percepção. Os alunos mais jovens demonstraram uma percepção mais positiva do que os alunos mais velhos, os alunos de BSN sênior demonstraram uma percepção positiva em comparação com os alunos de RN, e as associações são estatisticamente significativas em <0,001. A análise temática levou aos seguintes temas. Alguns preferiram o aprendizado on-line devido à sua "flexibilidade", "conveniência" e "acesso a sessões gravadas", enquanto outros preferiram o presencial: o aprendizado on-line é "bom apenas para a teoria", mas para as sessões práticas são necessárias interações presenciais, "sensação de isolamento", "falta de interação com os alunos", "menos interação entre alunos e professores". As barreiras identificadas foram "problemas de conectividade com a Internet", "problemas de eletricidade" e "problemas tecnológicos". Os facilitadores foram: "conveniência", "custo reduzido de transporte", "economia de tempo" e oportunidade de se tornar "conhecedor de tecnologia". Conclusão: As aulas on-line são adequadas para os aspectos teóricos, mas exigem interação presencial para os componentes práticos.

Exposición a pantallas de niñas, niños y adolescentes: recomendaciones, límites y controversias en el marco del distanciamiento social obligatorio: un estudio cualitativo / Child and Teenage Screen Exposure: Recommendations, Limits,and Controversies in the Context of Enforced Social Distancing: a Qualitative Study

Introducción: la utilización de pantallas durante la niñez y la preocupación por su potencial daño aumentaron en los últimos años. La recomendación de no superar dos horas diarias de uso resultó controvertida durante la pandemia por COVID-19. El objetivo principal de esta investigación fue explorar las opiniones y actitudes de los profesionales con respecto al uso de pantallas y comprender cómo se modificaron durante dicha pandemia. Materiales y métodos: estudio exploratorio con enfoque cualitativo y estrategia de teoría fundamentada, realizado entre 2020 y 2021.Participaron 23 profesionales (pediatras y generalistas) en cuatro grupos focales. Se realizaron lecturas del material desgrabado para interpretación del contenido. El análisis incluyó la generación de códigos que fueron agrupados en cinco ejes temáticos. Resultados: los ejes resultantes fueron: 1) temática de las pantallas en la consulta ambulatoria de niños sanos, 2) percepción sobre daños, 3) percepción sobre beneficios, 4) pantallas en épocas de ASPO (Aislamiento Social Preventivo y Obligatorio) y 5) pensamientos y acciones contradictorios sobre el uso de pantallas. Discusión: a la hora de recomendar sobre exposición a pantallas, en nuestros entrevistados predominó la intuición personal por sobre la evidencia científica disponible. Reconocieron que el contexto de ASPO visibilizó algunos beneficios asociados a la conectividad que brindan estos dispositivos. Conclusión: nuestros resultados muestran que la percepción sobre las pantallas se está volviendo cada vez más neutral en términos del balance entre sus riesgos y beneficios, conduciendo a que los profesionales sean más flexibles en sus recomendaciones al respecto. (AU)

Introduction: screen use during childhood and potential harm concerns have increased in recent years. Advice not to allow more than two hours of screen use per day was contested during the COVID-19 pandemic. The primary purpose of this research was to probe the opinions and attitudes of professionals regarding the use of screens and to understand how these changed during the pandemic. Materials and methods: this exploratory study, with a qualitative approach and theory-based strategy, was made between 2020 and 2021, and involved the participation of 23 professionals (pediatricians and general practitioners) in four focus groups. The recorded material was analyzed for content interpretation. The analysis included generating codes that were grouped into five thematic areas. Results: the resulting axes were: 1) the issue of screens in the outpatient practice of healthy children; 2) perception of harm; 3) perception of benefits; 4) screens in times of Preventive and Compulsory Social Isolation (ASPO, for its acronym in Spanish); and 5) contradictory thoughts and actions on the use of screens. Discussion: when making recommendations regarding screen exposure, the interviewees' intuition predominated over available scientific evidence. They recognized that the ASPO context highlighted some of the benefits associated with the connectivity provided by these devices. Conclusion: our results show that awareness of screen displays is becoming increasingly neutral concerning the trade-off between their risks and benefits, prompting practitioners to become more flexible in their recommendations. (AU)